Background: Due to their efficacy and tolerability, utilization of proton pump inhibitors (PPI) has significantly increased worldwide. Parallel to the clinical benefits, potential longterm side effects have been observed, which, along with increasing medical expenses and potential drug interactions, justifies the analysis of the trends of utilization. Objective: The aim of the present study was to show the level, pattern, and characteristics of PPI use. Methods: We assessed the nationwide use of proton pump inhibitors in ambulatory care based on aggregated utilization data from the National Health Insurance database. The annual PPI utilization was expressed as the number of packages and as number of DDDs per 1,000 inhabitants and per year. For 2018, we estimated PPI exposure as the number of packages and as the number of DDDs per user per year. The annual reimbursement costs of proton pump inhibitors were also calculated. Moreover, three patient-level surveys were carried out in non-gastroenterological inpatient hospital departments to reveal characteristics of proton pump inhibitor use, namely dose, duration, and indication. Results: The PPI utilisation increased from 5867.8 thousand to 7124.9 thousand packages and from 41.9 to 50.4 DDD per 1,000 inhabitants and per day between 2014 and 2018. Nationwide data showed that 14% of the adult population was exposed to proton pump inhibitors in 2018, while among hospitalized patients, the prevalence of proton pump inhibitor use was between 44.5% and 54.1%. Pantoprazole was the most frequently used active ingredient, both in the nationwide data and in the patient-level surveys. In the patient-level survey in majority of patients (71.5%-80.0%) proton pump inhibitors were prescribed for prophylaxis. Many inpatients (29.4%-36.9%) used 80 mg pantoprazole per day. The average number of PPI packages per user was 6.5 in 2018 in the nationwide data. The duration of PPI therapy was typically between 1 and 5 years in the patient-level surveys and nearly 20% of the inpatients had been taking proton pump inhibitors for more than 5 years.

Background Many studies have addressed influenza vaccine uptake in risk-group populations (e.g. the elderly). However, it is also necessary to assess influenza vaccine uptake in the active adult population, since they are considered to be a high-transmitter group. In several countries pharmacists are involved in adult vaccination in order to increase uptake. This study therefore aimed to investigate the determinants of influenza vaccination uptake and examine the willingness to be vaccinated by pharmacists. Methods A cross-sectional study was conducted among Hungarian adults using a self-administered online questionnaire distributed via social media (Facebook). The questionnaire included five domains: demographics, vaccine uptake, factors that motivated or discouraged vaccination, knowledge and willingness of participants to accept pharmacists as influenza vaccine administrators. Descriptive statistics were applied and logistic regression was conducted to assess the possible determinants of vaccination uptake. Results Data from 1631 participants who completed the questionnaires were analysed. Almost 58% of respondents (944/1631) had occupational and/or health risk factors for influenza. Just over one-tenth (12.3%;200/1631) of participants were vaccinated during the 2017/18 influenza season, 15.4% (145/944) of whom had a risk factor for influenza. Approximately half of the participants (47.4%) believed that influenza vaccination can cause flu, and just over half of them (51.6%), were not knowledgeable about the safety of influenza vaccine ingredients. Logistic regression found that age, sex, health risk factor and knowledge on influenza/influenza vaccination were associated with influenza vaccination uptake (p < 0.05). The most frequently cited reason for having an influenza vaccination was self-protection (95.0%). The most common reason given for refusing the influenza vaccine was that the respondent stated they rarely had an infectious disease (67.7%). The number of participants who were willing to be vaccinated by pharmacists was two-times higher than the number of participants who were actually vaccinated during the 2017/18 influenza season. Conclusion Influenza vaccine uptake in the active adult population is low in Hungary. Public awareness and knowledge about influenza vaccination and influenza disease should be increased. The results also suggest a need to extend the role played by pharmacists in Hungary.

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. This retrospective observational study evaluated the antibiotic prescription patterns and associations between guideline adherence and outcomes in patients hospitalized with CAP in Hungary. Main outcome measures were adherence to national and international CAP guidelines (agent choice, dose) when using empirical antibiotics, antibiotic exposure, and clinical outcomes. Demographic and clinical characteristics of patients with CAP in the 30-day mortality and 30-day survival groups were compared. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. Adherence to the national CAP guideline for initial empirical therapies was 30.61% (45/147) for agent choice and 88.89% (40/45) for dose. Average duration of antibiotic therapy for CAP was 7.13 ± 4.37 (mean ± SD) days, while average antibiotic consumption was 11.41 ± 8.59 DDD/patient (range 1–44.5). Adherence to national guideline led to a slightly lower 30-day mortality rate than guideline non-adherence (15.56% vs. 16.67%, p > 0.05). In patients aged ≥ 85 years, 30-day mortality was 3 times higher than in those aged 65–84 years (30.43% vs. 11.11%). A significant difference was found between 30-day non-survivors and 30-day survivors regarding the average CRP values on admission (177.28 ± 118.94 vs. 112.88 ± 93.47 mg/L, respectively, p = 0.006) and CCI score (5.71 ± 1.85 and 4.67 ± 1.83, p = 0.012). We found poor adherence to the national and international CAP guidelines in terms of agent choice. In addition, high CRP values on admission were markedly associated with higher mortality in CAP.

The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015–December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, −26.3%), and quinolones (J01M, −36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year’s monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods’ monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.

A gyógyszerrosta (az angol deprescribing magyar megfelelője) tervezett, szisztematikus gyógyszerleépítési folyamat, amely egészségügyi szakember felügyeletével zajlik, és lényegében a helyes gyógyszerrendelési gyakorlat részének tekintendő. A gyógyszerrosta nemcsak a teljes gyógyszerelhagyást jelentheti, hanem a dóziscsökkentés folyamata is lehet. Megtervezése során létfontosságú figyelembe venni a terápiás célkitűzéseket, valamint a beteg egészségi állapotát, időbeli életkilátását, értékrendjét és igényeit. A gyógyszerrosta célja betegenként változhat, alapvetően azonban prioritásnak tekinthető a beteg számára fontos célok elérése, a beteg életminőségének javítása. Közleményünkben a nemzetközi szakirodalom alapján áttekintjük a gyógyszerrosta folyamatának lehetséges célpontjait: azokat a nagy egészségügyi kockázatú betegcsoportokat, amelyeknél előnyös lehet a gyógyszerleépítés; a gyógyszereket és gyógyszercsoportokat, amelyek szedése esetén szükség lehet a terápia felülvizsgálatára; valamint összefoglaljuk a folyamat lehetséges színtereit. Ezenkívül kitérünk a folyamat általános lépéseire, előnyeire, kockázataira, és ismertetjük a rendelkezésre álló specifikus irányelveket, algoritmusokat. Részletesen tárgyaljuk a folyamatot segítő és hátráltató tényezőket, mind az egészségügyi szakemberek, mind pedig a betegek szemszögéből, végül pedig kitérünk a nemzetközi kezdeményezésekre és a gyógyszerrosta jövőjére is. Orv Hetil. 2023; 164(24): 931–941.