3MPP is a useful treatment option for patients who are adequately treated with the 1 monthly formulation of paliperidone palmitate (PP) but who may benefit from longer dosing intervals. Aim and objectives To assess the appropriateness of 3MPP prescriptions and the effectiveness of treatment in our centre. Material and methods This was an observational retrospective study of patients with a 3MPP prescription between January 2018 and July 2020. The variables used to evaluate appropriateness were the number of switches from PP to 3MPP, dosage and administration time. Effectiveness was evaluated by recording treatment interruptions, dose variations and switch back to PP. Data were extracted from an administrative database and collected in Excel. Results 38 patients were included, 23 men (60.5%), with a mean age of 50±14 years. The dosages of 3MPP were: 175 mg in 5 patients (13.2%), 263 mg in 6 (15.8%), 350 mg in 18 (47.4%) and 525 mg in 9 (23.7%). In 30 patients (78.9%), the 3MPP prescription was appropriate. The number of switches was 35/38 (92.1%): 3 patients received a first prescription of 3MPP without a previous prescription of antipsychotic depot drugs from our centre. An appropriate dosage was selected in 33/35 patients (94.3%): 1 patient switched from PP 100 mg to 3MPP 263 mg and another from PP 150 mg to 3MPP 263 mg. An appropriate administration time was selected in 35/38 patients (92.1%): 1 patient took the drug every 4 months and two patients received only one administration of 3MPP. In total, six patients interrupted treatment (3 in 2019; 3 in 2020). Dose variation of 3MPP during treatment occurred in 2 patients: 1 switched from 3MPP 350 mg to 525 mg and the other from 3MPP 263 mg to 350 mg. Two patients returned to treatment with PP. Conclusion and relevance Most of the 3MPP prescriptions were appropriate. This treatment has been shown to be effective in this setting where clinical diagnosis and therapeutic choice are not simple and medication adherence is a clinical challenge. The intervention of the pharmacist by auditing prescriptions is important to further increase appropriate treatments in these patients.

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BackgroundDarunavir/cobicistat (DRV/COB) is the first fixed combination inhibitor of protease. Both are metabolised by the cytochrome CYP3A4, the reason why they are susceptible to present a multitude of drug interactions (DI).PurposeTo describe the DI of DRV/COB in HIV patients to avoid and to optimise therapy.Material and methodsRetrospective observational study performed in a county hospital. We reviewed the digital clinical history to collect the following data: patients treated with DRV/COB from 1 January 2016 to 1 November 2016, demographics, duration of treatment, concomitant medications, drugs involved, and DI. We review HIV-drug interactions using the database of the University of Liverpool to classify DI according to the mechanism of action (MA) and their potential severity. The pharmaceutical intervention (PI) was to notify to the prescribing physician, by report attached in the patient’s medical record, the contraindicated interactions (CI).ResultsThirty-five patients, 51% males (n=18). Race: 54% non-Caucasian (n=19). Median age 37 years (IQR 64–20). Median days of treatment 195 (IQR 465–22), total of concomitant medications 199, median 5 (IQR 1–19), DI 31% (n=62) median 1 (IQR 0–8), 40 drugs involved in DI. Type of DI according to their MA: CYP3A inhibition 62% (n=25), inhibition CYP2D6 10% (n=4), inhibition CYP3A and CYP2D6 7% (n=3) and inducer CYP3A 5% MA 15% (n=6). DI type according to its potential severity: high (CI) 15% (n=6) (midazolam, budesonide, phenobarbital, ivabradine, simvastatin and domperidone); and potential: 89% (n=35). PI: accepted 3 (50%): one change from simvastatin to rosuvastatin, one change from phenobarbital to levetiracetam and a change from midazolam to lormetazepam.ConclusionA high rate of DI is observed in patients receiving treatment with DRV/COB. The most relevant interactions are observed at the level of the CYP3A family. Acceptance of PI was low in the case of CI detected, probably because the prescribing physician was unaware of it. To have a higher success rate we could have made a phone call to him to put him on notice. The pharmacist is important in optimising drug therapy.References and/or AcknowledgementsThanks to all my colleagues in the Hospital de Poniente for their selfless helpNo conflict of interest

BackgroundCutaneous diphtheria is a skin infection caused by toxigenic and non-toxigenic strains of Corynebacterium diphtheriae. It is characterised by chronic nonhealing ulcers. Diagnosis may be delayed because it is a rare infection in developed countries. Usual treatment is erythromycin or penicillin, although erythromycin is more effective than penicillin.PurposeTo describe a case of cutaneous diphtheria caused by non-toxigenic C. diphtheriae in a Visiting Friends and Relatives (VFR) patient.Material and methodsData were obtained by a review of the electronic medical records, Pubmed and Uptodate.ResultsA 25-years-old female. No known drug allergy. No usual treatment. She is from Guinea Bissau but she has lived in Spain since she was 7-years-old. She has been on holiday in Guinea Bissau from April to May 2017. Two weeks before her return she had a papular lesion in her left leg and subsequently it was ulcerated. Two days after she returned, she went to the hospital. Progressively similar lesions appeared in both legs, right shoulder and back. Exudate samples from ulcers were taken for microbiological culture and biopsy. In addition, we performed a protocol to care for immigrants: serology for strongyloides, treponema pallidum, plasmodium falciparum/vivas/malariae/ovale and HIV-1/2 were negative as well as PCR for Loa-loa and filarias. Skin histology showed eosinophil infiltrates with a central ulceration. PAS/Ziehl–Neelsen stains remained negative. Microbiological culture of ulcer swabs revealed C. diphtheria with Streptococcus pyogenes group A and methicillin-sensitive Staphylococcus aureus superinfection. PCR analysis for C. diphtheria toxin was negative. Pharyngeal swab cultures remained negative for C. diphtheriae. The patient was treated with erythromycin 500 mg/6 hours for 14 days. Topical treatment included daily fusidic acid. Lesions improved progressively with the treatment. Within 2 weeks all skin lesions had completely resolved.ConclusionCutaneous diphtheria was caused by non-toxigenic C. diphtheria. It is a highly contagious infection. Due to high vaccination rates it is a quite a rare infection in developed countries, but due to the increase in migration and refugees into Europe, more cases are being seen. Cutaneous diphtheria should be included in the differential diagnosis of patients with skin ulcerations, especially in immigrants.No conflict of interest

Background The Septic Ward treats patients with bone-, jointand prosthetic-joint infections. The treatment of these infections requires complex, long-term antibiotic therapies. Clinical pharmacy services were introduced in 2015. This included