Although some have reported that Astragali Radix, which has a diuretic effect and is contained in herbal preparations for kidney disorders, suppresses the progress of renal dysfunction, its effects on chronic-phase patients after renal transplantation have not been verified. Therefore, the effect of Astragali Radix on improving the creatinine levels of patients with chronic kidney allograft dysfunction (CKAD) and the possibility of its interaction with immunosuppressants were studied. The subjects were 13 patients who had received living-donor kidney transplantation at our hospital for stage 4/5 chronic kidney diseases (CKD) and agreed to cooperate in the study. Their serum creatinine (sCr) level, which was 3.6 ± 0.8 mg/dL before Astragali Radix administration, decreased significantly by 1 month later and was 3.0 ± 0.7 mg/dL after 3 months, resulting in a significantly increased estimated glomerular filtration rate (eGFR). In all cases, the 1/sCr level after Astragali Radix administration exceeded the value estimated from the approximate line obtained by plotting the pre-administration 1/sCr levels on the administration period. The area under the curve (AUC) of blood concentration standardized by dose for 12 hours after immunosuppressant administration increased by approximately 20％ for tacrolimus (TAC) after Astragali Radix administration, but did not change significantly for mycophenolic acid (MPA), which is an active metabolite of mycophenolate mofetil (MMF). Astragali Radix reduced sCr significantly and suppressed the progress of CKAD. Since the blood TAC level increase caused by Astragali Radix was not clinically significant, it was considered safe for use in combination with TAC or MMF.
Linezolid is used as a first-line treatment for methicillin-resistant Staphylococcus aureus (MRSA) infections. We aimed to analyze the clinical courses of patients who received linezolid therapy in order to determine the most appropriate point for assessing the validity of linezolid therapy and identify predictors of the clinical outcomes of linezolid therapy for early stage MRSA infections.
We retrospectively retrieved demographic and laboratory data from the medical records of 123 patients who underwent linezolid therapy for proven MRSA infections. We compared the post-linezolid therapy clinical courses of the clinical success and clinical failure groups, and the most appropriate point for assessing the validity of linezolid therapy was investigated.
Clinical success was achieved in 99 patients. The maximum body temperature of the clinical success group was significantly lower than that of the clinical failure group at 3, 5, and 7 days after the initiation of linezolid therapy. Among the patients who achieved clinical success, hemodialysis (adjusted odds ratio [OR] = 5.36 [1.41-20.30], P = 0.014), an elevated baseline C-reactive protein (CRP) level (adjusted OR = 1.09 [1.01-1.17], P = 0.023), and non-respiratory infections (adjusted OR = 0.09 [0.01-0.76], P = 0.027) were found to be significant risk factors for late-appearing effects of linezolid.
In conclusion, we suggest that patients' maximum body temperature and CRP levels should be carefully monitored for at least 3-4 days to assess the effects of linezolid against early stage MRSA infections; however, they should be monitored for 7 days in patients without the above-mentioned risk factors for late-appearing linezolid effects in order to obtain more accurate information about the outcomes of such treatment.
The main function of pharmaceutical care is to dispense drugs. The process of drug dispensing is getting simpler as a result of the development of automated dispensing systems, however the traditional dispensing system/process, manually selecting drugs from shelves and transferring the correct number of dose units to labeled paper bags, is complicated and still adopted in a majority of hospital pharmacies in Japan. The complicated dispensing process leads to human error. Thus, pharmacists must address and minimize human error in drug dispensing. To address human error in dispensing, we adopted a dispensing support system (Patient oriented risk management system: PORIMS) with using personal digital assistance (PDA). In this study, to evaluate efficiency PORIMS in dispensing incidents, we categorized dispensing incidents into 2 groups, prevented dispensing incidents (PreDIs) and dispensing incidents (DIs), and then investigated the number of dispensing incidents. Incidents were recorded and categorized when a pharmacist double-checked assembled products/medication. As a result, the total number of PreDIs was significantly reduced by using PORIMS, 52.4 to 39.5 /1,000 prescriptions/month (P < 0.001). Selection errors and forgetful dispensing were completely prevented. Counting errors were significantly reduced by recording the number of agents before assembly (13.85 ± 3.19 to 5.37 ± 1.15/month, P = 0.026). The use of PORIMS was associated with a decrease in the number of reports on drug dispensing errors. In this study, we clearly demonstrated that PORIMS should be useful in the prevention of human error in drug dispensing. PORIMS enhances the performance of pharmacists.
In many hospitals, semi-solid enteral nutrients are administered. Dietary fibers are used as the main component of semi-solid agents, but some studies have reported that dietary fibers influence the bioavailability of drugs. In this study, we examined the influence of the adsorption of phenobarbital (PB) to dietary fibers and semi-solid agents used for the manufacturing of enteral nutrients. Five types of dietary fiber or 3 semi-solid agents were dissolved in 0.01％ PB solution to prepare concentrations of 1.0, 0.5, and 0.1％, and the adsorption rate and viscosity were measured. In PB solution containing 1.0％ guar gum, which was prepared with purified water, the adsorption rate of PB was 33.7％. It reduced with a decrease in the concentration of guar gum. The adsorption rate of PB to xanthan gum was also similar, although it was slightly lower than that to guar gum. There was no adsorption of PB to dextrin hydrate or cellulose under any condition. The first and second solutions established by the Japanese Pharmacopoeia also showed similar results. The results of this study indicate that the adsorption rates of PB to guar gum and xanthan gum were high. When administering drugs to patients receiving semi-solid enteral nutrients, the timing of administration at which there is no influence of adsorption must be reviewed.
We studied the effect of heparinoid pre-treatment on dermopathy caused by application of a rotigotine transdermal patch (Rotigotine). Hairless mice with intact and dry skin were used in this study. Study groups were divided into intact skin + rotigotine, dry skin + rotigotine, and dry skin + rotigotine + pre-treated heparinoid groups. The application time of rotigotine was 24 h, after which time transepidermal water loss (TEWL), stratum corneum water content and epidermal thickness in the skin were examined. TEWL in the dry skin + rotigotine group increased compared to that of the intact skin + rotigotine group. However, in the dry skin + rotigotine + pre-treated heparinoid group, TEWL was less than that of dry skin + rotigotine group animals, and epidermal thickness was increased. These results suggest that heparinoid pre-application may reduce application site failure caused by rotigotine.
Amphotericin B is recommended for the treatment of pyelonephritis caused by Candida glabrata. However, as its nephrotoxicity is well known, liposomal amphotericin B (L-AMB) was developed to reduce the adverse effects. There have been few reports of L-AMB as a treatment for urinary tract infection. One reason is its low excretion rate in urine. We report the first case of pyelonephritis caused by C. glabrata successfully treated with L-AMB.
In 2011, a 52-year-old diabetic woman developed pyelonephritis and renal abscess caused by C. glabrata after transurethral ureterolithotripsy, which was treated with oral fluconazole administration for 12 days. Residual fragments of renal pelvic calculus then gradually increased and caused intermittent asymptomatic candiduria with C. glabrata.
In 2015, a week after right ureteral stenting for a ureteral stone, the patient was hospitalized for management of a fever and left lumbar pain. A left ureteral stone had caused hydronephrosis and pyelonephritis, and left ureteral stenting was thus performed. Fluconazole was administered intravenously for pyelonephritis with C. glabrata for 3 days, but failed to control the high-grade fever, and was thus discontinued. L-AMB administration for 11 days treated the pyelonephritis successfully. Although slight increases in serum creatinine and blood urea nitrogen levels and a serum potassium decrease were observed, no treatments were necessary.
L-AMB is highly concentrated in renal tissue and plasma, which may account for its efficacy in treating pyelonephritis, which is an infection of the renal parenchyma.
The aim of this report was to evaluate whether days of therapy (DOT), antimicrobial use density (AUD), and the rate of resistance of Pseudomonas aeruginosa to meropenem (the rate of resistance) change after stepwise execution of antimicrobial stewardship for carbapenems.
Since April 2012, antimicrobial stewardship for carbapenems has been performed by an infection control team comprising physicians and pharmacists specializing in infectious diseases. The stewardship included surveillance of all cases of carbapenem use since April 2012, intervention and feedback for cases of inappropriate carbapenem use since April 2013, and unification of carbapenems since November 2014. Surveillance implementation alone led to an increase in the rate of resistance, DOT, and AUD. However, the rate of resistance, DOT, and AUD decreased when surveillance implementation was combined with intervention and feedback. On the other hand, DOT and AUD decreased and the rate of resistance was unchanged upon combining these approaches and unification of carbapenems.
These results suggest that focus on implementation of surveillance would not be sufficient to ensure the appropriate use of carbapenems and that interventions and feedback regarding inappropriate carbapenem use would be important for promoting appropriate carbapenems use. Furthermore, these results suggest that unification of carbapenems does not negatively affect the rate of resistance.
As they prepare to enter the world of work, university students must use the knowledge and experience gained from their long-term practical training and study at universities to imagine a career path for themselves and decide on their next step after graduation. Therefore, we investigated the students who are planning to work in hospitals or pharmacies as pharmacists in order to understand their thoughts on their future careers and used this information to consider what should be taught in universities. Defining the study group as sixth-year students at this university, we (1) asked questions about their specializations as pharmacists, job positions in the workplace, and views on changing jobs or transferring for career advancement (conjoint analysis) and (2) conducted an open-ended questionnaire survey related to their visions regarding their future (content analysis). The results showed that students tended to aim for generalist rather than specialist positions, gave little thought to or showed little concern for their workplace, and pictured themselves advancing in their careers by continuously working at the same location without transferring or changing jobs (lifetime employment). In addition, it was revealed that there is a gender difference in consciousness to specializations and job positions. For these reasons, it is important that universities teach students about the realities of career paths in hospitals and pharmacies, as well as the career planning and career autonomy required to achieve their visions for the future.