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Background Few studies compare the therapeutic efficacy of different iron deficiency anaemia treatments. Aim Evaluate the therapeutic response of the most common iron preparations. Material and methods Retrospective, observational-analytical study based on medical records from the Haematology Department, conducted from March to October 2014, including 121 adults with ferropenic anaemia and 3-month follow-up. Patients with comorbidities or pregnancy were excluded. Results 85.8% were women ( n = 103) and 14% men ( n = 17), with a mean age of 42 (16–83) years. Seventy patients (58.3%) started with oral administration; the rest received intravenous iron. Efficacy was similar among all the iron preparations, with no significant differences ( p > 0.05). Iron sucrose was most effective in rapidly replenishing body iron stores. Conclusions Despite comparable efficacy among treatments, ferrous fumarate had the lowest treatment failure and was the therapy of choice.

Which injectable medication can be administered orally or enterally? In this article we collect the ethical and legal principles when we have to decide on the use of a drug in conditions other than those on its data sheet. Medicines are not always available in formulations which are suitable for patients with swallowing difficulties or patients with enteral feeding tubes. The alteration of medication formulations may therefore be necessary. This text provides a list of injectables that can be administered orally or via enteral feeding tubes when there are no available alternatives. However, they vary widely in their suitability for oral or enteral feeding administration. In this paper we do not consider the rectal route, as an adequate enteral route for administration of injectables.

Com base em análise documental, foram discutidas e problematizadas as limitações associadas à utilização de organizadores e cortadores de comprimidos, como questão de saúde pública. Os organizadores destinados ao armazenamento e transporte de comprimidos e cápsulas expõem essas formas farmacêuticas a fatores ambientais dos quais estariam protegidos em suas embalagens originais, comprometendo sua estabilidade, eficácia e segurança. Os cortadores oferecem risco adicional quanto a perda da eficácia, reações adversas e intoxicação. Por outro lado, o transporte de medicamentos pelo usuário é reflexo da conciliação entre autonomia e autocuidado e a partição de comprimidos é necessária para cumprir certos regimes posológicos. Conclui-se que cabe aos profissionais observar e orientar pacientes e cuidadores, visando à adequação dessas condutas e à prevenção dos riscos envolvidos. In this essay, based on documental analysis, the limitations associated with the use of pill organizers and cutters are discussed and analyzed as a matter of public health. The use of the organizers for storing and carrying tablets and capsules exposes these medications to environmental factors from which their original packaging protected them, compromising their stability and safeness. Cutters also pose the additional risk of causing loss of efficacy, adverse reactions and overdose. On the other hand, the user carrying their own medication reflects the balance between autonomy and self-care, and splitting is sometimes required to comply with certain regimens. It can be concluded that healthcare professionals should observe and guide patients and caregivers in order to avoid risks. Objetivo Con base en análisis documental, se discutieron y señalaron los problemas de las limitaciones asociadas a la utilización de organizadores y cortadores de comprimidos, con respecto a la salud pública. Los organizadores destinados al almacenamiento y transporte de comprimidos y cápsulas exponen las formas farmacéuticas a factores ambientales de los cuales estarían protegidos en sus embalajes originales, comprometiendo su estabilidad, eficacia y seguridad. Los cortadores ofrecen riesgo adicional con relación a la pérdida de la eficacia, reacciones adversas e intoxicación. Por otro lado, el transporte de medicamentos por el usuario es reflejo de la conciliación entre autonomía y autocuidado, y la partición de comprimidos es necesaria para cumplir ciertos regímenes posológicos. Se concluye que resta a los profesionales observar y orientar pacientes y cuidadores, buscando la adecuación de esas conductas y la prevención de los riesgos involucrados.

Objetivo. Conocer las preferencias de vías de administración de medicamentos de los pacientes y las diferencias según sea medio urbano o medio rural. Diseño. Estudio observacional, descriptivo, transversal. Participantes. Pacientes de atención primaria cuyo motivo de consulta fue dolor y éste precisó tratamiento analgésico. Mediciones principales. Escala visual del dolor para la variable intensidad del dolor. Otras variables: sociodemográficas (sexo, edad, lugar de residencia y nivel de estudios), preferencias de vía de administración de tratamiento y eficacia de vía de administración. Resultados. Se realizaron 400 encuestas (33% hombres y 66% mujeres, con edad media de 58 años). Habitaban en ciudad un 59% y un 41% en medio rural. El 44.6% calificó su dolor como moderado, el 42% como intenso, el 4.2% leve y el 4.2% insoportable. El 48% prefería tratamiento parenteral, el 50% oral y el 1.8% tratamiento tópico. Preguntados sobre eficacia a igual dosis, el 74% se inclinó por tratamiento parenteral, el 8.9% por tratamiento oral y el 19.6% igual. Las personas mas jóvenes y con estudios universitarios prefieren el tratamiento oral. En el medio rural la preferencia por los tratamientos parenterales es mayor que en el medio urbano, aunque la diferencia no es estadísticamente significativa. Conclusiones. Las preferencias por los tratamientos parenterales son superiores en el medio rural y en las personas mayores de 65 años, debido principalmente a que creen que es más potente. Los jóvenes, los que poseen estudios universitarios y los que residen en el medio urbano prefieren tratamiento oral, principalmente por ser más cómodo. La vía de administración del medicamento debe ser consensuado con el paciente, puesto que la predisposición de éste puede ayudar al efecto terapéutico de dicho medicamento.

Background Mortality from invasive meningococcal disease (IMD) has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848) diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72%) of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93). Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

Background The objective of this research was to evaluate data from a randomized clinical trial that tested injectable diacetylmorphine (DAM) and oral methadone (MMT) for substitution treatment, using a multi-domain dichotomous index, with a Bayesian approach. Methods Sixty two long-term, socially-excluded heroin injectors, not benefiting from available treatments were randomized to receive either DAM or MMT for 9 months in Granada, Spain. Completers were 44 and data at the end of the study period was obtained for 50. Participants were determined to be responders or non responders using a multi-domain outcome index accounting for their physical and mental health and psychosocial integration, used in a previous trial. Data was analyzed with Bayesian methods, using information from a similar study conducted in The Netherlands to select a priori distributions. On adding the data from the present study to update the a priori information, the distribution of the difference in response rates were obtained and used to build credibility intervals and relevant probability computations. Results In the experimental group (n = 27), the rate of responders to treatment was 70.4% (95% CI 53.2-87.6), and in the control group (n = 23), it was 34.8% (95% CI 15.3-54.3). The probability of success in the experimental group using the a posteriori distributions was higher after a proper sensitivity analysis. Almost the whole distribution of the rates difference (the one for diacetylmorphine minus methadone) was located to the right of the zero, indicating the superiority of the experimental treatment. Conclusion The present analysis suggests a clinical superiority of injectable diacetylmorphine compared to oral methadone in the treatment of severely affected heroin injectors not benefiting sufficiently from the available treatments. Trial Registration Current Controlled Trials ISRCTN52023186