The purpose of this study was to compare surgical-site infection (SSI) rates in women who had prophylactic antibiotics for 3 to 4 days (Group 3-4 days) versus 1 day (Group 1 day) of Flomoxef sodium (FMOX) in obstetrical and gynecological surgery and to identify risk factors for SSI. This retrospective study was conducted from November 2011 through November 2012 in the International University of Health and Welfare Hospital. The main outcome measure was the rate of incidence of SSI, and backgrounds were compared between patients with and without SSIs. There were 266 patients (110 in the Group 3-4 days and 156 in the Group 1 day). A total of 6 cases had SSIs: 2 cases (1.8%) in the Group 3-4 days and 4 cases (2.6%) in the Group 1 day (P = 0.516). Those 6 cases with SSIs included more patients with a past history of infection (83% vs 23%; Odds Ratio, 16.7; 95% confidence interval, 1.91-145; P = 0.004) and with BMI > 30 kg/m2 (50% vs 9%; Odds Ratio, 10.8; 95% confidence interval, 2.06-56.8; P = 0.012). Both administration for 3 to 4 days and 1 day of FMOX had similar efficacy in the prevention of SSI in obstetrical and gynecological surgery. The BMI level was a known risk factor, but the results also showed that a past history of infection could become a new risk factor for SSI.
Owing to the popularity of health food consumption for improving health or beauty, the health food market has been steadily growing in Japan in recent years. Accordingly, harmful interactions between health foods and prescription drugs are predicted to increase because patients who are administered prescription drugs are reported to consume more health foods. We aimed to determine the status of health food consumption in patients and consumers visiting pharmacies, and we investigated whether health foods inhibit cytochrome P450 2D6 (CYP2D6) activity in vitro. We conducted a questionnaire survey in pharmacies on the current use of health foods. We received 1,041 responses, and of these respondents, 69.3% consumed health foods, over-the-counter drugs, or foods with health claims, and the use of 249 health foods was confirmed. In addition, a CYP2D6-expressing cell model was constructed using the human hepatoma cell line and the CYP2D6-expressing adenovirus; this model was used to assess the in vitro inhibitory effects of 172 of the 249 products, which were available at drug stores or on the Internet, on CYP2D6 activity by using high performance liquid chromatography and liquid chromatography/tandem mass spectrometry. CYP2D6 activity was inhibited by 6 products, including turmeric-, a component having diet effect-, garlic-, and collagen-containing health foods. This study revealed the status of health food utilization and identified the health foods that are currently consumed. Furthermore, we found that 6 products found in these health foods have the potential to inhibit CYP2D6 activity. Our results may provide helpful information to avoid health food-drug interactions during medication use.
In order to elucidate the cost-effectiveness of various ophthalmic solutions used for the treatment of glaucoma, we compared the daily price for solutions resulting in a 1-mmHg reduction in intraocular pressure (IOP) in glaucoma patients. The IOP reduction achieved by each ophthalmic solution was obtained from the literature and standardized to the reduction achieved by 0.5% timolol maleate. We applied these values to a model patient with a baseline IOP of 24 mmHg, who showed a 20% reduction (4.8 mmHg) after treatment with 0.5% timolol maleate, and calculated an IOP reduction estimate for each product. The total number of drops per bottle, and the National Health Insurance (NHI) prices of the products were used to calculate the daily price of the ophthalmic solutions. The daily price of solutions resulting in 1-mmHg IOP reduction ranged from 6.7 to 17.0 yen. Further, the daily price distribution was notably different from that of the NHI prices per bottle. The approach used in the current study could be applied to generic products if the clinical data and actual products were obtained, and should be a part of routine glaucoma management.
Guidance on Risk Management Plan (RMP) for pharmaceuticals was announced in April 2012 in Japan. RMPs include post-marketing pharmacovigilance and risk minimization activities. Treatment outcome studies have been the main part of post-marketing surveillance (PMS) in Japan, which are carried out based on a contract between a company and a medical institution. However, there has been no report exploring the relation between pharmacies in medical institutions and treatment outcome studies in general. Therefore, we carried out a questionnaire survey in medical institutions in Tokyo to obtain information on their implementation systems of treatment outcome studies. As a result, pharmacies in 77 of 166 medical institutions are somehow engaged in treatment outcome studies, but most of their duties involve business such as the inquiry counter or the contract. It was also shown that there is little incentive for pharmacies to support treatment outcome studies.
STROMECTOL® (ivermectin), an oral scabicide, is often administered to patients as a simple suspension via a feeding tube. It has been reported that the effectiveness of ivermectin administration via a feeding tube is dependent on the devices or techniques employed. This route of administration reduces the dose of ivermectin by 10-50% compared to that associated with oral administration. Therefore, here we propose appropriate devices and techniques. In this report, we compared the recovery ratio when a simple suspension was administered via transnasal tubes of different diameters, different materials, flushing water volumes, slack and bed angle. No differences in recovery ratio were observed following the use of tubes constructed from polyvinyl chloride, ethylene vinyl acetate, polyurethane, and silicone. Furthermore, no significant differences in ivermectin recovery were observed as a result of using tubes with diameters of 8 French (Fr) and 12 Fr. However, we found tubes with diameters of 7 Fr were blocked during use. Furthermore, no noticeable differences in the recovery ratio were observed after flushing water volumes higher or lower than the internal volume of the transnasal tubes. Slack in the tubes had no influence on the recovery ratio. In contrast, a 9% increase in the recovery ratio of ivermectin was observed when the patient's bed was angled at 30° compared to that when the bed remained horizontal. In conclusion, to ensure higher recovery ratios of ivermectin with administration via transnasal tubes, it is recommended that tubes with diameters over 8 Fr be used, and that an angle greater than 30° be applied to the patient's bed.
This study examined the reduction in medical expenses achieved by pharmaceutical inquiries at a community pharmacy. The total number of inquiries was 1,053 out of a total of 29,875 prescriptions filled at one community pharmacy (incidence: 3.5%). Pharmaceutical inquiries regarding the elimination of prescribed medicines were classified into two categories: leftover (incidence: 0.76%) and those regarding duplicate prescriptions filled by other institutions or drug interactions (incidence: 0.18%). The doctors accordingly reduced the number of medicines after these inquiries, which led to a reduction in dispensing and medical fees. The reduction in patient medical expenses per prescription from leftover medicines was 1,425 yen (median) for children (under 14 years), 390 yen for adults (15-64 years), and 1,165 yen for elderly patients (over 65 years). The reduction in patient medical expenses per prescription from eliminating duplicate prescriptions was 955 yen for children, 250 yen for adults, and 360 yen for the elderly. The reduction in patient medical expenses from leftover medicines was statistically higher compared with that from duplicate prescriptions for elderly patients (P < 0.01). This difference was because of long-term drug prescriptions for cardiovascular diseases and diseases of the digestive and central nervous systems. Our findings show that community pharmacists can effectively reduce patient medical expenses and increase patient safety by responding to pharmaceutical inquiries and collecting leftover medications.
We disclosed laboratory data on the prescription for outpatients from April 2011. In order to evaluate the usefulness of this approach, we regularly have meetings with pharmacists of plural outpatient pharmacies. We analyzed the data that was accumulated to investigate the usage of laboratory data and related medicines. As a result of the questionnaire to pharmacists of the outpatient pharmacy, more than Nineteen in twenty two pharmacists (19/22) checked prescriptions and patient instructions using the laboratory data. The high-frequency laboratory data printed on the prescriptions were Prothrombin Time - International Normalized Ratio (PT-INR) value, the serum creatinine value and the serum potassium value. When the pharmacists felt uncertain about usage related with laboratory data in prescriptions, they gave suggestions to the doctor. Approximately 40% of pharmacist's suggestions were accepted by the doctor. Printing of the laboratory data could become a helpful tool in cases of uncertainty. However, there were cases in which there were differences in recognition of the examinations results among pharmacists, especially in the outpatient pharmacy. Therefore, we need information sharing and reinforcement of cooperation with the outpatient pharmacy.
In patients in whom an angiotensin receptor blocker was switched to tablets containing an ARB, candesartan, at 8 mg and a diuretic, hydrochlorothiazide, at 6.25 mg (ECARD® HD tablets), efficacy and safety were examined. Of the 38 patients analyzed for efficacy assessment, 24 aged 65 years or older were assigned to an elderly group, and 14 aged 64 years or younger to a non-elderly group. The results were compared between the two groups. There were significant decreases in the systolic and diastolic blood pressures in the two groups (P < 0.05). In the elderly group, the blood pressure gradually reduced. In this group, there was a significant decrease in the heart rate (P < 0.05). There were no significant changes in the serum creatinine or potassium levels in either group. There was a significant increase in the uric acid level in the elderly group (P < 0.05). These results suggest that switching of an ARB to ECARD® HD tablets is an option for blood pressure control in elderly people. However, the monitoring of the heart rate, the serum creatinine, and the uric acid is required.