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The current morbimortality of serious infections is unacceptable and there is a need to promote the increase in the efficacy of empirical and targeted antibiotherapy. This could be achieved by initiatives coming from ASP teams aimed at promoting increased efficacy of antibiotic therapy .In the optimization of the antibiotic therapy there are several critical points in which an adequate timing could achieve benefits in the survival of patients with severe infections: prompt initiation of empirical treatment; de-escalation performance, appropriate targeted treatment; and finally, curtail antibiotic duration.

Background The current treatment for psoriasis depends on the severity of the disease, in mild disease topical therapies alone, and with increasing disease severity in combination with phototherapy and/or traditional systemic therapy (methotrexate, cyclosporine, acitretin) or biologics agents. Apremilast is a selective inhibitor of phosphodiesterase 4, able to down-regulate the inflammatory associated with psoriasis. An oral option for treating chronic moderate/severe plaque psoriasis (PP) in adults whose disease has not responded to other therapies or are contraindicated/not tolerated. Purpose To report the hospital cases of moderate/severe PP treated with apremilast, describing patients’ profile and analysing the efficacy and safety of apremilast. Material and methods A retrospective case series. We reviewed the clinical history of the patients with moderate/severe PP treated with apremilast until August 2018. To assess the severity of the disease: Psoriasis Area and Severity Index (PASI) or% of body surface area (BSA). Moderate disease: PASI≥10 or 5%–10% of BSA; severe disease: PASI>20 or BSA >10%. Adequate response to treatment: 90%, 75% or 50% reduction (improvement) from baseline in PASI score (PASI90, PASI75 or PASI50) at 16 weeks. We investigated previous treatments from the beginning of the disease, analysed the efficacy of apremilast collecting the PASI or BSA scores at the beginning, after 16 and 32 weeks, and collected the adverse events during the treatment. Results Eighteen patients, 83% men, mean age 52 (±12) years. Three patients suffered PP and psoriatic arthritis. Previous treatment: 83% (15) topical therapies and 17% (three) phototherapy. Sixty-seven per cent (12) had received prior systemic therapy with conventional agents and 17% (three) biologic agents. At the start of apremilast: five patients suffered severe disease, nine moderate disease and one without data. Three patients were unmeasurable because of the recent start of apremilast. Sixty per cent (nine) of patients achieved PASI75/PASI90 from baseline at week 16, thirty-three per cent (five) PASI50% and 7% (one) without improvement. Maintenance improvement at week 32 (21% without data): 64%. During treatment six gastrointestinal adverse events, one atrial fibrillation and two cholesterol increased. Conclusion Almost all patients had received prior systemic therapy with conventional agents and/or biologics. The use of premilast has some advantages including oral administration, being well tolerated and with a safer profile. It will likely be of value to these patients and those who may not be candidates for biologics. References and/or acknowledgements No conflict of interest.

Background Nephrogenic diabetes insipidus (NDI) results from the inability of the late distal tubules and collecting ducts to respond to vasopressin. The lack of ability to concentrate urine results in polyuria and polidipsia. NDI is almost always drug-induced, however, there are other causes such as electrolyte abnormalities. Purpose To describe a case of NDI associated with the high-dose and long-term use of liposomal Amphotericin B. Material and methods Data were obtained from electronic medical records. Bibliographic research was conducted to find similar cases. The Nnaranjo algorithm was used to estimate the probability of adverse drug reactions. Results A 39-year-old man diagnosed with diffuse large B-cell non-Hodgkin lymphoma underwent an allogeneic bone marrow transplant. After 2 months, disease progression was detected, and immunosuppressive treatment was withdrawn and rescue treatment initiated. One month later, the patient was diagnosed with graft-versus-host disease grade III (GVHD). Immunosuppressive therapy was started with cyclosporine, micophenolate, sirolimus, methylprednisolone, and oral and rectal beclametasone. Additionally, meropenem, acyclovir, levofloxacine, cotrimoxazole and caspofungine were used as antimicrobial prophylaxis. During hospitalisation, the patient developed invasive pulmonary aspergillosis with isolations of Aspergillus fumigatus and Aspergillus flavus. The patient was treated with liposomal amphotericin B 6 mg/kg (440 mg) for 41 days with a cumulative dose reaching 18.04 g. Voriconazol and Posaconazol were discarded because of concomitant treatment with sirolimus and parenteral nutrition respectively. On day 5, the serum potassium level began to decrease achieving 6 litr/day. The patient was transferred to the medical intensive care unit and treated with vigorous potassium administration. NDI was diagnosed and treated with desmopressin 10 mcg/12 hour nasal drops, hydrochlorothiazide 50 mg/24 hour and spironolactone 50 mg/24 hour. According to the Naranjo algorithm, this event would be classified as a possible reaction because of the temporal correlation between NDI and treatment with liposomal Amphotericin B. Several cases were reported related to NDI induced by Amphotericin B,1 2 regardless of formulation. Conclusion It is very important to understand the etiology and symptoms related with nephrotoxicity and NDI. The association of other nephrotoxic drugs and persistent hypokalaemia also contributed to this event.Specific intervention is required to prevent nephrotoxicity in patients receiving Amphotericin B. References and/or acknowledgements 1. Metzger NL, Gill KLV. Nephrogenic diabetes insipidus induced by two amphotericin B liposomal formulations. Pharmacotherapy2009;29:613–20. 2. Canada TW, Weavind LM, Augustin KM. Possible liposomal amphotericinb-induced nephrogenic diabetes insipidus. Ann Pharmacother2003;37:70–3. No conflict of interest.

Background Vancomycin is a glycopeptide antibiotic active against gram-positive bacteria. Vancomycin pharmacokinetic parameters can vary widely among individuals. Drug monitoring is recommended if the duration of therapy is expected to be more than 72 hours or for patients receiving other nephrotoxic drugs, obese patients, patients with unstable renal function, central nervous system infections, endocarditis, sepsis etc. Purpose The purpose of this study was to implement the monitoring of vancomycin in specific services. Material and methods A prospective quasi-experimental study during 9 months (1 October 2015 and 30 June 2016) was carried out in a tertiary-care university hospital. Traumatology and rehabilitation, neurosurgery, neurology, and plastic and maxillofacial surgery services were included. Daily, vancomycin prescriptions were selected from electronic records. The interventions were performed by a pharmacist responsible for monitoring. The variables analysed were:type of infection, request for serum vancomycin concentration, number of determinations per patient, rate of administration of loading dose, number of patients who developed an increase of 0.5 mg/L of serum creatinine after starting treatment with vancomycin. The dose adjustment was performed through the Abottbase PKSystem (PKS) program. The optimal trough concentrations were considered as 15 to 20 mg/L. The first measuring was realised before the 4th to 5th dose and every 48 to 72 hours after every change. To achieve this range, monitoring was performed weekly along with serum creatinine levels. The local guideline recommends the administration of 1 g every 12 hours of vancomycin. Results A total of 254 patients were enrolled int the study: 137 (53.9%) were male. The median age was 59 (IQR, 47–72) years, weight 78 (IQR, 69–85) kg. Baseline serum creatinine 0.7 (IQR, 0.64–0.82) mg/L. One hundred and thirty-three patients (52.4%) had osteoarticular infections, 43 (17%) skin and soft tissues infections, 23 (9.1%) central nervous system infections and 55 (21.5%) other infections. 199/254 (78.3%) patients were requested for microbiological cultures and in 95/199 (47.7%) were isolated gram-positive bacteria. In 211 (83.1%) patients the vancomicyn was prescribed as 1 g every 12 hours without considering weight. The loading dose was administered in 28 (11.0%) patients. The median duration of the treatment was 6 days (IQR, 4–9). Vancomycin was monitored in 128 (50.4%) patients. The therapeutic range was achieved in 69/128 (53.9%) patients. The median number of determinations per patient was 1 (IQR, 0–1). Three (1.2%)patients developed nephrotoxicity. The number of recommendations made by a pharmacist for dose adjustment were 73 (28.7%). Conclusion In conclusion, the implementation of monitoring had a favourable uptake. The standard dosage of vancomycin is not enough to achieve the therapeutic range. Loading dosage and patient weight should be considered. No conflict of interest

Background The emergence of highly-resistant gram-negative bacteria, in particular acinetobacter baumanii pseudomonas aeruginosa, and carbapenem-resistant klebsiella species has been associated with high rates of morbidity and mortality. Therapeutic options for these pathogens are limited. Because of the lack of newer antimicrobial agents, colistimethate sodium (CMS) has been recently reused for the treatment of infections caused by this microorganism. Purpose The study aimed to assess CMS prescriptions and analyse the occurrence of nephrotoxicity after CMS administration. Material and methods A retrospective observational study was performed at a tertiary-care university hospital between 1 January 2016 and 31 July 2017 including every patient who had received intravenous CMS for at least 48 hours. Clinical data were obtained from electronic medical records. Only one treatment per patient was considered in the analysis. The following variables were collected: patient characteristics, site of infection, type of microorganism, daily dosage and duration of CMS used and concomitant antimicrobial treatment, and laboratory data: serum creatinine (at day 1 and during the therapy), albumin, haemoglobin and leukocytes. Nephrotoxicity was defined as at least two consecutive serum creatinine measurements with an increase of 0.5 mg/dl from the baseline after 2 or more days of CMS therapy. Results A total of 75 patients received CMS therapy, 53 (70.7%) were male. The median age of the patients was 69 (IQR, 57–79) years, Charlson index 2 (1–3)and eGFR (CKD-EPI) was 91. 1 (IQR, 78.9–113.2) ml/min/1.73 m 2 . Nephrotoxicity developed in 35 (46.7%) patients. The median onset time for nephrotoxicity was 7 days (IQR, 3–12). Patients with nephrotoxicity were older than those without it (74 years vs 64 years, p=0.025) and had lower median serum albumin and haemoglobin levels 2.9 vs 3.1 (p=0.501) and 9.4 vs 10.1 (p=0.069) respectively. The median daily dose of CMS was 9 MU, the loading dose was administered in 25 (33.3%) patients. In 24 patients (32.0%) the dosage was adjusted according to eGFR. The median duration of treatment was 10 (IQR, 6–15) days. Bloodstream infections occurred in 19 (25.3%) patients. Principal infectious sources were: respiratory (38.7%), urinary (25.3%) and skin and soft tissue (17.3%). Pathogens were A. baumanii 73.3%, P. aeruginosa 17.3% and carbapenem-resistant enterobacteriaceae 10.7%. In 41 patients (54.7%) CMS was administered in combination therapy. Causes for the end of treatment were clinical resolution (56.0%), change to other (13.3%), toxicity (13.4%) and death (17.3%). Conclusion In conclusion, very low rates of adjustment of the dosage by eGFR were observed. Almost half of the patients developed nephrotoxicity due to the CMS therapy, which was significantly associated with the age of patients. No conflict of interest

Background Dalbavancin (DBV) is an antibiotic from the lipoglycopeptide family that is active against Gram +cocci (GPC) that reaches adequate concentrations to allow dosing once a week. It is currently only approved for skin and soft tissue infections, although its PK/PD properties could allow a potential use for infectious endocarditis (IE) and/or bloodstream infections caused by GPC. The estimated duration of bloodstream infections is 10 to 14 days and 28 to 42 days for IE, both requiring intravenous treatments and prolongued hospital stay, all of which entails a high use of hospital and economic resources. Purpose The purpose of this study was to evaluate the economic impact of switching to dalbavancin from standard antibiotic treatment Material and methods Observational,restrospective,single-centre study. All patients with IE and/or bloodstream infections caused by GPC who had received at least one dose of DBV were included. The proportion of patients presenting clinical resolution was calculated, as well as the reduction in days of hospital stay and associated costs. For the estimate of reduction of costs, public prices provided by the health system were used. Results Thirty patients were included: 22 (73.3%) were males,with a median age of 66 (IQR 47.5–75.5),Charlson Index 1 (IQR 1–3). Twenty-two patients (73.3%) had IE and 8 (26.7%) had a bloodstream infection. The isolated microbiological agent was coagulase-negative staphyloccoci in 46.7% of patients; 13.3% streptococus spp, 10% enterococcus spp; and 10% SAMS y 3.3% SAMR. The reason for administering DBV was: 83.3% early discharge, 10% failure of previous treatment and 6.6% toxicity. The median length of stay was 27 (IQR 18–38) days. The initial dose of DBV was 1500 mg in 21 (70%) patients;1000 mg in eight (26.7%) patients and in one patient the dose was 750 mg adjusted for renal function. Four patients (13.3%) received an extra dose of 1000 mg on day 14. 73.3% of patients had previously received treatment with daptomycin, and 24 (80%) presented clinical resolution at the time of the analysis. Hospital stay was reduced in 24 (80%) patients by a median of 11 days (IQR 1–14), leading to average savings of €6830.96 per patient. The average cost of treatment with dalbavancin was €1341.9 compared to €1475.63 for 14 days of treatment with daptomycin (€133.73). Conclusion In conclusion, the administration of DBV for patients with a positive clinical evolution could be an effective alternative treatment, with an important reduction in health costs. No conflict of interest

Background The Antimicrobial Stewardship Programme promotes strategies to improve antibiotic prescriptions, optimise clinical outcomes, minimise costs and avoid adverse effects. It is also recommended for the prevention and decrease in the appearance of emerging resistant bacteria. One of the goals of this programme is therapy de-escalation with broad spectrum antibiotics. Purpose To analyse carbapenem prescriptions and de-escalation therapy in intra-abdominal infections, and determine the impact of de-escalation on hospital stay and inhospital mortality. Material and methods This prospective observational study of carbapenem prescriptions and de-escalation performance was conducted in a third level hospital between 1 August 2013 and 31 July 2014. Data were gathered on the number of carbapenem prescriptions and patients characteristics, carbapenem treatment duration, culture requests, de-escalation performance, length of hospital stay and mortality rate. The oncology–haematology, traumatology, neurosurgery and neurology departments were excluded. Results 489 prescriptions for 437 patients were recorded during this period. Mean age of patients was 65.3 years; 57.7% were men. The median Charlson Index score was 4 (2–6). 76.5% of inpatients were from the surgical department and 7.6% had sepsis. 78.9% of prescriptions were for monotherapy. 64.4% of carbapenems were prescribed as firstline therapy and 35.6% as rescue therapy. 68.9% of microbiological cultures were requested and 50.4% were positive. The most prescribed carbapenems were ertapenem (44.4%) and imipenem (30.7%). De-escalation was performed in 31.9% of cases, and 53.6% in the presence of positives cultures versus 46.4% of negative cultures(p=0.418). Median duration of carbapenem therapy was 6 (4–9) days, 5 days in the de-escalation group versus 6 days in the no de-escalation group(p=0.006). Length of hospital stay was 10 (6–20) days, 10 days in de-escalation group versus 12 days in non-de-escalation group (p=0.052). Total inhospital mortality was 10.8%; in de-escalation group 4.7% versus 13.9% in the non-de-escalation group(p=0.003). Conclusion The de-escalation of carbapenem therapy reduces patient mortality, exposure to carbapenems treatment and length of hospital stay. No conflict of interest

The incidence and mortality rates of severe infections are still very high. Moreover, the growing threat of bacterial resistance and the progressive reduction of research into new antibiotics, overshadows the future of the fight against infections. We need to preserve the effectiveness of available antibiotics. This can only be achieved if we minimize the development of bacterial resistance. We have sufficient evidence to show that reducing the duration of antibiotic treatment can minimize the potential development of bacterial resistance, without worsening the prognosis of infections. So, we think that the proposal to shorten the antibiotic treatment should become a key element of our antibiotic stewardship programs.

Background Nowadays, Clostridium difficile infection (CDI) is the leading cause of nosocomial diarrhoea in industrialised countries and the incidence is increasing. Purpose To examine whether fidaxomicin prescribing was following the Pharmacy Committee criteria. Material and methods This was a retrospective observational study carried out over one year. Fidaxomicin prescribing was considered appropriate in the following cases: when the first recurrence had previously been treated with vancomycin and there was a high risk of recurrence (considered in the presence of at least two of these factors: age >65 years, serious underlying disease, concomitant use of antimicrobials) and if the recurrence was severe (10 or more loose stools or fever >38.5°C or leukocyte count >15,000/mm 3 or a rise in serum creatinine >1.5 times above the baseline) and if it had a clinical impact (the persistence of the disarrhoea endangered the health of the patient worsening the underlying disease and/or increasing the length of hospital stay); in second or subsequent recurrences after considering the risk or severity of recurrences and their clinical impact. Results A total of eight prescriptions were written for six patients. 25% did not comply with the approved criteria. The median age was 53 years (range: 41–83). When prescriptions were appropriate (75%), all cases presented severe underlying disease and a recurrence with clinical impact; 66.7% were prescribed as treatment for first recurrence and 75% of the patients were already receiving antimicrobial treatment. Regarding the severity of the recurrence, leucocytosis was found in 50% of cases, ten or more loose stools in 25% of cases and a rise of serum creatinine in 25%. 12.5% of patients had recurrences after being treated with fidaxomicin. 87.5% of these prescriptions were supervised by the Infectious Disease Unit (IDU). Conclusion Since fidaxomicin has been introduced into the hospital, there have been few prescriptions for this drug. Most prescriptions were appropriately and accurately prescribed under IDU supervision. References and/or acknowledgements No conflict of interest.

Background The implementation of an Antimicrobial Stewardship Program (ASP) in our hospital has attempted to streamline the use of antibiotics. Within this program, pharmacist interventions have been introduced on the de-escalation of antimicrobial treatment and on the adjustment of duration of treatment. Purpose To analyse ertapenem prescriptions since establishing pharmacist interventions in a tertiary university hospital. Material and methods This was a retrospective study where we compared ertapenem prescriptions dispensed between March and May 2012 with the prescriptions dispensed in the same period in 2014. We analysed the following variables: number of prescriptions, request for microbiological cultures, duration of treatment, indication and de-escalation performed. The Oncology-Haematology, Orthopaedics and Trauma, Neurosurgery and Neurology, Paediatrics and Gynaecology departments were excluded. To measure and compare the drug consumption, we used the Daily Defined Doses (DDD) per 100 stays. Results In 2012, there were 167 prescriptions for ertapenem, while in 2014, this figure was110. Microbiological cultures were requested in 64% of cases in 2012 and in 68% in 2014. The mean duration of treatment was 5 days in 2012 and 4 days in 2014. In 2012, ertapenem treatment was interrupted because of discharge from hospital (39.5%), escalation or replacement with other antibiotic with similar spectrum of coverage 37.1% and de-escalation (18.6%); in 2014, these percentages were 37.5%, 27.9% and 29.1% respectively. In 2012, ertapenem was most commonly prescribed for intra-abdominal infections (45.0%), skin and soft tissues infections (21.6%) and respiratory infections (19.0%); whereas in 2014, it was prescribed for intra-abdominal (46%), urinary (20%) and respiratory (18.5%) infections. The DDD per 100 stays in 2012 was 2.9 and in 2014 was 1.5 Conclusion Since the launch of ASP, we have observed that the consumption of ertapenem has decreased significantly. The duration of treatment is also shorter thanks to the system for de-escalation. Still, more microbiological tests need to be requested References and/or acknowledgements No conflict of interest.

Background Antimicrobial stewardship includes a de-escalation strategy for antimicrobial treatment. Treatment of urinary tract infections (UTI) offers a good opportunity to de-escalate antimicrobial treatment. Purpose To evaluate the prescription of carbapenems for complicated UTIs in patients requiring hospitalisation and to measure the frequency with which de-escalation was performed. Materials and methods A retrospective three-month study (March to June 2012) in a tertiary university hospital, of inpatients empirically treated with carbapenems for UTIs. The variables analysed were: number of patients prescribed carbapenems for UTI, requests for urinary cultures, analytical data such as leukocytes and C-reactive protein (CRP) at hospital admission, microorganisms isolated, duration of treatment, length of hospital stay and de-escalation performed. The Oncology-Haematology, Orthopaedics &Trauma, Neurosurgery and Neurology departments were excluded. De-escalation was defined as the replacement of the empirical carbapenem treatment by an antibiotic with a narrower spectrum. Results A total of 433 prescriptions with carbapenems were recorded over these months, 52 (12%) for UTIs. The mean age was 73.5 ± 12.79 years and sex ratio: 60% Female. The most prescribed carbapenems were ertapenem (36.5%) and meropenem (30.8%). Out of a total of 27 requests for a urinary culture and sensitivity testing for carbapenem prescriptions for UTI, 17 (62.9%) were positive. The average length of treatment with carbapenems was 5 ± 2.28 days, 42% of carbapenem prescriptions were suspended due to decisions to change the antibiotic treatment (including de-escalation), 46% were discharged and 12% died. The most common pathogen isolated was Escherichia coli (70.5%), 75% of which were sensitive to amoxicillin-clavulanic acid and 96% to fosfomycin. Less common were Pseudomonas aeruginosa (8.3%) and Enterobacter cloacae (8.3%). Total treatments subject to de-escalation represented 66.6% (18/27). Conclusions The rate of carbapenem prescriptions for UTI was low. Meropenem and ertapenem were the most prescribed. De-escalations was undertaken in a high proportion. Based on these data, more requests need to be made for microbiological tests. No conflict of interest.

Background Boceprevir (BOC) and telaprevir (TLV) have been approved recently for the treatment of chronic hepatitis C virus (HCV) infection but their safety remains to be studied. Purpose To analyse the incidence of adverse events (AEs) in patients treated with BOC and TLV according to their previous response to treatment with interferon and ribavirin. Materials and methods Retrospective, observational, multicentre study. Adverse events (AEs) and analytical data were collected from pharmacotherapeutic records of patients who started treatment with TLV or BOC between January 2012 and January 2013. Anaemia was defined as haemoglobin 3 /mm 3 and thrombocytopenia: platelet count 3 . The variables were: previous response to treatment: treatment-naive (N), non-responder (NR) or patient who had a relapse (R), age, sex, FibroScan, nadir haemoglobin, neutrophil count, platelet count, presence of rash and anorectal discomfort. The number of patients requiring erythropoietin (EPO) and filgrastim were recorded. Results 78 patients were investigated, the mean age was 50.9 years and 21 were women. Mean FibroScan value was 18.2 kPa. Patients: N = 19; (24.3%), NR = 29 (37.2%) and R = 30 (38.5%). The incidence of AEs were: a) hematologic: anaemia 47.4% (N), 55.5% (NR) and 60% (R); thrombocytopenia: 31.6% (N), 69% (NR) and 40% (R) and neutropenia: 5.3% (N), 34.5% (NR) and 20% (R). b) Dermatologic: pruritus 15.8% (N), 31% (NR) and 40% (R); rash: 31.6% (N), 17.2 (NR) and 10% (R) and anorectal discomfort: 0% (N), 17.2% (NR) and 40% (R). The percentage of patients requiring EPO: N = 26.3%, NR = 20.7% and 6.7% (R). Filgrastim was only used in four NR. Conclusions Haematological AEs: R patients showed a higher incidence of anaemia, conversely EPO was used in 26.3% of N patients indicating more severe anaemias. Neutropenia and thrombocytopenia were more frequent in NR. Dermatological AEs: Pruritus and anorectal discomfort were more common in R patients, nevertheless rash was more frequent in N patients. No conflict of interest.

Background Current recommendations for the management of pneumonia promote two important measures to optimise antibiotic treatment: start sequential treatment early and do not extend antibiotic treatment more than five days in community-acquired pneumonia and eight days in pneumonia related to healthcare. Purpose To analyse the duration of levofloxacin and moxifloxacin treatment in pneumonia and to evaluate the use of sequential treatment. Materials and methods A cross-sectional observational study was performed including all patients admitted for pneumonia to the Pneumology Service of a tertiary hospital, between February–April 2013. The electronic prescribing program was used to identify all patients who started treatment with levofloxacin and moxifloxacin. The diagnosis was confirmed by consulting the electronic medical history. The following variables were analysed: length of treatment in hospital, sequential treatment performed, duration of IV treatment, discharge of patients who had antibiotic treatment and full duration of treatment. Results The total number of patients included in the study was 100. 13 started oral treatment directly with intrahospital treatment lasting 3.92 days. 87 started with IV treatment (82.76% levofloxacin and 17.24% moxifloxacin). 57.47% (50/87) received sequential treatment, with a mean duration of intravenous treatment of 4.04 days. 36 received only inpatient intravenous treatment, with an average duration of 5.67 days. 59% (59/100) patients continued antibiotic treatment at discharge, the calculated mean overall duration being 11.28 and median of 12 days. 41% (41/100) did not maintain antibiotic treatment at discharge, with the average duration of 7.76 days and median of 5. Conclusions Sequential treatment shows a high rate of use of fluoroquinolone in the treatment of pneumonia with an average duration of IV treatment of 4 days. Although the number of patients receiving only IV treatment in hospital can be considered high the duration was less than six days. The factor that contributes to the diversion from current recommendations is the maintenance of antibiotic treatment at discharge, which increased the duration up to 12 days. No conflict of interest.

Background Therapeutic de-escalation enables us to improve the effectiveness of empirical antimicrobial therapy and avoids the development of resistance. Purpose To analyse the preliminary results of a pilot project of pharmacy interventions to achieve de-escalation of treatment with carbapenems, within a programme of optimisation of antibiotics use. Materials and Methods Prospective study of pharmacy interventions aimed at de-escalation in patients starting treatment with carbapenems, over three months (from March to June 2012) in a tertiary hospital, based on available microbiology results. The de-escalation suggestion was made through the electronic prescribing software. The variables analysed were: number of patients prescribed carbapenems, prescribing speciality, request for cultures, microorganisms isolated and interventions performed. De-escalations carried out without pharmacy intervention were also assessed. Results Total number of prescriptions was 433. The most prescribed carbapenem was ertapenem (37.6%) followed by meropenem (36%). The carbapenem most used in Internal Medicine was meropenem (58.2%) and in Urology, imipenem (75%). Ertapenem was used more frequently in General Surgery (53.7%) and Vascular Surgery (86.0%). Out of a total of 316 requested tests, 172 (54.4%) were positive. The most common pathogen isolated was Escherichia Coli (24.7%) 20.8% of which were Extended-Spectrum Beta-Lactamase (ESBL)-producing, 60% of which were sensitive to piperacillin-tazobactam or fosfomycin. Klebsiella spp. were isolated in 3.6%, of which 33.3% were ESBL-producing and 50% were sensitive to piperacillin-tazobactam. Total treatments subject to de-escalation were 96 (55.8%), out of 172 showing this possibility, where 74 (77.1%) were carried out by initiatives of medical teams and 22 (22.9%) after pharmacy interventions. The Services with a higher degree of acceptance of pharmacy interventions were Internal Medicine (36.4%) and General Surgery (27.3%). Conclusions Although the therapeutic de-escalation of empirical treatments with carbapenems was a low percentage, nevertheless pharmacy interventions achieved an increase of this practise, with the more receptive specialties being Internal Medicine and General Surgery. No conflict of interest.

Background The antifungals are among the pharmacological groups that contribute more to the increase in the number of drugs used each year in Spanish hospitals. One of the strategies adopted to contain the increase in pharmaceutical waste is the agreement of departments to optimise the use of drugs. Purpose To analyse the changes in the trend towards using antifungals of the Haematology department in a tertiary hospital, after the creation and introduction of a protocol for use of those drugs was agreed as an objective for 2011. Materials and methods A descriptive study was made of all the antifungals used by the Haematology department between January-September, performing a comparative analysis 2010-2011. The differences in use of groups of antifungals were found in terms of the number of defined daily doses (DDDs) used, as well as in the financial repercussions. Results The number of antifungals purchased annually by the Haematology department decreased by 20.9%, compared with the overall decrease in the hospital of 22.04%. An increase in the use of echinocandins was noted, the number of DDDs prescribed increasing by 2.88%, Caspofungin being the most used (73.5%). The total DDDs of azoles decreased by 5.93%, oral voriconazole being the drug used less (-33.19%), while an increase in the use of posaconazole was observed (80.18%). The polyene antifungals experienced a higher reduction in use, the DDDs used dropping by 55.49%. The financial repercussions of this reduced use in the Haematology department represented a decrease in the amount of this pharmacological group of 102,200.68 €, contributing 31.36% of the savings achieved by this department in the hospital9s total drugs bill. Conclusions The objective agreed for 2011 has modified the trend in antifungal use in the Haematology department. The decrease in the use of polyene antifungals has been the change with the most effect. These modifications have contributed to containing pharmaceutical waste in our hospital.

The authors followed up 20 full-term and 52 premature neonates given breast milk and substitutes differing in the character of the fatty component: "Malyutka", "Malyutka with a new fatty composition", and "similac". In the full-term children, the level of vitamin E in the blood serum was higher than that in the premature children and remained greater whatever the type of feeding. In the premature children, the tocopherol content in the blood serum depended on the child's age and was higher in children of a 36-37 week gestation age. Both the full-term and premature children showed sufficient supply with vitamin E during natural feeding and during feeding with "Similac" and "Malyutka" mixtures. Upon feeding with a "Malyutka with a new fatty composition" all the neonates had a lower content of vitamin E in the blood serum as compared to that in children given a different type of feeding. This is likely to be related to the high content of polyunsaturated fatty acids and to a relatively little content of vitamin E in the mixture under consideration.

The efficacy and adequacy of fat component depending on the feeding type (breast milk, Malyutka, Malyutka with a new fatty composition and Similak mixtures) were defined in the course of feeding 90 premature infants aged 33 to 37 weeks on the basis of clinical observations, determination of fat assimilation and the main indicators of lipid metabolism. All the mixtures were shown to be tolerated well. No significant differences were revealed in the mean daily weight gain and in the monthly body length gain. The children fed breast milk showed a higher assimilation of fats and an increase in the cholesterol level in the blood serum. The indicators of fat retention in children fed Similak and Malyutka with a new fatty composition mixtures were similar to those in children on natural feeding. The milk mixtures under consideration are found to be effective enough and thus can be used for feeding premature children born to mothers with hypo- and agalactia.