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BACKGROUND: The aim of this study was to determine incidence of COVID-19 in relationship to geographical distribution among Spain. METHOD: Cluster analysis taking into consideration the incidence of COVID-19 in the provinces and autonomous cities of Spain in each of the first six waves of the pandemic. RESULTS: All the provinces of the Canary Islands, Catalonia and Andalusia form independent clusters. In Comunidad Valenciana, Galicia, País Vasco and Aragón two out of three provinces (three out of four in Galicia) were in the same cluster, with no other provinces. DISCUSSION: The incidence of COVID-19 in Spain in the first six waves forms clusters that reproduce the territorial division of Spain into autonomous communities. Although this could be explained by greater mobility within a community, it cannot be ruled out that this distribution is due to differences in screening, diagnosis, registration or reporting of COVID-19 cases.

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Ceftolozane/tazobactam (C/T) and ceftazidime/avibactam (CZA) are new possibilities of antimicrobial treatment that combined a ß-lactam with a ß-lactamase inhibitor. The United States (US) and European regulatory agencies approved their clinical use in adults with complicated intra-abdominal infections. This study aims to know if one of the two antibiotics obtain better efficacy in adults with complicated intra-abdominal infections and by specific pathogens such as P. aeruginosa or E. coli. A search of all trials in MEDLINE, Scopus, and Web of Science comparing a C/T or CZA based antimicrobial regimen with other treatments in patients with intraabdominal infections until August 2021 was performed. To make indirect comparisons, we used a frequentist approach using the R package netmeta.The effects have been expressed through the relative risk (RR) with its confidence interval. Considering the clinical cure and failure rates between the different trial populations (mMITT, CE, ME) and the mortality at the end of the study, we have not found significant differences between CZA and C/T. In the case of Pseudomonas, the RR of treatment failure between these two antibiotics is 1 (95% CI 0.55-1.18). In the case of E. Coli, although it seems that CZA would have a worse result than C/T, differences did not reach statistical significance (RR1.06; 95% CI 0.9-1.14). In conclusion, we have not found statistically significant differences between ceftolozane-tazobactam and ceftazidime-avibactam in treating cIAI. In regards to E. Coli, our results do not reach significance, but it would be possible that C/T and meropenem had better results than CZA. Perhaps new trials would allow a better profile of the role in different types of patients or infections caused by specific microorganisms in the future.

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Fundamento. Estimar la prevalencia de prescripción potencialmente inadecuada (PPI) y de problemas relacionados con los medicamentos (PRM) en pacientes ancianos polimedicados hospitalizados, y evaluar el impacto de la intervención farmacéutica sobre dicha prevalencia. Material y métodos. Estudio de intervención, cuasi-experimental, en pacientes polimedicados (≥ 6 fármacos) que ingresaron en un servicio de Geriatría en 2018-2019. Se analizaron las PPI según criterios STOPP/START 2014 y los PRM según el Tercer Consenso de Granada. Los PPI y PRM detectados, junto con posibles acciones para solucionarlos, se remitieron al geriatra responsable. Si al alta el cambio en la prevalencia de PPI y PRM fue ≥75%, se consideró aceptada la intervención. Resultados. Se realizó intervención farmacéutica en 218 pacientes, analizándose 1.837 prescripciones. Al ingreso se observaron PPI (90,8%) y PRM (99,5%). Se realizaron 1.227 intervenciones, el 57,6% sobre PRM. Se aceptó el 53,6% de las intervenciones farmacéuticas; la PPI según criterios STOPP y START se redujo un 49,7 y un 22,1%, respectivamente; los PRM disminuyeron un 60,1%. Las frecuencias y medianas de PRM y de PPI según criterios START y STOPP se redujeron significativamente al alta. Las variables más asociadas con la aceptación de la intervención farmacéutica fueron el geriatra responsable, el número de PPI START y el número de PPI STOPP. Conclusiones. Durante el ingreso hospitalario, la detección de PPI y PRM del tratamiento crónico por el farmacéutico, y en colaboración con el médico del paciente, ayuda a disminuir, la prevalencia de PPI y PRM.(AU)

Background. The aim of the study was estimate the prevalence of potentially inappropriate prescribing (PIP) and drug related problems (DRP) in an acute geriatric ward, and to evaluate the impact of pharmaceutical intervention on their prevalence. Methods. Quasi-experimental, interventional study in polymedicated patients (≥ 6 drugs) who were admitted to a Geriatric ward in 2018-2019. PIP were analyzed according to STOPP/START 2014 criteria and DRP on the Third Consensus of Granada. The PIP and DRP detected, and the possible actions to correct them, PI were sent to the physician in charge. The effect of the intervention was analyzed at hospital discharge; if the change of prevalence of PIP and DRP was ≥75%, the pharmaceutical intervention was considered to be accepted. Results. Pharmaceutical intervention was performed on 218 patients, analyzing 1,837 prescriptions. On admission, PIP (90.8%) and DRP (99.5%) were observed. We carried out 1,227 interventions, 57.6% on DRP. More than half (53.6%) of the pharmaceutical interventions were accepted; the PIP according to the STOPP and START criteria was reduced by 49.7 and 22.1%, respectively; DRP decreased by 60.1%. The frequencies and medians of PRM and PPI according to the START and STOPP criteria decreased significantly at discharge. The variables most frequently associated with acceptance of the pharmaceutical intervention were the geriatrician at charge, the number of PPI START and the number of PPI STOPP. Conclusion. The detection of PIP and DRP of chronic treatment during hospital admission by the pharmacist, and in collaboration with the patient’s doctor, helps to reduce the prevalence of PIP and DRP.(AU)

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BACKGROUND: The aim of the study was estimate the prevalence of potentially inappropriate prescribing (PIP) and drug related problems (DRP) in an acute geriatric ward, and to evaluate the impact of pharmaceutical intervention on their prevalence. METHODS: Quasi-experimental, interventional study in polymedicated patients (= 6 drugs) who were admitted to a Geriatric ward in 2018-2019. PIP were analyzed according to STOPP/START 2014 criteria and DRP on the Third Consensus of Granada. The PIP and DRP detected, and the possible actions to correct them, were sent to the physician in charge. The effect of the intervention was analyzed at hospital discharge; if the change of prevalence of PIP and DRP was =75%, the pharmaceutical intervention was considered to be accepted. RESULTS: Pharmaceutical intervention was performed on 218 patients, analyzing 1,837 prescriptions. On admission, PIP (90.8%) and DRP (99.5%) were observed. We carried out 1,227 interventions, 57.6% on DRP. More than half (53.6%) of the pharmaceutical interventions were accepted; the PIP according to the STOPP and START criteria was reduced by 49.7 and 22.1%, respectively; DRP decreased by 60.1%. The frequencies and medians of PRM and PPI according to the START and STOPP criteria decreased significantly at discharge. The variables most frequently associated with acceptance of the pharmaceutical intervention were the geriatrician at charge, the number of PPI START and the number of PPI STOPP. CONCLUSION: The detection of PIP and DRP of chronic treatment during hospital admission by the pharmacist, and in collaboration with the patient's doctor, helps to reduce the prevalence of PIP and DRP.

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BACKGROUND: Dalbavancin is a semisynthetic lipoglycopeptide antimicrobial agent with activity against Gram-positive bacteria including anaerobes. RESEARCH DESIGN AND METHODS: Meta-analysis of randomized control trials and large case series (more than 20 patients), were identified by searching Pubmed and Cochrane databases through 14 December 2020. RESULTS: 3,073 patients from 6 RCTs met the inclusion criteria. Treatment emergent adverse effects were described in 30.6% dalbavancin patients, and 38.1% patients with other treatments. Our meta-analysis supports favorable results for dalbavancin treatment (OR 0.79; 95%CI 0.66-0.94; p = 0.01). 2.74% dalbavancin patients had to discontinue treatment versus 2.49% patients on other antibiotics. 4.80% dalbavancin patients versus 5.30% patients with other treatments had severe adverse events. 0.31% in the dalbavancin group and 0.95% receiving other antibiotics died. There was no statistically significant difference in severe adverse effects with OR 0.77; 95% CI 0.52-1.14; p = 0.19. Dalbavancin therapy was shown to have statistically significant lower mortality rate (OR 0.26; 95% CI 0.07-0.90; p = 0.03). Observational studies reported few side effects but included a heterogeneous population of patients concerning their diagnosis and the duration of antibiotic treatment. CONCLUSIONS: Dalbavancin has comparable safety profile relative to other antibiotics and is well-tolerated.

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The pandemic caused by the new SARS-CoV2 coronavirus has led to an effort to find treatments that are effective against this disease that the World Health Organization calls COVID-19. In severe cases of COVID-19, there is an increase in cytokines, among which IL-6 seems to play an important role. A search has been performed for studies using IL-6 blocking drugs (tocilizumab, siltuximab, and sarilumab) in PubMed, Web of Science, and Scopus. Also, a search of ongoing trials registered at clinicaltrials.gov was performed. We found very little published clinical experience with these drugs, consisting mainly of case reports or case series with few patients. The results of clinical trials are necessary to clarify the role of these drugs in patients with COVID-19.

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A pesar de que la insuficiencia cardiaca es uno de los síndromes clínicos más frecuentes en medicina y de su elevada mortalidad, pocos son los pacientes que se benefician del acceso a unos cuidados paliativos adecuados a su situación clínica. Recientemente se han publicado varios ensayos para comprobar la utilidad de iniciar tratamiento paliativo junto con el tratamiento cardiológico en pacientes con insuficiencia cardiaca avanzada. En la presente revisión se analizan aspectos sobre el diagnóstico y el control de síntomas de pacientes con insuficiencia cardiaca avanzada, y se ofrece una recopilación de ensayos clínicos que analizan la eficacia de una intervención paliativa en este grupo de pacientes. Es preciso dotar al médico de estrategias para reconocer la necesidad de este tipo de intervenciones sin que ello implique descuidar el tratamiento activo de su insuficiencia cardiaca

Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure

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Although heart failure is one of the most common clinical syndromes in medicine and has a high mortality rate, few patients have access to adequate palliative care for their clinical situation. Several trials have recently been published on the usefulness of starting palliative treatment along with cardiac treatment for patients with advanced heart failure. In this review, we analyse the aspects of diagnosing and controlling the symptoms of patients with advanced heart failure and provide a collection of clinical trials that have analysed the efficacy of a palliative intervention in this patient group. Physicians need to be equipped with strategies for recognizing the need for this type of intervention without it resulting in neglecting the active treatment of the patient's heart failure.

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Objetivos. Conocer la práctica y los factores asociados a la limitación del esfuerzo terapéutico y las órdenes de no reanimación en una planta de hospitalización convencional de Medicina Interna de un hospital comarcal. Material y métodos. Estudio retrospectivo en el que se han buscado los pacientes que recibieron órdenes de no reanimación (ONR) y los pacientes fallecidos entre los ingresados en Medicina Interna entre enero y mayo de 2011 en el Hospital de Villarrobledo. Se describen en este grupo de pacientes aquellas actuaciones que pueden calificarse de limitación de tratamientos de soporte vital (LTSV). Resultados. En total se han analizado 106 casos, de los cuales 80 recibieron ONR (10,2% de los ingresos durante este periodo). Cincuenta y cuatro pacientes recibieron alguna otra actuación de LTSV. La información encontrada sobre los motivos y la comunicación con el paciente y familiares es incompleta en la mayoría de los casos. No se han encontrado diferencias entre los pacientes fallecidos con y sin LTSV o con y sin ONR. Conclusiones. Debe mejorarse el registro de los motivos que llevan a tomar las decisiones de LTSV/ONR, así como de las personas que participan en estas decisiones, sea el médico, familiares o el propio paciente(AU)

Objectives. To determine the practice and associated factors of limiting therapeutic effort and do not resuscitate (DNR) order in a general Internal Medicine ward in a regional hospital. Material and methods. A retrospective search was performed to find patients who received do not resuscitate orders and patients who died, among those admitted to Internal Medicine between January and May 2011 at the Hospital of Villarrobledo. The limitation in therapeutic effort (LTE) in this group is described. Results. A total of 106 cases were analyzed, 80 of them received DNR (10.28% of admissions during this period). Fifty four patients received other LTE. The information on the reasons and communication with the patient and family was incomplete in most cases. No differences were found between patients who died with and without LTE or with and without DNR orders. Conclusions. The information on the reasons that lead to LTE/DNR orders decisions should be improved, as well as the information on the people involved in these decisions(AU)

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OBJECTIVES: To determine the practice and associated factors of limiting therapeutic effort and do not resuscitate (DNR) order in a general Internal Medicine ward in a regional hospital. MATERIAL AND METHODS: A retrospective search was performed to find patients who received do not resuscitate orders and patients who died, among those admitted to Internal Medicine between January and May 2011 at the Hospital of Villarrobledo. The limitation in therapeutic effort (LTE) in this group is described. RESULTS: A total of 106 cases were analyzed, 80 of them received DNR (10.28% of admissions during this period). Fifty four patients received other LTE. The information on the reasons and communication with the patient and family was incomplete in most cases. No differences were found between patients who died with and without LTE or with and without DNR orders. CONCLUSIONS: The information on the reasons that lead to LTE/DNR orders decisions should be improved, as well as the information on the people involved in these decisions.

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We searched the Spanish and Portuguese pharmacovigilance databases for spontaneous case reports of heart rhythm disturbances associated with rupatadine and other new H1 antihistamines. Five cases were found involving patients treated with rupatadine (13.9% of all reports relating to this drug). In all five cases, the reaction started after exposure and resolved when the drug was discontinued. In two cases, rupatadine was the only medication being taken by the patient, and no other condition that could explain the heart rhythm disturbances was diagnosed. The reporting odds ratio was 3.2 (95% confidence interval, 1.0-10.5). The reporting rate was 2 cases per 100,000 patients treated per year (95% confidence interval, 0.4-6.0). These results suggest a causal relationship between rupatadine and heart rhythm disturbances.

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INTRODUCTION: Epilepsy and the epileptic syndromes are common neurological diseases and represent an important public health problem that has given rise to marked social and healthcare concerns. AIM: To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). MATERIALS AND METHODS: The consumption of the N03 subgroup has been studied using data from the ECOM database of the Spanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). RESULTS: A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. CONCLUSION: Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs.

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Las epilepsias y los síndromes epilépticos constituyen enfermedades neurológicas frecuentes y representanun importante problema de salud pública, que ha dado lugar a una gran preocupación sanitaria y social. Objetivo. Analizar la evolución del consumo de fármacos antiepilépticos en la Comunidad Autónoma del País Vasco en un período de 13 años (1992-2004). Materiales y métodos. Se ha estudiado el consumo del subgrupo N03 con datos procedentes de la base de datos ECOM del Ministerio de Sanidad y Consumo de España, que ofrece el número de envases de medicamentos dispensadosmediante recetas realizadas a cargo del Servicio Nacional de Salud. Los resultados se presentan en dosis definidas diarias por 1.000 habitantes y día (DHD). Resultados. Se ha producido un aumento significativo en la utilización de fármacos antiepilépticos en el período estudiado (5,53-9 DHD). Los fármacos más utilizados han sido el fenobarbital, la carbamacepina, el ácido valproico y la fenitoína, y destaca en los últimos años el amplio uso de la gabapentina. Conclusiones. Los estudios epidemiológicos sobre epilepsia son difíciles de realizar por diversos problemas metodológicos, que fundamentalmente parten de la heterogeneidad de la enfermedad. Los estudios farmacoepidemiológicos constituyen una herramienta eficaz, fácil y de bajo coste para estimar la prevalencia de la enfermedad, además de dar a conocer los fármacos utilizados y contribuir al uso racional de los mismos (AU)

Epilepsy and the epileptic syndromes are common neurological diseases and represent an importantpublic health problem that has given rise to marked social and healthcare concerns. Aim. To analyse the changes in the consumption of antiepileptic drugs in the Basque Country Autonomous Community over a 13 year period (1992-2004). Materials and methods. The consumption of the N03 subgroup has been studied using data from the ECOM database of theSpanish Ministry of Health and Consumer Affairs, which records the number of drug packets dispensed on National Health Service prescription. The results are expressed as defined daily doses per 1,000 inhabitants per day (DID). Results. A significant increase is observed in the consumption of antiepileptic drugs over the study period (5.53-9 DID). The most widely used drugs were phenobarbital, carbamazepine, valproic acid and phenytoin and, in recent years, the extensive use of gabapentin is of particular note. Conclusion. Epidemiological studies on epilepsy are difficult to perform due to a number of methodological problems which are caused fundamentally by the heterogeneity of the disease. Pharmacoepidemiological studies constitute a simple, effective, low-cost tool for estimating the prevalence of the disease, and furthermore enumerates the drugs used, thus contributing to a rational use of these drugs (AU)

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BACKGROUND: Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. PATIENTS AND METHODS: Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. RESULTS: Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR-: 0,02), and with a blood neutrofil percentage < or = 65% (LR+: 6,6; LR-: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR-: 0,01), an erythrocyte sedimentation rate > or = 60 mm/h (LR+: 11,3; LR-: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR-: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR-: 0,06), and a delay of > or = 8 weeks in first consulting (LR+: 10,6; LR-: 0,07) were associated with tuberculous spondylitis. CONCLUSION: The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucellar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment.

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Fundamento. La osteomielitis vertebral (OV) es una patología infrecuente que requiere un tratamiento antibiótico precoz para prevenir secuelas invalidantes. El objetivo de este estudio es identificar variables clínicas que permitan orientar el tratamiento inicial. Pacientes y métodos. Estudio retrospectivo de una serie de 103 casos atendidos durante un período de 13 años diagnosticados en su mayoría (94%) mediante resonancia magnética nuclear. Se clasificaron como espondilitis brucelares (50 casos), piógenas (29 casos), tuberculosas (20 casos) y otras (4 casos). Los parámetros clínicos y de laboratorio se introdujeron en un análisis multivariante para identificar aquellos que se asociaban independientemente con cada grupo etiológico. Resultados. La espondilitis brucelar se asoció a antecedentes epidemiológicos de exposición (LR+: 14,9; LR­: 0,02), y a un porcentaje de neutrófilos en sangre ≤ 65% (LR+: 6,6; LR­: 0,12). La espondilitis piógena se asoció a la presencia de enfermedad crónica de base (LR+: 29,5; LR­: 0,01), una cifra de velocidad de sedimentación globular ≥ 60 mm/h (LR+: 11,3; LR­: 0,07) y ausencia de síntomas constitucionales (astenia, anorexia, adelgazamiento) (LR+: 5,2; LR­: 0,18). La espondilitis tuberculosa se asoció a antecedentes de tuberculosis o contacto tuberculoso (LR+: 11,2; LR­: 0,06) y a un tiempo de evolución en la primera consulta ≥ 8 semanas (LR+: 10,6; LR­: 0,07). Conclusión. La combinación de unas pocas variables clínicas y de laboratorio facilita el diagnóstico diferencial entre OV piógena, brucelar y tuberculosa, permitiendo orientar el tratamiento antibiótico inicial

Background. Vertebral osteomyelitis (VO) is an infrequent disease that requires early antibiotic treatment to prevent serious disabling sequels. The aim of our study was to identify clinical variables capable to guide the initial treatment. Patients and methods. Our retrospective study involved 103 patients seen during a 13 years period, mostly (94%) diagnosed by magnetic resonance imaging. Patients were classified as having brucellar (50 patients), pyogenic (29 patients), tuberculous (20 patients), and other (4 patients) spondylitis. Clinical and laboratory variables entered into a multivariate analysis to identify those independently associated with each etiologic subgroup. Results. Brucellar spondylitis was associated with epidemiological exposure (LR+: 14,9; LR­: 0,02), and with a blood neutrofil percentage ≤ 65% (LR+: 6,6; LR­: 0,12). The presence of an underlying chronic disease (LR+: 29,5; LR­: 0,01), an erythrocyte sedimentation rate ≥ 60 mm/h (LR+: 11,3; LR­: 0,07), and the absence of constitutional symptoms (LR+: 5,2; LR­: 0,18), were independent predictors of a pyogenic spondylitis. Finally, previous exposure or tuberculous disease (LR+: 11,2; LR­: 0,06), and a delay of ≥ 8 weeks in first consulting (LR+: 10,6; LR­: 0,07) were associated with tuberculous spondylitis. Conclusion. The combination of a few clinical and laboratory variables facilitates the differential diagnosis between pyogenic, brucelar and tuberculous vertebral osteomyelitis, allowing the choice of the initial antibiotic treatment

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Objetivo. Conocer la evolución de la oferta, el consumo y el patrón de utilización de antiinflamatorios no esteroideos (AINE) en España entre 1990 y 2003, así como sus repercusiones económicas. Diseño. Estudio de utilización de medicamentos. Emplazamiento. Sistema Nacional de Salud, ámbito extrahospitalario. Mediciones principales. La información sobre el consumo de AINE en España se obtuvo de la base ALHAQUEM del Ministerio de Sanidad y Consumo, que contiene el número de envases que las oficinas de farmacia facturaron con cargo al Sistema Nacional de Salud. Los resultados se han expresado en dosis diarias definidas (DDD) por 1.000 habitantes y día (DHD). Resultados. El consumo de AINE en España se incrementó desde 23,67 DHD en 1990 a 45,82 DHD en 2003 (+ 93,6%). El ibuprofeno fue el AINE que experimentó el mayor incremento (15,33 DHD en 2003). El consumo de coxibs alcanzó un máximo de 7,74 DHD in 2001, pero descendió a 3,59 DHD en 2003 tras la introducción del visado. Durante el período de estudio, el porcentaje de uso de los AINE de bajo riesgo gastrointestinal aumentó del 29 al 59%. Para el conjunto de los AINE, los costes pasaron de 117 millones de euros en 1990 a 329 millones de euros en 2003. Conclusiones. El consumo de AINE en España se ha duplicado en el período de estudio, en tanto que el coste se ha triplicado. El patrón de uso ha cambiado considerablemente y se ha observado un uso creciente de los AINE con mejor perfil gastrointestinal. El impacto de los inhibidores selectivos de la COX-2 ha sido moderado

Objective. To know the trends of supply, consumption and pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) in Spain from 1990 through 2003, as well as their costs. Desing. Drug utilization study. Setting. National Health System, outpatient setting. Main measurements. Information on drug utilization was obtained from the ALHAQUEM database of the Spanish Ministry of Health, which contains the number of packages sold in community pharmacies and charged to the National Health System. Data were expressed in defined daily doses (DDD) per 1000 inhabitants per day (DHD). Results. NSAIDs consumption in Spain increased from 23.67 DHD in 1990 to 45.82 DHD in 2003 (a 93.6% increase). Ibuprofen was the NSAID which showed the greatest increase (15.33 DHD in 2003). The consumption of coxibs reached a maximum of 7.74 DHD in 2001, but decreased to 3.59 DHD in 2003 once prior-authorisation programs were set up. Over the study period the share of NSAIDs use with a low gastrointestinal risk increased from 29% to 59%. Overall costs of NSAIDs increased from 117 million euros in 1990 to 329 million euros in 2003. Conclusions. Over the study period the consumption of NSAIDs in Spain has increased twofold while costs increased threefold. The pattern of use has remarkably changed showing an increasing use of NSAIDs with a better gastrointestinal profile. The impact of coxibs marketing has been moderate

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