Péter Doró

Reasons for polypharmacy among psychiatric patients

Introduction: Increasing attention has recently been focused on polypharmacy, which is often referred to as an indicator of irrational drug consumption. Although polypharmacy is an important risk factor for problems arising from drug therapies, certain health concerns and conditions or patient-specific factors may justify the need for polypharmacy. In recent years there no data have been published regarding polypharmacy in Hungary.Objective: The authors examined the frequency of polypharmacy among psychiatric patients. The study also looked at the extent to which comorbidity and demographic characteristics (age, gender) were responsible for the multiple drug use.Methods: An inpatient database of the year 2001 at the psychiatric department was analysed. Based on the standard definition of polypharmacy the authors enrolled into the polypharmacy group those patients who were on more than five drugs as part of chronic and simultaneous therapy. The data were analysed with the SPSS 9.0 statistics program package.Results: Among the psychiatric patients included in the study (N=984) the frequency of polypharmacy was 33.6%. Significant correlation was found between the investigated factors (age, gender, comorbidity) and polypharmacy. On the basis of OR-values, comorbidity was the strongest inducer of polypharmacy.Conclusion: Polypharmacy cannot be fundamentally regarded as unnecessary drug use. Numerous facts prove that in certain diseases and conditions adequate polypharmacy is necessary.

Gender inequalities in the treatment of osteoporosis

INTRODUCTION Our aim was to perform both gender- and age-specific analysis regarding the utilisation of anti-osteoporotic drugs in Hungary, between 2007 and 2011, and to compare our results with other European countries. METHODS The database of the Hungarian National Health Insurance Fund was screened for anti-osteoporotic medications, covering 100% of the Hungarian population (10 million people). ICD coding system (International Classification of Diseases) and WHO ATC/DDD methodology were used for medication screening and analysis. RESULTS In Hungary, the total bisphosphonate use was 6.66 DDD/TID (Defined Daily Dose/1000 inhabitants/day) in 2007, and 6.22 DDD/TID in 2011; the rate of bisphosphonate combinations slightly increased from 1.60 to 2.81 DDD/TID. The total vitamin D use almost doubled (13.73 DDD/TID in 2011), while the calcium supplementation tripled (4.47 DDD/TID in 2011), and so did the strontium ranelate utilisation (0.70 DDD/TID in 2011) within the investigated time period. Denosumab consumption was marginal. Male patients were disproportionately, 10-20 times undertreated in all age groups, and treatment choice was restricted among men. Several differences were seen in our results compared to those in Baltic countries, Finland and in Norway. CONCLUSIONS Men were significantly undertreated in all age groups, compared to women. The 10 to 20-fold difference calls attention to this unrecognised problem.

Quantitative disparities in outpatient antibiotic exposure in a Hungarian county

OBJECTIVES Although antibiotic utilization data expressed in defined daily doses (DDDs)/1000 inhabitants/day are often available for a given period and area, the actual antibiotic exposure of the population is rarely explored. We aimed to identify the real antibiotic exposure of the inhabitants of one Hungarian county. METHODS The patient-level dispensing data for 2005 for Csongrád County were retrieved from the database of the Hungarian National Health Fund Administration. The number of antibiotic users was quantified, and differences in antibiotic use (quantity and frequency) were explored. Disparities were revealed by Lorenz curves. A new form of Lorenz curve was also introduced. The DDD values for 2005 were used. RESULTS In 2005, a total of 486 115 antibiotic prescriptions were redeemed, and 3 329 385 DDDs were dispensed to 213 748 different patients; 50.3% of the inhabitants of Csongrád County (total population 424 615) took antibiotics. The average consumption of 1-, 2-, 3-, 4- and 5-time users was 7.5, 14.6, 21.0, 26.9 and 32.2 DDDs per user, respectively. Lorenz curves (including the new form of Lorenz curve) demonstrated the existence of disparities in antibiotic use. One percent of the users with the heaviest consumption were responsible for 6.9% of the total use and redeemed antibiotic prescriptions nine times or more during 2005. CONCLUSIONS Disparities in antibiotic use were detected: half of the inhabitants were exposed to antibiotics, and among antibiotic users, the quantity of antibiotics that they redeemed displayed great variance, mainly due to differences in the prescribing frequency. Special attention should be paid to those with frequent antibiotic use (five times or more annually).

Treatment of Community-Acquired Pneumonia in Adults: Analysis of the National Dispensing Database

Crude national ambulatory antibiotic dispensing data (2007–2011) of adult patients (aged between 20 and below 65 years) with CAP were obtained and expressed as DDD per 1000 inhabitants and per day (DID). European quality indicators of antibiotic prescribing were calculated and adherence rate to the national CAP guideline was assessed. Antibiotic use for CAP in adults ranged between 0.27 and 0.30 DID in various years. The most frequently used antibacterials were levofloxacin, co‐amoxiclav and clarithromycin. Antibiotic use in CAP was compliant with the European recommendations in 6.4% in 2007, which decreased to 4.9% by 2011, in contrast to the optimal compliant range of 80–100%. The consumption of fluoroquinolones mounted up to ~40% in both genders, which exceeded the recommended range (0–5%) substantially. National guideline also favoured the use of macrolides in the empiric therapy of CAP in otherwise healthy adults; hence, guideline‐concordant antibiotic use ranged between 24.0–32.3%. Agents that were contra‐indicated in the empiric therapy of CAP were also used in 6.5–9.0% in various years. These data reflect some worrisome figures and trends in the outpatient antibiotic treatment of adults with CAP. Clarified and updated national guidelines focusing on outpatients and incentives/regulations to increase guideline concordance are warranted.

Hungarian Hospital Antibiotic Consumption at the Regional Level, 1996–2005

Background:Regional variations in antibiotic consumption in outpatients have been reported previously, but nothing is as yet known about the regional distribution of antibiotic consumption in the hospital sector in Hungary. This study was designed to explore regional variations and investigate determinants of antibiotic consumption in hospital care in Hungary.Materials and Methods:Regional distribution-based antibiotic sales data were obtained for a 10-year period (1996–2005) for the 20 Hungarian counties. Systemic antibacterial use (Anatomical Therapeutic Chemical code: J01) was expressed as the number of defined daily doses (DDD) per 100 patient-days. The multiple linear regression model was applied to investigate the determinants of regional differences in hospital antibiotic consumption. Independent variables related to health care access, utilization of hospital resources, doctors’ workload, type of hospital care provided, and patient’s characteristics and infections were considered as possible determinants, and data on these variables were obtained for 2 years (2004, 2005). We also tested the association between hospital and ambulatory care antibiotic consumption in Hungarian regions using the Pearson correlation test.Results:For each year during the 1996–2005 study period, there were large and stable variations in total hospital antibiotic consumption (e.g., min–max1996: 16.0–28.2; min–max2005: 15.2–32.2 DDD per 100 patient-days) depending on the region. In the two developed models (Model 1 and Model 2), the number of reported infections accounted for 53% of the observed regional variations in hospital antibiotic consumption (Model 1), and the number of reported infections together with the case-mix index were responsible for 61% (Model 2) . Total antibiotic consumption in hospitals showed a positive correlation (R = 0.71, p = 0.002) with total antibiotic consumption in ambulatory care.Conclusion:The case-mix index and the number of reported infections explained some of the observed regional variations. However, the moderate value of the models in explaining these regional variations suggest that determinants which could not be explored in this preliminary study may also contribute to regional differences. Future studies should aim at collecting data for each individual hospital as well as data on possible determinants for hospital antibiotic consumption.

Iatrogenic Skin Disorders and Related Factors in Newborn Infants

Recent technological advances and diagnostic and therapeutic innovations have resulted in an impressive improvement in the survival of newborn infants requiring intensive care. Consequently, with the use of modern invasive diagnostic and therapeutic procedures, the incidence of iatrogenic events has also increased. The aim of this study was to assess various iatrogenic complications in neonates requiring intensive care and determine possible contributing factors to the injuries.

Variations and determinants of antibiotic consumption in Hungarian adult intensive care units.

The aim of this work was to study the use of systemic antibacterials and its possible determinants in Hungarian intensive care units (ICUs).

Physical compatibility of MCT/LCT propofol emulsions with crystalloids during simulated Y-site administration

Objective In intensive care units numerous drugs have to be infused simultaneously, resulting inline incompatibility. Propofol is formulated as a lipid emulsion and it is well known that electrolytes can affect the stability of an emulsion system. Our goal was to evaluate and to compare the physical compatibility of three commercial propofol lipid emulsions of different manufacturers, mixing them with the most commonly used crystalloids in intensive care units. Methods Simulated Y-site administration was accomplished by mixing the 2% MCT/LCT propofol emulsions with the commonly used crystalloids in the intensive care unit in a 1:1 ratio in a polypropylene syringe. The aliquot samples were evaluated immediately and at 15, 30, 60 and 120 min after preparation by visual observation, pH and droplet size measurement. Results There was no emulsion breakdown or any visible change during the study period. Mixing the propofols with crystalloids, 10% magnesium sulphate or 10% potassium chloride there was no significant change in the droplet size compared with the original propofol emulsions. A slight alteration in droplet size was noticed in a few of the propofol samples, when magnesium, potassium or both were the secondary additives to the crystalloids, but this is not considered clinically relevant. Conclusion The physical properties of emulsions are determined by component, therefore the compatibility data in literature has to be evaluated prudently. All three commercially available MCT/LCT propofol emulsions are considered physically compatible with the tested crystalloids.

Hazai kórházi antibiotikum-alkalmazás az elmúlt két évtizedben (1996–2015)

Absztrakt Bevezetes: A bakterialis rezisztencia kozegeszsegugyet fenyegető problema, amely mersekelhető, lassithato megfelelő antibiotikum-alkalmazassal. Celkitűzes: A hazai fekvőbeteg-ellatas szisztemas antibiotikum-felhasznalasanak bemutatasa. Modszer: A korhazi antibiotikum-felhasznalasi adatokat az Egeszsegugyi Vilagszervezet anatomiai-terapias-kemiai rendszere szerint osztalyoztak es a Defined Daily Dose metodika szerint kvantifikaltak. A standardizalas korhazi betegforgalmi mutatokra, valamint – a nemzetkozi osszehasonlitas vegett – populaciora tortent. Eredmenyek: A fekvőbetegszektor antibiotikum-felhasznalasa az elmult 20 evben mennyisegileg kiegyenlitett volt (22,4 ± 1,5 DDD/100 apolasi nap), mintazata folyamatos valtozason ment keresztul. Megfigyelhettuk a parenteralis keszitmenyek alkalmazasanak emelkedeset (1996-ban 26,4%, 2015-ben 41,6%). Kiemelendő a felhasznalas osszetetelenek homogenizalodasa az amoxicillin-klavulansav ternyerese miatt, a fluorokinolon (2,3 vs. 4,2 DDD/100 apolasi nap) es ...

CP-117 Risks of surgical intervention in patients taking oral anticoagulants

Background Oral anticoagulants (OAC) play a crucial role in preventing thromboembolic diseases. However, these medications may carry numerous problems and risks while applied. Patients taking oral anticoagulants may have a higher risk of bleeding during a surgical intervention. Purpose Our aim was to analyse the risks that patients on oral anticoagulant therapy may have during their hospitalisation and surgical procedure. Material and methods Patients were recruited from the traumatology department, admitted with osteoporotic hip fractures. A retrospective analysis was performed for the period between January 2011 and August 2012. Data were recorded from the patient charts and documentation. Data comparison was made regarding the risks of patients on OAC and of patients not taking oral anticoagulants (control group). Results 510 patients were enrolled in this study (133 males, 377 females), mean age 79.68 ± 9.81 years (mean ± SD). On admission, 49 patients were taking OAC (14 males, 35 females, mean age 80.88 ± 10.04 years), which was acenocumarol. 119 men and 342 women (mean age 79.56 ± 7.22 years) were included in the control group. In the OAC group, more time elapsed between the admission date and the surgical procedure: 3.43 days (±2.30 days) versus 1.74 days (±2.21 days) in the control group (p ≤ 0.001). At the same time, there was no substantial difference in the length of operation between the two groups: 1 h 54 min versus 1 h 50 min. Following the surgical intervention, the mean length of hospital stay did not differ significantly between the two groups (11.24 days). Complications during the surgical procedure and/or hospital stay occurred in 57.1% in the OAC group and in 51.8% of controls. During the hospital stay, 53.1% of the OAC group received blood transfusion compared with 45.3% of the control group. Mortality rate was 8.16% in OAC patients versus 3.14% in the control group. Autopsy confirmed cause of mortality was not available. Conclusion Although the overall hospital stay did not differ significantly, considerable differences were seen regarding length of time elapsed until surgery, complication rate and mortality rate between the OAC and control groups. The higher mortality rate highlights the frailty of patients receiving oral anticoagulant therapy. No conflict of interest.