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Purpose: The aim of the present study was to determine whether de-escalation guided by blood cultures for patients with a diagnosis of sepsis, severe sepsis or septic shock reduces mortality, and antimicrobial drug resistance (ADR).Methods: A prospective, single-center, cohort study was conducted with adults admitted to the ICU with a diagnosis of sepsis, severe sepsis, or septic shock at a public hospital in Sorocaba, State of São Paulo, Brazil, from January 2013 to December 2013. We excluded patients who had negative blood cultures. Patients who had replaced the initial empirical broad-spectrum antibiotic therapy (EAT) by the antibiotic therapy guided by blood cultures were compared with those who continued receiving EAT. The outcome included mortality and antimicrobial drug resistance. We used the Cox regression (proportional hazards regression) and the Poisson regression to analyze the association between antibiotic therapy guided by blood cultures (ATGBC) and outcomes. The statistical adjustment in all models included the following variables: sex, age, APACHE II (Acute Physiology And Chronic Health Evaluation II) score and SOFA (Sequential Organ Failure Assessment) score.Results: Among the 686 patients who were admitted to the intensive care unit, 91 were included in this study. The mean age of the patients was 52.7 years (standard deviation = 18.5 years) and 70.3% were male. EAT was replaced by ATGBC in 33 patients (36.3%) while 58 patients (63.7%) continued receiving EAT. Overall hospital mortality decreased from 56.9% in patients who received EAT to 48.5% in patients who received ATGBC [Hazard ratio- HR 0.44 (95% CI 0.24–0.82), p = 0.009]. There was no association between ATGBC and ADR [HR 0.90 (95% CI 0.78 – 1.03) p = 0.15].Conclusions: Although the early and appropriate empirical EAT is undoubtedly an important factor prognostic, ATGBC can reduce the mortality in these patients.

Introdução: A frequência de eventos adversos é alta em hospitais e esse contexto embasou a elaboração de metas, cujo cumprimento envolve a farmácia hospitalar (FH). Objetivo: Avaliar a participação da FH na gestão de risco no uso de medicamentos em 15 hospitais públicos do Distrito Federal (Brasil). Método: Estudo transversal cuja coleta de dados foi realizada de maio a novembro de 2016 e envolveu caracterização e hierarquização dos hospitais, avaliação das FH conforme indicadores relacionados à gestão de risco na utilização de medicamentos e cálculo dos percentuais de cumprimento das atividades previstas nos indicadores (variável desfecho) com posterior correlação a variáveis que poderiam influenciar seus resultados por meio de regressão linear. Resultados: A proporção média de apresentação dos itens previstos nos indicadores relacionados à gestão de risco foi de 28,3%. Menos da metade dos leitos ativos tinha dose individualizada como sistema de distribuição de medicamentos. Foram realizadas 48 notificações de farmacovigilância no período. Os parâmetros que influenciaram a variável desfecho foram: programação para capacitação de pessoal, horas de funcionamento da FH com farmacêutico, leitos ativos com dose individualizada e percentual de cumprimento dos serviços farmacêuticos (p < 0,05). Conclusões: Os resultados remetem à necessidade de adequação e monitoramento dos serviços visando intervenções racionais que busquem tornar o processo de utilização de medicamentos mais seguro, perpassando pela implantação de modelos de gestão relacionados à FH.

INTRODUCTION: Despite the therapeutic benefits of drugs, adverse drug reactions (ADRs) occur. Method: We assessed a series of suspected ADRs identified from notifications and intensive monitoring of inpatients from March 2013 to March 2014. RESULTS: Skin reactions predominated (31%). Systemic anti-infective agents were implicated in 16 (72%) reactions. Fifteen (68%) ADRs were classified as possible. The implicated drug was not correctly identified by the healthcare team in 12 cases. CONCLUSIONS: Some reactions were not correctly attributed to the causative drug(s), suggesting that the use of a validated evaluation method can promote successful identification of causal links between ADRs and drugs.

INTRODUCTION: Benznidazole is used for treating Chagas disease (CD). This cross-sectional study aimed to characterize the adverse drug reactions (ADRs) of benznidazole at a public hospital in Brazil’s Federal District. METHODS: Medical records were analyzed and ADRs were categorized by type, intensity, seriousness, and causality. RESULTS: Of the 62 patients who started benznidazole treatment for CD, 41 (66%) presented with 105 ADRs; 23 (37%) discontinued the treatment. Most reactions were classified as probable (81%), severe (63%), serious (67%), and dose-dependent (56%). CONCLUSIONS: The high incidence of ADRs because of treatment withdrawal revealed the need for safer alternatives for CD treatment.

To evaluate pharmaceutical services in public hospital pharmacies of the Federal District Health Department - Brazil (Secretaria de Saúde do Distrito Federal, SES-DF).A cross-sectional evaluative study involving the 15 public hospitals under the SES-DF management. Hospitals were characterized and classified into four hierarchical strata. The pharmaceutical services related to programming (quantity of medication to order), acquisition, storage, distribution, management, selection, information, pharmacotechnical component, pharmacotherapy follow-up, teaching and research were evaluated using validated indicators. Next, algorithms were applied and the approximation percentages of service compliance were calculated, then correlated to variables that could influence their results through linear regression analysis.Only four hospital pharmacies presented good compliance with the evaluated services, three of them belonging to less complex hospitals. Only the storage and management services presented good performance. The variables that most influenced the performance of the services were managerial aspects related to pharmacists and non pharmacists' workload per bed, the existence of a program for human resources qualification, planning goals and targets and a manual of norms and procedures, as well as professional qualification and adequacy of the area in which the services were performed (plt; 0.01).The evaluated hospital pharmacies had average performance for services compared to the ideal and better performance in logistics activities. Pharmaceutical services require constant evaluation for rational interventions that increase the proportion of executed health care activities and local management capacity to make such actions more effective, efficient, qualified and safe in the context of the SES-DF hospital network.Objetivo: Evaluar los servicios farmacéuticos en farmacias públicas de hospitales del Departamento de Salud del Distrito Federal – Brasil (Secretaria de Saúde do Distrito Federal, SES-DF).Método: Estudio transversal evaluativo de los 15 hospitales públicos bajo gestión de la SES-DF. Los hospitales fueron caracterizados y se clasificaron en cuatro estratos jerárquicos. Los servicios de programación, adquisición, almacenamiento, distribución, gestión, selección, información, farmacotécnica, seguimiento farmacoterapéutico, enseñanza y investigación fueron evaluados utilizando indicadores validados. Se aplicaron algoritmos y se calcularon los porcentajes de aproximación del cumplimiento del servicio, que se correlacionaron con variables que podrían influir en los resultados a través de la regresión lineal.Resultados: Solo cuatro farmacias hospitalarias presentaron un buen cumplimiento de los servicios evaluados; tres pertenecientes a hospitales menos complejos. Solo el almacenamiento y la gestión presentaron un buen desempeño. Las variables que más influyeron en el desempeño de los servicios fueron la carga de trabajo de farmacéuticos y no farmacéuticos por cama; la existencia de un programa de cualificación de recursos humanos, objetivos y metas; el manual de normas y procedimientos, y la cualificación profesional y la adecuación del área de ejecución de los servicios (plt; 0,01).Conclusiones: Las farmacias hospitalarias evaluadas presentaron un cumplimiento medio de los servicios en comparación con el ideal y el mejor desempeño de las actividades logísticas. Los servicios farmacéuticos requieren una evaluación constante con vistas a intervenciones racionales que amplíen la ejecución de las actividades asistenciales y la capacidad de gestión local con el objetivo de hacer tales acciones más efectivas, eficientes, cualificadas y seguras.

Secondary successional vegetation represents one-third of the 7% of the original area covered with tropical dry forest that remains in central Veracruz, Mexico. In this region, fallow periods are short, in general, no longer than 7–10 years, and old secondary successional sites are not available. Therefore we evaluated the potential of very early successional stages of tropical dry forest with different land use histories for recovering the structure and composition of regional forest. We compared five early successional sites (7–72 months) with five nearby forest remnants. Successional sites had reached 38 and 30%, respectively, of the average basal area and density recorded for the forest understories, but only 5 and 10%, respectively, of the basal area and density of forest overstories. A total of 132 tree species were recorded, 45 at successional and 107 at forest sites. Individuals of tree species with animal-dispersed seeds (57%) were significantly better represented than wind-dispersed (22%) and self-dispersing (21%) species in both successional and forest sites. Successional sites had already recruited 10% of the intermediate and shade-tolerant species that grow in forest remnants. However, only 20 species occurred in both early successional and forest sites, several showing resprouting ability. We conclude that the entry of forest species to the successional process at very early stages and the recruitment of individuals from resprouting may facilitate the recovery of the dry forest in Veracruz.

Embora no Brasil o número de casos confirmados de febre maculosa esteja em declínio desde 2005, a taxa de mortalidade (20 a 30%) ainda é muito alta quando comparada a outros países. Esse alto índice de mortalidade tem estreita relação com a dificuldade em fazer o diagnóstico e estabelecer a terapia apropriada. Apenas dois grupos de antibióticos têm comprovada eficácia clínica, o cloranfenicol e as tetraciclinas. Até pouco tempo atrás, as tetraciclinas eram reservadas aos pacientes adultos em virtude das alterações dentárias e ósseas em crianças. Recentemente, entretanto, a Academia Americana de Pediatria e diversos autores têm recomendado a utilização da doxiciclina também em crianças. Em casos mais severos, a falta de experiência com uma tetraciclina injetável no Brasil faz com que se opte pelo cloranfenicol injetável. Como o pronto diagnóstico e a escolha adequada do fármaco são fatores determinantes de um prognóstico positivo, todos os profissionais da saúde devem estar melhor preparados para reconhecer e tratar a febre maculosa.Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20% to 30%) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

INTRODUÇÃO: O objetivo deste estudo foi conhecer os padrões de utilização de antibióticos no município de Sorocaba, avaliando o diagnóstico referido, a terapêutica empregada e sua utilização. MÉTODOS: Utilizou-se um instrumento de avaliação aplicado por 12 meses em usuários de antibióticos. Foram coletados dados de 403 usuários e referiram-se à: informações sociodemográficas e de saúde, diagnóstico e terapêutica. RESULTADOS: Encontrou-se grande utilização e a maior utilização prévia na faixa etária de 0-10 anos (p

No Brasil o PBM (Pharmacy Benefits Management) é de utilização relativamente nova, podendo-se classificá-lo como um sistema de gerenciamento de saúde que administra benefícios na compra e venda de medicamentos. Considerando que o surgimento de bactérias resistentes está relacionado à prescrição inapropriada de antibióticos ou ao uso de antibióticos de baixa atividade, este estudo avaliou se o sistema PBM pode fornecer informações úteis sobre os perfis de prescrição e aquisição de antibióticos de efeitos sistêmicos, a partir da base de dados de uma empresa de PBM brasileira, referente a um grupo formado por 6 525 metalúrgicos de uma empresa da região de Campinas, SP, e seus dependentes, cobrindo o período de janeiro a abril de 2005. Observou-se que 7,7% de todos os medicamentos adquiridos eram antibióticos sistêmicos, numa média 2,4 antibióticos e ao custo de R$ 51,80 por receita. A amoxicilina foi o fármaco mais prescrito e em 92,7% dos casos o usuário adquiriu o medicamento até um dia após a consulta médica. A partir das listas das especialidades farmacêuticas adquiridas (por unidade de venda), dos laboratórios fabricantes, dos antibióticos que compunham cada produto, das datas de emissão das receitas e da dispensação, foi possível concluir que o sistema permite extrair informações relevantes sobre o tema enfocado. Pharmacy Benefits Management (PBM), a system that manages benefits in the purchase and sale of drugs, is of relatively recent implementation in Brazil. Taking into account that the development of bacterial resistance is related to the inadequate prescription of antibiotics or to the use of low activity antibiotics, this study sought to assess the capability of PBM to provide useful information on the profiles of prescription and purchase of systemic antibiotics. The data used for this purpose were collected from the database of a Brazilian PBM company and related to a group of 6 525 metalworkers of a company located in the region of Campinas, SP, and to their dependents, covering the period from January to April 2005. Of the drugs purchased, 7.7% were systemic antibiotics, with a mean of 2.4 antibiotics and a mean cost of R$ 51.80 per prescription. Amoxicillin was the most prescribed drug. In 92.7% of cases, users purchased the prescribed drug within one day of the medical visit. Based on the lists of purchased pharmaceutical specialties (per retail package), manufacturers, antibiotics present in the composition of each product, prescription dates, and dispensation dates, the system was found capable of providing relevant information on the theme investigated.

Vários mecanismos foram propostos para reduzir a toxicidade gástrica dos fármacos antiinflamatórios. A complexação com zinco foi proposta considerando-se o fato de que o zinco possui ação protetora sobre a mucosa gástrica. O complexo piroxicam-zinco apresenta atividades antiinflamatória e analgésica semelhantes às do fármaco livre. No entanto, a modificação de propriedades físico-químicas acarretou alteração do perfil cinético do fármaco. A fim de investigar as diferenças farmacocinéticas , o complexo piroxicam-zinco foi estudado quanto à farmacocinética em sangue e linfa de ratos. Estudaram-se também os efeitos do complexo na mucosa gástrica em comparação com o piroxicam livre em modelos de úlcera induzida por ácido acetilsalicílico e por etanol. Estudos cinéticos foram conduzidos em ratos Wistar machos que receberam doses equivalentes de 10 mg/kg de piroxicam ou piroxicam-zinco por via oral através de sonda de polipropileno. O sangue e a linfa dos animais foram coletados em pequenos intervalos por período de 22 horas. O piroxicam foi extraído das amostras, utilizando-se mistura de cicloexano/éter e as determinações quantitativas feitas através de cromatografia líquida de alta eficiência. Além desses ensaios, testou-se a solubilidade do complexo e determinou-se o coeficiente de partição em noctanol-tampão fosfato utilizando o método de \"shake-flask\". Os resultados mostram que o perfil plasmático do complexo piroxicam-zinco é semelhante ao do fármaco livre tanto em sangue quanto em linfa, mostrando, no entanto, absorção mais lenta da forma complexada. Estes dados podem ser explicados pela menor solubilidade do complexo e pela diferença encontrada no coeficiente de partição de piroxicam e piroxicam-zinco. Nos modelos estudados, verificou-se que o piroxicam-zinco não apresenta vantagem sobre a forma livre, no que se refere ao agravamento de úlcera gástrica Several procedures have been proposed for reducing the gastric toxicity of anti-inflammatory drugs. Among them, complexation with zinc has been recommended on the grounds that zinc exerts a protective action on the gastric mucosa. Indeed, zinc-piroxicam complex shows anti-inflammatory and analgesic activities similar to those provided by the free drug. Complexation, however, not only modifies the physico-chemicat properties of the free drug, but also alters its kinetic profile. In order to investigate such differences, the pharmacokinetics of zinc-piroxicam complex was studied in the blood and Iymph of rats. In addition, the effects of this drug complex on the gastric mucosa, as compared to those of free piroxicam, were studied in ASA- and ethanol-induced ulcer models, and through the determination of mucus in the gastric barrier. Kinetic studies were performed in mate Wistar rats receiving equivalent doses (10 mg/kg) of piroxicam or zinc-piroxicam orally by means of a polypropylene probe. Both blood and Iymph samples were collected at intervals during a period of 22 hours. Piroxicam was extracted from the samples employing a mixture of cyclohexane/ether, and determinations were performed through HPLC. Solubility of the drug complex was also assessed, and the partition coefficient was determined in n-octanolphosphate buffer employing the shake-flask method. Results showed the plasmatic profile of zinc-piroxicam complex to be similar to that of the free drug, both in blood and in Iymph, although absorption was slower in the complexed form These results can be explained by low solubility of the zinc-piroxicam and by the differences found for the partition coefficients of piroxicam and zinc-piroxicam. Overall, in the models employed, the use of zinc-piroxicam was not found to be advantageous over that of free piroxicam regarding the aggravation of gastric ulcers

We read with great interest the recently published paper by Santa-Ana-Tellez et al. ([1][1]). In that work, the authors measured the changes in the seasonal variation in penicillin use before and after the restrictions on over-the-counter (OTC) antibiotic sales went into effect in Mexico and Brazil

Establishing an effective antimicrobial therapeutic requires choosing the appropriate antibiotic and ensuring compliance with times and doses prescribed. Problems concerning early abandonment and unfinished prescriptions due to lack of information, as well as more resistant microorganisms, have been identified as the major factors responsible for therapeutic failure in bacterial infections. This study aimed to determine the level of information among antibiotic users undergoing treatment with these drugs, and habits related to other therapies. A survey was applied to 403 users and identified great difficulties in understanding prescriptions, especially among users with no formal schooling who understood only 21 to 28% of the prescribed instructions. This same group reported having received the lowest amount of information during the consultation, with only 28.6% receiving verbal information from the prescriber on the length of course with the drug. Additionally, 21% of this group reported a tendency to use the antibiotic until symptoms resolved, without heeding the length of course prescribed. Guidance on antibiotics use should be an integral and fundamental part of effective therapy.Para se estabelecer uma terapêutica antimicrobiana eficaz, é necessário que se escolha o fármaco adequado e que este seja utilizado na dose e tempo prescritos. Abandonos precoces e o não cumprimento da prescrição, originados por falta de informação adequada, têm sido apontados, juntamente com microrganismos resistentes, como os grandes responsáveis por falhas terapêuticas no tratamento de infecções bacterianas. Este trabalho teve por objetivo conhecer o nível de informação de usuários de antibióticos sobre estes fármacos, tanto na terapêutica a que estavam sendo submetidos, quanto em seus hábitos em outras terapêuticas. Por meio de um questionário aplicado a 403 usuários, notou-se uma grande dificuldade de entendimento da prescrição, especialmente por usuários sem estudo formal, chegando a níveis de entendimento de apenas 21 a 28% das prescrições estabelecidas. Esse mesmo grupo relatou ter recebido a menor quantidade de informações durante a consulta, apenas 28,6% receberam informações verbais do prescritor sobre o tempo que deveriam utilizar o medicamento. Adicionalmente, foi percebido que 21% desse grupo informaram que têm o costume de utilizar o antibiótico até desaparecer os sintomas, sem se preocupar com o tempo prescrito. A orientação para a utilização do medicamento é parte integrante e fundamental de uma terapêutica eficaz.

The vancomycin dose for hemodialysis (HD) patients should be adjusted by monitoring drug serum concentrations. However, this procedure is not available in most health services in Brazil, which usually adopts protocols based on published studies. The trials available are controversial, and several have not been conducted with current dialyzers. This study aimed at assessing the suitability of vancomycin serum concentrations in HD patients at a public hospital. Blood samples of HD patients were collected from November 2006 to May 2007, at time intervals of 48, 96, 120, or 168 hours after vancomycin administration. Drug measurement was performed with polarized light immunofluorescence. Approximately 86% of trough vancomycin serum concentrations were below the recommended value, indicating exposure to subtherapeutic doses and a higher risk for selecting resistant microorganisms. Keywords: vancomycin, chronic renal failure, hemodialysis

The toxicity of a hydroethanol extract of the subterranean part of Cochlospermum regium was evaluated in mice and rats. The extract had moderate acute toxicity when administered intraperitoneally and low toxicity upon oral administration. A subacute toxicity test revealed that the extract is well tolerated by these animals.

Although the number of confirmed cases of spotted fever has been declining in Brazil since 2005, the mortality rate (20% to 30%) is still high in comparison to other countries. This high mortality rate is closely related to the difficulty in making the diagnosis and starting the correct treatment. Only two groups of antibiotics have proven clinical effectiveness against spotted fever: chloramphenicol and tetracyclines. Until recently, the use of tetracyclines was restricted to adults because of the associated bone and tooth changes in children. Recently, however, the American Academy of Pediatrics and various researchers have recommended the use of doxycycline in children. In more severe cases, chloramphenicol injections are often preferred in Brazil because of the lack of experience with injectable tetracycline. Since early diagnosis and the adequate drug treatment are key to a good prognosis, health care professionals must be better prepared to recognize and treat spotted fever.

The aim of this study was to find out about the patterns of antibiotic use in the municipality of Sorocaba, through evaluating the reported diagnosis and the therapy used.An evaluation tool was applied among antibiotic users over a 12-month period. Sociodemographic data and information relating to health, diagnosis and therapeutics were gathered in relation to 403 users.Great present use and the greatest previous use was found in the 0-10 year-old age group (p0.05). Infections with lung involvement were the ones most mentioned (p0.05) and penicillins were the drugs most used, present in 45.1% of the prescriptions. The mean duration of therapy for otitis (8.9 days) was below the recommendation. For sinusitis, 22% of the prescriptions did not give guidance regarding recommended use (10 days).The lack and/or nonuse of therapeutic protocols resulted in great differences in prescription patterns, thereby leading to therapeutic failure and recurrence of infections, which were situations frequently found in this study.

Uma transfusão de sangue com o tipo ABO incorreto pode resultar na morte do paciente, com reação hemolítica intravascular, seguida de alterações imunológicas e bioquímicas. Considerando a pequena quantidade de estudos sobre as hemolisinas anti-A e anti-B e a importância desses anticorpos na prática transfusional, o objetivo deste trabalho foi verificar a frequência dessas hemolisinas e a associação a fatores como etnia e gênero em doadores de sangue dos bancos de sangue dos municípios de Itapeva e de Ourinhos, no interior do estado de São Paulo. Foram analisadas todas as amostras de doadores tipo O cadastradas nos bancos de sangue, com elevado nível plasmático de hemolisinas (doadores considerados perigosos). Coletaram-se os dados relativos à frequência das hemolisinas, etnia, gênero e procedência destes doadores. A frequência de doadores de sangue do grupo sanguíneo O perigosos é de 1,2% em Itapeva e de 5,3% em Ourinhos. Na cidade de Ourinhos, o risco de um doador branco ter hemolisina positiva é 2,16 vezes maior do que para outros doadores, e na cidade de Itapeva notou-se que o risco é menor para brancos do que para outros doadores. Em relação ao gênero, em Ourinhos o risco de um doador ter hemolisina positiva é 1,82 vezes maior para o gênero masculino, e na cidade de Itapeva, o risco foi maior para doadores do gênero feminino. A relação entre o gênero, a etnia e a frequência de hemolisinas foi diferente nas duas cidades. Mesmo assim, destaca-se a importância dos bancos de sangue estarem atentos às características de prevalência deste tipo de doador. Blood transfusion using unmatched ABO blood types can result in patient death due to intravascular hemolytic reactions followed by immunological and biochemical changes. Considering the small number of studies on anti-A and anti-B hemolysins and the relevance of these antibodies in the transfusional practice, this work aimed at assessing the frequency of these hemolysins and their relationship to factors such as ethnic background and gender in blood donors of blood banks located in Itapeva and Ourinhos, São Paulo State, Brazil. All samples from type O donors recorded in these two blood banks with high serum levels of hemolysins (donations considered high-risk) were analyzed. Data related to hemolysin frequencies, ethnicity, gender and origin of blood donors were collected. The frequency of donors belonging to the high-risk O blood group was 1.2% in Itapeva and 5.3% in Ourinhos. In Ourinhos the risk of a Caucasian donor being positive for hemolysin is 2.16 times higher than other ethnic groups and in Itapeva, it was observed that the risk is lower for Caucasians than other ethnic groups. Regarding the gender, in Ourinhos the risk of a donor being positive to hemolysin is 1.82 times greater in men and in Itapeva the risk is higher in women. The ratios of gender and ethnic background in respect to frequency were different between the two regions. Thus it is important for blood banks to be aware of regional variations.