Background The number of patients infected by HIV and hepatitis has increased over the years. Some of them have swallowing difficulties that require the placement of nasogastric or gastrostomy tubes. These chronic treatments need high compliance rates to avoid antiviral drug resistance and, eventually, treatment failure. Purpose To review the existing antiviral drugs literature and develop administration recommendations for patients with swallowing problems. Materials and Methods Formulations and recommendations were obtained directly from the manufacturers, or by a PubMed search and a search on the Micromedex database, when information was not available. A guide published by SENPE with physicochemical and formulation properties of drugs was also checked. ResultsTable 1 shows the results. Extensive administration recommendations were found during literature searches but are not included in the present abstract. There was no information about the administration of adefovir, maraviroc or saquinavir through gastrostomy or nasogastric tube. Conclusions Treatment compliance is key to ensuring the success of chronic antiviral treatments and it is important to consider special situations, such as swallowing problems. This guide for nasogastric or enteral administration helps clinicians to choose the most appropriate treatment. Further research is needed to determine specific bioavailability data. Abstact DGI-024 Table 1Antiviral Drug Formulations and Administration Drug Solution available (mg/ml solution) Can be crushed/sprinkled abacavir 20 Yes didanosine 2 g/ml solution powder Use tablets, not capsules emtricitabine 10 Discouraged lamivudine 10, 5 Yes stavudine 1 Yes tenofovir Yes zidovudine 50 Discouraged efavirenz 30* Use capsules etravirine Yes nevirapine 10 Discouraged atazanavir 50 mg/1.5 g solution powder * Discouraged darunavir Yes fosamprenavir 50 indinavir Discouraged lopinavir/ritonavir 80/20 Discouraged nelfinavir Yes ritonavir 80 Discouraged tipranavir 100 raltegravir Yes abacavir/lamivudine ** abacavir/lamivudine/zidovudine ** zidovudine/lamivudine ** Yes tenofovir/emtricitabine Yes tenofovir/emtricitabine/efavirenz Discouraged boceprevir Discouraged telaprevir Discouraged ribavirin 40 Discouraged entecavir 0.05* telbivudine 20* Discouraged *Not in Spain **Individual drugs available in solution No conflict of interest.

Background Vancomycin is primarily effective against Gram-positive cocci. However, as it can only penetrate the tissue superficially, it is uncertain if it is really able to achieve concentrations of therapeutic benefit at the site of infection. Suboptimal concentrations have been associated with lack of clinical response and increased resistance. There are no clear criteria on pharmacokinetic parameters associated with a good response, although the most conservative proposals consider an AUC/MIC > 400, in pathological conditions such as pneumonia and meningitis. Some authors have described the failure to achieve these values with the usual doses when the MIC > 2. Purpose Our work evaluates the pharmacokinetic data of vancomycin in a group of 30 inpatients, and individual Bayesian estimates of the dose needed to overcome the described value of AUC/MIC > 400. Materials and MethodsWe estimated the kinetic parameters of a population of 30 patients with a staphylococcal infection through a Bayesian model with application v.1.0 Abbotbase Pharmacokinetic Systems. From each patient we obtained the MIC, and the dose required to obtain an AUC/MIC > 400. We calculated the percentage of patients who reached target values for AUC/MIC with a standard dose of 1 g/12 h and those receiving an individualised dose according to the kinetic parameters obtained by Bayesian setting. Maximum doses of 4 grammes/day were considered. ResultsMean clearance (CI 95%) obtained through Bayesian estimation was 3.91 l/h (3.2–4.6). Median MIC value was 1 mcg/ml. According to these data, 57% of patients would reach therapeutic AUC values with conventional dose. However, if the dose is set individually 90% of patients would reach the target value, with a mean calculated dose of 2300 mg (CI95%: 1550–3000). Conclusions Most patients with staphylococcal infections can be treated with vancomycin, which also contributes to cost reduction. A Bayesian approach shows better pharmacodynamic results than conventional dosing, with a 90% of patients successfully treated in a real setting. No conflict of interest.

TechnologyEur J Hosp Pharm 2013;20(Suppl 1):A1-238 A75anhydrous, 50 mL of sterile water and simple syrup. The phosphorus strength of 67.4 mg/mL is close to that of Phosphoneuro. For 12 weeks, the solution appeared unchanged, clear and colourless. pH about 4.14 remained constant. Sodium and phosphorus contents were stable and the observed values were within 10% of the theoretical values. Microbiological results were in accordance with European Pharmacopeia: viable aerobic bacteria ≤ 10 3 (CFU/ml), fungal ≤ 10 2 , no E.coli. Conclusions Microbiological compliance and physicochemical stability were verified at 12 weeks according to the standards of the European Pharmacopeia. After users had insisted, the French Regulatory agency urged Bouchara Recordati to produce Phosphoneuros again, effective in May 2012. This is an example of the hospital pharmacist's role in compounding drugs to allow patients to continue their treatment in case of shortages of commercial products.No conflict of interest. Background Information and communication technologies increase efficiency and safety in health systems. The SiMON protocol (Monitored Information System), developed by the R&D department of hospital's Computing Service, provides a tool for monitoring patients attending a particular consultation and is adaptable in line with the needs of each clinical service. Its main objective is to streamline care by automating patient information related to such consultation. Furthermore, it provides a record for future analysis of information collected, making it possible to export information, scorecards and predict comorbidities. Purpose To describe the implementation of SiMON in pharmaceutical monitoring of patients with viral diseases (HIV/HCV). ImplementatIon of a monItored InformatIon Materials and MethodsReview of antiretroviral technical datasheets, pegylated interferon, ribavirin and protease inhibitors (boceprevir/telaprevir) and of the necessary literature to collect criteria and general recommendations for treatment of these diseases, adverse drug effects, interactions between these drugs and others, and contraindications for use. Results In order to implement SiMON in the pharmaceutical monitoring of patients with HIV/HCV, the Pharmacy Service reviewed 15 datasheets of antiviral drugs. Usage alerts were established as well as recommendations for each drug that depend on patient data (83 alerts), prescribed dosage (34 alerts), laboratory test results (94 alerts) and interactions between different medicinal products (484 alerts). Each of these alerts can refer to a contraindication or usage precaution, with a possible recommendation to suspend treatment, adjust the dose or change the drug involved in the interaction for an alternative. We also collected 482 adverse drug effects that had to be structured in tree form so they could be encoded by the Computing Service. Conclusions The SiMON protocol, a tool that increases the efficiency of patient monitoring in a multidisciplinary way, makes it possible to record side effects and g...

Background The efficacy and safety of anti-retroviral treatment is affected by many factors and compliance is key in therapy success. A lack of adherence may lead to therapeutic failure and higher rates of drug resistance. PurposeTo describe collected data about outpatient antiretroviral treatment adherence and analyse characteristics and factors associated with the non-adherent population. Materials and Methods A retrospective observational study was conducted over 27 months on all outpatients on antiretroviral therapy who attended our hospital for human immunodeficiency virus (HIV) monitoring between June 2010 and September 2012. Each patient’s adherence was checked and recorded every 6 months. This was measured as ‘(Total no. of units dispensed/Total no. of units needed) × 100’. Those patient with adherence >95% were considered as ‘adherent’ and those with <95% as ‘non-adherent’. All results were recorded in a database. For the ‘non-adherent’ population the following features were reviewed: Sex, age, drug use, presence of Hepatitis B (HBV) or Hepatitis C (HCV) and total number of tablets/day, including drugs for other diseases besides HIV. Results During the period of study, 1841 adherence cheques were made on a total of 630 patients (2.9 tests/patient). 24.6% of the HIV patients in treatment were non-adherent in at least one cheque. Their average age was 45.5 ± 8.6 years, 74% men, mean treatment duration of 8 ± 4.4 years, and a median consumption per day of 4 doses (range 1 to 16). 35.5% of these patients took drugs, 7.1% were co-infected with HBV and 45.2% were co-infected with HCV (5.2% was co-infected with both viruses). The Chi-square test showed a significant relationship (p < 0.05) between substance abuse, HCV infection and male gender in non-adherent patients. Conclusions The study revealed a large percentage of non-adherent patients who compromised the effectiveness of their antiretroviral treatment. The intervention of hospital pharmacists, checking on compliance and following up with patients, could play an important role in reducing this negative factor, especially in those with HCV and/or substance abuse. No conflict of interest.

BackgroundHospital/home treatment reconciliation often finds a lack of concordance between how patients take their medicines and how they should take them.PurposeTo reveal which drugs patients take and are not included in our clinical information sources (medical income report and electronic primary care history) and which drugs patients do not take but are recorded in these sources. All of them were detected by a pharmacist-patient interview.Material and methodsFor two months a hospital pharmacist carried out treatment reconciliation at admission. Home treatment information from the two clinical information sources was recorded, and then a medicines interview was conducted. A report was written reflecting the real use of medicines in every case. All omitted or overprescribed drugs were recorded for statistical analysis.Results23 patients were interviewed, 73.6 ± 11.6 years, with a median of 9 drugs in their home treatment (range 5 to 20), 63.6% women. We found that 25.9% of patients had medicine (s) omitted from their medical admission reports, and 17.8% from their electronic primary care history. A total of 83 drugs were omitted in the physician admission reports. These included some high-risk drugs: 3 patients taking digoxin, 3 antiplatelet drugs and 2 anticoagulants. 36 drugs were omitted in the primary care electronic clinical history, including 2 omissions of anticoagulants and 2 antiplatelet agents. Regarding medicines that the patient did not take but were stated in the information sources: the physician admission report overprescribed 30 drugs, including 1 antiplatelet drug, 1 antipsychotic and 1 antidepressant (high-risk drugs). With respect to the electronic clinical history, 24 drugs were overprescribed, including the high-risk drugs 1 antiplatelet drug, 2 antipsychotics and 2 antidepressants.ConclusionThe quality of the data provided by the information sources is not sufficient, creating a risk of drugs omission or over-prescription. Hospital pharmacists could contribute positively to medicines reconciliation at admission.ReferenceGalvin M, Jago-Byrne MC, Fitzsimons M, et al. Clinical pharmacist’s contribution to medication reconciliation on admission to hospital in Ireland. Int J Clin Pharm 2013;35:14–21No conflict of interest.