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Background Vancomycin is a glucopeptide antibiotic widely used to treat Gram positive related infections. It is well known for its nefrotoxic and ototoxic profile, but neutropaenia and thrombocytopaenia are not so well described. Purpose The aim of this study was to describe the prevalence of some relevant vancomycin-related adverse events (AE): neutropaenia, thrombocytopaenia and acute kidney injury (AKI). Material and methods This retrospective observational study was conducted in all patients admitted to Donostia University Hospital that received vancomycin during 2016 and 2017 and were monitored by the pharmacy department (PD). Exclusion criteria: patients with neutropaenia, thrombocytopaenia or AKI prior to vancomycin therapy. Collected data: diagnosis, absolute neutrophil count (ANC), absolute platelet count (APT) and creatinine clearance (CrCl, calculated with Cockcroft–Gault formula) prior and during vancomycin therapy. Neutropaenia was defined as ANC Results A total of 177 patients were reviewed, with a mean age of 63.4±16.4 and 32.8% were women. Almost half of the patients 48.6% (n=86) had an ostearticular infection: bacteriemia accounted for 36.2% (n=64). The rest of the infections were related to the central nervous system 3.4% (n=6), endovascular system 3.4% (n=6) and others 8.4% (n=15). Patients excluded: eight due to neutropaenia (n=169), 15 due to thrombocytopaenia (n=162) and 14 due to AKI (n=163) prior to vancomycin therapy. Neutropaenia was developed in seven patients (=1:24), thrombocytopaenia in 12 patients (=1:14) and AKI in 26 patients (=1:6). The prevalence of nephrotoxicity is described as common (1:100–1:10) in the summary product characteristics (SPC). However, neutropaenia and thrombocytopaenia are classified as rare undesirable effects (1:10.000–1:1.000). Conclusion The prevalence of AE related to vancomycin therapy is higher than reported in SPC. In our study neutropaenia was reported in 7:169 patients, thrombocytopaenia in 12:162 and AKI in 26:163. The difference between SPC and our clinical practice is considerable. However, it should be noticed that only patients monitored by PD were reviewed, and therefore the number of patients included is low. It is of high importance to continue reporting any AE related to vancomycin therapy to the appropriate pharmacovigilance institution in order to better understand the toxic profile of the drug. References and/or acknowledgements No acknowledgements. No conflict of interest.

Background Following a request by the Central Management Organisation of our Health System (HS), a decision was made to change from a patented drug of three active principals, emtricitabine/tenofovir-disopropilo/rilpivirine (FTC/TDF/RPV) to two drugs, one patented (RPV) and one generic drug (FTC/TDF). Both were administered once-daily, providing the same therapeutic efficacy and treatment compliance but in a more cost-effective way. Purpose To describe the procedure to implement this strategy and patient’s acceptance of it. Material and methods After several meetings between the Pharmacy (PD) and the Infectious Diseases Department (IDD) it was decided to make the change at the following patient’s visit to the HS, either in the PD when the patient attended to pick up the medication or in the IDD in the patient’s scheduled consultations. Inclusion criteria: HIV patients treated with FTC/TDF/RPV up to June 2018 using e-prescribing records. Patients that did not contact our HS were excluded. A retrospective review from July to October 2018 was conducted. Patients that would not accept the PD’s change were referred to the IDD. Collected data were: age, gender, treatment after the change and acceptance. Results Out of 133 patients, seven were excluded. Mean age 47.6 years, 20% women. PD was responsible for 86% of the changes. Out of 126 patients included, 16 (13%) did not accept the change. Of these 16 patients, five ended up accepting it (three after visiting the IDD and two on their second visit to the PD) and 11 declined to switch therapy for the following reasons: swallowing problems (one) (actual treatment: elvitegravir/cobicistat/emtricitabine/tenofovir-alafenamide); adverse events (actual treatment: dolutegravir ±TDF/FTC (one); abacavir/lamivudine (two) or lamivudine (one); and six patients continued with FTC/TDF/RPV (four waiting for IDD next consultation and two due to medical decisions). Conclusion By the time this abstract was written, the change was made in 115/126 patients (91%). It is very important to highlight the efficient teamwork between the PD and the IDD in order to implement the new strategy in a short period of time. Although initially 13% disagreed, finally only 9% of patients did not accept the proposed change. On the other hand, this strategy has reduced the economic impact of HIV treatment in 51% of patients. References and/or acknowledgements Infectious Diseases Department. No conflict of interest.

Background A drug adjustment programme for patients with renal disease was started in 2013 in our hospital. In this system, information from the electronic prescription programme is linked (using an Access application) with information sent by the laboratory (creatinine) and with a list of drugs that may require renal adjustment. Afterwards, an adjustment warning for the physician is added to the electronic prescription programme. Purpose To assess the acceptance by the physicians of pharmaceutical interventions in drug dosing in renal disease. Material and methods This prospective descriptive study was conducted in a tertiary university hospital with 1,200 beds. The study period was 39 days (from January 21st to March 20th, 2014). The pharmaceutical interventions were recorded during daily practice. The following data were collected: date of pharmaceutical intervention, clinical chart number, medical service, age, sex, creatinine, glomerular filtration rate, adjusted drug, adjustment warning. Finally, the degree of acceptance of these interventions by the physicians was reviewed. Results During the study period, 153 patients (mean age 75.3 years, 78 male and 75 female) were included and 271 renal adjustment interventions were performed (mean: 7 interventions per day). The degree of acceptance of the interventions was: accepted 84 (31.0%), partially accepted 25 (9.2%), not assessable 49 (18.1%), not accepted 112 (41.3%) and other (not an appropriate intervention) 1 (0.4%). Excluding not assessable and inappropriate interventions (finally 221 interventions), the result was: accepted 84 (38.0%), partially accepted 25 (11.3%) and not accepted 112 (50.7%). Conclusion The acceptance of pharmaceutical interventions by the physicians is approximately 40%, which is relatively low. One of the reasons of this low acceptance could be the location of the adjustment warning. Finally, it is necessary to consider what could be done to improve the acceptance of this type of pharmaceutical interventions. References and/or Acknowledgements No conflict of interest.

Background Oral chemotherapy against metastatic or advanced renal-cell carcinoma (mRCC) is currently benefiting from a wide range of possibilities. Purpose To analyse the effectiveness of the actual therapy for the treatment of the mRCC in real conditions based on survival at one and two years and modifications in dosage or drug. Materials and methods Retrospective evaluation of clinical history from November 2011 to September 2013. In our hospital tyrosine kinase inhibitors were the first line treatment and mTOR inhibitors were the second line. Results 68 patients were treated for mRCC. Male/Female: 73/27. Average age: 64.6 years. After 1 year of treatment 81.4% patients survived (22/27) and 42.8% after two years (3/7). 44/68 patients (65%), needed a drug change due to progression. Average time to change was 6.4 months (59% CL: 4.6–8.1) (median: 5.1). 8/68 (11.7%) required a treatment change towards a third line. Of these 8 patients; 3 restarted treatment with sunitinib as fourth line. Out of 41 patients who initiated therapy with sunitinib 50 mg once daily on schedule 4–2; 19 patients (46.3%) needed a descending adjustment of the dose. The average time to dose adjustment was 4.2 months (59% CL: 2.6–5.7) Conclusions Oral treatment of advanced renal cancer has several therapeutic possibilities; which must be treated with rigorous criterion in favour of the clinical benefit applying the maximum efficiency. Even limited by the small sample size, the results are similar to those previously reported in this setting. First year survival rate: 81.4% vs. 75% 1 Second year survival rate: 42.8% vs. 50% 1 Of the 68 patients studied, 65% required a drug change during their treatment mostly due to loss of efficacy. Sunitinib 50 mg 4–2 schedule dose adjustment: 46.3% vs. 46% 2 (33% + 13%) Time to dose adjustment: 4.2 months versus 7.5 months 2 References RJ Motzer, B Escudier, R Bukowski, et al . Prognostic factors for survival in 1059 patients treated with sunitinib for metastatic renal cell carcinoma. British Journal of Cancer 2013;108:2470-2477 Martin E Gore, Cezary Szczlik, Camillo Porta, et al . Safety and efficacy of sunitinib for metastatic renal-cell carcinoma: an expanded-access trial. Lancet Oncol 2009;10:757-63 No conflict of interest.