Medication adherence is still a critical issue in pediatric and adolescent patients, for whom bitterness is a major barrier to oral drug intake. This study aimed to assess food-based bitterness-masking effects in junior high school students, with comparisons to adults. Junior high school students and adults participated in a nonblinded sensory evaluation in which a bitter food model (bitter gourd powder) was ingested alone or together with commercially available foods with different taste qualities. Bitterness intensity was assessed using a numerical rating scale. The effects of water temperature (room temperature, cold, and warm) on bitterness perception were examined using mineral water. A questionnaire survey assessed medication experience and taste preferences among junior high school students. The results revealed that sweet, salty, or fatty foods significantly reduced bitterness scores in junior high school students, whereas sour foods showed no significant bitterness-masking effects. Contrarily, adults demonstrated significant bitterness reduction with sweet, salty, fatty, and sour foods. In the mineral water test, bitterness scores in junior high school students were significantly higher with cold or warm water than with room-temperature water, whereas no temperature-related differences were observed in adults. Furthermore, habitual preference for bitter foods, including black coffee, was negatively correlated with bitterness perception in junior high school students. These findings suggest that bitterness-masking effects of foods and the influence of water temperature vary by age group and that habitual taste preferences may affect bitterness perception in adolescents. Strategic food selection can serve as a critical adjunctive therapy to improve medication adherence among pediatric and adolescent patients.

Surgical site infections (SSIs) are associated with prolonged hospitalization, increased medical costs, and higher mortality rates. Optimizing perioperative prophylactic antibiotic use reduces SSI incidence. Nonetheless, evidence on the clinical impact of pharmacists’ involvement is still limited. This study aimed to assess the effects of perioperative pharmacist audit and feedback (PPAF) on SSI incidence and adherence to prophylactic antibiotic guidelines in patients undergoing colorectal surgery.

This retrospective cohort study involved patients who underwent colorectal surgery before (between January 1 and December 31, 2021) and after PPAF implementation (between May 1, 2024, and April 30, 2025). PPAF comprised a preoperative chart review, intervention based on body weight, renal function, allergy, recommendations for intraoperative redosing, and postoperative feedback. The primary outcome was SSI incidence. The secondary outcomes were adherence to prophylactic antibiotic guidelines, inappropriate antibiotic use, and associated costs.

We analyzed 410 patients (201 pre-PPAF and 209 post-PPAF). SSI incidence decreased from 18.4％ to 15.3％, with no statistical significance (odds ratio [OR]: 0.80, 95％ confidence interval [CI]: 0.46 – 1.39, P = 0.43). Guideline adherence improved across all categories, with significant improvements in preoperative timing and intraoperative redosing. Multivariate analysis identified (BMI) ≥ 21.8 and operative time ≥ 129 min as risk factors for SSI, whereas adherence to the prescribed dosage of postoperative infection prevention antibiotic was protective (OR: 0.20, 95％ CI: 0.05 – 0.87).

PPAF did not significantly reduce SSI incidence; nevertheless, it improved guideline adherence. Pharmacist-led interventions may contribute to enhancing the quality of perioperative care.

Mirogabalin besylate is an effective treatment for neuropathic pain; nevertheless, its safe use requires appropriate dose adjustment based on renal function and adherence to a gradual dose escalation schedule. At Oita University Hospital, a prescription order alert prompting renal function–based dosing and appropriate dose escalation was implemented in the electronic medical record system in January 2025. This study evaluated the impact of introducing this alert on physicians’ prescribing behavior for mirogabalin besylate. Patients prescribed mirogabalin besylate tablets (2.5, 5, or 10 mg) at our hospital between July 2024 and June 2025 were included. Renal function testing rates, appropriate use rates among patients with impaired renal function, and prescription switch rates from 10 to 20 mg were compared before and after alert implementation. After implementation, renal function testing rates among patients prescribed 2.5-mg tablets demonstrated an increasing trend, despite that the difference was not statistically significant. In contrast, appropriate use significantly improved in patients with creatinine clearance <60 mL/min, particularly among those aged ≥65 years. Moreover, the rate of appropriate dose escalation from 10 to 20 mg after an interval of at least 7 days increased significantly. These findings suggest that prescription order alerts at the time of mirogabalin besylate prescribing promote renal function assessment and adherence to recommended dose escalation schedules, thereby improving appropriate use. As a low-cost and widely applicable intervention using standard electronic medical record functions, such alerts may represent a practical strategy for enhancing medication safety in clinical practice.

Japan’s universal health insurance system has long ensured access to high-quality medical care at relatively low cost; however, its sustainability is increasingly challenged by population aging and rising healthcare expenditures. This study examined how self-medication relates to public awareness of necessary measures for maintaining the system, perceptions of its sustainability, and recognition of threats to its continuity. A cross-sectional questionnaire survey was conducted among 314 participants at nationwide over-the-counter medicine awareness events in 2021 and 2022. Latent class analysis identified three clusters of awareness regarding system maintenance: “Efficiency-oriented with support for restrictions,” “Quality-oriented with utilization of professional support,” and “Cost-conscious with preference for service retention.” More than half of respondents (56.37％) practiced self-medication, and these individuals were significantly more likely to belong to the “Quality-oriented” cluster and to perceive the health insurance system as sustainable in the future. Self-medication practitioners also tended to focus on drug costs as a major sustainability concern, whereas nonpractitioners were more concerned about overall medical expenditure and service overuse. These findings suggest that self-medication may represent a supportive and participatory behavior that contributes to sustaining the healthcare system through responsible self-care and appropriate collaboration with professionals, rather than merely avoiding medical services.

We report a successful case of treatment with daptomycin (DAP) in an extremely low-birth-weight infant presenting with persistent bacteremia caused by methicillin-resistant Staphylococcus epidermidis (MRSE).

The case involved a male infant diagnosed with twin-to-twin transfusion syndrome, born via emergency cesarean section at 26 weeks of gestation with a birth weight of 814 g.

On the ninth day of life, the infant developed an elevated inflammatory response. After submitting various cultures, cefazolin and amikacin were started. Blood cultures taken the same day identified MRSE. On Day 11, antibiotics were changed to vancomycin (VCM) and meropenem. On Days 13 and 14, the peripherally inserted central catheters (PICC) in both upper limbs were replaced. VCM administration continued until Day 24, but blood cultures remained positive.

On Day 24, antimicrobial therapy was changed to DAP (10 mg/kg/day), which resulted in improvement of the inflammatory response and general condition. The PICC were removed on Days 31 and 33, respectively. Blood cultures were negative by Day 33. DAP was administered for 24 days without adverse effects such as elevated CPK or eosinophilia.

The use of DAP in extremely low-birth-weight infants is extremely rare both domestically and internationally. Moreover, its efficacy and safety are still unclear. This case suggests that DAP can be a useful option for persistent MRSE bacteremia in neonates where catheter removal is difficult.

This study aimed to determine factors that are associated with the continued use at hospital discharge of newly initiated insomnia medications in patients requiring intensive care unit (ICU) management after cardiovascular surgery and to elucidate indicators for pharmacist intervention in perioperative insomnia management. We retrospectively analyzed 94 patients admitted to the ICU following cardiovascular surgery between April 2023 and March 2024. Continued use was defined as the prescription at discharge of an insomnia medication newly initiated during hospitalization. Patient characteristics and insomnia medication-related variables were evaluated using multivariate logistic regression analysis. Thirty patients (31.9％) continued insomnia medication at discharge. After adjustment for insomnia severity, assessed by the cumulative number of insomnia medications administered during hospitalization, scheduled daily administration (odds ratio [OR], 19.98) and zolpidem use (OR, 26.77) were independently associated with continued use at discharge. These findings indicate that routine daily prescribing and zolpidem use are independently associated with persistent use ofinsomnia medications after hospitalization. Early identification of high-risk patients and proactive pharmacist involvement in modifying dosing schedules and optimizing medication selection based on clinical status may help prevent unnecessary continuation.

Cancer pain is common among patients with advanced disease, and strong opioids are the standard therapy for moderate to severe pain. Nonetheless, dose escalation of a single opioid does not always provide adequate analgesia. Low-dose methadone add-on therapy has attracted attention as a strategy to improve pain relief while maintaining tolerability. We retrospectively examined the efficacy and safety of low-dose methadone add-on therapy for uncontrolled cancer pain and explored clinical factors associated with treatment response. Adult patients with cancer who received low-dose methadone besides an ongoing strong opioid at our institution between May 2019 and March 2023 were reviewed. Safety was assessed in 39 patients. Efficacy was analyzed using an available case analysis, including only patients for whom numeric rating scale (NRS) data were available. Responders were defined as patients with a ≥30％ reduction in NRS from baseline by Day 14. The median NRS significantly decreased on Days 7 and 14 compared with Day 0 (6 vs 4; P < 0.01, 6 vs 3; P < 0.01). Within 14 days after methadone initiation, adverse events were primarily Grade 1 – 2 somnolence and constipation, and no treatment discontinuations due to adverse events occurred. The time from initiation of prior strong opioid to methadone add-on was significantly shorter in responders than in nonresponders, suggesting that earlier introduction of methadone may improve analgesic outcomes. These findings show that low-dose methadone add-on therapy is a useful and well-tolerated option for managing uncontrolled cancer pain in clinical practice.

Specialized medical institution cooperation pharmacies (SMICPs) are required to provide follow-up via telephone and other means for outpatients receiving cancer drug therapy and to share patient information with medical institutions. Nonetheless, the actual implementation status of such pharmaceutical care has not been fully elucidated. This study aimed to clarify the actual content of pharmaceutical care provided by SMICPs, with a focus on outpatients undergoing CAPOX therapy as adjuvant chemotherapy after colorectal cancer surgery. A retrospective study using medication history records was performed at three community pharmacies certified as SMICPs. The study included 56 patients scheduled to receive four courses and 43 patients scheduled to receive eight courses of CAPOX therapy. The telephone follow-up implementation rates were 62.5％ and 88.4％ in the four- and eight-course groups, respectively. No clear difference in completion rates was observed between patients with and without telephone follow-up, whereas telephone follow-up was carried out for all patients who did not complete the full courses. Among patients who completed therapy, those with more severe adverse events tended to receive a greater number of telephone follow-up calls. With respect to side effect-specific counseling, intensive guidance for hand-foot syndrome was initiated either before onset or at a mild stage. These findings suggest that telephone follow-up for patients was selectively implemented based on dose reduction, treatment interruption, or adverse events and may have functioned as a form of triage by community pharmacists. This study provides foundational data that illustrate the current state of cancer drug therapy support provided by community pharmacists in SMICPs.

Quantitative risk assessment prediction of drug-drug interactions (DDIs) caused by metabolic enzyme inhibition is essential in both new drug development and clinical practice. Regulatory guidance recommends three approaches: cutoff criteria that conservatively evaluate the potential for DDIs using minimal data and quantitative prediction using mechanistic static pharmacokinetic (MSPK) models and physiologically based pharmacokinetic (PBPK) models. In clinical settings, the CR-IR method is also applied, which predicts DDIs using the contribution ratio of cytochrome P450 (CYP) isoforms to substrate clearance together with the inhibition ratio of an inhibitor toward the corresponding CYP.

This study examined 27 clinically reported DDIs, including 20 cases of reversible CYP inhibition and seven of time-dependent inhibition, by comparing observed increases in the area under the plasma concentration-time curve (AUC) with those predicted by the three approaches. The ratio of predicted to observed increases in AUC was within twofold (0.5 – 2.0) in approximately half of the cases for both the MSPK and PBPK models, whereas this criterion was met in 26 cases using the CR-IR method. PBPK models can accommodate analyses that involve flexible dosing regimens, and even a simple PBPK model was able to adequately predict increases in AUC. Thus, the PBPK model analysis is suggested to be applicable in clinical settings.

The CR-IR method showed the most accurate prediction of AUC increase, suggesting that this method can be applicable for the prediction of AUC increases in clinical settings. Nevertheless, further investigations are required to confirm its accuracy for other DDIs.

In Japan, with the increasing demand for home medical care, medication management regarding drug-drug interactions (DDIs) is essential, particularly for elderly patients who are susceptible to these risks owing to declined pharmacokinetic functions, including impaired renal and hepatic metabolism. This study aimed to evaluate the prevalence and details of potential DDIs (pDDIs) and their relationship among 196 elderly patients aged over 65 years in home care and facility settings between April 2022 and March 2025 using a drug interaction checker, UpToDate^®Lexidrug™. Clinically significant pDDIs were identified in 31.1％ of patients (pDDI-positive group). The pDDI-positive group had significantly higher numbers of comorbidities (P < 0.05), concomitant medications (P < 0.001), and total interactions (P < 0.001) compared to the pDDI-negative group. Among the pDDI-positive group, 95％ had concurrent renal or hepatic impairment. Multivariate logistic regression analysis identified polypharmacy (≥ 6 medications) as a significant independent factor for pDDIs (adjusted odds ratio: 2.80, P = 0.004). Regarding drug categories, hypnotics (P < 0.001) and gastric acid suppressants (P < 0.005) were significantly associated with an increased risk of pDDIs. The DDI mechanisms were based on pharmacodynamic interactions in 56.9％ of cases and on pharmacokinetic interactions in 41.2％. The primary mechanisms of pDDIs were pharmacodynamic interactions, particularly central nervous system depression (29.4％). Elderly patients undergoing home-based medical care represent a population at high risk for pDDIs, significantly influenced by polypharmacy and impaired organ functions. Integrating DDI detection systems with pharmacist intervention is essential to optimizing pharmacotherapy in this vulnerable population.