Macrolide (ML) antimicrobials are frequently prescribed in outpatient care, and it is difficult to obtain support from an Antimicrobial Stewardship Team (AST). Therefore, appropriate use of ML antimicrobials must be promoted in outpatient care. Several medical facilities have introduced a system for the notification of antimicrobial use, and electronic medical records display the notification form during prescribing. A system for notification of the use of clarithromycin (CAM), an ML antimicrobial, was introduced, and a physician has to select the purpose for prescribing it. The notification form states that CAM is not recommended for upper respiratory tract infections, which are mostly viral, and it lists other antimicrobials recommended by the AST. The notification of use system was introduced after COVID-19 was downgraded to a class 5 infectious disease (under the Infectious Diseases Control Act). Comparison of the period before COVID-19 and the H1NI influenza pandemic indicated that inappropriate use of CAM in outpatient settings tended to decrease and that the system helped to prevent its inappropriate use. CAM is sometimes prescribed as low-dose long-term therapy, and evaluating its appropriate use based on the duration of its prescription or its dose compared with other antimicrobials is difficult. A notification system would allow the purpose for prescribing an antimicrobial to be determined from electronic medical records, potentially reducing the workload of the AST in evaluating appropriate antimicrobial use. ML antimicrobials are frequently prescribed in outpatient settings, and numerous medical facilities should consider a notification of use system to promote their appropriate use.

Pharmaceutical access remains a major challenge in Japan’s remote and underserved areas, driven by aging, pharmacist shortages, and inadequate infrastructure. To forge a practical solution, we conducted a pilot study deploying a disaster-response mobile pharmacy vehicle (MPV) for routine, non-disaster use within a pharmacy-less community in Gifu Prefecture. The MPV was operational twice per week for 6 months (October 2022–March 2023), receiving outpatient prescriptions, dispensing medications, and providing essential counseling and adherence support. Over 49 days of operation, 96 patients were served with 97 prescriptions. Pharmacists conducted 13 prescriber clarifications (13.4％), which included leftover-medication adjustments, regimen simplification, and a re-examination referral. One-dose packaging was provided to 15 patients (15.6％). Generic drug use increased from 60.8％ during prepilot in-clinic dispensing to an average of 79.2％ during the pilot. Furthermore, medication notebook presentation increased to 93.8％. The patient reported an enhanced understanding of drug effects and adverse reactions despite a decrease in satisfaction regarding the waiting time. The clinic staff reported substantial benefits, including reduced dispensing workload, relief from inventory management, and increased prescribing flexibility. Even with existing legal and operational limitations, routine MPV deployment was deemed feasible, successfully enhancing pharmaceutical access, improving medication safety, and boosting the quality of care. The findings indicate that MPV is valuable beyond disaster response, establishing it as a sustainable model for enhancing health system resilience and promoting the separation of prescribing and dispensing in remote and medically underserved areas. Additional multisite, controlled studies are required to validate its effectiveness and long-term sustainability.

In recent years, overdose of over-the-counter drugs, which are easily available for purchase by the general public at drug stores or on the Internet, by young people has become a social problem. When a patient who has overdosed or mistakenly ingested a drug comes to the hospital, the necessary drug information is collected from poisoning-related books and package inserts, poisoning information from the Japan Poison Information Center, and other sources. However, although the package inserts of over-the-counter drugs contain information on dosage and active ingredients, they do not contain information on pharmacokinetics or toxicity; therefore, these must be looked up separately. In emergency outpatient clinics, where urgency is high, the time it takes to obtain information has been an issue. To enable a rapid response, we collected information on the toxicity of 61 ingredients contained in over-the-counter drugs in advance and then used Microsoft^® Office Access^® to link the active ingredients of 64 general cold medicines and 34 antipyretic analgesics among over-the-counter drugs with information such as the half-life and toxic dose of the ingredients, creating a system that allows simultaneous searches. This shortened the time required to collect drug information and standardized the information provided. We believe that using this system to provide drug information is useful in terms of speed and accuracy.

A man in his 60s was diagnosed with distal cholangiocarcinoma after presenting to a local clinic with back pain and weight loss. Gemcitabine plus cisplatin therapy was initiated, and durvalumab was added 10 months later. The patient received 10 cycles of induction therapy after which follow-up contrast-enhanced computed tomography revealed disease progression, prompting the substitution of gemcitabine monotherapy for the original treatment regimen. Following 17 cycles of gemcitabine, the patient developed bilateral lower extremity edema and worsening renal function, leading to hospitalization. Laboratory tests revealed elevated serum creatinine levels, increased tubular injury markers and microscopic hematuria. Based on these findings, the patient’s history of immune checkpoint inhibitor administration, and after excluding other differential diagnoses, our provisional diagnosis was late-onset durvalumab-associated renal injury. Ultrasonography revealed deep vein thrombosis, prompting the initiation of anticoagulant therapy with rivaroxaban. As renal biopsy was contraindicated, empirical steroid therapy was initiated. This initially resulted in decreased serum concentrations of creatinine, N-acetyl-β-D-glucosaminidase, and β₂-microglobulin. However, serum creatinine and β₂-microglobulin levels subsequently increased, accompanied by a sudden and marked decrease in platelet count, indicating gemcitabine-induced thrombotic microangiopathy. To the best of our knowledge, this is the first reported case of coexisting late-onset immune checkpoint inhibitor-related nephrotoxicity and gemcitabine-induced thrombotic microangiopathy, the latter being strongly suspected based on the prevention of rapid renal function deterioration by steroid therapy. Steroid monotherapy was insufficient to achieve full renal recovery from thrombotic microangiopathy, highlighting the need for early recognition and timely intervention when administering gemcitabine to patients with a history of immune checkpoint inhibitor therapy.

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第51巻　第9号　540頁　引用文献13）を次の通り訂正いたします

誤：13）高子裕子, 細見健吾, 久井裕美子, 杉田裕貴, 小牧佐知子, 稲田智子, 増本憲生, 大槻裕朗, 岡本禎晃, 金　啓二, 名徳倫明, 抗がん薬のバイアル内圧の記載に関する兵庫県下67病院における薬剤師の意識調査, 医療薬学, 2018, 44, 363-369.

正：13）高子優子, 細見健悟, 久井裕美子, 杉田裕貴, 小牧佐知子, 稲田智子, 増本憲生, 大槻裕朗, 岡本禎晃, 金　啓二, 名徳倫明, 抗がん薬のバイアル内圧の記載に関する兵庫県下67病院における薬剤師の意識調査, 医療薬学, 2018, 44, 363-369.

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