Background Improving the haemoglobin levels preoperatively leads to a reduction in transfusions required. Intravenous iron III sucrose (IVI), with a good safety profile, represents a new therapeutic option for the treatment of anaemia. Purpose To determine whether IVI administration in postoperative colorectal cancer (CRC) decreases the number of transfusions required. Materials and methods Retrospective case-control study in patients undergoing CRC surgery in the years 2008, 2009 and 2010, matched by age (±3 years), sex, type of surgery, tumour stage and surgical approach. Variables recorded: sex, age, tumour location, tumour stage, type of surgery, surgical approach, haemoglobin prior to surgery (Hbs) and at discharge (Hbd), number of transfusions after surgery (Ts) and doses of IVI received. Statistical analysis: Pearson's χ2 test or Fisher's exact test and Student's t or Mann-Whitney test using SPSS 15.0. software. Results The number of patients was 342, of which 104 were paired into 2 groups of 52 patients (G1-IVI treated and G2-IVI untreated), 33 men and 19 women per group, with a mean age of 70.9±11.1 and 70.6±10.9 years, respectively. Tumour location in both groups: rectum (25/22), left colon (15/17), and right colon (12/13). Tumour stage in both groups: III in 36.5%, 0 in 26.9%, IV in 13.5%, I in 11.5% and II in 11.5%. Type of surgical procedure in both groups: anterior resection of rectum in 36.4%, left and right colectomy in 28.8% and 21.2%, respectively. Surgical approach: 92.3% by laparotomy and 7.7% by laparoscopy. Hbs was 12.3±1.6 g/dl (G1) and 12.8±1.9 µg/dl (G2)(p=0.133), and Hbd was 10±1.1 g/dl (G1) and 10.6±1.2 µg/dl (G2)(p=0.012). Ts was 3±1.6 (G1) and 3.3±3 (G2)(p=0.682). 28.8% and 30.8% in groups 1 and 2, respectively, were transfused (p=0.830). The mean dose of IVI was 592±445 mg. Conclusions Administration of IVI does not appear to decrease transfusion requirements, possibly because bone marrow physiologically requires a period longer than the hospital stay to increase haemoglobin levels. Additional studies are needed to show more clearly the value of IVI.

Background Conversion from intravenous (IV) to oral treatment has many advantages, such as avoiding the adverse events attributed to IV treatment and using less costly drugs. It is also more comfortable, requires fewer human resources and it potentially shortens the length of hospital stay. However it is very important not to have any contraindication for oral treatment. The drugs involved must have excellent bioavailability following oral administration. Purpose To evaluate the results of a pharmaceutical intervention on switching sequentially from IV to oral antibiotics. Materials and methods Prospective and comparative study, carried out over 3 months (between March and May 2012); consisted of a phase of observation and another phase of intervention. We collected demographic data, diagnosis, antibiotic dosage and treatment duration, signs and symptoms related to the infection improving and oral tolerance to medicines and nutrition. We selected all the patients on IV treatment with levofloxacin, ciprofloxacin, metronidazole and clindamycin. Over the intervention phase and after 48–72 h of the intravenous treatment, we consulted the physician for approval to switch to the oral drug. Statistical analysis was performed using SPSS 19.0 Results 140 patients were involved. 44 in the observation phase and 96 in the intervention phase. Mean age was 72.8 (95% CI 66.0–79.6) and 71.8 years old (95% CI 68.5–75.7) respectively. Main diagnoses were divided into these infections: respiratory, gastrointestinal, urinary tract and other. During observation phase these were as follows: respiratory 24 (54.5%), gastrointestinal 10 (22.7%), urinary tract 2 (4.5%) and other 8 (18.1%). During intervention phase the numbers were: 45 (46.8%), 21 (21.8%), 6 (6.25%) and 24 (25%) respectively. In the observation phase, IV treatment duration was 6.5 days (interquartile range, 3–11) and it reduced to 4 days (interquartile range, 3–9) in the intervention phase (p = 0.068). A tendency was seen in the number of days of IV administration to decrease. Conclusions Pharmaceutical intervention reduces length of IV treatment. Therefore, a pharmacist-managed intravenous to oral step down system may be a good tool to reduce costs and potential adverse events attributed to IV treatment. This could be an example of the importance of pharmaceutical care in hospitalised patients. No conflict of interest.

Background Pneumonia is one of the most common causes of mortality in geriatric patients. The appropriate antibiotic treatment of this pathology can decreases the mortality rate in the patient group. Purpose To study the features of the patients with community acquired pneumonia (CAP) and the use of antibiotics in their treatment. Materials and methods We selected 102 hospitalised patients who met the CAP criteria. Demographics, stay, comorbidities, smoking/drinking habits, microbiological tests performed and empirical antibiotic treatment were collected. Finally, we compared the treatment we found with clinical practice guidelines. Results Of the 102 patients selected (58.8% men and 41.2% woman) 75 (73.5%) of patients were over 65, and the median age was 70. The average stay was 8.6 days. The most frequent comorbidities in patients with CAP were diabetes in 31 patients (30.4%) and onco-haematology disease in 26 patients (25.5%) follow by respiratory disease in 22 patients (21.6%). The most common empirical treatments were fluoroquinolone monotherapy (36.27%) and fluoroquinolone associated with B-lactam (38.25%). Finally 14 (87.5%) of the 16 who died had at least one comorbidity, and 5 (31.25%) had at least three comorbidities. Conclusions Patients with CAP included in the study were treated in accordance with clinical guidelines. In patients with comorbidities there is a greater risk of dying. No conflict of interest.

Background Linezolid is an antibiotic approved for treatment of nosocomial pneumonia (NP), community-acquired pneumonia (CAP) and complicated skin and soft tissue infections caused by Gram-positive bacteria susceptible to linezolid. Purpose To determine the use of intravenous linezolid in a 400-bed general hospital, where its use is only sanctioned for: NP due to methicillin-sensitive and methicillin-resistant S. aureus (MSSA and MRSA) or methicillin-sensitive S. pneumoniae. CAP due to methicillin-sensitive S. pneumoniae or MSSA. Skin and soft tissue infections with MSSA or MRSA, S. pyogenes or S. agalactiae. Materials and methods One-year retrospective study (2010). Data were obtained from: clinical records, Savac and Selene programs and laboratory tests. The case report form used had the following items: diagnoses, bacterial culture, indication, dose, duration, concomitant antibacterial treatment, previous treatment with glycopeptides and adverse effects, creatinine level and possibility of oral administration. Results Sixty-seven episodes corresponding to 52 patients whose mean age was 60.7 years. Episodes were reviewed from: intensive medicine (68.3%), surgery (15%), internal medicine (6.6%), other (10.1%). Only 17.3% of patients used the drug according to indications for which it is restricted according to the hospital protocol. Non-indicated uses included: pneumonia not matching the above conditions (20.3%) and postoperative abdominal abscess (20.3%). In 100% of cases bacterial culture was performed, and its use was justified in 19% of cases. The recommended dose was used in 95% of cases. Mean duration of therapy was 9.7 days. Significant concomitant antibiotics were: piperacillin-tazobactam (29.2%), meropenem (25.2%), cefepime (8%), and amikacin (8%). 41.6% had been treated previously with glycopeptides. Mean creatinine was 0.8 mg/dL. Conclusions There is low compliance with the authorised indications. Those treated the longest (11.5%) had blood toxicity. Almost half could have been treated orally at the same dose (100% bioavailability).

Background Linezolid and vancomycin are the antibiotics most commonly used in the treatment of pneumonia caused by methicillin-resistant Staphylococcus aureus. Purpose To study the mortality of inpatients diagnosed with pneumonia and treated with vancomycin and linezolid. Materials and methods Retrospective and descriptive study of patients with pneumonia in 2011 treated with vancomycin and/or linezolid. Information was collected through the SAVAC and SELENE computer systems and medical record review. The parameters analysed were: length of stay, mortality during hospitalisation and at 30 days, age and sex. Results Thirty patients were included. Twenty of them were treated with vancomycin 1 g/12 h and ten with linezolid 600 mg/12 h. Four of them were first treated with vancomycin, and after failure they were switched to linezolid. The vancomycin group consisted of 15 (75%) men and 5 (25%) women. Median age was 78 years. Median hospital stay was 25 days. Total mortality was 65%, since 3 (15%) of the 13 died within 30 days of leaving hospital. The linezolid group consisted of 8 (80%) men and two (20%) women. The median age was 78 years. The median hospital stay was 17 days. Total mortality was 80%, all deaths occurring while they were still in hospital. The fact that 4 patients were switched to linezolid treatment after treatment failure with vancomycin may possibly explain the high mortality rate in this group. Excluding these four patients in the two groups, mortality was 45% in the vancomycin group and 40% in the linezolid group, although the hospital stay was 7 days shorter for the linezolid group. Conclusions For this group of patients, the linezolid group presented a shorter hospital stay compared with the vancomycin group, but mortality appears to be similar between the two drugs. Considering the limitations of the study, further studies would be necessary to confirm or refute the results of this study. No conflict of interest.