BackgroundA 81-years-old female was admitted due to a surgical cleaning of an infected knee prosthesis and the administration of targeted antibiotics. After starting with daptomycin, the patient developed an acute eosinophilic pneumonia.PurposeTo analyse whether the symptomathology was related to antibiotic treatment and to establish the cause.Material and methodsA descriptive observational study design was carried out. The medical history was obtained from the digital clinical history (DIRAYA) and the optimised computerised order entry software from the Pharmacy Department (APD-PRISMA). A bibliographic research was conducted to find similar cases or if it was an uncommon adverse effect. Modified Karch–Lasagna’s algorithm was applied to assess the relationship between the acute eosinophilic pneumonia and daptomycin.ResultsAfter the surgical cleaning, fever appeared and the patient started with ceftazidime and linezolid treatment. In the intraoperative culture it was detected as methicillin-resistant Staphylococcus epidermidis showed most sensitivity to daptomycin. After 4 weeks with daptomycin 6 mg/kg/day, fever and dyspnea appeared. The x-ray study showed bilateral pneumonia with eosinophylia and the patient needed admission to an intensive care unit. A new culture was obtained and the results were negative. With the suspicion of an eosinophilic pneumonia and after being the EPAR-Product Information was consulted, daptomycin was switched to vancomycin 30 mg/kg/day for the treatment of prosthesis infection, empiric antibiotic therapy was suspended and methylprednisolone was prescribed to treat the eosinophilic pneumonia. Five days’ later, the patient was discharged with positive synovial fluid cultures and a prescription of a once-weekly dalbavancin. After 4 weeks of treatment, cultures were negative. In contrast with notified case series, Staphylococcus aureus was not the causative strain in our case.1 Modified Karch–Lasagna’s algorithm established a ‘probable’ relationship between daptomycin and eosinophilic pneumonia. Adverse effect was reported to the local pharmacovigilance centre.ConclusionOur data suggest that daptomycin could provoke serious adverse effects and prolongation of hospitalisation time. Hospital pharmacists must perceive possible drug adverse effects and establish reporting systems to contribute to appropriate pharmacotherapy management.Reference and/or Acknowledgements1. Uppal P, LaPlante KL, Gaitanis MM, Jankowich MD, Ward KE. Daptomycin-induced eosinophilic pneumonia: A systematic review. Antimicrob Resist & Infect Control [Internet] 2016;5(1):55.No conflict of interest

BackgroundThe development of new direct acting antivirals (DAAs) for hepatitis C virus (HCV) represents an evolution in the treatment. As HIV-HCV coinfection is common, evaluation of DAAs’ effectiveness and drug interactions with antiretroviral therapy (ART) is useful in this population.PurposeTo assess the effectiveness of DAAs and drug interactions with ART in HIV/HCV-coinfected patients.Material and methodsRetrospective observational study, including HIV/HCV-coinfected patients who started DAAs (August 2015 to August 2017).Data were obtained from outpatient software, electronic health records or interview with patients.Effectiveness was assessed by achievement of virological response (week 4 of treatment, end of treatment and post-treatment week 12).Interactions between DAAs and ART were evaluated by using the University of Liverpool Drug Interaction database.ResultsSixty-six HIV/HCV-coinfected patients (21.2% females), mean age 50.1 years (40–57; SD 3.9). HCV genotype distribution: 1a (40.9%), 4 (22.7%), 3 (18.2%), 1b (16.7%) and 2 (1.5%). 37.9% had cirrhosis and 15.2% were pretreated HCV patients. Median baseline HCV viral load was 1,942,570 IU/mL.DAA regimens were mostly sofosbuvir/ledipasvir (63.6%), daclatasvir +sofosbuvir (19.7%) and ombitasvir/paritaprevir/ritonavir+dasabuvir (10.6%). Length of HCV treatment was 12 weeks in 89.4%.Before starting DAAs, patients were receiving ART, being triple-drug in 66.7%. Most common ART was: NRTI/NtRTI+NRTI/NtRTI+boosted PI (30.3%), NRTI/NtRTI+NRTI/NtRTI+NNRTI (13.6%), NRTI/NtRTI+NRTI/NtRTI+integrase inhibitor (12.1%), boosted PI (10.6%) and NRTI/NtRTI+boosted PI (9.1%).Thirty-nine potential interactions and five contraindications between DAAs and ART were identified, mostly only required monitoring. In 12 cases, the prescription of DAAs supposed a modification in ART and in one case a dose adjustment for the DAA.At the analysis date, 58 patients had finished treatment, three were still receiving DAAs and five had discontinued it. 63.6% had a rapid virological response (undetectable serum HCV RNA level at week 4 of treatment). Regarding patients who completed DAA regimens, 92.1% had undetectable viral load at the end of treatment. Of 54 patients who had reached post-treatment week 12, 50 had sustained virological response, two presented detectable viral load (resistance mutations were found) and two had missed data.ConclusionDAAs have shown a high effectiveness in HIV/HCV co-infected patients. In this population, an appropriate revision and management of drug interactions with ART is essential.No conflict of interest

BackgroundCompounded sterile drugs have to be prepared in appropriate conditions that ensure their safety in order to prevent medication error and avoid patient harm.PurposeTo analyse risks associated with preparation of intravitreal injections (aflibercept and ranibizumab) in our Pharmacy Department to classify them according to their risk level.Material and methodsA risk assessment was conducted to determinate the risk level that had to be applied in the preparation of aflibercept and ranibizumab intravitreal injections.We used two documents as a base: ‘Guide to good manufacturing practice for medicinal products in hospital pharmacy services’, promoted by our national Ministry of Health, and a form elaborated by Group of Pharmaceutical Compounding of our national association of hospital pharmacists to calculate in an easy and quick way the final risk level.Six items were analysed:Preparation procedure.Route of administration.Drug safety profile.Number (quantity) of prepared units.Sensitivity to microbiological contamination.Distribution of the sterile preparation.The assessment of each one resulted in a letter which ranged from the lowest (A) to the highest (D) risk. A combination of all letters allowed us to classify every drug preparation procedure at an appropriate level. If we obtained at least a ‘D’, it was considered a high-risk preparation; if there were a ‘C’ or at least three ‘B’ (and no ‘D’), it had a medium risk; and if less than three ‘B’ (and no ‘C’ and ‘D’) were present, it was classified as a low-risk preparation.ResultsIn the case of aflibercept and ranibizumab intravitreal injections we obtained more than one ‘C’ (and no ‘D’) when matrix risk was applied, and their preparation process was considered to have a medium risk level. It implies they had to be prepared in a laminar flow cabinet in a clean room and be stored in a refrigerator for 9 days.ConclusionMatrix risk application to the compounding process of aflibercept and ranibizumab intravitreal injections in our Pharmacy Department has allowed us to classify them according to their appropriate risk level, and to check their preparation and conservation conditions.No conflict of interest

BackgroundEribulin has been approved for locally advanced or metastatic breast cancer after at least one previous chemotherapy regimen for advanced disease, including an anthracycline and a taxane.PurposeTo evaluate the effectiveness and safety of eribulin in a tertiary-level hospital.Material and methodsA retrospective observational study was conducted. We included patients treated with eribulin from 1 February 2014 to 11 October 2017.Following variables were recordedage, number of cycles, duration of treatment, number and type of previous chemotherapy regimens, progression-free survival (PFS), reported adverse events (AEs), dose reductions and dose delays between cycles.We obtained data from electronic clinical records and the chemotherapy management software.ResultsTwenty-four patients were included, mean age 50.9 years (SD 9.4, range 32–67). As the data analysis showed, four patients were still in treatment with eribulin and 20 had finished it, with a median duration of 3.15 months (4.5 cycles, range 1–8).Patients had a median of three previous chemotherapy lines in the locally advanced or metastatic stage, in the range 1–6. Most common regimens used before eribulin in metastatic disease were: albumin-bound paclitaxel (54.2%), non-pegylated liposomal doxorubicin (50%), paclitaxel +bevacizumab (37.5%), cisplatin +gemcitabine (20.8%), capecitabine (20.8%), vinorelbine (20.8%), docetaxel monotherapy (16.7%), pegylated liposomal doxorubicin (12.5%), epirubicin +docetaxel (12.5%) and paclitaxel monotherapy (8.3%), being less frequent than other regimens.Median PFS in the 17 patients who progressed during or after eribulin (but without having received a later treatment) was 2.8 months.62.5% of patients had an AE during treatment. The most frequent were: asthaenia (37.5%), neuropathy (33.3%), joint pain (20.8%), mucositis (12.5%), neutropaenia (12.5%), infection (8.3%), constipation (8.3%), sickness (8.3%) and epigastric pain (8.3%). one patient interrupted the treatment due to AEs.In patients who finished their treatment, there were two delays because of neutropenia and three dose reductions due to toxicity.ConclusionIn our patients, eribulin median PFS was lower than in the EMBRACE trial. This could be explained because our patients received more previous regimens of chemotherapy for metastatic disease. In addition, our sample size was smaller.Regarding safety, eribulin was well tolerated and in most cases the AEs did not force an interruption to treatment.No conflict of interest

No abstract