S. Grau

Pacientes con riesgo de desnutrición: valoración de 11 casos gravemente desnutridos con nutrición parenteral total individualizada

Objective: To describe and assess the efficacy and safety of individualised nutritional support during the first week of total parenteral nutrition in moderately to severely malnutritioned patients who are susceptible to the refeeding syndrome. Method: Retrospective observational study carried out between January 2003 and June 2006, including adult patients with moderate to severe malnutrition who received ≥ 5 days total parenteral nutrition. The nutritional support was described and the appearance of severe hydroelectrolytic and metabolic disturbances were assessed during the first week of nutrition. Results: The study included 11 patients with a mean body mass index of 15.4 kg/m2. These patients received an average of 23 Kcal/kg/day. They did not show any signs of severe hydroelectrolytic or metabolic disturbances. Three patients presented with hypophosphataemia, five with hypokalaemia and four with hypomagnesaemia, all of which were mild to moderate and with the exception of two cases, all were corrected within one week of feeding. Conclusions: Individualised nutritional support in moderately to severely malnourished patients does not produce refeeding syndrome. Individualised nutrition is an essential strategy for avoiding complications associated with overfeeding.

Robotización de la farmacia comunitaria aplicada a la farmacia hospitalaria: un nuevo reto

132 Farm Hosp. 2008;32(2):124-34 Al alta, fue diagnosticada de enfermedad del suero-like secundaria a la administración de clopidogrel. Su tratamiento al alta fue: ticlopidina, ácido acetilsalicílico, bisoprolol, atorvastatina, ezetimiba, metilprednisolona (en dosis decreciente durante 15 días) y dexclorfeniramina. Esta reacción ha sido notificada al Sistema Español de Farmacovigilancia mediante el sistema de “tarjeta amarilla”.

Economic Evaluation of Linezolid Versus Teicoplanin for the Treatment of Infections Caused by Gram-Positive Microorganisms in Spain

Abstract The aim of this study was to perform a comparative cost-effectiveness analysis of linezolid vs teicoplanin (i.v., switching to oral/i.m. respectively) in Spain. A decision tree model was used with the results of a randomized, comparative, controlled clinical trial with linezolid vs teicoplanin in the treatment of infections caused by Gram-positive microorganisms, with a timeline of 31 days. The efficacy endpoint was the percentage of patients with clinical healing or improvement in their infection. Direct medical costs were included using Spanish 2005 prices. Average cost per patient, average cost-effectiveness ratio and several sensitivity analyses were carried out. In the intent-to-treat (ITT) analysis linezolid obtained a higher percentage of therapeutic success than teicoplanin (95.5% vs 87.6% respectively, p = 0.005), both with similar tolerability. The average cost per treated patient was €8,064.76 for linezolid vs €8,727.36 for teicoplanin, with an incremental cost of €622.59 (−7,6%). Linezolid yielded a lower average cost-effectiveness ratio, €8,444.78 (8,195.90 – 8,709.25) than teicoplanin, €9,962.74 (9,465.68 – 10,502.23), with a slight reduction in average cost per successfully treated patient of 15.2% (€1,517.96). The results were robust to the sensitivity analysis. In conclusion, linezolid is a more cost-effective option than teicoplanin in the treatment of infections caused by Gram-positive microorganisms, since it offers superior clinical benefits with a lower use of associated resources.

Successful Treatment of an Aspergillus fumigatus Infection with Voriconazole Via a Nasogastric Tube

Voriconazole is a triazole antifungal agent active against fungi implied in invasive mycoses such as Aspergillus and Candida species 1. It provided superior efficacy when compared to amphotericin B for the treatment of invasive aspergillosis 2. While both oral and intravenous formulations are available, intravenous administration is contraindicated in patients whose glomerular filtration rate falls below 50 mL/min due to the potential for excipient accumulation 1. Voriconazole administered via nasogastric tube (NGT) could be an alternative in such cases. We present a case on a successful treatment with voriconazole via NGT in a critically ill patient with an invasive aspergillosis. A 74-year old woman admitted with anemia, diverticulosis and melena underwent a sigmoidectomy and a Meckel’s diverticulectomy. Ten days later, wound and urine cultures yielded Morganella morganii and Escherichia coli respectively. Cefotaxime was prescribed and intravenous metronidazole was added empirically. Four days later, she presented rectorrhage and hypovolemia requiring fluid resuscitation, subtotal colectomy, and an ileorectal anastomosis with ileostomy. Postoperatively, she became hemodynamically unstable and needed mechanical ventilation being admitted to the ICU (APACHE II: 15). Antibiotic treatment was then changed to imipenem-cilastatin and vancomycin. Parenteral nutrition was also started. The daily chest radiography and blood gasometry worsened 4 days later, despite a previous CT scan without evidence of lung Journal of Chemotherapy Vol. 18 n. 4 (445-446) 2006

Alcohol Ingestion and Topical Tacrolimus: A Disulfiram-Like Interaction?

documented their search strategy, 5 used a broad-based approach, while 5 used only MEDLINE. Interestingly, the articles where search methods were not described had a higher percentage of bibliographic articles not indexed in MEDLINE (2%) compared with those articles describing >3 search methods (1%). McAlister et al.4 reviewed 158 review articles from 6 general medical journals in 1996. These authors found that only 28% of these articles (n = 44) described how evidence was located for their reviews. A similar study by Mulrow5 in 1987 reported that only 2% (1 in 50) of review articles described their literature-searching methods. Our small study shows a growing trend, 2% (1987), 28% (1996), to now 50% (2003) of academic reviews describing their literature-searching methods, but this is far short of what should be part of every review article. The small number of non-MEDLINE references utilized in these academic review articles is worth pondering. Why did authors find so few non–MEDLINE-indexed articles that were worthy of inclusion? Are authors biased toward MEDLINE-indexed articles or are non–MEDLINEindexed articles of poor quality? Are non-MEDLINE articles difficult to obtain and therefore not utilized? It is possible that the 88% of the literature not included in MEDLINE is not of sufficient quality to be included. It is also possible that authors are searching only what is available and familiar to them and ignoring that trove of the literature that is perhaps difficult to obtain, published in other countries, and/or not as recognizable to us. Further research is necessary to fully explore these issues. Larger studies comparing review article bibliographies in different databases, such as EMBASE and Science Citation Index, could also shed additional light on this subject.

Factors associated with adherence to guidelines for the use of tigecycline in a tertiary care hospital.

Abstract We assessed the adherence to the prescribing hospital protocol for tigecycline and factors associated with noncompliance. A total of 103 patients were included in the study. In 23 (22.3%) patients, tigecycline was not administered according to the protocol, mostly because of the availability of other therapeutic alternatives and prescription for indications that were not included in the guidelines. Factors independently associated with nonadherence to the protocol were community-acquired infection (OR, 14.01; 95% CI, 1.54-127.12; P=0.019), and empirical tigecycline treatment (OR, 6.97; 95% Ci, 0.88- 55.40; P=0.066). Penicillin allergy (OR, 0.004; 95% CI, 0.000-0.071; P=0.001) and previous antibiotic treatment (OR, 0.025; 95% CI, 0.003-0.233; P=0.001) were factors associated with adherence to the hospital protocol. A positive time trend between total number of prescriptions and non-compliant prescriptions with the protocol was observed (Spearmans rho coefficient 0.971; P=0.001). Adherence to tigecycline protocol could be improved by focusing on protocols for community-acquired infections, mainly skin and soft tissue infections.