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[ES] Los fármacos pertenecientes a la familia de los ß-lactámicos son los antibióticos más usados en todo el mundo. Estudios recientes revelan que hasta un 10% de la población refiere haber presentado síntomas alérgico, esta porción de la población se considera "alérgica". En el diagnóstico de la alergia a antibióticos ß-lactámicos existen varios tipos de pruebas que sirven para orientar y confirmar la presencia de una alergia, clasificadas como ensayos in vivo e in vitro. En lo que se refiere a los ensayos in vivo, la detección de los procesos alérgicos más comunes se realiza mediante pruebas de exposición oral controladas, y pruebas intraepidérmicas e intradérmicas. No obstante, estas pruebas tienen sus limitaciones como es el riesgo de inducir reacciones alérgicas sistémicas graves. Por todo ello, su práctica requiere personal entrenado. Este requisito limitan la realización de este tipo de pruebas a centros hospitalarios especializados. La aplicación y desarrollo de técnicas de diagnóstico in vitro tiene como objetivo llegar a un diagnóstico de la alergia sin riesgos para el paciente. Entre las distintas pruebas serológicas y celulares que se pueden emplear, la detección de IgE específica es una de las más extendidas debido a que, dada su sensibilidad y especificidad, y mayor seguridad. Los sistemas de diagnóstico in vitro actuales utilizan una instrumentación analítica cara y de gran tamaño, así como materiales desechables caros, manejados por personal cualificado, por lo que este tipo de pruebas se realizan únicamente por servicios de alergia y/o análisis clínicos de grandes centros sanitarios. En consecuencia, hay una necesidad de desarrollar nuevos métodos de diagnóstico que cumplan los requisitos de sensibilidad, rapidez, sencillez, multiplexado y portabilidad, a un precio reducido para su implantación en todo tipo de laboratorios clínicos de los diferentes niveles de atención sanitaria. Por este motivo, en esta tesis doctoral se plantea como objetivo principal la puesta a punto de un inmunoensayo múltiple, utilizando la tecnología de disco compacto para la detección y cuantificación in vitro de niveles de IgE específica a un amplio espectro de antibióticos ß-lactámicos en muestras de suero humano. Las limitaciones más críticas para la determinación de IgE específica multianalito mediante métodos inmunoquímicos son las relacionados con la sensibilidad y selectividad. Por lo tanto, una parte importante de la tesis se ha centrado en la preparación y caracterización de un panel antígenos ß-lactámicos, selección de inmunoreactivos, formato y estudio de diferentes parámetros claves del inmunoensayo. Otra parte importante de la tesis se ha enfocado en abordar la mejora de la reproducibilidad de los resultados. La estrategia ha consistido en estudiar diferentes sistemas de calibración con el objetivo de estandarizar la cuantificación de los métodos in vitro de diagnóstico de este tipo de alergias. Para ello, se han evaluado las prestaciones de la calibración homóloga, heteróloga y el uso de un patrón interno, comparado sus prestaciones analíticas (relación señal ruido, sensibilidad, reproducibilidad, etc.) con el sistema de referencia. Finalmente, la validación del inmunoensayo se realizó con un conjunto de 101 muestras de suero de pacientes y controles. Los resultados obtenidos han sido comparados con los obtenidos mediante las técnicas de referencia, mostrando una mejor sensibilidad, especificidad, precisión, y linealidad. La capacidad múltiplex de la tecnología de disco compacto permitió llevar a cabo paralelamente estudios de reactividad cruzada frente a diferentes antibióticos ß-lactámicos esclareciendo el patrón de reconocimiento de los pacientes. En esta línea de trabajo, el uso de otras estrategias de conjugación de haptenos ha resultado en la mejora de la sensibilidad clínica del ensayo, identificando nuevos epítopos / [CA] Els fàrmacs que pertanyen a la família dels beta-lactams, són els antibiòtics d'us més estès a tot el món. Estudis recents posen de manifest que fins un 10% de la població ha presentat símptomes d'al·lèrgia, essent considerats població al·lèrgica als beta-lactams. En el diagnòstic de l'al·lèrgia front aquest tipus d'antibiòtics, existeixen diferents tipus de proves que serveixen per orientar i confirmar la presència d'una al·lèrgia, classificades com assajos in vivo i in vitro. Pel que fa als assajos in vivo, la detecció dels processos al·lèrgics més comuns es realitza mitjançant proves d'exposició oral controlades, i proves intra-epidèrmiques i intradèrmiques. No obstant això, aquestes proves tenen les seues limitacions com és el risc d'induir reaccions al·lèrgiques sistèmiques greus. Per tot això, la seua pràctica requereix personal entrenat. Aquests requisits limiten la realització d'aquesta mena de proves a centres hospitalaris especialitzats. L'aplicació i desenvolupament de tècniques de diagnòstic in vitro té com a objectiu arribar a un diagnòstic de l'al·lèrgia sense riscos per al pacient. Entre les diferents proves serològiques i cel·lulars que es poden emprar, la detecció d'IgE específica és una de les més esteses donada la seua sensibilitat, especificitat, i major seguretat. Els sistemes de diagnòstic in vitro actuals utilitzen una instrumentació analítica cara i de gran grandària, així com materials d'un sol ús també cars, que requereixen de personal qualificat, per la qual cosa aquest tipus de proves es realitzen únicament per serveis d'al·lèrgia i/o anàlisis clíniques de grans centres sanitaris. En conseqüència, hi ha una necessitat de desenvolupar nous mètodes de diagnòstic que complisquen els requisits de sensibilitat, rapidesa, senzillesa, multiplexatge i portabilitat, a un preu reduït per a la seua implantació en tota mena de laboratoris clínics dels diferents nivells d'atenció sanitària. Per aquest motiu, en aquesta tesi doctoral es planteja com a objectiu principal la posada a punt d'un immunoassaig múltiple, utilitzant la tecnologia de disc compacte per a la detecció i quantificació in vitro de nivells d'IgE específica a un ampli espectre d'antibiòtics ß-lactáms en mostres de sèrum humà. Les limitacions més crítiques per a la determinació d'IgE específica multianàlit mitjançant mètodes inmunoquímics estan directament relacionades amb la sensibilitat i selectivitat. Per tant, una part important de la tesi s'ha centrat en la preparació i caracterització d'un panell antígens ß-lactáms, selecció d'inmunoreactius, del format d'assaig i estudi de diferents paràmetres claus de l'immunoassaig. Una altra part important de la tesi s'ha enfocat a abordar la millora de la reproductibilitat dels resultats. L'estratègia ha consistit a estudiar diferents sistemes de calibratge amb l'objectiu d'estandarditzar la quantificació dels mètodes in vitro de diagnòstic d'aquesta mena d'al·lèrgies. Per a això, s'han avaluat les prestacions del calibratge homòleg, heteròleg i l'ús d'un patró intern, comparant les seues prestacions analítiques (relació senyal soroll, sensibilitat, reproductibilitat, etc.) amb el sistema de referència. Finalment, la validació de l'immunoassaig es va realitzar amb un conjunt de 101 mostres de sèrum de pacients i controls. Els resultats obtinguts han sigut comparats amb els obtinguts mitjançant les tècniques de referència, mostrant una millor sensibilitat, especificitat, precisió, i linealitat. La capacitat múltiplex de la tecnologia de disc compacte va permetre dur a terme paral·lelament estudis de reactivitat creuada enfront de diferents antibiòtics ß-lactáms esclarint el patró de reconeixement dels pacients. En aquesta línia de treball, l'ús d'altres estratègies de conjugació d'haptens ha resultat en la millora de la sensibilitat clínica de l'assaig, identificant nous epítops / [EN] ß-lactam antibiotics are one of the most widely used antimicrobials worldwide. However, up to 10% of the population reports having presented allergic symptoms derived from their consumption. Consequently, this portion of the population is considered "allergic". In the diagnosis of allergy to ß-lactam antibiotics there are several types of tests that serve to orient and confirm the presence of an allergy. These diagnostic methods are classified as in vivo and in vitro assays. Regarding in vivo tests, the most standardized tests are the provocation, prick and intradermal test. The aim of these assays is to observe the response produced by the different beta-lactam antibiotics in the patient after oral or cutaneous administration. Despite their wide use, these tests have their limitations, such as the risk of inducing severe systemic allergic reactions. Therefore, their practice requires specialized professionals for their indication, performance and interpretation. This requirement limit the performance of this type of test to specialized hospitals. The use and development of in vitro diagnostic techniques can overcome these disadvantages and allow the diagnosis of allergy without risks. In vitro assays are less invasive and therefore neither pose a risk of adverse reactions. Among the different serological and cellular tests that can be used, the detection of specific IgE is one of the most widespread due to its sensitivity and specificity. Current in vitro diagnostic systems use expensive and bulky analytical instrumentation and high-cost single-use materials, handled by qualified professionals. Therefore, such tests are performed only by allergy and/or clinical analysis services of hospitals or by companies specialized in clinical diagnostics. Consequently, there is a need to develop new diagnostic methods that can be implemented in all types of clinical laboratories at diverse levels of health care, meeting the requirements of sensitivity, speed, simplicity, multiplexing and portability at a reduced price. For this reason, the main objective of this doctoral thesis is the development of a multiplex immunoassay using compact disc technology for the detection and quantification of specific IgE levels to a wide variety of ß-lactam antibiotics in human serum samples. The most crucial limitations for the determination of multianalyte specific IgE by immunochemical methods are those related to sensitivity and selectivity. Hence, an important part of the thesis has been focused on the preparation and characterization of a pool of beta-lactam antigens, selection of immunoreagents, format and optimization of different critical parameters of the immunoassay. Another important aspect of the thesis has been focused on improving the reproducibility of the results. The strategy consisted of studying different calibration systems with the aim of standardizing the quantification of in vitro diagnostic tests for this type of allergy. To achieve that goal, the performance of homologous and heterologous calibration and the use of an internal standard have been evaluated, comparing their analytical performance (signal-to-noise ratio, sensitivity, reproducibility, etc.) with the reference system. Finally, the validation of the immunoassay was performed with a total of 101 serum samples from patients and controls. The results obtained have been compared with those obtained using the reference techniques, showing improved sensitivity, specificity, precision, and linearity. The multiplex capability of the compact disc technology allowed carrying out parallel cross-reactivity studies against different beta-lactam antibiotics both from the penicillin family and from other families, elucidating the recognition profile. Following this working line, the use of other hapten conjugation strategies improved clinical sensitivity of the assay by identifying new epitopes. / Juárez Rodriguez, MJ. (2022). Metodologías bioanalíticas para el diagnóstico in vitro de alergia a antibióticos ß-lactámicos [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/184011 / Premios Extraordinarios de tesis doctorales

The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.

The most frequent intervention performed by physicians is the writing of a prescription. Modern medicine has been remarkably effective in managing diseases. Medicines play a fundamental role in the effectiveness, efficiency and responsiveness of health care systems. However, health care expenditure is a great cause for concern and many nations around the world struggle to contain rising health care costs. Pharmaceutical benefit management programmes such as pharmacoeconomics, drug utilisation review (DUR) and disease management have emerged as control tools to ensure cost effective selection and use of medicine. These managed care instruments are often used to determine whether new strategies or interventions, such as the implementation of a managed medicine reference price list, are appropriate and have "value". The general objective of this study was to investigate the influences of the implementation of a managed medicine reference price list on the usage and cost of antibiotic medicine in the private health care sector of South Africa. The research design used in this study was retrospective, non-experimental and quantitative. The data used for the analysis were obtained over a two-year study period (1 May 2001 to 31 April 2003) from the central medicine claims database of Medschem&. Data was analysed according to prevalence, cost and original (innovator) or generic medicine items. For the purpose of this study antibiotics referred to beta-lactams (penicillins, cephalosporins and "others"), erythromycin and other macrolides, tetracyclines, sulphonamides and combinations, quinolones, chloramphenicol and aminoglycosides. The results of the empirical investigation showed the total number of medicine items claimed during the study period amounted to 49098736 medicine items having a total expenditure of R7150344897.00. There was a decrease in the prevalence of original (innovator) products during the two-year period. The prevalence of generic products increased from 25.87% to 32.47%. A total of 4092495 antibiotic medicine items were claimed with a total cost of R526309279.43 representing 7.36% (n = R7150344897.00) of all pharmaceutical products purchased during the two-year period. Original antibiotics had a prevalence of 42.32%, while generic antibiotics constituted 57.68% of all antibiotic products claimed (n = 4092495). However, original (innovator) products contributed 62.32% and generic products 37.68% to the total cost of all antibiotics claimed. It was concluded that the beta-lactam antibiotics represented 56.99% of all antibiotics claimed (n = 4092495) and contributed 52.51% to the total antibiotic expenditure (n = R526309279.43) for the two-year period. The average cost of beta-lactam items ranged between R112.88 * 69.95 and R122.18 + 81.42. The Medschema Price List (MPL) was implemented in May 2001. The aim of this reference pricing system was to allocate a ceiling price to a group of drugs, which are similar in terms of composition, clinical efficacy, safety and quality, with the ultimate goal to reduce medicine expenditure. During the year of implementation of the MPL 62.24% of beta-lactam antibiotics claimed (n = 1303464) were MPL listed. These products contributed 43.25% to the total cost of all beta-lactam antibiotics (n = R157142778.38). Medical aid companies reimbursed R61649211.86 for penicillins claimed and MPL listed. If all penicillin products were claimed at the ceiling price set by the MPL, a cost saving of 2.79% could have been achieved. Cost analysis indicated that it is possible to reduce health care costs by implementing strategies with the aim to reduce medicine cost. Further research, however, is necessary and in this regard recommendations for further research were formulated. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2005.