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BackgroundCytomegalovirus disease is an important cause of morbidity and mortality in haematopoietic stem cell transplantation (HSCT) recipients. Foscarnet, an intravenous drug active against cytomegalovirus, represents an increasingly widespread alternative when there is resistance or intolerance to conventional treatments (ganciclovir/valganciclovir, acyclovir). More data about its use, effectiveness and safety in the clinical practice are necessary.PurposeTo analyse the effectiveness and safety of the use of foscarnet against cytomegalovirus in HSCT recipients, and its adaptation to clinical practice guidelines and expert recommendations in order to optimise future treatment strategies.Material and methodsObservational, retrospective, single centre study including all adult HSCT recipients treated with foscarnet for pre-emptive therapy or treatment of cytomegalovirus in a tertiary hospital between January 2013 and June 2015. Demographic, effectiveness and safety data about the treatment were collected and analysed using Access and Excel. After a literature search, results were compared with clinical trials and retrospective studies published, as well as with clinical practice guidelines and expert recommendations.Results43 episodes in 34 patients were included (50% women) with a median age of 52 years (range 47–57). In 9 cases (31%) of pre-emptive therapy, no patient experienced reactivation of cytomegalovirus. In 34 cases of treatment after reactivation, 85.7% (n = 29) started with a positive cytomegalovirus viral load. Of them, 72.4% reach negative viral load, 20.7% died and 6.9% were considered resistant. The remaining 14.3% (n = 5) maintained negative for viral load during treatment. All patients experienced at least one adverse effect but only 3% discontinued treatment. There were electrolytic disorders (100%), creatinine alterations (32.6%) and gastrointestinal disturbances (9%). Concomitant drugs causing electrolyte alterations or renal toxicity were not registered.ConclusionFoscarnet was shown to be effective with acceptable toxicity in cytomegalovirus treatment in HSCT recipients. The results are not entirely comparable with other published studies1,2 due to differences between populations and therapeutic regimens. The use of foscarnet (indications, dosage and treatment duration) in hospital mainly follows recommendations of experts and guidelines. More studies should be carried out in order to get the most beneficial treatment regimen with the minimum adverse effects.References and/or AcknowledgementsReusser P, et al. Randomised multicenter trial of foscarnet versus ganciclovir for preemptive therapy of cytomegalovirus infection after allogeneic stem cell transplantation. Blood 2002;99:1159–64Asakura M, et al. Use of foscarnet for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation from a related donor. Int J Hematol 2010;92:351–9No conflict of interest.

BackgroundThe increasing prevalence, morbidity and mortality rates of Clostridium difficile infection (CDI) turn its treatment into a challenge for researchers. Fidaxomicin is a new treatment option which has been shown to be effective for treating both primary and recurrent CDI in clinical trials but there is limited clinical experience.PurposeTo evaluate the use and outcome in patients with CDI treated with fidaxomicin in a tertiary hospital.Material and methodsBetween May 2013 and September 2014 patients undergoing treatment with fidaxomicin were assessed. Demographic and clinical data were collected from the patient electronic medical record. The outcome measure was Symptom-Free Interval (SFI), calculated in patients who were monitored for at least 1 month.ResultsThirteen patients were analysed (n = 13), 53.8% male, median age 54 years (range 27–83) and all had baseline disease which increased the risk of recurrent CDI, so fidaxomicin treatment was indicated by current clinical guidelines. Seven had a history of recurrent CDI and eleven had received previous treatment with vancomycin and/or metronidazole. Treatments with fidaxomicin were 200 mg twice daily for 10 days. Recurrence was found in 30.8% patients after the first treatment with fidaxomicin, but 6 patients were lost to follow-up (died). SFI varied with number of courses received. After the first treatment, the median SFI was 75 days (range 15–395). After the second course (2 patients) SFI was 66 and 180 days and following the third treatment (2 patients) SFI was 133 and 64 days.ConclusionUse of fidaxomicin is more common in patients with recurrence or non-responders to standard treatment (84.6%); the recurrence rate was high (30.8%). This study was limited by the number lost to follow-up and high inter-individual variability in SFI. More clinical experience is needed to determinate which patients may benefit most. Alternative dose regimens should be considered to improve treatment outcomes.References and/or AcknowledgementsNo conflict of interest

BackgroundThe preparation of total parenteral nutrition (TPN) is subject to a great deal of variability in clinical practice due to the complexity of TPN and the variety of professionals involved. Nutritional support is an important care activity in a pharmacy service.PurposeTo evaluate the activity of a parenteral nutrition unit in a hospital pharmacy.Material and methodsThis was a retrospective study analysing TPN during 2015 in a pharmacy service of a tertiary hospital. Data were obtained from the pharmacy service’s nutritional database and the pharmacy service’s dashboard of activity and quality. Pharmaceutical care in adults patients is based on validating the indication to assess the patient’s nutritional status, calculating the nutritional requirements, developing a nutritional plan and deciding on the composition of the TNP. In paediatric patients, the clinical pharmacist´s functions with regard to TPN are to ensure the quality (stability and osmolarity) and safety of the solutions prepared. The formulations were prepared by the hospital pharmacy, in totally or from three compartment bags (commercial preparations), or prepared by an external service.ResultsDuring the study period, 1510 patients (698 adults, 812 children) were treated with TPN. 21 008 TPN were dispensed from the hospital pharmacy. In institutionalised patients, 16 576 TPN were dispensed (42% adults, 58% children); 4432 TPN were delivered to home patients (9% adults, 91% children). A total of 11 146 formulations were prepared in whole by the hospital pharmacy (37% adults, 63% children); 1197 TPN were commercial preparations (all in adults) and 8665 TPN were prepared by an external service (24% adults, 76% children). The prescribing units in adult TPN were: anaesthesia–intensive care medicine (40%); oncologic-haematologic patients (26%); surgery patients (26%); haemodialysis patients (2%); and other units (6%). In paediatric patients, the prescribing units were: neonatal–intensive care unit (71%); oncologic and haematologic patients (11%); surgery patients (11%); and other units (7%).ConclusionMost TPN (60%) were prepared by the hospital pharmacy and 40% of TPN were acquired through an external service. Most TPN were dispensed to paediatric patients (65%). They were mainly prepared for critically ill patients (46%). The department of pharmacy was involved in the management of TPN to support the clinical and therapeutic needs of the patient.No conflict of interest