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Biomedical subjects

B García Díaz

Publications and source records attributed to B García Díaz.

12 recordsLinked to original sources
PubMed2004

[Evaluation of a pharmaceutical care program to improve adherence to antiretroviral therapy].

OBJECTIVE: To establish the impact of a pharmaceutical care program on the improvement of adherence to antiretroviral therapy, and on patient immunologic and virologic outcome. MATERIALS AND METHODS: A multicenter, observational, prospective study in a HIV-infected patient cohort under treatment with antiretrovirals selected by random sampling in 19 Spanish hospitals. The study lasted 12 months, in which the program was applied through a baseline preprocedural visit and 4 quarterly visits. Adherence estimation was based on pill counting. An adherence > or = 90, or > or = 95% was considered adequate (in two time points). RESULTS: 541 patients were included, most of them were males (68.8%) between 20 and 78 years of age. Major risk groups included injecting drug users (43.4%) and heterosexuals (29.4%). Sixty percent had already received treatment for more than 3 years. Mean baseline viral load and CD4 count values were 32,866 copies/ml and 485 cells/mm3, respectively. Throughout the study a slight increase in the percentage of adherent patients was seen; however, statistical significance was not reached (64.3 and 79.2% of patients showed an adherence > 95 and > 90%, respectively, during the fourth quarter, versus 59.8 and 75.5% at baseline). A statistically significant decrease in viral load and increase in CD4 cells was seen following program application. The percentage of patients with a viral load < 200 copies/ml was 72.2, 76.7, and 75.0% at the 2nd, 3rd, and 4th quarters, respectively, versus 64.2% at baseline. CD4 cell counts increased by 50 cells/mm3 on average from the start to the end of follow-up. CONCLUSIONS: Patients included in the program had a good immunologic and virologic outcome, and a trend towards an increased percentage of patients with good adherence was also seen. These results confirm the need to implement follow-up programs for patients receiving antiretrovirals in order to ensure maximum therapeutic benefits.

Adult↗
PubMed2003

[Once-daily gentamicin dosing versus thrice-daily dosing in infants with acute pyelonephritis].

BACKGROUND: Once-daily dosing (ODD) of gentamicin is advocated as an effective and safe treatment of Gram-negative bacterial infections in adults. There are insufficient data in the literature to justify its use in infants. OBJECTIVES: To compare the efficacy of ODD of gentamicin with that of classical thrice-daily (t.i.d.) administration in infants with acute pyelonephritis. METHODS: We performed a quasi-experimental study comparing 33 infants who received ODD of gentamicin with a historical control group of 25 infants treated with gentamicin t.i.d. Leukocytosis, C-reactive protein, creatinine, gentamicin dose, peak and trough values, time required for disappearance of fever, and outcome were analyzed. RESULTS: The mean doses of gentamicin (mg/kg/day) were higher in the t.i.d. group (6.4 1.14) than in the ODD group (5.06 0.22; p < 0.001). Peak serum gentamicin concentrations (micro g/ml) were significantly higher in the ODD group (9.32 1.4) than in the t.i.d. group (5.09 1.15; p < 0.001). Mean trough gentamicin concentrations (micro g/ml) were lower in the ODD group than in the t.i.d. group (0.23 0.26 vs 0.78 0.45; p 0.001). There were no significant differences in the duration of fever between the groups (30.64 32 hours in the t.i.d. group vs. 28.57 32 hours in the ODD group). Serum creatinine levels were normal during treatment in both groups. In all patients outcome was good and no adverse effects were noted. CONCLUSIONS: Treatment with ODD of gentamicin in our population of infants with acute pyelonephritis was as effective as traditional administration t.i.d. and possibly was equally safe or safer.

Acute Disease↗
PubMed1997

Calcium dobesilate-induced agranulocytosis.

Here we report a case of a patient in whom the administration of calcium dobesilate was associated with the development of an agranulocytosis episode. Eight weeks after the beginning of the treatment he was hospitalized with fever and leucopenia. Bone marrow biopsy showed a maturative promyelocytic interruption. All medication was withdrawn and blood cell count was completely recovered 7 days after admission. G-CSF was administered. A detailed study was performed and causal relationship was not suggestive for the other three drugs the patient was receiving. To date, there have only been reported two cases of calcium dobesilate induced agranulocytosis.

Agranulocytosis↗
PubMedDate not supplied

[Digitalis intoxication secondary to treatment with clarithromycin].

OBJECTIVE: The goal of this study was to investigate the percentage of patients concurrently receiving digoxin and clarithromycin who exhibited serum digoxin concentrations above the therapeutic range because of a likely interaction between both drugs, and whether digitalis intoxication ensued. METHOD: A descriptive, retrospective study carried out from January 2002 to December 2003 in all inpatients concurrently receiving digoxin and clarithromycin whose serum digoxin concentrations were monitored by the Pharmacy Department s Pharmacokinetics Section. RESULTS: Twenty-six patients having received digoxin and clarithromycin concurrently during their hospital stay were included in the study. Of these, 12 patients (46.2%) had serum digoxin concentrations above the therapeutic range: 7 received digoxin in doses unsuited for their age and/or renal function, and 2 fell short of the mean period of time considered adequate for an interaction to occur. Therefore, only 3 patients had serum digoxin concentrations above the therapeutic range, probably because of an interaction with clarithromycin, and all three had digitalis intoxication symptoms. CONCLUSIONS: According to the results of our study, 11.5% of patients concurrently receiving digoxin and clarithromycin had serum digoxin concentrations above the therapeutic range because of a likely interaction between these two drugs, with digitalis intoxication ensuing. Thus, we deem it necessary to monitor serum digoxin concentrations in patients receiving clarithtomycin.

Aged↗
PubMedDate not supplied

[Description of a computer program and results of its application to the follow up of enteral nutrition].

Computerization has been introduced little by little in the different activities which take place in a department of pharmacy, due to the fact that it means an increased agility of the tasks to be performed as well as an improvement of the care and managerial quality. In our hospital, the department of pharmacy makes up enteral nutrition units, and it participates in the follow up and control of the patients with this type of nutrition through a computer program designed for this purpose. The objective of the present study is to describe this computerized program as well as the results obtained by its application. The enteral nutrition computer program is made up of two data bases which are indexed between each other: that of daily follow up of the enteral nutrition prescriptions, and that of the follow up of the patients who have been given this nutritional support. In this way it allows us to obtain identification labels and consumption listings. During a two year period a total of 632 enteral nutrition treatments were given. The department with the greatest number of prescriptions was internal medicine (187, 29.5%). The polymeric diets were the most frequently used (435, 68.7%). The have mainly been used as a supplement to a hospital kitchen diet (149, 41.8%). The oral administration was the most frequent route of administration (331, 52.4%). The main reason for not implementing the nutrition was refusal by the patient (114, 38%). The computer program allows greater agility of the circuit which in our hospital generates the preparation of the enteral nutrition formulations, which are made up in the Department of Pharmacy, and given the large number of variables which this implies, this means a quality guarantee in the preparation and follow up of the patients with enteral nutrition.

Enteral Nutrition↗
PubMedDate not supplied

[Influence of foods on the absorption of antimicrobial agents].

Understanding the interaction between foods and antimicrobial agents is an aspect of therapy which may have an important clinical repercussion, which is why it must not be forgotten. This study reviews the interactions of foods with the anti-microbial agents which occur at the level of absorption, considering the mechanisms involved. The food-drug interaction can cause an increase, a decrease, or a delay in the bio-availability of the anti-microbial agents; foods may have no affect on the absorption of the anti-microbial agents, or they may improve the gastrointestinal tolerance. The Food and Drug Administration's bioequivalency criteria for considering whether or not there is an alteration in absorption have an orientative function, as generally all studies are conducted on healthy volunteers, but in clinical practice one must consider the physiological and pathological condition of the patient. The composition of the diet as well as the volume of liquid administered are other aspects which should be considered, as these may exert a different effect depending on the type of drug. After ingesting fatty foods, there is an increased absorption of albendazole, griseofulvin, itraconazole, and mebendazole. All foods but especially carbohydrates reduce the absorption of isoniazide. Among the anti-HIV drugs, the following must be administered on an empty stomach: didanosine, indinavir zalcitabine , and zidovudine ; lamivudine can be administered either on an empty or on a full stomach, because although food delays the absorption, it does not affect the amount absorbed; the absorption of stavudine is not affected by foods; ritonavir should be administered together with tile meals, and saquinavir must be administered after ingestion of food. It is advisable to administer clarithromycin together with foods, and azythromycin on an empty stomach; the same holds true for perfloxacin and rifabutine as for lamivudine.

Absorption↗