Active search about latex in injectable drugs for patient’s safety in medical therapy

Objectives: To classify injectable drugs used in a general hospital inventory according to latex presence or absence in vials with rubber stoppers, antibiotics, and electrolytes bags. Methods: The information about latex content has been collected from medicine industries, after identification of authorized manufacturers in Brazil, through the National Health Surveillance Agency (ANVISA) medicine search database. Medicines have been grouped per pharmaceutical manufacturers, and data were collected through telephone or e-mail. Only written information from pharmaceutical companies were considered. Results: Among 161 medicines used in the hospital packaged in vials with rubber stoppers, antibiotics, and electrolytes bags, 123 (76.4%) medicine-related responses were received, covering 540 (82.2%) different presentations. For this, from 87 contacts, 70 (80.5%) companies responded and 65 (74.7%) provided information related to the presence or absence of the allergen. Among the medicine list, 8 (6.5%) were identified as containing latex (in 12 different presentations – 2.2%) and 101 medications (82.1%) in 507 presentations (93.9%) do not contain latex. The manufacturers responded that the medicine was latex-free, but could not confirm for raw materials (6 medicines – 4.9% - in 6 different presentations – 1.1%) and that they were unable to ensure there was no contact with latex during manipulation (4 medicines – 3.3% - in 8 different presentations – 1.5%). For 4 medicines (3.3%) in 7 different presentations (1.3%), the companies were inconclusive, as they could not confirm whether they were latex-free or not. Conclusion: Although latex is a known allergen, information about the presence of latex components in pharmaceutical packaging and package inserts needs improvement, since the active search identified 161 medicines packaged in vials with rubber stoppers, antibiotics, and electrolytes bags that failed to depict this information. The results of this survey endorse the Importance of displaying this information on medicines label or packaging in order to ensure healthcare professionals easy access and prompt consultation.

WHO/INRUD Core drug use indicators and commonly prescribed medicines: a National Survey from Sri Lanka

Background Identification of internationally comparable indicators of medicines use are important for a country to implement strategies and regulations to improve usage of medicines. Sri Lanka established a new National Medicines Regulatory Authority in 2015 and this survey evaluated the medication use indicators in Sri Lanka, according to the International Network on Rational Use of Drugs (INRUD), prior to its implementation. Methods This descriptive-cross-sectional study was conducted in 80 pharmacies, representing all 25 districts of the country. Three pharmacy categories were included; privately owned pharmacies, ‘Rajya Osusala’ pharmacies operated by the State Pharmaceuticals Corporation (SPC) of Sri Lanka and SPC Franchisee pharmacy outlets. Selection of pharmacies from respective districts were done proportionate to estimated population. Data were collected to identify WHO/INRUD core drug use indicators and the commonly prescribed medicines. Results Total of 2328 prescriptions were included (‘Rajya Osusala 559; SPC Franchise 711; private pharmacies 1058). Altogether 7,255 medicines were prescribed, and the 3 most commonly prescribed medicines were atorvastatin, losartan and metformin. Average number of medicines per encounter was 3.1±1.9 (Median: 3; range 1-12) Highest average number of medicines per encounter was reported in prescriptions received at ‘Rajya Osusala’ pharmacies (3.6±2.2), significantly higher than in other categories of pharmacies (p<0.001). Percentage of medicines prescribed by generic name was only 35.5%, highest at the ‘Rajya Osusala’ pharmacies (40.6%), significantly higher than other categories of pharmacies. The overall percentage of medicines prescribed from essential medicine list (EML) was 68.8%, without any significant variation between different categories of pharmacies. The percentage of medicines actually dispensed and accurately labelled were 92.4 and 98.5% respectively. Conclusions The average number of medicines per encounter was higher than the WHO recommended value but the usage of antibiotic and injectable drugs were within recommended standards. Generic prescribing, was very much lower. The EML prescribing, labelling and percentage dispensed medicines fared much better although lower than the WHO recommended 100% compliance. This island wide study has provided national wide data before the implementation of key changes in regulation of medicines in Sri Lanka and a repeat survey will be useful to identify impact of the new legislations.

Seroprevalence and associated factors of HIV and Hepatitis C in Brazilian high-security prisons: A state-wide epidemiological study

The prevalence of hepatitis C virus (HCV) and the acquired immunodeficiency virus (HIV) is much higher in prisons than in community settings. Some explanatory factors for this burden include putative aspects of the prison environment, such as unprotected sexual relations and sexual violence, use of injectable drugs and syringe sharing. Nonetheless, efforts in better understanding the dynamics of both HCV and HIV are scarce in developing countries such as Brazil, which poses a risk not only to the inmates but to the community as well. In this investigation, we sought to determine the seroprevalence and sociodemographic and behavioral risk factors associated with HIV and anti-HCV antibodies among men detained at high-security institutions. This is an epidemiological, proportionally stratified observational study including 1,132 inmates aged 18 to 79 years-old (Mage = 32.58±10.18) from eleven high-security prisons located in the State of Paraná, Brazil. We found that HIV and anti-HCV prevalence were 1.6% (95% CI: 1.0–2.5) and 2.7% (95% CI: 1.0–2.5), respectively. Risk factors associated with HIV included not receiving intimate visits (OR = 8.80, 95% CI: 1.15–66.88), already having another sexually transmitted infection (OR = 3.89, 95% CI: 1.47–10.29), and reporting attendance in HIV preventive campaigns (OR = 4.24, 95% CI: 1.58–11.36). Moreover, anti-HCV seroprevalence was associated with higher age (OR = 4.03, 95% CI: 1.61–10.07), criminal recidivism (OR = 2.58, 95% CI 1.02–6.52), and the use of injectable drugs (OR = 7.32, 95% CI 3.36–15.92). Although prisons might increase the risk for acquiring and transmitting HIV and HCV, the adoption of permanent epidemiological surveillance programs could help reducing the circulation of viruses, involving strategies focusing on screening, treating, and preventing infections to assure proper prisoner health. Moreover, these policies need to take place inside and outside the prison environment to offer continued assistance to former prisoners once they leave the institution.

Safety in the administration of injectable medications: Scoping review

Objective: to raise scientific evidence on technologies for the safe administration of injectable drugs in hospitalized adult patients. Method: this is a study of the Scoping Review type, using the crossing of the descriptors Patient Safety, Medication Errors and Technology in the following databases: Medical Literature Analysis and Retrieval System Online Electronic Library Online, Science Direct, Virtual Health Library, Pubmed, Web of Science and Scopus. The choice of studies included in the sample and data extraction occurred in a paired manner by independent researchers. Results: 14 studies were classified as eligible. The interventions found were medication administration using a barcode, patient identification by plates, bracelets, radiofrequency and/or biometrics, personal digital assistants, mobile nursing carts, electronic medication administration record, safety syringe system based on key-lock adapters, smart infusion pumps, drugs organizer kits, storage bag, trays with dividers, adhesive in different colors for separating medicines by class, and double checking. Final considerations: The implementation of technologies, professionalism, changes in the organization and in the workplace linked to the empowerment of the patient and family/companion enables the quality of the injectable medication administration processes. It is considered an advantageous investment in technologies for the culture of safety.

Study of the cost variation analysis of anti-epileptic drugs available in different brands in Indian pharmaceutical market

Background: The aim of this study was to analyze the cost ratio and percentage cost variations in different brands of the commonly prescribed anti-epileptic drugs available in Indian pharmaceutical market.Methods: The maximum and minimum price of each brand of the drug given in Indian rupees (INR) was noted by using CIMS January to April 2020 edition and drug today April to June 2020 volume 1. The cost ratio and the percentage cost variation for individual drug brands was calculated. The cost of one bottle in case of 100 ml syrup and 10 tablets/capsules was calculated in case of oral drugs and the cost of one 1 vial or ampoule was noted in case of injectable drugs. At last the cost ratio and percentage cost variation of various brands was compared.Results: After calculation of cost ratio and percentage cost variation for each brand of anti-epileptic drug tablet clonazepam (2 mg) shows highest cost ratio and percentage cost variation as 10.41 and 941.66, carbamazepine (200 mg SR tablet) shows lowest cost ratio and percentage cost variation as 1.09 and 9.32.Conclusions: Epilepsy is the most common neurological disorder and epileptic drugs are to be prescribed for prolonged period. If a costly brand is prescribed, the patients have to pay more money unnecessarily for their treatment. There is a wide difference in the cost of different brands of anti-epileptic drugs available in India. The clinicians prescribing these drugs should be aware of these variations in cost to reduce the cost of drug therapy.

Increasing prevalence of resistance to second-line drugs among multidrug-resistant Mycobacterium tuberculosis isolates in Kuwait

Molecular methods detect genetic mutations associated with drug resistance. This study detected resistance-conferring mutations in gyrA/gyrB for fluoroquinolones and rrs/eis genes for second-line injectable drugs (SLIDs) among multidrug-resistant Mycobacterium tuberculosis (MDR-TB) isolates in Kuwait. Fifty pansusceptible M. tuberculosis and 102 MDR-TB strains were tested. Phenotypic susceptibility testing was performed by MGIT 960 system using SIRE drug kit. GenoType MTBDRsl version 1 (gMTBDRslv1) and GenoType MTBDRsl version 2 (gMTBDRslv2) tests were used for mutation detection. Results were validated by PCR-sequencing of respective genes. Fingerprinting was performed by spoligotyping. No mutations were detected in pansusceptible isolates. gMTBDRslv1 detected gyrA mutations in 12 and rrs mutations in 8 MDR-TB isolates. gMTBDRsl2 additionally detected gyrB mutations in 2 and eis mutation in 1 isolate. Mutations in both gyrA/gyrB and rrs/eis were not detected. gMTBDRslv1 also detected ethambutol resistance-conferring embB mutations in 59 isolates. Although XDR-TB was not detected, frequency of resistance-conferring mutations for fluoroquinolones or SLIDs was significantly higher among isolates collected during 2013–2019 versus 2006–2012. Application of both tests is warranted for proper management of MDR-TB patients in Kuwait as gMTBDRslv2 detected resistance to fluoroquinolones and/or SLIDs in 3 additional isolates while gMTBDRslv1 additionally detected resistance to ethambutol in 58% of MDR-TB isolates.

Analysis of drug compatibility in Y in intravenous therapy: preparation of a preventive tool for a university hospital in Petrolina – PE

Objectives: To elaborate instruments for the analysis of the compatibility of intrave-nous medications, in order to assist in the conduct and routines of the assistance teams of the Federal University of the São Francisco’s Valley (HU-Univasf) Methods: Injectable drugs were initially selected, which belong to the HU-Univasf stand-ardization list. Information on the pH of medicines, compatibilities and incompatibili-ties, were extracted from the databases: Lexi-comp® Inc, Micromedex IV Compatibil-ity, Internet website Stabilis and King Guide to Parenteral Admixtures®. This work was carried out in two stages: (1) Creation of a tool to analyze the compatibility of injectable medications used in the hospital in a guide format; (2) Elaboration of the cross-table for quick consultation of the compatibility of the most prevalent medica-tions in the Intensive and Semi-Intensive Care Unit (UCISIN), in the parenteral dos-age form for intravenous administration (IV). Results: The Guide for analysis of Y compatibility in intravenous drug administration for a University Hospital in Petroli-na-Pe, was published with ISBN (International Standard Book Number): 978-85-92656-19-5 and it is available on the HU-Univas institutional website for free ac-cess. This material suited as the basis for the construction of the drug compatibility chart that contains the 50 most distributed items from the pharmacy to UCISIN. From this table, 1,225 pairs of drugs were obtained, of which 36% (N = 444) corresponded to compatible pairs and 20% (N = 241) to incompatible pairs. It should be noted that a higher value of pairs was observed with the indefinite compatibility 44% (N = 540), that is, without data in the consulted literature. Conclusions: It was possible to prepare the Guide for Analysis of Y Compatibility in Intravenous Medication Administra-tion and the HU-Univasf Y-Drug Incompatibility Cross-Table Graph, already availa-ble for the entire team. Therefore, it is expected that these instruments facilitate the access of the multiprofessional team to quality information, expanding the role of the pharmacist in the care of critical patients, improving patient safety in the use of intra-venous medications in the hospital.