Traditional metrics for assessing antimicrobial usage, such as antimicrobial use density and days of therapy, do not reflect the antimicrobial spectrum of the drugs used, thereby limiting the evaluation of programs aimed at promoting the use of narrow-spectrum antimicrobial agents. To overcome this limitation, a new metric using days of antibiotic spectrum coverage (DASC) was developed. DASC uses the antibiotic spectrum coverage (ASC) score, assigning a score based on the categories of microorganisms covered by the antibiotics used in healthcare facilities, thereby providing an assessment of the antimicrobial spectrum of the antibiotics. Despite this innovative approach, the implementation of DASC faces challenges, including validation of already-defined ASC scores, achieving consensus on undefined drugs, and integration into a national surveillance system. This study examines the potential applications of DASC in domestic healthcare facilities and proposes strategies for addressing the challenges associated with its implementation.

To prevent skin disorders caused by anti-EGFR antibodies, smooth multidisciplinary care is required. However, few studies have demonstrated the usefulness of multidisciplinary care in this field. In this study, as a tool for multidisciplinary collaboration, we created a treatment progress sheet to share skin symptoms among physicians, nurses, and pharmacists. We established a system in which dermatologists can intervene as soon as possible when there is no improvement in Grade 2 skin disorders. To evaluate this collaboration system, we surveyed the incidence of more than Grade 3 skin symptoms in patients who received anti-EGFR antibodies (panitumumab or cetuximab) and compared the incidence rates between January 2014 and August 2017 (before the system was established) and between September 2017 and September 2022 (after the system was established). After establishing the collaborative system, the incidence of severe skin disorders during anti-EGFR antibody treatment significantly decreased from 19.5％ to 4.4％. This result clearly demonstrated that the development of severe skin disorders can be suppressed by sharing information among multiple professions using treatment progress sheets.

Chemotherapy-induced nausea and vomiting (CINV) remains an unresolved medical condition, and suitable combinations for a 1-day dexamethasone antiemetic regimen have not been adequately investigated for carboplatin-based chemotherapy. Herein, we evaluated the efficacy of olanzapine (2.5 mg) combined with an NK1 receptor antagonist, a 5-HT₃ receptor antagonist, and a 1-day dexamethasone antiemetic regimen in patients with lung cancer who received carboplatin-based chemotherapy. The efficacy and safety of olanzapine against CINV were compared between two propensity score–matched groups of 22 patients each. The primary endpoint, complete response rate in the delayed phase, and secondary endpoints, including the overall incidence of nausea, incidence of grade ≥2 nausea, and time to treatment failure, were considerably improved in the olanzapine group. The results indicate that the addition of olanzapine (2.5 mg) to a triple antiemetic regimen of an NK1 receptor antagonist, a 5-HT₃ receptor antagonist, and 1-day dexamethasone may be a useful option for patients undergoing carboplatin-based chemotherapy.

In 2021, we conducted a questionnaire survey in 939 hospitals, including special functioning, regional medical care support, and designated cancer care hospitals, to evaluate how pharmacists intervene with outpatients undergoing chemotherapy comprising oral anticancer agents alone or a combination of oral and injectable anticancer agents. The response rate of the questionnaire was 36.6％ (344/939). The percentages of board-certified pharmacists in oncology pharmacy, JSPHCS-certified oncology pharmacists, and accredited pharmacists of Ambulatory Cancer Chemotherapy in these hospitals were 62.7％, 41.8％, and 40.1％, respectively. Regardless of the combination of injectable anticancer agents, pharmacists intervened with outpatients when necessary, and the proportion of board-certified oncology pharmacists was the highest among facilities with full-time pharmacists exclusively working with outpatients. The number of beds per pharmacist was the lowest when pharmacists exclusively worked with outpatients. In more than 80％ of the hospitals, pharmacists conduct interventions in outpatients, such as providing explanations and instructions for anticancer agents, monitoring the occurrence of side effects and patient condition, recommending supportive care medication, and checking for concomitant medications. However, protocol-based pharmacotherapy management, attendance at informed consent sessions, and follow-up via telephone until the next outpatient visit were performed in <20％ of these hospitals. Hospitals that performed interventions for outpatients had a higher proportion of board-certified oncology pharmacists and a lower number of beds per pharmacist than hospitals that did not perform interventions. These results indicate that a lack of manpower is an issue when enhancing interventions for outpatients with cancer.

Vancomycin (VCM) is a drug with a high incidence of acute kidney injury (AKI). It is important to evaluate renal function when administering VCM. However, if renal function is not properly evaluated and overestimated, blood levels may increase, increasing the risk of AKI. Renal function is often estimated using serum creatinine, which is often overestimated in the presence of muscle mass loss. In bedridden patients, renal function is often overestimated when drugs are administered because of decreased muscle mass. In fact, unexpected increases in blood levels have been experienced in bedridden patients. We investigated the association between bedridden status and VCM-induced AKI in elderly patients. As a result, bedridden patients were more likely to develop AKI due to VCM than nonbedridden cases (P = 0.008). The steady-state area under the curve (AUCss) deviation rate (Bayesian AUCss/population mean AUCss) was significantly higher in bedridden patients than in nonbedridden patients (P = 0.002), indicating that AUCss was nearly 30％ higher in bedridden patients. Therefore, consideration of the population mean AUCss when designing initial VCM dosing for elderly patients who are bedridden may help ensure safe VCM administration.

The administration of antihuman epidermal growth factor receptor type 2 (HER2) drugs during cancer treatment may cause cardiac dysfunction, and risk management is important. Therefore, we introduced protocol-based pharmacotherapy management (PBPM) to appropriately perform echocardiograms when anti-HER2 drugs are administered and evaluated its usefulness. We compared the rate of echocardiography performed before and after the introduction of PBPM in 33 patients who received anti-HER2 drugs at our hospital between June 2019 and January 2023. As a result, the rate of echocardiography performed during administration of anti-HER2 drugs was significantly higher in the PBPM group than in the non-PBPM group. This study revealed that pharmacist-based echocardiography ordering support based on PBPM contributed to improved cardiac function monitoring during the administration of anti-HER2 drugs.