Background Compliance is sometimes difficult for patients treated with temozolomide, because of the inconvenience due to the high daily number of capsules needed. Studies with other drugs showed that pillboxes increased patient satisfaction. Purpose To determine if pharmaceutical information and the use of pillboxes may improve satisfaction of patients treated with temozolomide. Materials and Methods This prospective and interventional study included adult patients who picked temozolomide up in our Hospital Pharmacy (01/03/2012 to 31/08/2012). In the first visit, patients previously treated with temozolomide completed a satisfaction questionnaire, which was adapted from the ESTAR questionnaire (ARPAS study). It consisted of 9 questions to be answered from 0 (very unsatisfied) to 6 (very satisfied), and another two items about temozolomide information. In addition, pharmaceutical information and pillboxes were provided to all patients. At their next visit, patients received another questionnaire, with 6 of the previous satisfaction questions and 5 new questions about usefulness of the pillbox and of the received information. Results 35 patients were evaluated with the first questionnaire (50.69 ± 13.38 years old; 77.14% were treated with ≥3 capsules per dose) and 28 of them filled in the second questionnaire (50.32 ± 12.45 years old; 75% taking ≥3 capsules per dose). 88.57% vs. 85.71% of patients took their pills in cycles of 5 days followed by 23 days without treatment. Satisfaction pre- and post-intervention was related to: the number of capsules prescribed per dose (4.43 ± 1.60 vs. 4.96 ± 0.84), the possibility of taking their treatment everywhere (5.17 ± 0.92 vs. 5.32 ± 0.82), and the convenience of the chemotherapeutic regime (5.06 ± 0.94 vs. 5.07 ± 1.05). The usefulness of the pharmaceutical attention, the pillbox and the leaflet were valuated as 5.46 ± 0.58, 5.39 ± 0.69 and 5.68 ± 0.48, respectively. Global satisfaction with pharmaceutical attention was 5.79 ± 0.42. Conclusions In this study, information provided by hospital pharmacist and the use of pillboxes improved satisfaction in patients treated with temozolomide. No conflict of interest.

BackgroundIn Cushing’s syndrome (CS), when surgery is unsuccessful or contraindicated, ketoconazole is the drug most frequently used to treat hypercortisolism.In July 2013, European Medicines Agency announced their negative risk-benefit assessment of oral ketoconazole as treatment of fungal infections, because it can cause liver damage and drug interactions due to cytochrome P450 inhibition. Ketoconazole was suspended as an antifungal in the European Union, but compassionate use is authorised for CS.PurposeTo analyse the hormonal effects and tolerance of ketoconazole in CS over the last year.Material and methodsNine patients [32–83 years old] were treated in hospital. All patients were retrospectively studied with a follow-up of 26 months; their treatment had lasted from 12 days–25 years. One patient had ectopic ACTH production, two had pituitary adenoma, and six had adrenal neoplasia. Four patients had previously had surgery, but it was not effective in two cases. The dose of ketoconazole was between 200–1,200 mg/day.Liver tests checked: transaminases, total bilirubin and alkaline phosphatase. Hormonal control was observed with Nugent’s test and 24 h urinary free cortisol. The patient’s current treatment was noted to check for drug interactions.ResultsAll patients were checked. No adrenal insufficiency was observed. Liver function tests were normal. Five patients stopped ketoconazole: two for surgery; two died of metastatic cancer; and one because of a potential drug interaction with calcium antagonism. 77.8% of the patients had some possible drug interactions, but only one stopped ketoconazole. Other interactions were with drugs metabolised by CYP450; or with proton pump inhibitors which reduce the pH-dependent absorption of ketoconazole. These problems were solved by changing the dose of the drugs concerned.ConclusionKetoconazole seems to be a safe and efficacious treatment in CS. However, it is necessary to perform a bigger study to get significant conclusions.ReferenceFeelders RA, Hofland LJ, de Herder WW. Medical treatment of Cushing’s syndrome: adrenal-blocking drugs and ketoconazole. Neuroendocrinology 2010;92(Suppl 1):111–15No conflict of interest.

BackgroundPleural aspergillosis (PA) was first described in 1842 but remains a relatively rare entity when compared with other Aspergillus infections.PurposeTo describe the pharmacological management of a patient diagnosed with PA and the efficacy of intracavitary instillation of amphotericin B (ICAB) treatment.Material and methodsA 32-year-old woman with multiple drug allergy syndrome (NSAIDs, pyrazolones, quinolones, lincosamides, SSRIs, ondansetron) was admitted to our hospital because of postoperative Pseudomonas pneumonia complicated with empyema and bronchopleural fistula. The patient underwent thoracostomy. Pleural biopsy showed septate fungal hyphae and pleural fluid culture grew Aspergillus fumigatus while serum galactomannan antigen was negative. Systemic antifungal therapy, with oral voriconazole at first and then with posaconazole, was started. Concurrently, amphotericin B deoxycholate, diluted in 75 ml of 5% glucose solution, was infused directly into the pleural cavity, at 5 mg on the first day, rising to 10 mg and 25 mg on the second and third day, respectively, and then 50 mg, after washing of the pleural cavity with 5% glucose solution. Daily dressing with amphotericin B-impregnated gauze was introduced in the cavity. Local treatment was continued for about two weeks.ResultsThe treatment was well tolerated with no adverse drug reactions. The symptoms and the physical signs improved greatly during hospitalisation and the patient left the hospital 3 days after the end of treatment. Repeat pleural fluid culture was negative 2 weeks after the end of treatment.ConclusionICAB may improve the efficacy of systemic antifungal therapy and it should be considered as an additional treatment option. Moreover, the use of this method avoids repeated needling of the cavity and may allow extended treatment on a domiciliary basis.ReferenceKravitz JN, Berry MW, Schabel SI, et al. A modern series of percutaneous intracavitary instillation of amphotericin B for the treatment of severe hemoptysis from pulmonary aspergilloma. Chest 2013;143(5):1414–21No conflict of interest.

Background Previous studies have reported an error rate between 11.7% and 49.0% in the medication process for hospitalised children. Off-label use and diluting medicines increase the risk of error in paediatric patients, in addition to developmental differences among children. Health care organisations are developing strategies in an attempt to reduce those errors, caused by many factors involving many people. Purpose To determine the overall incidence and incidence at different stages of medication errors (transcription, storage, preparation and administration stages) in a paediatric hemato-oncology ward. Materials and methods We conducted a descriptive observational study of drug administrations in a paediatric hemato-oncology ward of a large teaching tertiary hospital in Spain. Data were collected on 21 days, including weekends, between February and March of 2013 and they were analysed by SPSS statistical software. Medication errors were classified according with the updated classification of the Ruiz-Jarabo group (Otero et al., 2008). The error rate was calculated considering the number of doses with one or more errors as numerator and total opportunities of error (TOE) as denominator. TOE is defined as the total number of doses given, whether correct or incorrect, plus omitted doses. Results 23 patients (52.2% female, 47.8% male, average age 6.0 [3.0–10.0] years old) were observed. Of 1116 doses administrated, 302 had at least one error, so error rate was 27.1% (95%, CI: 24,1%-30.3%) or 24.1% excluding wrong-time errors. Stages with higher error rates were preparation (43.8%) and storage (32.3%). Most common errors were related to photoprotection (66.7%), timing errors (15.8%) and incorrect preparation of suspensions (10.5%). Pharmacological groups with higher error rates were cardiovascular (100.0%), gastrointestinal (61.9%) and nervous system (49.3%). Conclusions The error rates we obtained were similar to those published before. Most common errors were related to failures in working protocols because medicines were never protected against light. No conflict of interest.

Background Brentuximab is a monoclonal antibody targeting CD30 receptors, authorised in 2011 by FDA for the treatment of Hodgkin’s lymphoma and other lymphomas refractory to conventional treatment. Although there are limited references in the literature to related infusion reactions, they are an adverse effect described in the data sheet and can compromise treatment. Purpose To describe a case of hypersensitivity reaction to brentuximab and evaluate the utility of a desensitisation protocol. Materials and methods Male, 29 years old, diagnosed with Hodgkin’s lymphoma in progression to different lines of chemotherapy. Brentuximab was prescribed every 21 days at a dose of 180 mg over 30 min and premedicated with intravenous methylprednisolone, dexchlorpheniramine and paracetamol. During the first cycle he didn’t present any reaction. Twenty minutes after starting the second cycle, the patient presented a feeling of numbness in the extremities, itchy skin lesions, heat and nausea, so the infusion was stopped. He was treated with intravenous paracetamol and dexchlorpheniramine. The infusion was restarted but the signs reappeared, so was stopped. The severity of the reaction was considered grade 2. During the third cycle skin lesions reappeared and although the cycle was completed, it was suspended. The need to continue with the treatment led to a desensitisation protocol for brentuximab being prescribed, which consisted of 13 steps with a final dose equal to the therapeutic dose over 3 h and 10 min. At each step the dose was gradually increased until the full dose was reached. The initial dose was 0.01 mg and generally at each step twice the previous dose was given. The protocol was administered by the Allergy Service. Results Since brentuximab protocol desensitisation was prescribed, the patient has received 3 cycles, during which he hasn’t experienced any reaction, allowing continued treatment. Conclusions The use of a brentuximab desensitisation protocol allows patients with allergic reactions to the drug to be treated when it is the only available option. No conflict of interest.