Safety of opioid patch initiation in Australian residential aged care

Explores opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Abstract Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross-sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period Main outcome measure: The proportion of residents who were opioid-naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid-naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up-titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid-naive in the 4 weeks before initiation. &nbsp

Impact of Antibiotic Shortages on Antibiotic Utilisation in the Community

BACKGROUND: Drug shortages are an increasing and worldwide problem. Oral antibiotics are one of the most used medicines worldwide and have recently been affected by drug shortages. Despite this, little is known about the impact of antibiotic shortages on prescribing practices.AIM: To explore the impact of oral antibiotic shortages on national antibiotic utilisation.METHODS: A cross-sectional study of oral antibiotic shortages and antibiotic utilisation was conducted using Australian reimbursement and regulatory data from January 2022 to December 2023. All nationally reimbursed oral antibiotics were included in the study. The number and duration of reported antibiotic shortages per product were determined for each active ingredient. The clinical impact was assessed using national utilisation in Defined Daily Doses per 100 000 inhabitants. Changes in trends were analysed using Joinpoint regression.RESULTS: Shortages were reported for eighteen of the twenty-one (86%) oral antibiotics reimbursed in Australia. For ten active ingredients, shortages did not coincide with changes in utilisation data. No clear relation between the number and duration of shortages and impact on utilisation was observed. Changes in utilisation coinciding with shortages were observed for eight active ingredients. For cefaclor (-20% decrease in utilisation) and roxithromycin (-26% decrease), the impact of shortages is most clearly reflected by decreases in utilisation. For the other six, minor changes in utilisation were observed coinciding with shortages.CONCLUSIONS: Antibiotic shortages were common in Australia during 2022 and 2023. The impact of shortages differs per antibiotic, for some antibiotics there are shortages coinciding with declines in utilisation. For others, shortages occur without apparent changes in utilisation.</p

Impact of Hospitalization on Antihypertensive Pharmacotherapy among Older Persons

BACKGROUND: Little is known about the impact of hospitalization on antihypertensive pharmacotherapy and blood pressure control in older persons. OBJECTIVES: The aim of this study was to explore the impact of hospitalization on the management of hypertension and antihypertensive pharmacotherapy in a cohort of older patients with a documented diagnosis of hypertension. METHODS: A retrospective, cross-sectional medical record audit was conducted in a large Australian metropolitan teaching hospital. Patients aged 65 years or older, admitted between January 1st 2010 and December 31st 2010, and with a documented diagnosis of hypertension in their medical record were included in the study. Antihypertensive pharmacotherapy and blood pressure control was compared between admission and discharge. Factors associated with changes to antihypertensive pharmacotherapy were identified. RESULTS: Changes to antihypertensive pharmacotherapy occurred in 39.5 % (n = 135) of patients (n = 342). On discharge, the proportion of patients receiving antihypertensive pharmacotherapy (89.0 vs 85.3 %, p < 0.0001) and the mean number of antihypertensive agents per patient (1.7 ± 1.1 vs 1.5 ± 1.1, p < 0.0001) declined compared with admission. Adverse drug reactions [odds ratio (OR) = 5, 95 % confidence interval (CI): 2.80–9.34] were the main reason documented for antihypertensive pharmacotherapy changes. Patients admitted under the care of medical (OR = 0.3, 95 % CI: 0.17–0.70) or surgical (OR = 0.3, 95 % CI: 0.12–0.53) specialties were less likely to experience changes to their antihypertensive pharmacotherapy than those treated by gerontology or cardiology teams. CONCLUSIONS: Hospitalization has a significant impact on antihypertensive pharmacotherapy. Two out of every five older persons on antihypertensive medications will experience changes to their regimens during admission to hospital with most changes in antihypertensive pharmacotherapy due to adverse drug reactions

Temporal Trends of Escherichia coli Antimicrobial Resistance and Antibiotic Utilization in Australian Long-Term Care Facilities

UNLABELLED: Background/Objectives: Antimicrobial resistance (AMR) is a global problem with antibiotic consumption considered a key modifiable factor for the development of AMR. Long-term care (LTC) facilities have been identified as potential reservoirs for Escherichia coli ( E. coli) resistance due to high rates of urinary tract infection (UTI) and high levels of antibiotic consumption among residents. However, while the relationship between these two factors is well accepted, little is known about the possible temporal relationship between these. This study explores trends in E. coli resistance and antibiotic consumption in LTC focused on potential temporal relationships between antibiotic utilization and AMR. METHODS: A retrospective, longitudinal, and ecological analysis was conducted between 31 May 2016 and 31 December 2018. The primary outcomes were the monthly prevalence of E. coli AMR in urine isolates and the monthly percentage of residents using an antibiotic recommended for the management of UTI in national treatment guidelines (amoxicillin, amoxicillin with clavulanic acid, cefalexin, norfloxacin, and trimethoprim). RESULTS: During the study period, 10,835 urine E. coli isolates were tested, and 3219 residents received one or more medicines and were included in the medicines dataset. Over one-quarter were resistant to at least one of the target antibiotics (23.3%). For most antibiotics, the temporal relationship between AMR and antibiotic utilization was unclear; however, potential patterns were observed for both trimethoprim and amoxicillin with clavulanic acid. Trimethoprim showed a temporal decrease in both AMR and utilization, while amoxicillin with clavulanic acid showed a lag time of approximately four months between utilization and resistance. CONCLUSIONS: The dynamic nature of AMR demonstrated in this study highlights the need for more up-to-date local surveillance to inform antibiotic choice in this setting.</p

One Health Determinants of Escherichia coli Antimicrobial Resistance in Humans in the Community:An Umbrella Review

To date, the scientific literature on health variables for Escherichia coli antimicrobial resistance (AMR) has been investigated throughout several systematic reviews, often with a focus on only one aspect of the One Health variables: human, animal, or environment. The aim of this umbrella review is to conduct a systematic synthesis of existing evidence on Escherichia coli AMR in humans in the community from a One Health perspective. PubMed, EMBASE, and CINAHL were searched on “antibiotic resistance” and “systematic review” from inception until 25 March 2022 (PROSPERO: CRD42022316431). The methodological quality was assessed, and the importance of identified variables was tabulated across all included reviews. Twenty-three reviews were included in this study, covering 860 primary studies. All reviews were of (critically) low quality. Most reviews focused on humans (20), 3 on animals, and 1 on both human and environmental variables. Antibiotic use, urinary tract infections, diabetes, and international travel were identified as the most important human variables. Poultry farms and swimming in freshwater were identified as potential sources for AMR transmission from the animal and environmental perspectives. This umbrella review highlights a gap in high-quality literature investigating the time between variable exposure, AMR testing, and animal and environmental AMR variables.</p