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EAHP 2011 Congress: Prize-winning posters

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Congratulations to the winners of the poster awards which were submitted for the Vienna congress, judged on aspects like originality, scientific quality and practical applicability.

The full posters as displayed during the congress and which provide more detail, can be seen on the subsequent pages.

1st prize Development of a web-based antimicrobial resource to improve antimicrobial prescribing ñ a two year review

P. Howard, J.A.T. Sandoe, A. Olusoga, K. Warburton, J. Dunne Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds United; Kingdom; Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Leeds Health Pathways, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom

Background

Our Teaching Hospitals were poorly performing for Clostridium difficile infection (CDI) and MRSA bacteraemia, despite ‘CDIfriendly’ antibiotics used in patients >80 years.

Purpose

The project was to build a web-based infection-management resource to improve antimicrobial prescribing by providing:

  • evidence-based, peer-reviewed guidelines

  • educational resource

  • audit resources with results

  • decision support including calculators

Material and Methods

Templates were developed for each guideline development team of a clinician, microbiologist and pharmacist. Each guideline includes algorithms, investigations, empiric and directed therapy (including special populations), oral switch, duration, specialist referral criteria, references, review dates, and evidence levels. Drafts are peer reviewed for 4 weeks where they are endorsed without changes or with minor revision, or need a major revision. Guidelines are updated based on comments, and repeat peer-review if necessary. Once ratified, uploaded to Antimicrobial Resource website.

Results

  • 104 guidelines developed; average 73 draft views; 7 comments per draft (3 had second peer-review)

  • >7000 hits/month

  • Antimicrobial prevalence decreased from ∼35% to ∼25%

  • CDI decreased from ∼80 to ∼20 cases/month

Discussion

Many Trusts use pocket-sized guidelines which go out of date. Our pathways focus on diagnosis and investigations, with antimicrobials if necessary. Development processes promotes ownership and subsequent usage. Feedback mechanisms ensure continual update. Less patients are on antimicrobials or develop CDI. Changes in prescribing may have contributed.

Conclusion

Web-based, evidenced-based, peer-reviewed antimicrobial guidelines are an effective method to support prescribers in their diagnosis and treatment of infection. Links to resources such as eBNF, eMC and dose calculators improve patient safety. Feedback processes with regular update ensure that guidelines are always up-to-date. Guidelines designed and delivered in this manner promote usage, and when combined with other elements of antimicrobial stewardship, is associated with a decrease in the prevalence of antimicrobial usage and reductions in some HCAIs.

No conflict of interest.

2nd prize What can hospital pharmacists do for patient safety when encountering potentially counterfeit medicines purchased by patients over the internet

Background

The popularity and the number of internationally operated illegal online drugstores that are selling medications without prescriptions or deliver products with unknown origins are rising. As Europeans are spending billions of Euros on the illicit medicines market the chances of accidental overdose, drug interactions and toxicity is increasing.

Purpose

To estimate the significance of the problem in Hungary and to define adequate methods to assess the quality and potential danger of drugs sold online.

Material and Methods

The attitude of more than 500 patients regarding purchasing drugs online was evaluated in our survey implemented in hospital (n=107) and community pharmacy (n=434) setting.

A comprehensive methodology was set up by our institution which allows general and professional quality assessment by:

  • Standardised ranking method of online drugstores

  • Documentation, evaluation of distribution process

  • Identification of microbiologic contamination

  • Measurement of physical properties by pharmacotechnology methods

  • Chemical analysis of active substance

Results

Our results show that nearly 5% of the respondents of the questionnaire have ordered drugs or dietary supplements online and about same amount of people are considering this option in the near future. 163 online pharmacies were evaluated and followed for 28 months. Less than 7% of the sites require prior medical prescription and 38% do not exist after two years. Out of the thirteen medications (paracetamol, sildenafil, tramadol) test ordered, 11 arrived (85%). Main components were identified (HPLC, spectrophotometry) in all samples. Compared to original authorized medications, higher chemical contamination was observed, indicating lower quality ingredients. The increased microbiological contamination and the higher standard deviation of pharmacotechnology parameters suggest poor quality control of production.

Conclusion

Our observations not only draw the attention of hospital pharmacists to illegal online drugstores and counterfeit medicines but also suggest a comprehensive methodology for professional pharmaceutical quality assessment of medication ordered online.

No conflict of interest.

3rd prize Mercaptopurine suspension 10 mg/ml

Background

Internationally, the WHO emphasizes the importance of developing new paediatric medicines. In the Netherlands, this importance is generally recognized. When industry does not provide suitable preparations, formulations should be developed for small scale compounding in public or hospital pharmacies. To this aim, the Royal Dutch Association of Pharmacists (KNMP) cooperates closely with the Special Interest Group on Paediatric Medicine of the Dutch Association of Hospital Pharmacists (NVZA). One of the developed formulations is Mercaptopurine suspension 10 mg/ml.

Purpose

Mercaptopurine is practically insoluble in water. This means that an oral, liquid preparation with mercaptopurine is only feasible as a suspension. Literature1 suggests that ascorbic acid should be added as anti-oxidant, to protect mercaptopurine for oxidation. The need for an anti-oxidant is doubted, because the mercaptopurine will be merely suspended and is not dissolved. A stability study has been performed on two formulations, with and without ascorbic acid. Aim of the study is to find a formulation that yields a stable suspension for at least 6 months.

Material and methods

Several batches of mercaptopurine suspension 10 mg/ml were prepared in a standard suspension base, with and without ascorbic acid. The batches, packed in PET-bottles, were kept at 25 °C for 6 months. Samples were taken at 0, 1, 3, 6 and 9 months, and were analysed for appearance, pH, viscosity, related substances and content of mercaptopurine. For the assay a stability-indicating HPLC-method was used, based on the Ph.Eur. monograph for the active ingredient.

Results and conclusion

All suspensions show stability for at least 6 months, regarding the content of mercaptopurine. The addition of ascorbic acid has no additional value. On the contrary, ascorbic acid causes a slight colouration of the suspension, while the viscosity decreases in time. This is unwanted in regard to the physical stability. It is concluded that a formulation without ascorbic acid yields the most stable suspension.

Literature

1. Am J Health Syst Pharm 65(2008):441–7.

No conflict of interest.

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