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The overview approaches pharmacy practice in palliative care from a global viewpoint and aims to provide insight into front-line pharmacist-patient relationships by sharing case studies and personal experiences.
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Background: Lower urinary tract infections (LUTIs) are amongst the most common community acquired infections with frequent antibiotic prescribing. Objectives: To assess empiric antibiotic choice in different types of lower urinary tract infections. We also aimed to identify determinants of fluoroquinolone prescribing, as well as to determine the rate of short antibiotic courses. The frequencies of executing laboratory tests and recommending analgesics/anti-inflammatory drugs were also assessed. Methods: A prospective observational study was performed in 19 different Hungarian primary care practices. Participating general practitioners (GPs) filled out data sheets for each patient with a suspected urinary tract infection. Details of drug use were evaluated. Comparison of different LUTI groups were made by descriptive statistics and univariate analysis. Possible determinants of fluoroquinolone prescribing were assessed by logistic regression. Results: Data sheets of 372 patients were analyzed. The majority of patients (68.82%) had acute uncomplicated cystitis. While antibiotics were prescribed for almost every patient (uncomplicated cases: 92.58%, complicated cases: 94.83%), analgesics/anti-inflammatory drugs were recommended at a rate of 7.81% in uncomplicated, and 13.79% in complicated cystitis cases. Ciprofloxacin was the most commonly prescribed antibacterial agent in both types of cystitis. Short-term antibiotic therapy was prescribed in one third of relevant cases. Logistic regression found a weak association between fluoroquinolone use and patient's age and presence of complicating factors. Conclusions: Many aspects of suboptimal cystitis management were identified (e.g. unnecessarily broad spectra agents, too long antibiotic courses). In this study, patient characteristics has weakly influenced fluoroquinolone prescribing. Based on these results there is considerable room for improvement in primary care antibiotic therapy of cystitis in Hungary.
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Crude national ambulatory antibiotic dispensing data (2007-2011) of adult patients (aged between 20 and below 65 years) with CAP were obtained and expressed as DDD per 1000 inhabitants and per day (DID). European quality indicators of antibiotic prescribing were calculated and adherence rate to the national CAP guideline was assessed. Antibiotic use for CAP in adults ranged between 0.27 and 0.30 DID in various years. The most frequently used antibacterials were levofloxacin, co-amoxiclav and clarithromycin. Antibiotic use in CAP was compliant with the European recommendations in 6.4% in 2007, which decreased to 4.9% by 2011, in contrast to the optimal compliant range of 80-100%. The consumption of fluoroquinolones mounted up to ~40% in both genders, which exceeded the recommended range (0-5%) substantially. National guideline also favoured the use of macrolides in the empiric therapy of CAP in otherwise healthy adults; hence, guideline-concordant antibiotic use ranged between 24.0-32.3%. Agents that were contra-indicated in the empiric therapy of CAP were also used in 6.5-9.0% in various years. These data reflect some worrisome figures and trends in the outpatient antibiotic treatment of adults with CAP. Clarified and updated national guidelines focusing on outpatients and incentives/regulations to increase guideline concordance are warranted.
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Antibacterianos/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Neumonía Bacteriana/tratamiento farmacológico , Pautas de la Práctica en Medicina/tendencias , Adulto , Atención Ambulatoria/tendencias , Antibacterianos/efectos adversos , Infecciones Comunitarias Adquiridas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Bases de Datos Factuales , Revisión de la Utilización de Medicamentos , Adhesión a Directriz/tendencias , Humanos , Hungría , Persona de Mediana Edad , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/microbiología , Guías de Práctica Clínica como Asunto , Factores de Tiempo , Adulto JovenRESUMEN
Spherical micron sized terbutylazine imprinted polymers have been obtained by copolymerization of acrylates in solvent mixtures containing a highly viscous ('oil') component. The new method requires much less organic solvent than precipitation polymerization to produce spherical MIP particles. Different proportions of oil have been used to clarify its role on the morphology. The particles obtained with the optimal composition could be easily packed into short HPLC columns. Chromatographic retention of the template and other compounds has been determined on the novel ('OMIP') columns and was compared to MIP prepared by bulk polymerization. In 70% aqueous acetonitrile eluent the OMIP shows a higher imprinting factor (i. e. less non-selective binding) and lower retention than the bulk MIP. The chromatographic selectivity against template analogs is similar on OMIP and bulk MIP, while the selectivity against non-related substances is better on the OMIP. The effect of oil on the polymer structure appears to be due to its high viscosity.