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This study aims to evaluate the impact of implementing a specialized clinical pharmacy program in patients with allogeneic hematopoietic stem cell transplant (HSCT) on their adherence to the immunosuppression treatment after discharge. A prospective open interventional design using a retrospective control group was used. The intervention was based on pharmaceutical consultations: the first was performed the day before discharge of HSCT unit and the next consultations during day-care follow-up (weeks 2 and 4 after discharge). Proactive medication reconciliation was implemented with a complete list of medications before the discharge prescription. The discharge prescription summarized on a personalized drug schedule was explained to the patient. The importance of optimal adherence and the potential problems related to self-medication were explained to the patient. Immunosuppression drug adherence was assessed by a direct method using serum levels of calcineurin inhibitors. The potential impact on acute GvHD, and infection was investigated. Twenty-six patients were included in the specialized clinical pharmacy program and 35 patients were in the control group. Seventy-nine pharmaceutical consultations were conducted in the intervention group, lasting a mean 25 min and 16 min for the first and following consultations, respectively. Serum levels in the therapeutic target range were higher in the intervention group (61.5% versus 53.0%, p = 0.07), with greater intra-individual variation (p = 0.005). There was no significant intergroup difference in acute GvHD (53.8% versus 50.3%, p = 0.85) or infection (26.9 versus 22.8%, p = 0.72). The implementation of a specialized clinical pharmacy program for patients who have received allogeneic HSCT seems to be beneficial for immunosuppression drug adherence; this now needs to be confirmed in a multicenter study involving a larger number of patients.

No abstract

Klein et al. (1) suggest that defined daily doses (DDDs) are not a perfect outcome measure of antibiotic prescribing, particularly for penicillins (39% of total DDDs in 2015 for broad-spectrum penicillins). We identified the same limitations as illustrated by the results of our study (2), which measured the bias of estimation for amoxicillin's indicators (oral and i.v. administrations) and oral amoxicillin clavulanic acid's indicator. We identified that the DDDs for amoxicillin (oral and i.v.) and oral amoxicillin clavulanic acid are 1 g/d, whereas the average maintenance dose recommended by actual guidelines to treat common infections is 3 g/d (3-5). No difference was observed with i.v. amoxicillin clavulanic acid (3 g/d) (6). By modifying these DDDs to 3 g/d, we recalculated the French community consumption rate for the years 2004 and 2014. We also applied modified DDDs of amoxicillin (i.v. and oral) for community consumption rate in 2015 for the 10 largest European consumers (2). Concerning evolution of the French community consumption rate between 2004 and 2014, an initial increase of 6.7% became, by applying modified DDDs, a decrease of 9.9% (2).