The purpose of this study was to investigate whether the trough plasma concentration of voriconazole (VRCZ) in the steady-state (Cmin) influences efficacy and safety in adult and pediatric patients. Treatment was successful in 75% of pediatric patients and 56% of adult patients,and there was no association between Cmin and efficacy.However,liver dysfunction occurred more frequently in the case that Cmin was over 4μg/mL in both adult and pediatric patients.Also,pediatric patients,especially those younger than 2 years,required a higher dose of VRCZ than adults to achieve a similar Cmin. We concluded that the use of VRCZ at a constant dose over a long period may lead to an increase in Cmin.Therefore,careful,continuous monitoring of the Cmin of VRCZ is necessary for pediatric patients,particularly recipients of hematopoietic stem cell transplantation.
Lung cancer is the leading cause of cancer mortality.There are 3 major types of lung cancer therapy-surgery,chemotherapy and radiotherapy.In most cases,chemotherapy is the first choice and cisplatin-based combination therapy plays a major role in lung cancer chemotherapy. As the anticancer effects of lung cancer chemotherapy regimens have not been evaluated in vitro ,we evaluated the effects of combination therapy with cisplatin and irinotecan (IP therapy) and that with cisplatin and etoposide (EP therapy),using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay in human lung adenocarcinoma A 549 epithelial cell line cells.In the MTT assay,drug solutions were added according to the same schedule as for the regimens.The exposure times of the drugs were their half-lives,and drug concentrations were the IC50 values of the half-lives.Our results suggested that cisplatin had a much stronger antiproliferative effect than irinotecan and etoposide,and that all agents had a strong anticancer effect. It has been shown that in these combination therapies,together,the drugs have a stronger anticancer effect than they do when given alone.For IP therapy,cell viability returned at day 28,while it returned at day 15 for EP therapy.These results suggested that the MTT assay can be used in vitro to evaluate cancer chemotherapy regimens as well as dosing schedules for IP therapy and EP therapy.
The possibility of predicting future in-hospital medical product usage from usage trends was investigated based on previously provided prescription data saved in the ordering system.We compared quantities of medical products used based on previously provided prescription data saved in the system and dispensary data,and evaluated the predictive accuracy of such previously provided data and the benefits of predictions for inventory management.There was a strong correlation between predicted first-day quantities,whose prediction included prescription data prior to dispensing for that day,and dispensed quantities (R2=0.989)when the slope was 1.083.The predictive accuracy was high for item detection and payment prediction,at 93.5% and 90.5%,respectively.When using previously provided prescription data for the second day onwards,whose prescriptions had yet to be dispensed,item detection and payment prediction rates were 78.7% and 64.1%,respectively,on the second day ; 63.5% and 42.1% on the third day ; and,52.0% and 28.6% on the fourth day,showing improved predictive accuracy for dispensing days closer to the time of prediction.Correction of inventory ordering in consideration of predictions based on prior ordering data resulted in a decrease in frequency of being out of stock. These findings demonstrate that the use of previously provided data enables rapid and accurate assessment of trends in medical products likely to be used in-hospital.Using such data in this way would also be beneficial to medical product inventory management.
This study was undertaken in order to evaluate the effectiveness of interventions by the Department of Infection Control and Prevention in promoting the proper use of antibiotic drugs for methicillin resistant Staphylococcus aureus (MRSA) prescribed to inpatients.We performed 3 interventions : 1.Protocol improvement for anti-MRSA drug use ; 2.Change in alcohol-based handrub and training in hand hygiene and 3.Devised reporting system for drug use.The effects of the interventions were determined by segmented regression analysis of interrupted time series for drug usage and cost before and after the interventions were commenced. The change in slope of drug use was -1.05 vials/1000 inpatients per month (95% Confidence interval (C.I.) -2.84,0.74)and the change in level was -8.21 vials/1000 inpatients (95% C.I.-14.67,-1.75).There was a significant decrease in the ratio of the patients receiving anti-MRSA drugs to MRSA incidence between before and after the interventions.These results suggested that usage of anti-MRSA drugs was immediately reduced by the interventions to promote the proper use of drugs.An ordinary estimate of reduction in costs was ¥29 million per year while a more conservative estimate produced a decrease of ¥20 million per year. These findings suggest that monitoring antimicrobial use and promoting the proper use of antibiotics for MRSA are important roles for pharmacists to perform.
With a view to ensuring that medical expenditure is used in the most effective manner in Japan,self-medication and nonprescription drugs are beginning to receive more attention. When the revised Pharmaceutical Affairs Law went into effect on June 1,2009,the system for the sale of nonprescription drugs changed greatly,and before it was enacted,we conducted a survey of approximately 1,000 consumers regarding the new system for the sale of non-prescription drugs and self-medication at drugstores.When slightly ill or lightly injured,67.0% of the respondents tried self-medication.On the other hand,31.3% decided to go to a hospital.Fifty-eight point one percent of the respondents replied that they actively sought information on drugs from experts at drugstores,such as pharmacists and registered salesclerks.It was clear that they had high expectations regarding the advice on selfmedication they could receive from pharmacists and registered salesclerks. In spite of this,however,the most common source of information on drugs and health care was the Internet ; not pharmacists.The reasons respondents sought such information from the Internet was they had no time and pharmacists were not available at the drugstores they visited.To expand the use of self-medication,we believe that it is necessary for pharmacists and registered salesclerks to make people more aware of the importance of gaining information on non-prescription drugs and that pharmacists and registered salesclerks are a valuable source of such information.
To clarify problems in the identification of halved tablets,we classified scored tablets for drugs included in the price list based on the positional relationship between the score and label identification code,in order to investigate the ability to identify tablets divided in half.We also carried out an investigation on halved tablets brought to hospital by inpatients between October and December in 2007.1,235 products were classified into 5 types according to the positioning and other aspects of the label codes : codes printed on both halves on the tablet face only (A),or on both the face and back (B),company and product codes separately printed on the face only (C) and those with additional information on the back (D),and tablets with 2 lines of individual code information printed on both halves on the back (E).The identification of type E was very difficult when tablets were divided in half,and 17.2% of commercial type-E drugs were high-risk drugs.Moreover,28.5% of all halved tablets brought in were high-risk drugs,halved tablets of 5 type-E products (2.1%) were not identifiable,and 81.1% of patients who brought them to hospital were 60 years of age or older. Since the halving of tablets in Japan will increase as the elderlypopulationcontinuestogrow,itisnecessarytomanufac-ture tablets that are still easily identifiable when cut in half.
The purpose of the present study was to evaluate the bitterness intensity of various clarithromycin dry syrups (CAMDS) (the branded and 11 generic products) when in the mouth with an acidic sports drink or taken together with Mucodyne® dry syrup (MDS) by means of a human gustatory sensation test and a brief newly-developed in vitro test for predicting bitterness intensity. High bitterness intensity scores were obtained for 7 human volunteers when the 12 CAMDS formulations were suspended in an acidic sports drink for 30 sec and this sample was immediately put in the mouth.In a 2nd test,the CAMDS were suspended in water for 30 sec,the suspensions were kept in the mouth for 5 sec and then removed from the mouth.After 1 min,MDS suspensions were put in the mouth,this time for 5 sec,and a panel was asked to give them bitterness scores.Next,the order of taking the 2 dry syrups was changed and the bitterness was evaluated again. The most important factor affecting the final bitterness intensity of the 2 dry syrups in the mouth,was the type of CAMDS and/or the order in which the 2 syrups were taken. The procedure for the new brief in vitro test for predicting bitterness when 2 dry syrups were taken was as follows.Mixtures of the CAMDS and MDS were suspended in water for 30 sec,the CAM concentration was determined by HPLC and then used as prediction of the bitterness.The bitterness scores obtained by this method were well correlated with the results of the human gustatory sensation test.
Bortezomib was approved in 2006 for use in patients with multiple myeloma.Although a high frequency of adverse drug reactions (ADRs) was reported in some clinical studies on bortezomib,little information is available on the time of occurrence of the ADRs.Therefore,we investigated the ADRs in 15 patients with relapsed multiple myeloma who received bortezomib alone or combined with dexamethasone,for 2 cycles.The ADRs with high frequencies were constipation (80.0%),leucopenia (73.3%),anemia (73.3%),fatigue (73.3%),peripheral neuropathy (66.7%) and thrombocytopenia (66.7%).The number of leukocytes decreased to the minimum on the 9th day and had recovered on the 14th day.The number of platelets decreased to the minimum on the 13th day,and had recovered on the 19th day.Gastrointestinal adverse reactions including constipation,diarrhea,nausea and vomiting were observed from the 5th day. Based on these results,we prepared a patient education sheet showing the times of occurrence of high frequency ADRs in the therapy schedule visually.This sheet should be useful in gaining the understanding of patients and their families regarding bortezomib therapy as well as enhancing its safety.
We investigated levels of interest in clinical research among pharmacists working in the clinical field,and specific needs for education to nurture clinical researchers.For this purpose,we conducted a questionnaire survey of 240 participants in the“Basic Seminar on Clinical Research for Pharmacists”.The survey items included reason for being interested in clinical research,enthusiasm for participation in clinical research,recognition of importance of knowledge of clinical research,selfevaluation of proficiency in conducting clinical research,and knowledge of clinical research area of interest. Responses were obtained from 204 participants.The most common reason for being interested in clinical research was“to solve questions/problems in daily activities”.Regarding enthusiasm for participation in clinical research,many respondents were“willing to conduct clinical research at multiple institutions in different geographical areas,with professionals from various fields”.Responses concerning recognition of importance of knowledge of clinical research,and self evaluation of proficiency in conducting clinical research indicated that respondents recognized the importance of such knowledge,but did not regarded themselves as being so proficient.These results suggest that clinical pharmacists currently need practical educational programs in clinical research that can be implemented in clinical practice,and that it is important to improve the content of education in clinical research in response to their needs.