FARMACIA HOSPITALARIA最新文献

The management of pain, agitation/sedation and delirium is a fundamental part of the treatment received by patients admitted to Intensive Care Units (ICU). The use of different strategies for the prevention and treatment of pain, agitation and delirium is one of the bases in the management of these patients. Knowledge of the different techniques for monitoring pain and delirium, pharmacokinetic behavior and the dosage used in this population, as well as the adverse effects and their management, is essential in order to provide optimal pharmacotherapeutic validation by the ICU clinical pharmacist.

Introduction: Inhaled antibiotics are used in the treatment of various respiratory diseases, including cystic fibrosis (CF), non-CF bronchiectasis, and ventilator-associated pneumonia. While some of these drugs are marketed as ready-to-use formulations, others require prior manipulation, such as dilution or reconstitution procedures that are often not standardized. Furthermore, certain antibiotics are only approved for intravenous administration, making it necessary to develop specific protocols for their preparation and use via the inhaled route. Their biochemical properties may also compromise patient safety and tolerability. The aim of this study was to assess how frequently preparation methods and biochemical parameters of inhaled antibiotic solutions are described in the scientific literature. Additionally, we explored their prevalence of use in our country and evaluated their biochemical characteristics to assess tolerability.

Methods: A literature review was conducted using the MEDLINE database to identify studies describing the dilutions used for the administration of inhaled antibiotics. In addition, a nationwide survey was carried out to assess the dilutions currently used in hospital clinical practice. Biochemical analyses were performed in parallel to determine the pH, osmolality, and sodium and chloride ion concentrations of the solutions employed. Excipients present in each formulation were recorded based on information from the product's summary of characteristics.

Results: The literature review identified 533 full-text publications describing 737 different inhaled antibiotic mixtures. Of these, 476 were not standardized. Only 190 mixtures included precise dilution instructions, while just 31 provided data on pH and 28 on osmolality. The national survey revealed a high prevalence of inhaled antibiotic use among participating hospitals, with 22 centres (64.7%) reporting the use of intravenous formulations administered via inhalation. Laboratory analyses showed that some of the evaluated dilutions fell outside the acceptable tolerability range, particularly those involving reconstitution of dry powders or dilution of concentrated intravenous solutions.

Conclusion: There is limited information in the scientific literature regarding preparation methods and the biochemical characteristics of inhaled antibiotic solutions. Off-label use of intravenous formulations for inhalation is widespread, and some of the dilutions used exhibit biochemical parameters outside the recommended tolerability range, which may compromise both the safety and effectiveness of treatment.

Objective: Review the most relevant aspects to consider when selecting the optimal surface disinfectant for use in healthcare settings.

Method: The review was conducted over a three-month period (January to March 2024) based on the list of healthcare surface disinfectants authorized by the Spanish Agency of Medicines and Medical Devices and those in a transitional period, with marketing allowed until their registration in the Official Biocide Register. Biocidal agents belonging to the categories of skin antiseptics and insect repellents were excluded. A total of 100 biocidal agents were selected and evenly distributed among four researchers. The review strategy involved consulting the marketing representatives of these products via email or by reviewing their technical datasheets on their respective websites. The reviewed aspects of each disinfectant included marketed presentations, declared efficacy, composition, indication, dosage, and usage instructions.

Results: The total number of biocidal agents included in the study was 85. A total of 29 suppliers were consulted, covering 141 marketed presentations, 25 (29.41%) of which were sterile. Regarding the efficacy declared by suppliers, 100% (85 products) showed bactericidal activity, 81.18% (69) fungicidal activity, 78.82% (67) virucidal activity, 50.59% (43) yeasticidal activity, 20% (17) mycobactericidal/tuberculocidal activity, and 17.65% (15) sporicidal activity. In terms of usage instructions, 40 of the 85 biocides (47.06%) were presented in a ready-to-use dosage format, and 34 (40%) allowed for cleaning and disinfection in a single step. A total of 14 biocides (16.47%) included airborne disinfection options.

Conclusions: Selecting the most appropriate surface disinfectant is not straightforward, given the wide range of marketed products, the number of factors to consider, and the fact that not all products meet every criterion. For this reason, the selection process must be accompanied by the implementation of optimized programs aimed at reducing the transmission of pathogens from surfaces to patients and healthcare personnel.