European journal of hospital pharmacy : science and practice最新文献

Linezolid is an antibiotic of the oxazolidinone class which is highly effective in the treatment of serious Gram-positive infections. It is usually well tolerated, but rare adverse reactions like angioedema have been reported. This case report investigates the occurrence of eyelid angioedema induced by linezolid. The patient, a man in his early 70s with sepsis and cellulitis caused by Streptococcus pyogenes, developed bilateral eyelid angioedema after receiving a second dose of linezolid. The drug was discontinued and supportive treatment with methylprednisolone and azelastine eye drops resolved the symptoms within 72 hours. The temporal link between drug administration and eyelid oedema supports linezolid as the likely trigger, confirmed by the Karch-Lasagna and Naranjo algorithms.

Objective: To explore the medication-related knowledge, behaviours and support needs of children and young people (YP) aged 11-16 years with long-term conditions as they prepare to transition from paediatric to adult healthcare services.

Methods: This exploratory cross-sectional study was co-designed with YP living with chronic conditions, conducted at a district general hospital in Northwest London between April and September 2023. Participants were those aged 11-16 years admitted to the paediatric ward with long-term conditions requiring regular medication. YP self-completed a questionnaire on medication-related aspects of transition, including knowledge of medication names, dosages, reordering, side effects, adherence and their ability to manage medications independently.

Results: Of 41 eligible YP, 30 completed the questionnaire (73% response rate). Most knew the names and dosages of their medications (24/30) and why they were prescribed (25/30). However, only half (15) knew how their medicines worked, and fewer (10) were aware of potential side effects. Just 12 participants knew how to reorder their medication. Fifteen reported missing doses, mostly due to forgetfulness. Most relied on parents or carers to manage medicines (23), with only four managing independently. YP reported healthcare professionals (17) and family (19) as their main sources of medication information.

Conclusions: This study suggests that while YP often have good foundational medication knowledge, many lack the deeper understanding and practical skills required for independent self-management. Knowledge of side effects, reordering processes and shared decision-making was limited, areas which could undermine transition readiness if unaddressed. Pharmacists, working as part of the multidisciplinary team, are well placed to support YP through targeted, age-appropriate education and regular review.

Pemphigoid gestationis (PG) is a very rare autoimmune disorder that typically occurs during the second and third trimesters of pregnancy. It is characterised by intense pruritus, erythematous plaques and vesicles, primarily affecting the abdomen and extremities. The exact cause remains unclear, but type 2 inflammation and antibodies against the collagen protein BP180 are implicated. Diagnosis is confirmed through clinical findings and specific tests. Traditional treatments include topical and systemic corticosteroids, but they can have significant side effects.This case report discusses a 38-year-old woman with PG in her second pregnancy, who experienced the disorder in her first pregnancy with severe symptoms and was treated with corticosteroids and intravenous immunoglobulins but developed serious side effects. In her current pregnancy, dupilumab was introduced at week 30 (off-label use), leading to significant symptom improvement within a week.This case supports the potential of dupilumab as a first-line treatment for severe PG, demonstrating safety and efficacy for both mother and baby.

A woman in her 30s diagnosed with high-grade soft tissue sarcoma with pulmonary metastases began treatment with ifosfamide-epirubicin, netupitant/palonosetron and dexamethasone. Shortly after, she developed dizziness and dysarthria, raising suspicion of ifosfamide-induced encephalopathy. Ifosfamide was immediately discontinued before the first dose was completed, and treatment with methylene blue was initiated the following day as the clinical condition continued to worsen. Due to her clinical condition, she was transferred to the intensive care unit, where she was started on thiamine and dexmedetomidine combined with methylene blue. Three days later, her neurological status improved, allowing methylene blue and thiamine to be discontinued. Several publications have reported cases of ifosfamide-related encephalopathy in patients receiving concomitant aprepitant, a CYP3A4 substrate and inhibitor that may increase the levels of ifosfamide's toxic metabolites. However, no cases of ifosfamide-induced encephalopathy have been reported with the use of netupitant/palonosetron for antiemetic prophylaxis. In light of our patient's condition, it is possible that the concomitant use of ifosfamide and netupitant/palonosetron contributed to an earlier onset and increased severity of ifosfamide-related neurotoxicity.

Objectives: To evaluate the impact of clinical pharmacist-led antibiotic stewardship on enhancing the rational use of antibiotics in a geriatric-heavy neurology ward.

Methods: A retrospective analysis was conducted on all antibiotic-treated hospitalised cases during the study period, with a total of 123 patients. The study employed a consecutive enrolment design. Of these, 62 cases were managed under a pharmacist-led antibiotic stewardship programme as the intervention group, while the remaining 61 cases served as controls. Primary outcomes included hospitalisation stays, hospitalisation costs, antibiotic consumption, the duration of antibiotic use and the efficacy of antibiotic therapy.

Results: The intervention group exhibited a lower number of defined daily doses (DDDs) per patient between their stay compared with the control group (13.18±1.25 DDDs vs 20.03±2.15 DDDs, p=0.007). Moreover, the duration of single antibiotic treatment was notably reduced in the intervention group (10.40±0.75 days vs 13.16±1.16 days, p=0.047), as was the duration of the single longest empirical therapy with broad-spectrum antibiotics (6.77±0.55 days vs 10.29±1.15 days, p=0.007).

Conclusions: Pharmacist-led antibiotic stewardship effectively optimised antibiotic use in geriatric neurology patients, reducing unnecessary broad-spectrum antibiotic exposure and improving treatment efficiency.