In Tobu Chiiki hospital meropenem (MEPM) and tazobactam/piperacillin (TAZ/PIPC) have been selected as initial treatment for severe intra-abdominal infections, and there have been some cases that continued until the end of treatment. MEPM and TAZ/PIPC are broad spectrum antimicrobials used as a single agent and must be utilized accordingly. For this reason, the antimicrobial stewardship team took the lead in adopting Metronidazole (MNZ) injection formulation in the hospital from August 2018. Prior to adoption, we provided doctors with information on how to handle MNZ preparations for intra-abdominal infection in combination with β-lactam antimicrobials such as cefepime (CFPM), ceftazidime (CAZ), and ceftriaxone (CTRX). As a result when comparing Days Of Therapy, the amount of MEPM and TAZ/PIPC decreased, the amount of MNZ, CFPM, and CAZ increased, and there was no significant difference in the amount of CTRX and all antimicrobial injections used. There was no difference in the number of Clostridioides difficile infection occurrences, and there was no significant difference in the effect on the susceptibility of Pseudomonas aeruginosa. It is suggested that the adoption of MNZ and provision of information in advance may contribute to the proper use of broad spectrum antimicrobials.

Biosimilars are products that are equivalent to original bio-pharmaceuticals. The use of biosimilars increases medical access to useful treatments, improves the quality of treatment, and reduces costs. The inclusion criteria for the rituximab biosimilar clinical trials were limited to patients with follicular lymphoma, and an analysis of the efficacy and safety of this drug in clinical practice was needed. We compared the efficacy and safety of rituximab and the rituximab biosimilar. We reviewed the characteristics of patients who received rituximab or rituximab biosimilar for treating malignant lymphoma from January 2018 to October 2018. To measure the efficacy and safety of each drug, we evaluated the overall response rate and the side effects that correspond to important identified risks, respectively. Of the 71 patients who received chemotherapy during the study period, 29 and 42 patients used rituximab and rituximab biosimilar, respectively. The overall response rate was 78％ in the rituximab group and 86％ in the rituximab biosimilar group (P = 0.37). Adverse events were observed in 93％ and 95％ of the rituximab and rituximab biosimilar groups, respectively, whereas the frequency of infusion-related reaction was 20％ and 24％ in the rituximab and rituximab biosimilar groups, respectively. In the rituximab biosimilar group, one patient died from gastrointestinal perforation. In this study, the efficacy and safety of the treatments for malignant lymphoma using rituximab and rituximab biosimilar were considered equivalent. Since this study was a short-term survey, we will perform further studies on progression-free survival and safety assessment for long-term treatments.

With hepatitis B virus reactivation, it is crucial to identify patients with high-risk of contracting fatal hepatitis and initiate a prophylactic antiviral treatment. Since April 2016, our institution has introduced a systematic program to encourage prophylactic action for all patients using immunosuppressive agents. High-risk patients were identified in a data warehouse of our electronic medical chart system by applying an in-house software. An alert message was sent to the attending doctor in one of three ways. Strategy 1 was a direct message on paper from the pharmacist monitoring chemotherapy regimens or an on-screen notification two weeks after prescriptions of other immunosuppressants. Strategy 2 was an on-screen notification to remind the risk of prescription followed by a message on paper after two weeks. Strategy 3 was an on-screen notification only. The number of doctors who followed all steps in the guideline within four weeks of prescription were calculated. Rates of successful completion for each strategy were then compared using Ryan's multiple range test. The completion rates were 35.2％ (n = 193), 72.6％ (n = 449), 66.6％ (n = 413), and 50.0％ (n = 50) in no program and Strategies 1 through 3, respectively. They were significantly different in all combinations (P < 0.01 or P < 0.05) excluding the comparisons between no program and Strategy 3 or between Strategies 1 and 2. It is suggested that alerting doctors on paper is an effective measure to promote prophylactic action, while the efficacy of on-screen notifications was limited even when shown during prescription.

Hydroxychloroquine (HCQ) is widely used around the world to manage diseases such as malaria, systemic lupus erythematosus (SLE), and rheumatoid arthritis. In Japan, its manufacture and sale were approved for cutaneous lupus erythematosus (CLE) and SLE in 2015.

We previously experienced a case of atrioventricular block with HCQ. Therefore, we investigated the usage of HCQ for CLE and SLE in our hospital. The subjects were nine patients, three of whom had had administration discontinued due to HCQ-induced adverse events (including adverse events suspected of being due to HCQ administration). Administration in Case 1 was suspended because of HCQ-induced drug eruption, but HCQ was resumed after symptomatic relief. In Case 2, sinus bradycardia was recognized by electrocardiography, and HCQ was temporarily stopped but later resumed. Administration in Case 3 was suspended because of cheilitis and eczema-like eruption. The number of days of administration until symptom onset (median [range]) in the three cases was 19 (13 - 106) days, and the adverse events described above were detected relatively early.

In our hospital, we introduced a temporary ordering system for prescribing medicine that doctors can use. From June 2016, the pharmacist checked medicines brought and entered medication information into the electronic medical record as a temporary order when the patient was hospitalized.

The utilization rate after the introduction of medicines brought orders (79.9％) was approximately 1.25 times higher than that before introduction (63.6％). In addition, queries related to drug prescription decreased after the introduction of the temporary orders (22 cases/month) compared with those before introduction (86 cases/month). In addition, of the 22 cases that occurred after the introduction of the temporary ordering system, 17 cases occurred when the temporary ordering system could not be used.

It is considered that the temporary ordering system for taking medicine can prevent mistakes in taking medicine and contributes not only to the reduction of workload, but also to medical safety.

RETHIO Injection 100 mg is currently marketed as a medicinal drug composed of thiotepa, 1,1',1"-phosphorothioyltriaziridine, for the pretreatment of autologous hematopoietic stem cell transplantation in pediatric malignant solid tumors. Thiotepa is an antineoplastic alkylating agent and categorized as a highly potent compound. Also, since thiotepa is potentially carcinogenic and volatile, it is notified in the package insert that RETHIO should be handled carefully using containment systems and protective equipment to avoid exposure to the hazardous product.

In Japan, closed system drug transfer devices; CSTDs have been gradually introduced for the preparation of anticancer injections since 2016, when the MHLW revised the medical fees for the application of CSTDs. One purpose of this study was to investigate the exposure to RETHIO by monitoring spilled and volatilized thiotepa from preparation of infusion bags using a CSTD to administration with tubing and a vent filter. As a result, no thiotepa was detected in the preparation process performed in accordance with an appropriate guideline and using CSTD, and the safety was also confirmed for the administration process. The other purpose was to assess whether representative materials used in the preparation and administration were compatible with macrogol 400, the solvent of RETHIO. No issues for appearance and functionality were observed in the materials in contact with macrogol.

In conclusion, no exposure risk to thiotepa was verified by appropriate operation of CSTDs from preparation to the administration process. Also, the functionality of apparatuses for preparation and administration for RETHIO was maintained for the expected operation time.

The population of Saitama City is aging, and collaboration between community pharmacies and hospitals is becoming increasingly important for comprehensive community care. We conducted a questionnaire survey to promote pharmacy collaboration among insurance pharmacy pharmacist members who belong to Saitama City Pharmaceutical Association. The questionnaire collection rate was 39.8％（95％CI：34.5～45.1％). Many respondents wanted to hold regular study sessions to increase transparency between insurance pharmacy pharmacists and hospital pharmacists. As insurance pharmacy pharmacists and hospital pharmacists develop mutual understanding, information sharing using ICT would not only reduce the work burden on doctors and insurance pharmacy pharmacists, it would also promote local comprehensive care, including the relationship with regional insurance pharmacies, participation in management and joint guidance at discharge. In order to nurture current pharmacists in practice and future pharmacists, it is very important to promote collaboration between community pharmacies and hospitals in the region.