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INTRODUCTION: With the advent of the pandemic in 2020 and the lack of perspectives on the treatment of COVID-19, numerous therapeutic proposals have emerged, including hydroxychloroquine and azithromycin. Therefore, some studies have shown that in many countries, the demand for azithromycin has increased during the pandemic. In Brazil, antibiotics can only be purchased with a medical, dental, or veterinary prescription. This study aimed to determine whether the number of prescriptions made by veterinarians (which could be used by humans) has increased during the pandemic. METHODOLOGY: Data on the purchase of antibiotics made under veterinary prescriptions in Brazilian pharmacies between 2014 and 2021 were collected. To assess the changes in monthly trends in the use of the selected antibiotics, we applied the Joinpoint regression. RESULTS: The most prescribed antibiotic in all years was cephalexin (35%), followed by amoxicillin (24%). During the pandemic, sales of azithromycin substantially increased. Regression analysis showed that since 2014, azithromycin prescriptions grew by an average of 0.67% per month. At the beginning of the pandemic, the monthly growth rate became 12.64%. When comparing azithromycin sales during the pandemic with the historical average (2014-2019), the increase was 41%. CONCLUSIONS: During the pandemic, there was no animal health situation in Brazil that required the use of this antibiotic. Veterinary prescriptions may have been an instrument for human access to azithromycin for the treatment of COVID-19. Stricter enforcement policies are needed to address this problem to avoid antimicrobial resistance.
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Azitromicina , COVID-19 , Humanos , Azitromicina/uso terapéutico , Brasil/epidemiología , Pandemias , COVID-19/epidemiología , Tratamiento Farmacológico de COVID-19 , Antibacterianos/uso terapéutico , PrescripcionesRESUMEN
Background: The social restrictions among coronavirus disease 2019 (COVID-19) pandemic have posed a thoughtful risk to mental health and have implications in the use of drugs, including antidepressants, anxiolytics and other psychotropics. Objective: This study analyzed the sales data of the psychotropics prescribed in Brazil, in order to verify the change in consumption trends of these drugs during the COVID-19 pandemic. Methods: This interrupted time-series analyzed psychotropic sales data, between January 2014 and July 2021, using the National System of Controlled Products Management from The Brazilian Health Regulatory Agency. The monthly mean DDDs per 1,000 inhabitants per day of psychotropic drugs was evaluated by analysis of variance (ANOVA) followed by Dunnett Multiple Comparisons Test. The changes in monthly trends in the use of the psychotropic studied were evaluated by Joinpoint regression. Results: During the period studied, clonazepam, alprazolam, zolpidem and escitalopram were the most sold psychotropic drugs in Brazil. According to Joinpoint regression, an upward trend was observed in sales during the pandemic of pregabalin, escitalopram, lithium, desvenlafaxine, citalopram, buproprion and amitriptyline. An increase in psychotropic consumption was noted throughout the pandemic period, with the maximum consumption (2.61 DDDs) occurring in April 2021, with a downward trend in consumption that accompanied the drop in the number of deaths. Conclusions: The increase in sales, mainly of antidepressants during the COVID-19 pandemic, draws attention to issues related to the mental health of the Brazilian population and on the need for greater monitoring in the dispensing of these drugs.
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The COVID-19 brought a new model of sanitary behavior (social distancing, etc.) that may have reduced the transmissibility of respiratory diseases, reflecting in the number of antibiotic prescriptions. This study evaluated antibiotic prescriptions for children throughout Brazil, between 2014 and 2021. An interrupted time series was conducted to assess variations in antibiotic consumption by the 1-12-year-old children. Joinpoint regression was used to assess the monthly variations. 86 million prescriptions were evaluated. On average, there was a 54% reduction in prescriptions during the pandemic. Amoxicillin showed a reduction of 65%. Joinpoint regression showed that the pandemic altered the prescription growth curve, changing the trend to a 22% drop per month. The new sanitary behavior showed us that it is possible, decreasing the use of antibiotics, to control the children's respiratory health.
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Antibacterianos , COVID-19 , Humanos , Niño , Lactante , Preescolar , Antibacterianos/uso terapéutico , Brasil/epidemiología , Prescripciones de Medicamentos , COVID-19/epidemiología , Amoxicilina , Pautas de la Práctica en MedicinaRESUMEN
Background: In 2019, a new type of coronavirus emerged and spread to the rest of the world. Numerous drugs were identified as possible treatments. Among the candidates for possible treatment was azithromycin alone or in combination with other drugs. As a result, many clinicians in Brazil have prescribed azithromycin in an attempt to combat or minimize the effects of COVID19. Aim: This study analyzed the sales data of the main antibiotics prescribed in Brazil to verify the change in consumption trends of these drugs during the COVID-19 pandemic. Methods: This is an interrupted time series that analyzed antimicrobial sales data between January 2014 and July 2021, publicly accessible information obtained from the Brazilian government's website. Monthly means of "defined daily doses of DDDs" (DDDs per 1,000 inhabitants per day) of antibiotics were compared by analysis of variance, followed by the Dunnett Multiple Comparisons Test. Monthly trend changes in antibiotic use were verified using Joinpoint regression. Results: Amoxicillin (31.97%), azithromycin (18.33%), and cefalexin (16.61%) were the most sold antibiotics in Brazil during the evaluation period. Azithromycin consumption rose from 1.40 DDDs in February 2020 to 3.53 DDDs in July 2020. Azithromycin sales showed a significant increase in the pandemic period [Monthly Percent Change (MPC) 5.83%, 95% 1.80; 10.00], whereas there was a fall in amoxicillin sales (MPC -9.00%, 95% CI -14.70; -2.90) and cefalexin [MPC-2.70%, 95% (CI -6.30; -1.10)] in this same period. Conclusion: The COVID-19 pandemic changed the pattern of antibiotic consumption in Brazil, with a decrease in the use of amoxicillin and cefalexin and an increase in the consumption of azithromycin.
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OBJECTIVE: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in animals used to produce foods in the Americas. METHOD: A systematic literature review was performed in the following databases: Scopus, Web of Science, MEDLINE, EMBASE, and Virtual Health Library. Articles published in the past 10 years, without language limits, were selected. The outcome of interest was the prevalence of MRSA in food-producing animals. Prevalence rates were meta-analyzed in grouped random effects models using the DerSimonian and Laird method. The geographic distribution of MRSA and the time trend of resistance were also analyzed. RESULTS: Of 19 studies included, 11 were performed in the United States and 11 analyzed pig samples. Five studies were performed in South America. The samples analyzed in the studies were collected in farming, processing, and retail sites. MRSA prevalence in the Americas was 7.6% (95%CI: 5.6-9.5%), and was higher in pigs [12.6% (95%CI: 7.0-18.2%)] followed by bovine cattle [2.4% (95%CI: 1.2-3.7%)] and poultry [1.8% (95CI%: 0.3-3.4%)]. MRSA prevalence was higher in pigs in North America and bovine cattle in Latin America. There was no significant variation in MRSH prevalence along the 10-year period analyzed. CONCLUSIONS: MRSA prevalence in food-producing animals in the Americas was higher in pigs, without significant changes across time.
OBJETIVO: Determinar la prevalencia de Staphylococcus aureus resistente a la meticilina (MRSA por su sigla en inglés) en animales destinados a la producción de alimentos en la Región de las Américas. MÉTODOS: Se realizó una revisión sistemática en las siguientes bases de datos: Scopus, Web of Science, MEDLINE, EMBASE y Biblioteca Virtual de Salud (BVS). Se seleccionaron artículos publicados en los últimos diez años, sin restricción en cuanto al idioma. El resultado de interés fue la prevalencia de MRSA en animales destinados a la producción de alimentos. Las tasas de prevalencia se agruparon en metanálisis de efectos aleatorios por el método de DerSimonian y Laird. También se analizaron la distribución geográfica de los microorganismos resistentes y las tendencias de resistencia con el transcurso del tiempo. RESULTADOS: De los 19 estudios incluidos, 11 se realizaron en Estados Unidos y en 11 se analizaron muestras tomadas de cerdos. Se efectuaron cinco estudios en América del Sur. Las muestras analizadas se recogieron en lugares de cría, sacrificio y venta. La prevalencia de MRSA en la Región de las Américas fue de 7,6% (IC95%: 5,6-9,5%) con una tasa mayor en cerdos [12,6% (IC95%: 7,0-18,2%)], seguidos por bovinos [2,4% (IC95%: 1,2-3,7%)] y aves [1,8% (IC95%: 0,3-3,4%)]. Se observó una mayor prevalencia de MRSA en la población porcina de América del Norte y en la población bovina de América Latina. No hubo variación significativa de la prevalencia de resistencia en los diez años analizados. CONCLUSIONES: La prevalencia de MRSA en animales destinados a la producción de alimentos en la Región de las Américas fue mayor en cerdos, sin variación significativa de la prevalencia con el transcurso del tiempo.
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[RESUMO]. Objetivo. Determinar a prevalência de Staphylococcus aureus resistente à meticilina (MRSA) em animais destinados à produção de alimentos na região das Américas. Métodos. Foi realizada uma revisão sistemática nas seguintes bases de dados: Scopus, Web of Science, MEDLINE, EMBASE e Biblioteca Virtual de Saúde (BVS). Foram selecionados artigos publicados nos últimos 10 anos, sem restrição quanto ao idioma. O desfecho de interesse foi a prevalência de MRSA em animais destinados à produção de alimentos. As prevalências foram agrupadas em metanálises de efeitos aleatórios pelo método de DerSimonian e Laird. A distribuição geográfica dos microrganismos resistentes e o decurso temporal das tendências de resistência também foram analisados. Resultados. Dos 19 estudos incluídos, 11 foram conduzidos nos Estados Unidos e 11 analisaram amostras em suínos. Cinco estudos foram realizados na América do Sul. As amostras analisadas foram coletadas em locais de criação, de abate e de venda. A prevalência de MRSA na região das Américas foi de 7,6% (IC95%: 5,6 a 9,5%) e apresentou-se maior em suínos [12,6% (IC95%: 7,0 a 18,2%)], seguidos por bovinos [2,4% (IC95%: 1,2 a 3,7%)] e aves [1,8% (IC95%: 0,3 a 3,4%)]. Observou-se maior prevalência de MRSA na população de suínos da América do Norte e de bovinos da América Latina. Não houve variação significativa da prevalência de resistência nos 10 anos analisados. Conclusões. A prevalência de MRSA em animais destinados à produção de alimentos na região das Américas foi maior em suínos, sem variação significativa da prevalência no decurso temporal.
[ABSTRACT]. Objective. To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in animals used to produce foods in the Americas. Method. A systematic literature review was performed in the following databases: Scopus, Web of Science, MEDLINE, EMBASE, and Virtual Health Library. Articles published in the past 10 years, without language limits, were selected. The outcome of interest was the prevalence of MRSA in food-producing animals. Prevalence rates were meta-analyzed in grouped random effects models using the DerSimonian and Laird method. The geographic distribution of MRSA and the time trend of resistance were also analyzed. Results. Of 19 studies included, 11 were performed in the United States and 11 analyzed pig samples. Five studies were performed in South America. The samples analyzed in the studies were collected in farming, processing, and retail sites. MRSA prevalence in the Americas was 7.6% (95%CI: 5.6-9.5%), and was higher in pigs [12.6% (95%CI: 7.0-18.2%)] followed by bovine cattle [2.4% (95%CI: 1.2-3.7%)] and poultry [1.8% (95CI%: 0.3-3.4%)]. MRSA prevalence was higher in pigs in North America and bovine cattle in Latin America. There was no significant variation in MRSH prevalence along the 10-year period analyzed. Conclusions. MRSA prevalence in food-producing animals in the Americas was higher in pigs, without significant changes across time.
[RESUMEN]. Objetivo. Determinar la prevalencia de Staphylococcus aureus resistente a la meticilina (MRSA por su sigla en inglés) en animales destinados a la producción de alimentos en la Región de las Américas. Métodos. Se realizó una revisión sistemática en las siguientes bases de datos: Scopus, Web of Science, MEDLINE, EMBASE y Biblioteca Virtual de Salud (BVS). Se seleccionaron artículos publicados en los últimos diez años, sin restricción en cuanto al idioma. El resultado de interés fue la prevalencia de MRSA en animales destinados a la producción de alimentos. Las tasas de prevalencia se agruparon en metanálisis de efectos aleatorios por el método de DerSimonian y Laird. También se analizaron la distribución geográfica de los microorganismos resistentes y las tendencias de resistencia con el transcurso del tiempo. Resultados. De los 19 estudios incluidos, 11 se realizaron en Estados Unidos y en 11 se analizaron muestras tomadas de cerdos. Se efectuaron cinco estudios en América del Sur. Las muestras analizadas se recogieron en lugares de cría, sacrificio y venta. La prevalencia de MRSA en la Región de las Américas fue de 7,6% (IC95%: 5,6-9,5%) con una tasa mayor en cerdos [12,6% (IC95%: 7,0-18,2%)], seguidos por bovinos [2,4% (IC95%: 1,2-3,7%)] y aves [1,8% (IC95%: 0,3-3,4%)]. Se observó una mayor prevalencia de MRSA en la población porcina de América del Norte y en la población bovina de América Latina. No hubo variación significativa de la prevalencia de resistencia en los diez años analizados. Conclusiones. La prevalencia de MRSA en animales destinados a la producción de alimentos en la Región de las Américas fue mayor en cerdos, sin variación significativa de la prevalencia con el transcurso del tiempo.
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Farmacorresistencia Microbiana , Staphylococcus aureus Resistente a Meticilina , Revisión Sistemática , Américas , Farmacorresistencia Microbiana , Staphylococcus aureus Resistente a Meticilina , Américas , Revisión Sistemática , Farmacorresistencia Microbiana , Staphylococcus aureus Resistente a Meticilina , Américas , Revisión SistemáticaRESUMEN
Purpose: The aim of the present study was to determine whether de-escalation guided by blood cultures for patients with a diagnosis of sepsis, severe sepsis or septic shock reduces mortality, and antimicrobial drug resistance (ADR). Methods: A prospective, single-center, cohort study was conducted with adults admitted to the ICU with a diagnosis of sepsis, severe sepsis, or septic shock at a public hospital in Sorocaba, State of São Paulo, Brazil, from January 2013 to December 2013. We excluded patients who had negative blood cultures. Patients who had replaced the initial empirical broad-spectrum antibiotic therapy (EAT) by the antibiotic therapy guided by blood cultures were compared with those who continued receiving EAT. The outcome included mortality and antimicrobial drug resistance. We used the Cox regression (proportional hazards regression) and the Poisson regression to analyze the association between antibiotic therapy guided by blood cultures (ATGBC) and outcomes. The statistical adjustment in all models included the following variables: sex, age, APACHE II (Acute Physiology And Chronic Health Evaluation II) score and SOFA (Sequential Organ Failure Assessment) score. Results: Among the 686 patients who were admitted to the intensive care unit, 91 were included in this study. The mean age of the patients was 52.7 years (standard deviation = 18.5 years) and 70.3% were male. EAT was replaced by ATGBC in 33 patients (36.3%) while 58 patients (63.7%) continued receiving EAT. Overall hospital mortality decreased from 56.9% in patients who received EAT to 48.5% in patients who received ATGBC [Hazard ratio- HR 0.44 (95% CI 0.24-0.82), p = 0.009]. There was no association between ATGBC and ADR [HR 0.90 (95% CI 0.78 - 1.03) p = 0.15]. Conclusions: Although the early and appropriate empirical EAT is undoubtedly an important factor prognostic, ATGBC can reduce the mortality in these patients.
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Background: The vaccine against the rotavirus is an effective measure in reducing hospitalizations and mortality caused by the virus. However, its use can result in serious adverse effects. The available evidence on Kawasaki disease has not yet been reported in the literature. This study investigated the risk of developing Kawasaki disease with the use of rotavirus vaccines in children. Methods: This is a systematic review of data collected from studies retrieved on the following databases: Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, HealthSTAR, Lilacs, Clinical trial.gov, and International Clinical Trials Registry Platform, up to the 15th of August 2018, with no restrictions on language or date of publication. The outcomes measured were incidence of Kawasaki disease, risk of developing the disease, and rate of discontinuation of the vaccination schedule. Four reviewers independently selected the studies, performed data extraction, and assessed the quality of evidence. A meta-analysis of random effects was performed. Results: A total of 13 publications were included, with a population of 164,434 children included in the meta-analysis. The incidence of Kawasaki disease (24 cases per 100,000, 95% CI = 11.98-48.26) in the vaccinated children was low. No difference between the vaccines was found in the prevalence rate of adverse effects (RR = 1.55, 95% CI = 0.41-5.93). Use of the vaccines was not associated with risk of developing Kawasaki disease (low-quality evidence). None of the studies reported the rate of discontinuation of the vaccination schedule. Conclusions: The vaccines were associated with a low incidence of developing Kawasaki disease, showing no association with this serious adverse effect.
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Background: Biological agents used for the treatment of psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are associated with serious adverse effects (SAEs). Although several biologics have demonstrated good efficacy and tolerability in short-term trials, treatment guidelines recommend them as third line therapies due to a relative lack of long-term safety data. Objective: To determine the frequency and severity of adverse effects associated with the long-term use of biologics in the treatment of PsA and RA, and possible risk factors for such events in a real-life setting. Methods: We conducted a longitudinal study in PsA and RA patients only taking long-term biological agents from 2003 to 2011. Sources of information included dispensing pharmacy data and interviews with patients. Research staff conducted telephone interviews with patients inquiring about any apparent medication-related adverse drug reactions (ADRs) or SAEs. ADR/SAE's data was based on pharmacy reports. We conducted a multivariate analysis to identify the factors associated with the risk of ADRs. Results: Of the 305 patients identified, we interviewed 268 patients. Most of these were taking adalimumab 127 (47.4%), 52 (19.4%) etanercept, 42 (15.7%) infliximab, 25 (9.3%) rituximab, 10 (3.7%) abatacept, 9 (3.4%) efalizumab, and 3 (1.1%) tocilizumab. Of the 268 patients, 116 (43.3%) experienced one or more adverse events related to biological agents with 1.6 events per patient, and of these 29 (25%) experienced one or more SAEs, with majority subjected to hospitalizations. The most frequently reported ADRs were administration site reactions as observed in 73 patients (27.2%), infections in 30 patients (11.2%), effects on nervous system in 22 patients (8.2%), and 15 (5.6%) patients withdrew due to ADRs. The use of rituximab was related with less risk of ADR [PR 0.42, 95% CI 0.18-0.96; p = 0.04] than other agents. No other predisposing factors were associated with risk of ADR. The monitoring of patients (medical consultation and laboratory test) was only completed by 48 patients (30.4%). Conclusion: These data showed the early biological experience in Brazil that were associated with ADRs, withdrawals due to ADRs and SAEs. The quantification of adverse effects (serious or nonserious) considering close monitoring and patients' perceptions are increasingly important for future decision-making.
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Infections are the leading cause of morbidity and mortality among burn-injury patients. Even in the absence of documented infection, antibiotics are often given to burn-injury patients at the beginning of treatment, an empirical measure in response to signs and symptoms of infection. The choice of antimicrobial therapy for these patients should be based on technical criteria, based on laboratory findings, at the risk of further increasing antimicrobial resistance levels.
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Antiinfecciosos/uso terapéutico , Quemaduras/complicaciones , Utilización de Medicamentos , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
The aim of this study was to compare benzodiazepine (bzd) prescriptions for adults and older adults regarding appropriate use indicator. It is a cross-sectional study for collecting data on patients treated at the City's Mental Health Clinic in Sorocaba/SP, between March and December 2013. Appropriate use indicators were used: appropriate drug, with adequate posology and period of use; as well as the use of a single bzd, as anxiolytic for less than 3 months in depression treatment with antidepressants, use for less than 2 months if associated to an antidepressant and no use of long-acting bzd in older adults. From the 330 participants, most were women, with a family history of mental disorders and bzd use, without monitoring of a psychologist and using other psychotropic and polypharmacy (p>0.05).The minority of prescriptions had indication for the use of bzd (37.5% for older adults and 32.4% for adults) (p>0.05). Only 5.8% of the prescriptions for older adults and 1.9 for adults were rational (p>0.05). The chronic use was observed in all adults and older adults with depressive and anxiety disorders (p>0.05). A minority of prescriptions for adults and older adults was appropriate.
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Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Benzodiazepinas/uso terapéutico , Pautas de la Práctica en Medicina , Adulto , Antidepresivos/efectos adversos , Benzodiazepinas/efectos adversos , Estudios Transversales , Femenino , Humanos , Masculino , Salud MentalRESUMEN
Resumo Foi objetivo deste estudo comparar as prescrições de benzodiazepínicos (bzd) em adultos e idosos quanto aos indicadores do uso apropriado. Estudo transversal de coleta de dados de pacientes atendidos no Ambulatório Municipal de Saúde Mental de Sorocaba/SP, entre março e novembro de 2013. Foram utilizados indicadores de uso apropriado: medicamento apropriado, com adequada posologia e duração de uso; como também, o uso de apenas um bzd, como ansiolítico por menos de 3 meses, no tratamento da depressão com antidepressivo, uso por menos de 2 meses se associado ao antidepressivo e o não uso de bzd de longa ação em idoso. Dos 330 participantes, a maioria era mulheres, com histórico familiar de transtorno mental e uso de bzd, não realizava acompanhamento com psicólogo e fazia uso de outros psicotrópicos e de polifarmácia (p > 0,05). A minoria das prescrições tinha indicação de uso do bzd (37,5% para idosos e 32,4% para adultos) (p > 0,05). Apenas 5,8% das prescrições para idosos e 1,9% para adultos eram racionais (p > 0,05). O uso crônico foi observado em todos os adultos e idosos com transtornos depressivos e ansiosos (p > 0,05). Uma minoria das prescrições de bzd para adultos e idosos era apropriada.
Abstract The aim of this study was to compare benzodiazepine (bzd) prescriptions for adults and older adults regarding appropriate use indicator. It is a cross-sectional study for collecting data on patients treated at the City’s Mental Health Clinic in Sorocaba/SP, between March and December 2013. Appropriate use indicators were used: appropriate drug, with adequate posology and period of use; as well as the use of a single bzd, as anxiolytic for less than 3 months in depression treatment with antidepressants, use for less than 2 months if associated to an antidepressant and no use of long-acting bzd in older adults. From the 330 participants, most were women, with a family history of mental disorders and bzd use, without monitoring of a psychologist and using other psychotropic and polypharmacy (p>0.05).The minority of prescriptions had indication for the use of bzd (37.5% for older adults and 32.4% for adults) (p>0.05). Only 5.8% of the prescriptions for older adults and 1.9 for adults were rational (p>0.05). The chronic use was observed in all adults and older adults with depressive and anxiety disorders (p>0.05). A minority of prescriptions for adults and older adults was appropriate.
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Humanos , Masculino , Femenino , Adulto , Ansiolíticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Pautas de la Práctica en Medicina , Antidepresivos/uso terapéutico , Benzodiazepinas/efectos adversos , Salud Mental , Estudios Transversales , Antidepresivos/efectos adversosRESUMEN
The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation.
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Amputación Quirúrgica , Pie Diabético/cirugía , Hospitalización , Infección de Heridas/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Estudios Transversales , Desbridamiento , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Pie Diabético/microbiología , Progresión de la Enfermedad , Femenino , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Análisis Multivariante , Prevalencia , Modelos de Riesgos Proporcionales , Medición de Riesgo , Factores de Riesgo , Procedimientos Quirúrgicos Vasculares , Infección de Heridas/diagnóstico , Infección de Heridas/epidemiología , Infección de Heridas/microbiologíaRESUMEN
INTRODUCTION: Antimicrobial resistance (AR) is a multifaceted problem of global significance. In addition to developing new drugs and using antimicrobial guidelines, it is essential that health professionals understand all aspects of the problem and the most effective ways to handle it. This study evaluated pharmacists' level of knowledge about bacterial resistance and antibiotic use in Brazil. METHODOLOGY: The study was conducted using a survey provided electronically to pharmacists in São Paulo State, Brazil. RESULTS: In total, 754 pharmacists completed the survey. The majority of the pharmacists were young (under 30 years of age), female, and worked in community pharmacies. Pharmacists who worked in hospital or community pharmacies reported a greater AR interference in their work than did pharmacists working in other locations (p < 0.05). With respect to factors that contribute to AR, pharmacists placed little weight on the role of inadequate hand washing or lack of immunization campaigns. The pharmacists also believed that vaccination was of limited value in combating AR and instead placed the highest value on educational campaigns. The study showed that pharmacists who used package inserts and advertising material as their source for updated information had a poorer understanding of the appropriate use of antibiotics than did those who obtained their information from scientific journals, textbooks, or scientific meetings. CONCLUSIONS: The results highlight the need for adequate information regarding AR to reach health professionals such as pharmacists. Governments should promote campaigns for integrated actions to combat the serious global problem presented by AR.
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Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana , Farmacéuticos , Competencia Profesional , Adulto , Antibacterianos/uso terapéutico , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Adulto JovenRESUMEN
UNLABELLED: OBJECTIVE; To analyze the access and utilization profile of biological medications for psoriasis provided by the judicial system in Brazil. METHODS: This is a cross-sectional study. We interviewed a total of 203 patients with psoriasis who were on biological medications obtained by the judicial system of the State of Sao Paulo, from 2004 to 2010. Sociodemographics, medical, and political-administrative characteristics were complemented with data obtained from dispensation orders that included biological medications to treat psoriasis and the legal actions involved. The data was analyzed using an electronic data base and shown as simple variable frequencies. The prescriptions contained in the lawsuits were analyzed according to legal provisions. RESULTS: A total of 190 lawsuits requesting several biological drugs (adalimumab, efalizumab, etanercept, and infliximab) were analyzed. Patients obtained these medications as a result of injunctions (59.5%) or without having ever demanded biological medication from any health institution (86.2%), i.e., public or private health services. They used the prerogative of free legal aid (72.6%), even though they were represented by private lawyers (91.1%) and treated in private facilities (69.5%). Most of the patients used a biological medication for more than 13 months (66.0%), and some patients were undergoing treatment with this medication when interviewed (44.9%). Approximately one third of the patients discontinued treatment due to worsening of their illness (26.6%), adverse drug reactions (20.5%), lack of efficacy, or because the doctor discontinued this medication (13.8%). None of the analyzed medical prescriptions matched the legal prescribing requirements. Clinical monitoring results showed that 70.3% of the patients had not undergone laboratory examinations (blood work, liver and kidney function tests) for treatment control purposes. CONCLUSIONS: The plaintiffs resorted to legal action to get access to biological medications because they were either unaware or had difficulty in accessing them through institutional public health system procedures. Access by means of legal action facilitated long-term use of this type of medication through irregular prescriptions and led to a high rate of adverse drug reactions as well as inappropriate clinical monitoring.
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Anticuerpos Monoclonales/uso terapéutico , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Psoriasis/tratamiento farmacológico , Adulto , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Derechos del Paciente/legislación & jurisprudencia , Salud Pública , Adulto JovenRESUMEN
BACKGROUND: The safety of biological agents used to treat psoriasis remains uncertain. OBJECTIVE: The authors determined the frequency and severity of adverse effects associated with use of biologic agents for psoriasis through patient-registered lawsuits to the government of Sao Paulo, Brazil. METHODS: Sources of information included legal records, dispensing pharmacy data and interviews with patients. Research staff conducted telephone interviews with patients who used biologic drugs during 2004 - 2011, inquiring about medication-related adverse drug reactions (ADRs) and serious adverse events (SAEs). RESULTS: Of the 218 patients identified, 15 proved ineligible or refused participation. 203 patients were interviewed, with 111 (54.7%) taking infliximab, 43 (21.2%) efalizumab, 35 (17.2%) etanercept and 14 (6.9%) adalimumab. Of 84 (41.4%) patients who experienced one or more ADR related to biological agents, 57 (67.9%) experienced one or more SAE. The only risk factor associated with ADRs was comorbidity odds ratio = 6.54 (95% confident interval [CI] 3.20 - 13.32), p < 0.0001. CONCLUSION: Biologic agents were associated with high rates of ADRs and SAEs. The data suggests that for patients taking a biologic agent to treat psoriasis and who have one or more comorbidities, warnings of possible adverse events and enhanced surveillance are warranted.
Asunto(s)
Antiinflamatorios/efectos adversos , Factores Inmunológicos/efectos adversos , Psoriasis/tratamiento farmacológico , Adulto , Antiinflamatorios/uso terapéutico , Brasil/epidemiología , Estudios Transversales , Femenino , Humanos , Factores Inmunológicos/uso terapéutico , Masculino , Persona de Mediana Edad , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
OBJECTIVE To analyze the access and utilization profile of biological medications for psoriasis provided by the judicial system in Brazil. METHODS This is a cross-sectional study. We interviewed a total of 203 patients with psoriasis who were on biological medications obtained by the judicial system of the State of Sao Paulo, from 2004 to 2010. Sociodemographics, medical, and political-administrative characteristics were complemented with data obtained from dispensation orders that included biological medications to treat psoriasis and the legal actions involved. The data was analyzed using an electronic data base and shown as simple variable frequencies. The prescriptions contained in the lawsuits were analyzed according to legal provisions. RESULTS A total of 190 lawsuits requesting several biological drugs (adalimumab, efalizumab, etanercept, and infliximab) were analyzed. Patients obtained these medications as a result of injunctions (59.5%) or without having ever demanded biological medication from any health institution (86.2%), i.e., public or private health services. They used the prerogative of free legal aid (72.6%), even though they were represented by private lawyers (91.1%) and treated in private facilities (69.5%). Most of the patients used a biological medication for more than 13 months (66.0%), and some patients were undergoing treatment with this medication when interviewed (44.9%). Approximately one third of the patients discontinued treatment due to worsening of their illness (26.6%), adverse drug reactions (20.5%), lack of efficacy, or because the doctor discontinued this medication (13.8%). None of the analyzed medical prescriptions matched the legal prescribing requirements. Clinical monitoring results showed that 70.3% of the patients had not undergone laboratory examinations (blood work, liver and kidney function tests) for treatment control purposes. CONCLUSIONS The plaintiffs resorted to legal action ...
OBJETIVO Analisar o acesso e o perfil de utilização, por via judicial, de medicamentos biológicos para o tratamento de psoríase. MÉTODOS Estudo transversal descritivo. Foram entrevistados 203 pacientes com psoríase que demandaram medicamentos biológicos, por via judicial, ao Estado de São Paulo, entre 2004 e 2010. Informações sobre características sociodemográficas, médico-sanitárias e político-administrativas foram complementadas com dados obtidos das respectivas ordens de dispensação quanto a medicamento biológico para tratamento de psoríase e autos correspondentes. Os dados foram analisados em banco eletrônico e as variáveis sumarizadas por frequência simples. As prescrições contidas nos processos foram analisadas quanto aos preceitos legais contidos na lei. RESULTADOS Foram analisados 190 autos referentes aos medicamentos biológicos: adalimumabe, efalizumabe, etanercepte e infliximabe. Os proponentes obtiveram o medicamento por mandado de segurança (59,5%), sem nunca ter solicitado o medicamento biológico para outra instituição (86,2%), por sistema de saúde público ou privado. Utilizaram-se da prerrogativa de gratuidade de justiça (72,6%), embora fossem representados por advogado particular (91,1%) e atendidos em consultórios médicos privados (69,5%). Utilizaram o medicamento biológico por período > 13 meses (66,0%) e 44,9% faziam uso do medicamento no momento da entrevista. Quase um terço daqueles que deixaram de usar os medicamentos abandonou o tratamento por piora do quadro (26,6%), efeitos adversos (20,5%), falta de eficácia ou suspensão pelo médico (13,8%). Nenhuma prescrição médica atendeu aos preceitos legais; 70,3% dos pacientes não haviam realizado exames laboratoriais (hemograma, função ...
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Anticuerpos Monoclonales/uso terapéutico , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Psoriasis/tratamiento farmacológico , Brasil , Estudios Transversales , Programas Nacionales de Salud , Derechos del Paciente/legislación & jurisprudencia , Salud PúblicaRESUMEN
OBJECTIVE: In São Paolo, Brazil, patients can appeal to the courts, registering law suits against the government claiming the need for biological agents for treatment of psoriasis. If the lawsuits are successful, which is usually the case, the government then pays for the biologic agent. The extent to which the management of such patients, after gaining access to government payment for their biologic agents, adheres to authoritative guidelines, is uncertain. METHODS: We identified patients through records of the State Health Secretariat of São Paulo from 2004 to 2011. We consulted guidelines from five countries and chose as standards only those recommendations that the guidelines uniformly endorsed. Pharmacy records provided data regarding biological use. Guidelines not only recommended biological agents only in patients with severe psoriasis who had failed to respond to topical and systemic therapies (eg, ciclosporin and methotrexate) but also yearly monitoring of blood counts and liver function. RESULTS: Of 218 patients identified in the database, 3 did not meet eligibility criteria and 12 declined participation. Of the 203 patients interviewed, 91 were still using biological medicine; we established adherence to laboratory monitoring in these patients. In the total sample, management failed to meet standards of prior use of topical and systemic medication in 169 (83.2%) patients. Of the 91 patients using biological medicine at the time of the survey, 23 (25.2%) did not undergo appropriate laboratory tests. CONCLUSIONS: Important discrepancies exist between clinical practice and the recommendations of guidelines in the management of plaintiffs using biological drugs to treat psoriasis.
Asunto(s)
Factores Biológicos/uso terapéutico , Adhesión a Directriz , Pautas de la Práctica en Medicina/normas , Psoriasis/tratamiento farmacológico , Adulto , Antiinflamatorios/efectos adversos , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Factores Biológicos/efectos adversos , Recuento de Células Sanguíneas , Brasil , Femenino , Adhesión a Directriz/legislación & jurisprudencia , Humanos , Legislación de Medicamentos , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/legislación & jurisprudencia , Adulto JovenRESUMEN
INTRODUCTION: Inappropriate use of antibiotics leads to increased levels of bacterial resistance making it difficult to treat upper respiratory tract infections. The appropriate use of these drugs has a fundamental role in controlling resistance and in success of treatment of childhood infections. Therefore, the aim of this study was to assess the prescription and use of antibiotics for Brazilian children. METHODS: The use of antibiotics in 160 children was monitored in two Primary Health Centers by questionnaires administered to parents and caregivers that assessed the social, demographic and clinical conditions of the children. Furthermore, the antibiotic use pattern was ascertained in these children and compared to the recommendations of the Brazilian and international guidelines. RESULTS: The use of these drugs had an inverse relationship with children breast-fed to six months of age, showing that breast-fed children had a tendency to use less of these drugs. There was great variability in the amoxicillin doses used for upper respiratory infections ranging from 8.2 to 91.9 mg/kg/day. The doses used in most treatments were far below the doses recommended in the Brazilian and international guidelines (50% and 97%, respectively). CONCLUSION: Although there are guidelines for the use of these medications, compliance is still very low, leading to under dosage and therapeutic failures. It is essential for pediatricians to be aware of and comply with the guidelines, avoid personal decisions and take measures based on strong clinical evidence. The proper use of these medications, in addition to greater therapeutic success, decreases the possibility of the appearance of resistant microorganisms.