Antimicrobial stewardship programs, including ‘formulary restriction and preauthorization’ and ‘intervention and feedback,’ are strategies known to promote the appropriate use of antimicrobial agents. In this article, we reviewed our approach based on a strategy of antimicrobial stewardship.
An initial loading dose of teicoplanin is required to reach the optimal trough concentration. Therefore, we performed individual adjustment of the initial loading dose of teicoplanin based on population pharmacokinetics. Both the trough concentration and the proportion of patients who showed the optimal plasma concentration were higher in the individual loading dose regimen than in the conventional loading dose regimen.
To investigate the risk factors associated with the development of thrombocytopenia in patients who received intravenous linezolid therapy, risk factors associated with linezolid induced thrombocytopenia were retrospectively identified via logistic regression analysis. In multivariate analysis, daily dose (≧22 mg/kg) was a significant risk factor for thrombocytopenia associated with linezolid therapy.
Since August 2009, our hospital has established a review system for checking prescription in all patients receiving antimicrobial injections according to the intervention and feedback. Our intervention was found to be effective in shortening hospital stay, reducing the MRSA ratio, and saving medical expenses. Furthermore, frequent monitoring resulted in an increase in the frequency of recommendation by infection control team, reduction of antibiotic consumption, and further shortening of antibiotic therapy and hospital stay.
From these findings, we concluded that our established approach based on the antimicrobial stewardship guideline were useful for the promotion of the appropriate use of antimicrobial agents.

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In Japan, cancer has been the leading cause of death since the 1980s. 70-80％ of cancer patients need cancer pain treatment. Currently oxycodone has a central role in cancer pain treatment, and its consumption is increasing every year.However, nausea and vomiting are produced at the start of oxycodone dosing that often leads to discontinuation of treatment.
In this study, we retrospectively investigated the medical records of 112 patients who had cancer in order to examine risk factors related to nausea and vomiting at the start of oral oxycodone dosing. As a result, the incidence of nausea and vomiting was 25％ at the start of oral oxycodone dosing. Multiple logistic regression analysis showed that there were significant differences for young people under the age of 50 (odds ratio = 5.32, 95％ CI = 1.54-18.4, P = 0.008), nonsmokers (odds ratio = 8.39, 95％ CI = 1.47-48.0, P = 0.017) and gastrointestinal primary cancer (odds ratio = 4.14, 95％ CI = 1.32-13.0, P = 0.015).
We revealed risk factors at the start of oral oxycodone dosing. This result provides useful knowledge on maintaining the continuity of cancer pain treatment and QOL of patients.

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In pediatric otolaryngology, many patients are receiving antibiotics in the treatment of symptoms of otitis media. However, the relation between the use of antibiotics and the recurrence of acute otitis media after acute otitis media recovery is unclear. We collected information on prescription, clinical records, and the medication history in the International University of Health and Welfare Shioya Hospital to investigate the relation between the use of antibiotics and recurrent acute otitis media. Further, we analyzed the information of patients with recurrent acute otitis media to elucidate causative factors for the recurrence. As a result, it was suggested that the rate of recurrent acute otitis media reduces when antibiotics is administered over 4 weeks immediately after acute otitis media recovery. In addition, the number of days of taking macrolide antibiotics, and the number of days of detecting middle-ear effusion and redness at the eardrum were given as factors for the recurrence. Furthermore, a correlation was observed between the number of days of taking macrolide antibiotics and the number of days of detecting middle-ear effusion at the eardrum. Our results could be a help in preventing recurrent acute otitis media.

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In the Japanese Pharmacopoeia, there are no criteria for multiple uses, such as multidose vials, for rubber stoppers (RS), which may cause bacteriological contamination. To resolve this problem we would like to suggest the use of a closed system (CS), while considering the structure. However, multidose vials are not always kept in an aseptic environment. Hence, it is necessary to assess CS contamination and metal needles, so we compared the microbiological contamination level using Bacillus subtilis between the PhaSeal system (PS) and metal needles.
On the RS of a vial containing distilled water and the top of PS-P21's membrane, 3.0 × 10⁴ spores were prepared (“Bacillus-vial” and “Bacillus-P21”). An unused P21 was attached to the Bacillus-vial (Sample1). A metal needle was vertically inserted into the Bacillus-vial, and each of the puncture and vial inversion operations was carried out once, 5 times, and 10 times (Sample 2-1, 2-5, 2-10). Furthermore, Bacillus-P21 was attached to the Bacillus-vial, and PS-N35 was attached to Bacillus-P21. Each puncture was carried out once, 5 times, and 10 times (Sample 3-1, 3-5, 3-10). Viable bacterial cells were counted using the pour plate method.
Bacterial cells were detected in all samples; however, bacterial cells were not detected from control vials that were not administered prepared spores. The B. sublitis contamination rates of Sample 1/2-1/2-5/2-10/3-1/3-5/3-10 were 0.7/1.4/3.1/1.9/0.1/3.2/5.0 ％, respectively.
This study suggests that PS is almost equivalent to metal needles at up to 5 punctures in terms of microbiological contamination when PS is used multiple times for multidose preparation under preparation conditions where the vials are susceptible to bacterial contamination.

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Anxieties about the quality of generic drugs are one of reasons why these drugs are not generally used in therapies in Japan. To reduce anxieties, we propose a statistical and objective method to evaluate the quality of generic drugs using the coefficient of variances (CVs) calculated from their pharmacokinetic parameters. CVs were estimated from AUC, Cmax, Tmax, t1/2, and MRT, which were provided as publicly-available drug information. The generic drug assessment tool (G-DAT), an original equation derived from the ratio of CVs of corresponding generic to original drugs, and the quality of generic drugs was statistically evaluated. As expected, when evaluated with G-DAT, there was little variance between original and generic drugs using 11 medicines. Antihypertensive dihydropyridines with a lower solubility were shown to have a larger CV. No significant difference in CVs was observed when famotidine and ebastine OD tablets were taken with or without water. G-DAT and the ratio of CVs (CCVs) of generic to original drugs revealed pharmacokinetic equivalences between generic and original drugs. The proposed comparative evaluation showing equivalent pharmacokinetics of generic to original drugs can be used as one solution to reduce anxieties and increase the reliability of generic drugs.

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Drug testing is widely performed at the competitive level, both professional and amateur, and efforts to prevent doping are underway on a global scale.
The sports-pharmacist system was launched by the Japan Anti-Doping Agency (JADA) in 2009 and recommends the anti-doping activities to be conducted by sports-pharmacists.
In this study, we surveyed the awareness of doping among high school athletes enrolled in physical education and sports courses and their coaches, with the objective of identifying anti-doping activities that require intervention by sports-pharmacists and pharmacists.
Responses were obtained from 1052 athletes (collection rate: 93.2％) and 83 coaches (collection rate: 100.0％). The questionnaire results revealed a low level of knowledge on doping-related issues such as “careless doping” and “therapeutic use exemptions.” The results also suggest that the coaches showed a greater willingness to attend training sessions on doping than the high school athletes. Activities by pharmacists and sports-pharmacists will be important in the future in order to protect athletes and coaches from suffering the disadvantages of doping.

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Bone-marrow suppression, especially leukopenia, neutropenia or thrombopenia is a dose limiting factor of gemcitabine (GEM). It was previously reported that the rate of GEM excreted in the urine was only 5％. However, it is unknown whether renal dysfunction influenced hematotoxicity. No dose recommendations exist for patients with renal dysfunction. Therefore, we investigated the correlation between moderate renal dysfunction and GEM-induced bonemarrow suppression. Fifty-five patients were analyzed retrospectively. Renal function was estimated from creatinine clearance (CLcr) calculated by the Cockroft-Gault formula. We defined CLcr ≦ 50 mL/min as moderate renal dysfunction. In the standard GEM therapy, GEM 1000 mg/m² was administered intravenously on days 1, 8, and 15 every 4 weeks. However, patients with renal dysfunction often could not continue as scheduled the chemotherapy with GEM due to severe neutropenia. On day 15, the incidence of Grade 3 or 4 neutropenia in the renal dysfunction patients was significantly higher than that in the normal renal function patients (66.6％ vs 22.8％, P = 0.0194). Neutrophil counts on day 15 had a positive correlation with CLcr (R² = 0.152, P < 0.01). In conclusion, we found that GEM-induced severe neutropenia was caused more frequently in renal dysfunction patients than normal renal function patients. These results indicate that patients with moderate renal dysfunction need an appropriate dose determined respectively when GEM is administered especially in the first course.

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Sulfamethoxazole-trimethoprim (ST) is used in the prevention and treatment of Pneumocystis carinii pneumonia (PCP) infection today. However, the relevance of dosing regimens of ST and the preventive effect have not yet been clarified. Therefore, we retrospectively reviewed the medical records of patients who had been treated with ST for the prevention of PCP at Saga University Hospital to investigate the rates and the types of adverse events, and analyzed the factors influencing the adverse events.
We compared group A (2 tablets twice-weekly) and group B (1 tablet once-daily). As a result of multivariate analysis and the relationship between background factors (age, sex, doses, concomitant drugs) and adverse events, the incidence of adverse events in group A was significantly lower than in group B (Odds ratio = 6.185, 95％ confidence intervals 1.128-33.900, P = 0.036). However, there was no difference in the prophylactic effects of PCP between the two groups.
In conclusion, ST should be reduced or discontinued early before adverse events develop, when selecting an ST regimen of 1 tablet once-daily as PCP prophylaxis.

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