BackgroundIt is considered that 30% to 50% of antibiotic prescriptions in the Emergency Department (ED) are inappropriate. Urinary tract infections (UTI) are one of the most commonly diagnosed infections in the ED.PurposeTo assess the appropriateness of antibiotic prescriptions for UTI in the ED of a tertiary hospital.Material and methodsObservational, retrospective study which included patients who attended the ED, during November 2016, with an antibiotic prescription and an UTI discharge diagnosis. To assess the appropriateness of antibiotic prescriptions, they were compared to local empirical antibiotic treatment guidelines. Data were collected from the medical records of patients.ResultsOne hundred and eighty-four antibiotic prescriptions for UTI were included, representing 27.2% (676) of all antibiotics prescribed during the period of study. One hundred and thirty-eight females (75%), mean age 45.8±20.3. Patients’ diagnoses were: 61.4% (113) acute or recurrent lower UTI in females, 17.4% (32) UTI in males, 13% (24) pyelonephritis, 5.4% (10) catheter-related infections, 2.2% (four) prostatitis and 0.5% (one) bacteriuria.Prescribed antibiotics were: 32.1% (59) fosfomycin trometamol, 20.7% (38) ciprofloxacin, 14.1% (26) amoxicillin/clavulanate, 6.5% (12) cefixime, 5.8% (10) cefuroxime, 5.4% (10) calcium fosfomycin, 4.9% (nine) norfloxacyn, 4.3% (eight), cefditoren, 2.7% (five) levofloxacin, 2.2% (four) amoxicillin, 1.1% (two) asymptomatic ceftibuten and 0.5% (one) doxycycline.In 90.8% (167) of the prescriptions, the use of an antibiotic drug was indicated. When indicated, an appropriate antibiotic was selected in 61.7% (103/167) of the prescriptions, with an appropriate dosage and duration of antibiotic treatment in 77.7% (80/103) and 68% (70/103) of the prescriptions, respectively.In 16.3% (30) and 39.7% (73) of the analysed episodes, patients required previous or subsequent medical assistance (Emergency Department, ambulatory care and hospitalisation) for UTI, respectively.ConclusionOur results show a low appropriateness of antibiotic prescriptions mainly due to an incorrect selection of the antibiotic, dosage and duration. There is also an overuse of broad spectrum antibiotics: amoxicillin/clavulanate and ciprofloxacin. More than one-third of the patients needed subsequent medical assistance.Adherence to local empirical antibiotic treatment guidelines for UTI treatment should be enhanced, as the basis of a series of strategies to optimise antibiotic prescriptions in this area.No conflict of interest

Material and methods An observational, retrospective, descriptive study was conducted between January 2018 and October 2020. Age, sex, Barcelona Clinic Liver Cancer (BCLC) staging, adverse events (AEs), need for dose reduction or discontinuation, and time to progression or death were collected from our electronic records. None of the patients had received previous systemic therapy. The analysis was performed using R 4.0.3. Results 47 patients with metastatic HCC were treated with sorafenib. Patient characteristics are shown in table 1. Median overall survival (mOS) was 17.9 months (range 0.5-24.0; 95% CI 15.5 to not reached). The main AEs observed were: fatigue (42.5%), hand-foot skin reactions (42.5%), anorexia (40.4%), diarrhoea (38.3%), hypertension (14.9%), abdominal pain (14.9%), digestive bleeding (12.7%) and pruritus (10.6%). The most common reasons for treatment discontinuation were AEs (14 patients) and progression (22 patients). The rate of discontinuation due to AEs was 29.8%. 34 patients (72.3%) required dose reduction. Conclusion and relevance In our setting, mOS was superior to that reported in the pivotal clinical trial even though baseline characteristics were similar. Some of the AEs were more frequent, such as fatigue, hand-foot skin reactions, hypertension and anorexia, although the rate of discontinuation due to AEs was lower than reported in the SHARP trial. Sex M/F (n (%)) 42 (91.5)/5 (8.5) BCLC stage (n (%)) B (intermediate): 2 (4.3

BackgroundDrug related problems (DRP) are defined as negative clinical outcomes resulting from pharmacotherapy, which do not achieve therapy objectives or produce undesirable effects. They can be necessity, safety or effectiveness DRP.PurposeTo measure the incidence of DRP (effectiveness and safety) in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AE) treated with TNF antagonists (anti-TNF).Material and methodsA transversal, prospective, observational study was carried out in patients with AR and AE from the rheumatology unit in our hospital. Patients were selected by controlled randomisation (C4-study design pack), with voluntary study participation. Exclusion criteria: patients with anti-TNF for <3 months and <18 years. Pharmacotherapy follow-up (PFU) was conducted according to Dáder methodology-Universidad de Granada. All patients were interviewed twice a year. Variables collected: demographics (age, sex); clinical (diagnosis, time from diagnosis (TFD); and therapeutic: (previous and actual anti-TNF drug, initiation of use, adverse effects). Statistical study was conducted with Epidat 3.1-programme.Results85 patients were included. RA: mean age 49.7±6.62 years (83.9% women), TFD 11.5±9.2 years. AE: mean age 41.6±6 years (31% women), TFD 9.5±7.6 years. The table shows the DRP since PFU. Disease-anti-TNF No of patients Total No of DRP-effectiveness Effectiveness DRP per patient Total No of DRP-safety Safety DRP per patient RA-infliximab2590.490.4RA-etanercept1430.2181.3RA-adalimumab1750.3301.8AE-infliximab1990.590.5AE-etanercept530.6132.6AE-adalimumab530.6102 Anti-TNF No of patients Total No of DRP DRP per patient Infliximab44360.8Etanercept19371.9Adalimumab22482.2There were statistically significant differences when comparing total number of DRP with each drug (p=0.005), with a higher prevalence using adalimumab. There were 5 treatment changes undertaken between the 2 interviews: 2 because of safety DRP (optic neuritis in a patient with adalimumab; recurrent herpes virus infections in a patient with infliximab) and 2 because of ineffectiveness (1 patient with adalimumab; 1 patient with infliximab) and 1 because of the patient’s comorbidities.ConclusionInfliximab presented less DRP per patient. The data suggest a better safety and effectiveness profile for infliximab according to the number or related DRP compared with other anti-TNF.References and/or acknowledgementsFaus MJ. Programa Dáder. Pharm Care Esp2000;2:73–4.No conflict of interest

Describing vancomycin serum levels in pediatric intensive care unit (ICU) patients: are expected goals being met. BMC Pediatr 2019;19:240. 4. Arias Lopez MP, Fernandez AL, et al. Pediatric index of mortality 2 as a predictor of death risk in children admitted to pediatric intensive care units in Latin America: A prospective, multicenter study.

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