There is no report to date regarding the usage status of medications with driving with prohibitions or cautions in Japan. Upon sampling the national health insurance claims database (covering 1% of outpatients), we surveyed the prescriptions and use of medications in outpatient settings for patients aged 25 years and older, with the goal of encouraging the proper use of medications. We analyzed the ratio of outpatients who were administered medications with prohibitions or cautions on driving to total outpatients who were administered medications (prescribed and/or provided to them at the time of examination). We also examined daily dosages and deviations from specified dose-limits for their prescribed oral medications. Of 566,968 outpatients aged 25 years and older who were administered medications, 413,940 (73%) outpatients were given the medications with cautions or prohibitions on driving and 243,405 (43%) outpatients were administered the medications with a prohibition on driving. Daily dosages of many medications were reduced with the increase in age of the patient. The degree of dosage reduction varied widely, with some medications whose dosages were hardly adjusted with age. With some medications with dose-limitations or contraindications for the elderly, prescriptions were found with dosages that often exceeded the recommended limits. We conclude that outpatients given medications and/or prescriptions must exercise appropriate caution when driving and that the dosage of these medications should be adjusted especially in the elderly.
This study evaluated the efficacy and safety of sulfamethoxazole/trimethoprim (ST) prophylaxis after combination chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) for the treatment of non-Hodgkin's lymphoma. We retrospectively analyzed the incidence of fever in 63 lymphoma patients that received R-CHOP chemotherapy from October 2009 to November 2011. Thirty-five patients received ST prophylaxis (ST group). Twenty-eight patients received no prophylaxis (control group). Fifteen patients of the ST group and 19 patients of the control group experienced fever. The incidence of fever was lower in patients receiving ST. Two patients were diagnosed with pneumocystis jiroveci pneumonia (PJP) in the control group. There were no PJP patients in the ST group. There was no statistical significant difference in sex, age, pathology type, clinical stage and complications between the ST group and control group. Age, complications, grade 4 neutropenia, clinical stage Ⅳ and antifungal agent did not increase the fever risk. And there was no statistical significant difference of ST and antifungal agent in the multivariate analysis. For the odds ratio respectively, ST was 0.36, and antifungal agent was 0.33. Adverse events occurred in 3 patients, 2 were skin disorders, and 1 was aspartate aminotransferase/alanine aminotransferase elevation. Death by infection did not occur. The result in this study indicates that ST prophylaxis may reduce not only PJP, but also the incidence of fever.
Although accumulated evidence has shown the usefulness of the initial dosing setting for vancomycin, a gap exists between evidence and clinical practice, particularly in the night shift. The aim of this study was to fill the evidence-practice gap by using a newly developed procedure manual for planning the vancomycin dosing schedule and verifying the impact of the implementation of the initial dose setting for vancomycin. Twenty-five patients received an individual dose regimen using the present procedure (intervention group) and 23 patients who were taking the conventional dose by prescriber (non-intervention group) were enrolled in this study. Median (interquartile range: IQR) vancomycin serum trough concentration after 3 days of treatment was 12.1 μg/mL (10.1-15.3) for the intervention group, 9.5 μg/mL (5.6-15.0) for the non-intervention group. Clinical efficacy after 3 days of treatment was significantly superior in the intervention group(P = 0.004). Furthermore, the duration for 50% reduction of C-reactive protein and the duration for the reduction in body temperature to < 37°C were significantly shorter in the intervention group as compared with those in the non-intervention group. The incidence of vancomycin-induced nephrotoxicity tended to be lower (P = 0.24) in the intervention group than in the non-intervention group (0% versus 9%). In addition, the rate of initial dose setting in the night shift was significantly elevated after intervention (0% versus 70%, P < 0.001). These findings suggest that the present implementation system was useful for promotion of initial dose setting for vancomycin and improvement of patient's outcome.
There is less emergence of renal toxicity in Liposomal-amphotericin B (L-AMB) than amphotericin B (AMPH-B). However, there have been few reports on the analysis of this factor. I examined the factors involved in renal function decline via the creatinine clearance (Ccr) for 44 cases of L-AMB administered in our hospital. Reduced renal function was observed in 15 cases (34.1%). Multivariate logistic regression analysis for each factor revealed that Ccr ≧ G 1 (P = 0.006, odds ratio: 12.968, 95% confidence interval: 2.085 - 80.643) was a factor in the occurrence of decreased renal function. Results were subjected to multiple regression analysis of the dependent variable amount of change in Ccr before and after administration, and a significant statistical effect was shown by two factors. One is administration at the start of Ccr (P = 0.007); the other is the administration of concomitant medications (P = 0.04). Pharmacists used L-AMB administration to predict in advance the degree of renal function decline, and a regression equation was obtained. As pharmacists prescribe administration depending on the results, L-AMB is prescribed by doctors. For cases which can be a first choice, more aggressive? We believe that establishment of such a system would be ideal.
The effect of a febrile state on theophylline clearance in the asthmatic acute phase was quantitatively investigated in 71 Japanese pediatric patients (42 males and 29 females) aged 2 - < 7 years old. Theophylline clearance from each patient was estimated from the plasma steady-state theophylline concentration, which was retrospectively collected during constant-rate infusion of aminophylline. Theophylline clearances were grouped by the presence of a febrile state, and then these were compared in the same gender groups. In male pediatric patients, theophylline clearance during the febrile state was approximately 71% (P < 0.001) of that during the afebrile state in the asthmatic acute phase. Similarly, in female pediatric patients, it was 85% (P < 0.05) of that during the afebrile state in the asthmatic acute phase. Our findings suggest that the dose of theophylline in Japanese infants should be reduced during a febrile state in the asthmatic acute phase. However, we found some patients whose theophylline clearance in the asthmatic acute phase with fever was more than 50% lower compared with the theophylline clearance in the asthmatic assumed-remission phase without fever. Therefore, as for the degree of dose reduction during a febrile state from the asthmatic remission phase, the effects of both febrile state and asthmatic acute phase should be simultaneously considered. We propose that the initial dose of theophylline during a febrile state in the asthmatic acute phase should be reduced by half of the dose in the asthmatic remission phase without fever, similarly to the recommendation of the American Academy of Pediatrics.
In the present study, 0.5% povidone-iodine solution was prepared aseptically using various commercial products of 10% povidone-iodine solution, and the stability of 0.5% povidone-iodine solution after storage under various conditions was evaluated. Furthermore, a comparison between various commercial products was also performed. As a result, the stability of available iodine in 0.5% povidone-iodine solution was found to be affected by light, temperature and the sealability of the container. Of the storage methods investigated in the present study, the method of keeping the highest available iodine concentration was to store the povidone-iodine solution in a closed container under a light-shielded state at 4°C. The term of validity was 3 or 4 weeks in Hisiiode disinfectant solution or other products (Isodine® solution, Popiyodon solution, Negmin® solution, Popyral disinfectant solution and Iodine M disinfectant solution), respectively in storage in a closed container under a light-unshielded state at room temperature, which was the usual method of a disinfectant, from the results of a stability test of available iodine in 0.5% povidone-iodine solution. It was confirmed that bactericidal activity was maintained until at least 4 weeks after preparation in every commercial product from the results of a bactericidal activity test on the solution in the usual storage method (Staphylococcus aureus, Bacillus subtilis, Escherichia coli, Pseudomonas aeruginosa, Aspergillus niger, Candida albicans). Of the 0.5% povidone-iodine solution investigated in the present study, Popiyodon solution and Negmin® solution kept the available iodine comparatively stable under each storage condition.
In advanced pharmacy practice experiences (APPE) in community pharmacies in Japan, students are not always satisfied with over-the-counter (OTC) counseling practice. Aiming to improve the quality of such practice, we conducted a questionnaire survey of 167 students after their APPE to assess student satisfaction and the current status and problems they experienced with OTC counseling practice. The results revealed that opportunities for practice differed among sites. While 27.8% of students had experienced selling OTC drugs to patients, 11.4% of students carried out no selling, shadowing or role play (RP). The difference arose also in student satisfaction. As expected, most students who experienced selling OTC drugs to patients rated the practice most favorably, especially students who had experienced consultation sales obtained higher satisfaction. On the other hand, most students who experienced both shadowing and RP but not the opportunity to sell OTC drugs also rated the practice quite positively; in particular, students who had more than six opportunities for shadowing and RP rated the practice favorably. In conclusion, although OTC counseling is not well practiced during APPE, mainly because of limited opportunities to sell OTC drugs, student satisfaction may be improved by introducing and increasing opportunities for shadowing and RP.
Acetaminophen (APAP) is an analgesic used worldwide. However, the usage of APAP was lower and its effectiveness was underestimated in Japan before the indication was revised for APAP in 2011 compared with those in the United States (US) and Europe. This study investigated the prevalence of APAP in Japan. We conducted a questionnaire survey to determine the usage of APAP among hospital pharmacists and received answers from 430 pharmacists in Japan and 35 pharmacists in the US from December 2010 to October 2011. The range of the maximum dose of APAP for cancer pain was 900 -1500 mg/day (49%) in Japan, and 3000-4000 mg/day (83%) in the US. The pharmacists were questioned about the drug of choice among non-opioid analgesics for the treatment of cancer pain by patient age group. American pharmacists chose APAP (31%) and non-steroidal anti-inflammatory drugs (NSAIDs) (31%) for adult patients, while Japanese pharmacists chose APAP (2%) and NSAIDs (77%). American pharmacists chose APAP (49%) and NSAIDs (17%) for elderly patients, while Japanese pharmacists chose APAP (10%) and NSAIDs (64%). In addition, American pharmacists chose APAP (52%) and NSAIDs (17%) for pediatric patients, while Japanese pharmacists chose APAP (45%) and NSAIDs (12%). APAP is mainly prescribed for pediatric patients with cancer pain, and its usage for both adult and elderly patients with cancer pain is lower in Japan than that in the US. Safe, effective, and inexpensive APAP should be used as an adjunctive for the treatment of cancer pain in adult and elderly patients in Japan.