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Several factors appear to contribute to errors in prescribing medication for hospitalized patients. Physicians and pharmacists analyzed significant prescription errors caught and corrected by pharmacists at a large teaching hospital. They found 2,103 errors in a year period for a rate of 4 per 1,000 medication orders. Factors included failing to take declining kidney or liver function into account; ignoring patient history of allergy; using the wrong name, dosage form, or abbreviation; calculating errors; and overdosing. Many of these errors could be eliminated through such strategies as education, computer programs, and dosage standardization., Objective.--To quantify the type and frequency of identifiable factors associated with medication prescribing errors. Design and Setting.--Systematic evaluation of every third prescribing error detected and averted by pharmacists in a 631-bed tertiary care teaching hospital between July 1, 1994, and June 30, 1995. Each error was concurrently evaluated for the potential to result in adverse patient consequences. Each error was retrospectively evaluated by a physician and 2 pharmacists and a factor likely related to the error was identified. Participants.--All physicians prescribing medications during the study period and all staff pharmacists involved in the routine review of medication orders. Main Outcome Measures.--Frequency of association of factors likely related to medication errors in general and specific to medication classes and prescribing services (needed for medical, pediatric, obstetric-gynecologic, surgical, or emergency department patients); and potential consequences of errors for negative patient outcomes. Results.--A total of 2103 errors thought to have potential clinical importance were detected during the 1-year study period. The overall rate of errors was 3.99 errors per 1000 medication orders, and the error rate varied among medication classes and prescribing services. A total of 696 errors met study criteria (ie, errors with the potential for adverse patient effects) and were evaluated for a likely related factor. The most common specific factors associated with errors were decline in renal or hepatic function requiring alteration of drug therapy (97 errors, 13.9%), patient history of allergy to the same medication class (84 errors, 12.1%), using the wrong drug name, dosage form, or abbreviation (total of 79 errors, 11.4%, for both brand name and generic name orders), incorrect dosage calculations (77 errors, 11.1%), and atypical or unusual and critical dosage frequency considerations (75 errors, 10.8%). The most common groups of factors associated with errors were those related to knowledge and the application of knowledge regarding drug therapy (209 errors, 30%); knowledge and use of knowledge regarding patient factors that affect drug therapy (203 errors, 29.2%); use of calculations, decimal points, or unit and rate expression factors (122 errors, 17.5%); and nomenclature factors (incorrect drug name, dosage form, or abbreviation) (93 errors, 13.4%). Conclusions.---Several easily identified factors are associated with a large proportion of medication prescribing errors. By improving the focus of organizational, technological, and risk management educational and training efforts using the factors commonly associated with prescribing errors, risk to patients from adverse drug events should be reduced. JAMA. 1997;277:312-317

Zidovudine appears to retard the development of AIDS in those infected with HIV, but its effectiveness seemingly lasts no longer than approximately two years. A total of 1,565 HIV-positive patients who were asymptomatic for AIDS but had CD4 lymphocyte counts below 500 per microliter were given either zidovudine or a placebo and were followed for up to 4.5 years. A dose of 500 milligrams of zidovudine was found to significantly slow the progression to AIDS. However, its effectiveness was less pronounced on those whose initial CD4 cell counts were less than 300 per microliter, and the relative risk of AIDS progression between those receiving zidovudine and those receiving a placebo was the same after roughly 2 years. Other drug treatment and prevention measures should be developed to overcome the long-term ineffectiveness of zidovudine., Objective.--To determine the durability of zidovudine-induced delay in clinical progression of asymptomatic human immunodeficiency virus (HIV) disease and to assess the relationship between this effect and the entry [CD4.sup.+] cell count. Design and Interventions.--Extended follow-up data from subjects participating in protocol 01 9 of the AIDS [acquired immunodeficiency syndrome] Clinical Trials Group were examined. Subjects were offered a total daily dose of 500 mg of open-label zidovudine after the unblinding of the original randomized trial in 1989. Original treatment groups included placebo, 500 mg of zidovudine, or 1500 mg of zidovudine daily in divided doses. Three distinct analyses were conducted to assess the duration of zidovudine's effect on progression to AIDS or death: (1) analysis of all follow-up information from all subjects, (2) analysis of all subjects but with follow-up of original placebo-assigned subjects censored at the time open-label zidovudine was initiated, and (3) analysis of the effect of initiating zidovudine in subjects initially assigned to receive placebo. Setting.--University-based and university-affiliated AIDS research clinics participating in AIDS Clinical Trials Group protocol 019. Patients.--A total of 1565 asymptomatic HIV-infected subjects with entry [CD4.sup.+] cell counts less than 0.50x[10.sup.9]/L (500/[mu]L). Main Outcome Measure.--Time to progression to AIDS or death. Results.--During follow-up of up to 4.5 years (mean, 2.6 years), 232 subjects progressed to AIDS or died. In each of the three analyses described herein, zidovudine was associated with a significant (P=.008,.004,.007) decrease in the risk of such progression. However, each of these analyses also indicated a decreasing placebo:zidovudine relative risk with duration of use (P=.002,.08,.04), suggesting a nonpermanent effect. The duration of benefit appeared to be related to entry [CD4.sup.+] cell count, with greater benefit in those with higher counts at entry. No significant differences in survival were found between those originally randomized to zidovudine or placebo. Conclusions.--Zidovudine at 500 mg/d caused a significant delay in progression to AIDS or death, but its earlier use in asymptomatic disease was not associated with an additional prolongation of survival compared with delayed initiation. The delay in progression diminished over time especially in subjects with entry [CD4.sup.+] cell counts less than 0.30x[10.sup.9]/L (300/[mu]L). Treatment strategies that alter drug regimens before the loss of zidovudine benefit should be explored. (JAMA. 1994;272:437-442)

It has recently been shown that zidovudine (formerly called AZT) provides benefits to people with early human immunodeficiency virus (HIV) disease and who are either without symptoms or have only mild symptoms. Although the rates of newly acquired HIV infections appear to have stabilized for American homosexuals, they have continued to increase in American blacks, Hispanics, women, and intravenous (IV) drug users. A study was undertaken to determine if the previously noted benefits of zidovudine treatment also apply to blacks, Hispanics, women, and IV drug users. There were 2,048 patients with early HIV infection who were analyzed; among these subjects, there were 155 blacks, 190 Hispanics, 144 women, and 221 IV drug users. The rate of progression of HIV disease to acquired immune deficiency syndrome (AIDS) was significantly lower among those given zidovudine therapy than those given placebo among the blacks, whites, Hispanics, non-Hispanics, men, and non-IV drug abusers. For women and IV drug users, there was no statistically significant difference in disease progression between the two treatment groups. The relative risks for women and IV drug users were similar to those for men and non-IV drug abusers. It is concluded that the beneficial effect of zidovudine in delaying the progression of HIV infection to AIDS, as established in larger studies, also applies to minority subpopulations. (Consumer Summary produced by Reliance Medical Information, Inc.)

Comments on a report featured in a previous issue of the periodical 'Journal of the American Medical Association,' regarding the use of antibiotics in treating endocarditis due to nutritionally deficient streptococci.