Antibiotics are often used in nursing homes, both as treatment and prophylaxis. The most common infections treated with antibiotics were UTIs, followed by RTIs. Choice of antibacterial, dosage and duration of treatment were in accordance with recommendations in guidelines.

BackgroundUrinary tract infections (UTIs, including upper and lower symptomatic) are the most common infections in nursing homes and prevention may reduce patient suffering, antibiotic use and resistance. The spectre of agents used in preventing UTIs in nursing homes is scarcely documented and the aim of this study was to explore which agents are prescribed for this purpose.MethodsWe conducted a one-day, point-prevalence study in 44 Norwegian nursing homes during April-May 2006. Nursing home residents prescribed any agent for UTI prophylaxis were included. Information recorded was type of agent and dose, patient age and gender, together with nursing home characteristics. Appropriateness of prophylactic prescribing was evaluated with references to evidence in the literature and current national guidelines.ResultsThe study included 1473 residents. 18% (n = 269) of the residents had at least one agent recorded as prophylaxis of UTI, varying between 0-50% among the nursing homes. Methenamine was used by 48% of residents prescribed prophylaxis, vitamin C by 32%, and cranberry products by 10%. Estrogens were used by 30% but only one third was for vaginal administration. Trimethoprim and nitrofurantoin were used as prophylaxis by 5% and 4%, respectively.ConclusionsThe agents frequently prescribed to prevent UTIs in Norwegian nursing homes lack documented efficacy including methenamine and vitamin C. Recommended agents like trimethoprim, nitrofurantoin and vaginal estrogens are infrequently used. We conclude that prescribing of prophylactic agents for UTIs in nursing homes is not evidence-based.

BackgroundRELIS is a Norwegian network of four regional medicine-information and pharmacovigilance centers where pharmacists and clinical pharmacologists provide feedback to health care professionals in spontaneous drug-related questions and adverse drug-reaction (ADR) reports published in a question–answer pair (QAP) database (the RELIS database) and the Norwegian ADR database, respectively.ObjectiveTo describe the potential of RELIS’s dual service to improve detection and communication of drug-safety problems.Materials and methodsWe searched the RELIS database for QAPs about ADRs with use of the Norwegian ADR database as a reference. We also searched the Norwegian ADR database for reports that used the RELIS database as a reference. Both searches were limited to the years 2003–2012. We then selected the example of pregabalin and drug abuse after the marketing of Lyrica in Norway in September 2004 to illustrate RELIS’s potential to detect new drug-safety information through a limited number of QAPs and ADR reports.ResultsA total of 5,427 (26%) of 21,071 QAPs in the RELIS database concerned ADRs. QAPs from this database were used as references in 791 (4%) of a total of 22,090 reports in the Norwegian ADR database. The Norwegian ADR database was used as a reference in 363 (7%) of 5,427 QAPs that concerned ADRs. Between September 2004 and September 2008, RELIS received eleven questions and 13 ADR reports about suspicion of Lyrica (pregabalin) and different aspects of abuse.ConclusionRELIS processes data through two databases that facilitate communication about ADRs. Our service also has the potential to detect new drug-safety problems with a limited number of questions and ADR reports.

We present a case of hepatitis and jaundice are associated with ingestion of Lotus-f3 submitted to our regional pharmacovigilance centre. A 56-year-old woman with psoriatic arthritis developed increased liver enzymes and jaundice 3 weeks after having started to take the product. The woman had been treated with etanercept for more than a year. She was hospitalized with hepatitis, and viral causes were ruled out. Liver biopsy suggested autoimmune or toxic hepatitis. Both etanercept and Lotus-f3 were withdrawn, and 6 weeks later the liver enzymes were normalized without any treatment. Etanercept was subsequently successfully reintroduced, and based on the rapid resolution of the hepatitis, a toxic effect of Lotus-f3 was suggested. This was the first report in the national adverse drug reaction database for this product, but three similar cases have now been reported. Lotus-f3 contains an extract of green tea, which has been associated with hepatotoxicity. The Norwegian adverse drug reaction database contains nine reports of hepatitis or jaundice associated with natural products. Four different natural products containing extracts of green tea have been suspected in eight out of these nine reports.Natural products are often marketed as safe. However, both national and international reports show that natural products can cause serious adverse reactions including hepatotoxicity [1][2][3]. Female gender seems to be a risk factor for adverse hepatic reactions [3]. Development of liver disease can be due to the claimed constituents, pesticides, residues from the production processes, contamination or added drugs. Lotus-f3 is marketed as a weight-reducing product, and contains extracts of the five herbals, Lotus arabicus , Citrus aurentium , Camellia sinensis , Fraxinus excelsior , Betula pendula , and chrome. A complete list of constituents and extractions are listed in table 1, as described by the producer (Faun Pharma AS, Drøbak, Norway). The Regional Drug Information Centres in Norway (RELIS) have the responsibility for regional pharmacovigilance based on a spontaneous adverse drug reaction reporting system. The present report was submitted to RELIS in 2006 where acute hepatitis was associated with ingestion of Lotus-f3. The presentation of the case follows the guidelines for submitting adverse event reports for publication [4]. Materials and methodsCase report. A 56-year-old woman with a history of psoriatic arthritis for about 10 years, otherwise healthy, was treated with Enbrel ® (etanercept) 25 mg injection once a week for more than a year. She used no other drugs. Two weeks before the incident Enbrel was increased from 25 to 50 mg weekly. In the last weeks before admission to hospital she gradually developed cough, nausea, and fever. Her appetite was good, but her weight had been slightly reduced by 3 kg. Because of abdominal pain, nausea, vomiting, and diarrhoea she consulted her family physician. Jaundice and increased liver enzymes were diagnosed, and she was admitted to hospital. In addition to Enbr...