<b>Background</b> Antibiotic resistance is an important societal health issue. The greatest risk factor for developing a resistant infection is antibiotic use. Almost 75% of all antibiotics in the UK are prescribed in the community, and mostly for acute respiratory tract infections (RTIs). Yet, the majority of RTIs are self-limiting, viral and do not need antibiotic treatment, especially in young children. While the effects of antibiotic-resistant infections have been widely studied in hospitals (e.g. the MRSA 'superbug'), we know less about how antibiotic-resistant infections affect people in the community, even though this is where most antibiotics are prescribed. There is also widespread public misconception about antibiotic use and resistance despite several high-profile, multimillion antibiotic awareness campaigns. This is important to address because consultation behaviour and expectations for antibiotics are a significant determinant of antibiotic use in the community. <b>Methods</b> Three studies were conducted for this thesis. First, a systematic review and meta-analysis to assess the evidence of the impact of antibiotic resistance for patients with common infections in the community; second, a retrospective analysis of routinely collected primary care data to examine the relationship between antibiotic exposure and antibiotic 'response failure' in preschool children presenting with acute RTIs; third, a qualitative interview study to explore parents' perceptions and understanding of antibiotic use and resistance when they consider consulting in the community with their preschool child who has a respiratory tract infection. <b>Results</b> Antibiotic resistance significantly impacts on patients' illness burden for common infections in the community. Patients who presented in community health care settings with antibiotic-resistant E. coli urinary tract infections and S. pneumoniae respiratory tract infections were more likely to experience delays in recovery after antibiotic treatment. From routinely collected primary data (2009-2016), preschool children receiving two or more antibiotic courses in the previous year for acute RTIs had greater likelihood of antibiotic 'response failure' to treatment for subsequent acute RTIs compared to children that had received no previous antibiotics. When interviewing parents of young children, most parents were quite reticent about antibiotics for their children. However, very few considered antibiotic resistance as a possible harm of antibiotics. Parents thought their families were at low risk of antibiotic resistance because their families were 'low users' of antibiotics and did not perceive any association between their individual consumption of antibiotics and the development and spread of antibiotic-resistant bacteria in the community. They wanted future antibiotic awareness campaigns to have a universal message relevant to their families that fit into their daily lives. <b>Conclusions</b> The findings challenge the perception that antibiotic prescribing and resistance in the community poses little or no additional risk to patients in the community, or is remote from everyday prescribing decisions. Rapid diagnostic tests and other prognostic tools need to be promoted and evaluated to better identify patients who might need an antibiotic, and reduce the risk antibiotic response failures. Clinicians and parents should exercise caution about whether further antibiotics for acute RTIs are likely to be beneficial in those children who have received two or more antibiotic prescriptions for acute RTIs during the previous 12 months. Incorporating this into clinical practice guidelines and decision-support systems will help clinicians and parents consider a non-antibiotic strategy for acute RTIs. Future guidelines, campaigns and interventions around antibiotic resistance should tailor initiatives to outcomes that patients and clinicians in the community can relate to and slot into their daily lives. More research is needed to evaluate the impact of other common infections in primary care, and determine the relative contribution of antibiotic resistance to patients not responding to antibiotic treatment for common infections.

Analysis of pharmacoterapy hospice care patients Author: Jakub Sládek Tutor: doc. PharmDr. Josef Malý, Ph.D. Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University Introduction and purpose: The therapy of hospice care patients is accompanied by many changes and pitfalls that need to be balanced when choosing appropriate therapy. In the teoretic part we can find available information about paliative therapy of hospice care patients, with emhasis on pain therapy. The aim of this thesis is the analysis of pharmacotherapy hospice care patients. Methods: The data were collected in a hospice from September 2019 to November 2019. The farmacotherapy was revised every first day of the month. Informations from personal, drug, family and occupational social history of patients were noted into an electronic database and, after revision, were classified and evaluated by frequency analysis. In four randomly selected patients was described the management of drug-related problems (DRP). Results: In total we noted medical therapy in 40 patients, women were 75 % of this number. Average patient's age was 72.4 years for men and 74.6 for women. Patients most often used drugs from group N (drugs of the nervous system) according to the ATC classification. We indentified 115...

Thesis (Ph. D.)--Rand Graduate School, 2002. / Includes bibliographical references (p. 64-70).

Thesis (Ph. D.)--Rand Graduate School, 2002. / Includes bibliographical references (p. 64-70). Also available online.

Thesis (Ph. D.)--Rand Graduate School, 2002. / Includes bibliographical references (p. 64-70).

<p>Zbog visoke stope morbiditeta i mortaliteta od kardiovaskularnih bolesti, udeo lekova za terapiju kardiovaskularnih bolesti značajno učestvuje u ukupno utro&scaron;enoj količini lekova u svetu. Evidentan je porast potro&scaron;nje lekova za kardiovaskularne bolesti. Radi postizanja &scaron;to je moguće vi&scaron;eg stepena racionalizacije terapije u većini zemalja stručna tela donose farmakoterapijske smernice kako bi se mogućnost pogre&scaron;nog lečenja svela na najmanju moguću meru. Na ovaj način lekaru-praktičaru pružena je sigurnost pravilnog izbora i najadekvatnijeg postupka u datim okolnostima. Ciljevi ovog istraživanja bili su: 1) izračunavanje ukupne vanbolničke potro&scaron;nje lekova za lečenje kardiovaskularnih bolesti na teritoriji Novog Sada i njeno poređenje sa propisivanjem u Republici Srbiji i u zemljama sa razvijenom farmakoterapijskom praksom; 2) analiza strukture propisanih lekova za lečenje kardiovaskularnih bolesti (grupa C prema ATC klasifikaciji) po grupama i njeno poređenje sa propisivanjem u Republici Srbiji i u zemljama sa razvijenom farmakoterapijskom praksom; 3) analiza strukture propisanih lekova po dijagnozama i provera usklađenosti sa farmakoterapijskim smernicama; 4) komparacija propisanih lekova sa morbiditetnom statistikom kardiovaskularnih bolesti; 5) analiza farmakoekonomskih aspekata propisivanja lekova za kardiovaskularne bolesti. Sprovedeno istraživanje spada u IV fazu kliničkih ispitivanja-farmakoepidemiolo&scaron;ko, retrospektivno, opservaciono. Podaci su prikupljeni na osnovu izve&scaron;taja iz elektronske baze podataka za period od 6 meseci (01. 01. 2012 &minus; 01. 07. 2012), na teritoriji grada Novog Sada. Na osnovu ovih podataka na teritoriji grada Novog Sada analizirana je upotreba lekova za kardiovaskularne bolesti na 100% uzorku stanovnika. Ispitivanje se sastojalo iz dva dela. Prvi deo obuhvata prikupljanje, obradu i analizu podataka o ukupno propisanoj količni lekova za kardiovaskularne bolesti na teritoriji grada Novog Sada. U drugom delu istraživanja kori&scaron;ćenjem podataka dobijenih iz državne &bdquo;Apoteke Novi Sad&ldquo; detaljnije je analizirana upotreba lekova za lečenje kardiovaskularnih bolesti izdatih na recept. Upotreba lekova analizirana je: prema uzrastu i polu pacijenata, prema dijagnozama za koje su lekovi propisani i prema ceni. Sruktura upotrebe lekova po indikacijama za dijagnoze kod kojih je ukupna upotreba propisanih lekova bila veća od 1 DDD/1000stanovnika/dan upoređena je sa postojećim nacionalnim vodičima i sa upotrebom u zemljama sa razvijenom farmakoterapijskom praksom, odnosno sa međunarodnim vodičima. Ovi podaci upoređeni su sa morbiditetnom statistikom na teritoriji grada Novog Sada. Ukupno propisana količina lekova za kardiovaskularne bolesti u posmatranom periodu iznosila je 399,79 DDD/1000st/dan. Od te količine, preko polovine (201,11DDD/1000st/dan) propisivanih lekova za kardiovaskularne bolesti su lekovi koji deluju na sistem renin-angiotenzin, slede blokatori kalcijumskih kanala, zatim blokatori beta-adrenergičkih receptora, a na četvrtom mestu po ukupno propisanoj količini su lekovi za terapiju bolesti srca. Od najče&scaron;ćih dijagnoza za koje su propisivani lekovi za kardiovaskularne bolesti, najzastupljenije su bile arterijska hipertenzija, a potom ishemijska bolest srca. Upotreba lekova za kardiovaskularne bolesti u vanbolničkoj sredini na teritoriji grada Novog Sada (399,79 DDD/1000st/dan) vi&scaron;a je u odnosu na zemlje u okruženju (Hrvatsku, Crnu Goru), a niža u odnosu na zemlje sa razvijenom farmakoterapijskom praksom. U odnosu na zemlje sa razvijenom farmakoterapijskom praksom postoje odstupanja u pogledu strukture propisivanja. Struktura propisivanja lekova za kardiovaskularne bolesti odstupa od važećih nacionalnih vodiča o racionalnoj upotrebi lekova za kardiovaskularne bolesti u Republici Srbiji. Istovremeno struktura propisanih lekova nije u skladu sa morbiditetnom statistikom kardiovaskularnih bolesti prema zvaničnim podacima. Među 10 najče&scaron;će propisanih lekova nalaze se i skupi lekovi, koji imaju adekvatne, a mnogo jeftinije paralele. Nedovoljno i neracionalno lečenje kardiovaskularnih bolesti verovatno su jedan od značajnih razloga za visoku smrtnost od kardiovaskularnih bolesti u Srbiji.</p> / <p>Due to high rates of morbidity and mortality from cardiovascular diseases, the share drugs for the treatment of cardiovascular diseases significantly contributes to a total utilization among drugs in the world. There is an evident increase in the consumption of drugs for cardiovascular diseases. In order to achieve as much as possible a higher level of rationalization of therapy in most countries the professional bodies making pharmacotherapeutic guidelines to the possibility of the wrong treatment was reduced to a minimum. In this way, the physician-practitioner provided the security proper selection and the most appropriate procedure in the circumstances. The objectives of this study were: 1) the calculation of the total outpatient consumption of drugs for the treatment of cardiovascular diseases on the territory of Novi Sad and its comparison with the prescribing in the Republic of Serbia and the countries with developed pharmacotherapeutical practice; 2) analysis of the structure of prescribed drugs for the treatment of cardiovascular diseases (group C according to the ATC classification) by the groups and its comparison with the prescribing in the Republic of Serbia and the countries with developed pharmacotherapeutical practice 3) analysis of the structure of prescribed drugs per diagnosis and verification of compliance with pharmacotherapeutic guidelines; 4) comparison of prescribed drugs with morbidity statistics cardiovascular diseases; 5) analysis of pharmacoeconomic aspects of prescribing drugs for cardiovascular diseases. A research conducted among the phase IV clinical trials-pharmacoepidemiological, retrospective observational. Data were collected on the basis of a report from the electronic database for the period of 6 months (01. 01. 2012 - 01. 07. 2012), on the territory of the city of Novi Sad. Based on these data on the territory of the city of Novi Sad analyzed the use of drugs for cardiovascular diseases at 100% sample of the population. The research consisted of two parts. The first part comprises the collection, processing and analysis of data on the total quantity of the prescribed cardiovascular drugs on the territory of the city of Novi Sad. In the second part of this research using data from the public &quot;Pharmacy Novi Sad&quot; is a more detailed analysis of the utilization of drugs for the treatment of cardiovascular diseases of prescription. The utilization of drugs is analyzed: according to the age and sex of patients, in diagnosis for which the drugs prescribed and to the cost. Structure of the use of drugs by indications for diagnosis in which the total utilization of prescribed drugs was greater than 1 DDD/1000inhabitants/day was compared with the existing national guidelines and use in countries with developed pharmacotherapeutical practice, and with international guidelines. These data were compared with morbidity statistics on the territory of the city of Novi Sad. Total amount of prescribed drugs for cardiovascular diseases in the examined period was 399.79 DDD/1000inh/day. Of this amount, more than half (201.11 DDD/1000inh/day) were drugs acting on the renin-angiotensin system, followed by calcium channel blockers, beta adrenergic receptor blockers, and fourth in total prescribed quantity drugs for treatment of heart diseases. Of the most common diagnosis for which drugs for cardiovascular diseases were prescribed, the most common were arterial hypertension, and then ischemic heart disease. The use of drugs for cardiovascular diseases in outpatient environment on the territory of the city of Novi Sad (399.79 DDD/1000inh/day) is higher compared to neighboring countries (Croatia, Montenegro), and lower than in countries with developed pharmacotherapeutical practice. Compared to countries with developed pharmacotherapeutical practice there are variations in terms of the structure of prescribing. Structure of prescribing of drugs for cardiovascular diseases deviates from the existing national guidelines on rational use of drugs for cardiovascular diseases in the Republic of Serbia. At the same time the structure of prescribed drugs is not in compliance with morbidity statistics cardiovascular diseases according to official data. Among the 10 most commonly prescribed drugs are costly drugs, that have adequate, and much cheaper parallels. Insufficient and irrational treatment of cardiovascular diseases are probably one of the major reasons for the high mortality from cardiovascular diseases in Serbia.</p>