COVID-19 Patient Management in Outpatient Setting: A Population-Based Study from Southern Italy

Evidence on treatments for early-stage COVID-19 in outpatient setting is sparse. We explored the pattern of use of drugs prescribed for COVID-19 outpatients’ management in Southern Italy in the period February 2020–January 2021. This population-based cohort study was conducted using COVID-19 surveillance registry from Caserta Local Health Unit, which was linked to claims databases from the same catchment area. The date of SARS-CoV-2 infection diagnosis was the index date (ID). We evaluated demographic and clinical characteristics of the study drug users and the pattern of use of drugs prescribed for outpatient COVID-19 management. Overall, 40,030 patients were included in the analyses, with a median (IQR) age of 44 (27–58) years. More than half of the included patients were asymptomatic at the ID. Overall, during the study period, 720 (1.8%) patients died due to COVID-19. Azithromycin and glucocorticoids were the most frequently prescribed drugs, while oxygen was the less frequently prescribed therapy. The cumulative rate of recovery from COVID-19 was 84.2% at 30 days from ID and it was lower among older patients. In this study we documented that the drug prescribing patterns for COVID-19 treatment in an outpatient setting from Southern Italy was not supported from current evidence on beneficial therapies for early treatment of COVID-19, thus highlighting the need to implement strategies for improving appropriate drug prescribing in general practice.

Patterns and Predictors of Off-Label Drug Prescribing in Psychiatric Practice: A Qualitative Study

Off-label drug prescribing (OLDP) must be based on strong scientific evidence to make sure that patients get the optimum therapeutic outcomes. Adherence to the prerequisites is determined by the physicians’ attitude and knowledge. In this context, the present study was conducted with the goal of investigating psychiatrists’ perceptions of the use of OLDP in their clinical practice. A total of 14 psychiatrists were interviewed using a semi-structured interview guide. Thematic content analysis was performed. Data saturation was achieved at the 12th interview. Six major themes and fifteen subthemes emerged from qualitative interviews. Among the major themes were knowledge and concepts about the off-label drugs, attitude and current practice of prescribing off-label drugs, and rationale of prescribing and suggestions for reducing the use of off-label drugs. Almost all of the respondents interviewed provided detailed comments concerning the OLDP concept, depicted an optimistic approach and deemed that OLDP is quite common in psychiatry. Off-label usage of benzodiazepines such as clonazepam, diazepam and lorazepam in mania, depression, and obsessive–compulsive disorder were commonly reported. It was observed that the majority of the respondents did not inform the patients before prescribing off-label drugs. The present findings revealed that respondents had awareness; however, they depicted diverse attitudes towards prescribing off-label drugs. Further education and sensitization in regions with impoverished knowledge would certainly assist in preventing the risks associated with the use of OLDP.

Physicians’ perspectives on adverse drug reactions in pediatric routine care: a survey

Background Children and adolescents are at particular risk for adverse drug reactions (ADRs). We investigated physicians’ perceptions on ADRs in pediatric routine care. Methods In this exploratory study from April to November 2020, we invited physicians treating pediatric patients across Germany to complete an online questionnaire consisting mainly of closed questions. Results Completion rate was 98% (127/129). Of all participants, 23% (29/127) stated they were not able to estimate how many of their pediatric patients experienced ADRs during drug therapy. The remaining physicians estimated that 7.5% (median; Q25/Q75 3%/20%) of their pediatric patients were affected by ADRs. Regarding counseling on ADRs, 61% (77/127) stated they do not ask regularly the extent to which parents want to be informed. In total, 26% (33/127) stated they avoid counseling on ADRs concerning commonly used approved therapies, whereas only 4% (5/127) did so concerning off-label use (P < 0.001). Altogether, 16% (20/127) stated they rather prescribe new medicines as they hope for better effectiveness; 72% (91/127) said they are cautious about doing so owing to yet unknown ADRs. Of all respondents, 46% (58/127) stated they do not report ADRs to the authorities. Concerning the black triangle symbol, a European pharmacovigilance measure, 11% (14/127) stated they knew it and 6% (7/127) stated they reported any suspected ADR for drugs with that symbol. Conclusions Physicians’ perspectives on ADRs were ambivalent: ADRs influenced their parent counseling and drug prescribing; yet, they struggled to estimate the impact of ADRs on their patients and were not aware of specific pharmacovigilance measures.

Oral surgery in and after the COVID-19 period from the consultation to the operating room

Severe acute respiratory syndrome (SARS) caused by the SARS-CoV-2 virus was first reported in Wuhan, China, in December 2019 has rapidly spread worldwide at an unprecedented rate and has profound health and socioeconomic effects directly affecting all fields. From the onset of the pandemic, the authors realized the impending impact on the dental field. Dental professionals are uniquely exposed to environments with high levels of infection risk from aerosols and oral fluids. Dental treatment has become a challenge during the epidemic. However, the light of optimism has faded with the onset of vaccination. The purpose of this article is to provide guidance to dental surgeons on how to adapt their current practice during and after the COVID-19 pandemic with respect to consultation activity, surgical activity, and drug prescribing in oral surgery. Thus, an electronic search was performed from PubMed (MEDLINE), Scopus, Cochrane, Google Scholar and Sciencedirect databases. 35 articles were identified of which 24 were selected to compose this article. Within the limitations of this literature review, the presence of the virus is inevitable in oral surgery practice. Dentists must continue to provide care to their patients while monitoring the evolution of Covid-19.

Veterinary Drug Prescribing Practices at Selected District Veterinary Clinics of Rift Valley Areas of Ethiopia

The rational use of drugs in veterinary medicine has various significances, such as reducing the risk of drug resistance, increasing efficacy, reducing drug residue, and decreasing adverse drug reactions. A retrospective study was conducted to assess veterinary drug prescribing practices at Batu and Arsi-Negelle district veterinary clinics in the rift valley areas of Ethiopia. A total of 2,464 cases were recorded from the case registration books at both the clinics for diseases treated between September 2012 and February 2015. The study results showed that for a total of 2,464 cases diagnosed at both clinics, 3,811 different drugs were prescribed, with an average per encounter of 1.6. Among the total drugs, oxytetracycline, ivermectin, penstrep, sulfa drugs, and albendazole were the most leading prescribed drugs with a frequency of 43.0%, 17.6%, 10.2%, 6.5%, and 1.3%, respectively. All drugs were prescribed by the generic name without any laboratory support of the disease. About 68.3% of the cases were diagnosed by unspecified professionals, whereas 21.7% and 10.1% were done by animal health assistants and veterinarians, respectively. The prescribing practices showed 61.0% of antibiotics and 29.7% of anthelmintics where 45.3% and 54.7% of antibiotics and 17.8% and 82.2% of anthelmintics were given at Batu and Arsi-Negelle veterinary clinics, respectively. Of the prescribed drugs, 4.6% oxytetracycline and 2.6% penstrep were prescribed irrationally to treat diseases that were tentatively diagnosed as parasitic cases. Similarly, 40.5% ivermectin and 17.7% albendazole were prescribed for bacterial infections. In conclusion, this study revealed problems in antibiotics and anthelmintics use, description of routes of administration and length of treatment, and shortage of laboratory diagnostic facilities. Therefore, veterinary drugs, particularly antibiotics and anthelmintics, should be used appropriately to safeguard the public from residual drug impacts and resistance development.

Substrate specificity of CYP2D6 genetic variants

Genetic variation in the gene encoding CYP2D6 is used to guide drug prescribing in clinical practice. However, genetic variants in CYP2D6 show substrate-specific effects that are currently not accounted for. With a systematic literature, we retrieved 22 original studies describing in vitro experiments focusing on CYP2D6 alleles ( CYP2D6*1, *2, *10 and *17) and substrates. Allele activity (clearance of the allele of interest divided by the clearance of the wildtype) was extracted. The results support the hypothesis of the existence of substrate specificity of the CYP2D6*17-allele (higher debrisoquine clearance), a subtle effect of the CYP2D6*10-allele (lower dextromethorphan clearance) but no substrate-specific effect of the CYP2D6*2-allele. Although our results support substrate specificity, for most substrates data are too sparse and require further studies.