PubMed · 14893354
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G C BELLINGER. 1951. Address.. https://pubmed.ncbi.nlm.nih.gov/14893354/
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BACKGROUND: Medical literature reports that adequate prophylaxis with antibiotics can reduce the incidence of postoperative infections. OBJECTIVE: To investigate the impact of adopting multiple practices for improving the rational use of antibiotic prophylaxis in patients undergoing cholecystectomy and evaluate, during 2 periods, compliance with the hospital Drug Committee's recommendation and guidelines published in the medical literature. METHODS: Data were collected from patients' medical records at the Hospital de Clínicas de Porto Alegre (HCPA), Brazil, in 2003. We evaluated 222 procedures as set by guidelines published in the literature and the hospital's recommendation. RESULTS: In 24.5% of the cases, the choice of whether to use the prophylactic antibiotic was not made according to the guidelines. The choice of the antibiotic agent, prophylaxis duration, dose administered, and time for administration was appropriate in 95%, 80.5%, 100%, and 81.8% of cases, respectively. A significant improvement in guideline compliance was observed since multiple practices were adopted to improve the rational use of antibiotic prophylaxis. CONCLUSIONS: Compliance with the guidelines for antibiotic prophylaxis for cholecystectomy, in combination with a greater integration among the professionals involved in the HCPA Infection Control Service, resulted in a more appropriate use of these prophylactic agents. Improving physicians' awareness of the importance of meeting guidelines is critical and will benefit patients and the hospital as a whole.
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PURPOSE: The implications of the findings from clinical studies and pharmacokinetic analyses of the antiviral agent valganciclovir for dosing of the drug to prevent cytomegalovirus (CMV) disease in solid organ transplant recipients are reviewed. SUMMARY: Valganciclovir, an oral prodrug of ganciclovir, is as effective as oral ganciclovir for preventing CMV disease, although prophylaxis with either agent may delay CMV disease. Dosage reduction is required for both drugs in patients with renal impairment to prevent high plasma ganciclovir concentrations and toxicity. A valganciclovir dosage of 900 mg/day is required in patients with normal renal function, especially those at high risk for CMV disease, to provide adequate systemic ganciclovir exposure. Some studies suggest that a lower dosage might suffice for patients at a low risk for CMV disease. CONCLUSION: Valganciclovir dosing should be based on renal function to avoid toxicity.