pmedpharmФармация и фармакологияPharmacy & Pharmacology2307-92662413-2241Pyatigorsk Medical and Pharmaceutical Institute - branch of Volgograd State Medical Univer10.19163/2307-9266-2022-10-3-267-277pmedpharm-1119Research ArticleФАРМАКОЛОГИЯ И КЛИНИЧЕСКАЯ ФАРМАКОЛОГИЯPHARMACOLOGY AND CLINICAL PHARMACOLOGYПОЛИПРАГМАЗИЯ ПРИ ЛЕЧЕНИИ СТАЦИОНАРНЫХ БОЛЬНЫХ С НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИЕЙ COVID-19POLYPHARMACY IN MANAGMENT OF IN-PATIENTS WITH NOVEL CORONAVIRUS DISEASE (COVID-19)https://orcid.org/0000-0002-0258-4092ПетровВ. И.PetrovV. I.

доктор медицинских наук, профессор, академик РАН, заведующий кафедрой клинической фармакологии и интенсивной терапии ФГБОУ ВО ВолгГМУ Минздрава России; главный внештатный специалист – клинический фармаколог Министерства здравоохранения РФ; заслуженный деятель науки РФ; заслуженный врач РФ

400131, Россия, г. Волгоград, пл. Павших Борцов, д. 1

Doctor of Sciences (Medicine), Professor, Academician of the Russian Academy of Sciences, Head of the Department of Clinical Pharmacology and Intensive Care, Volgograd State Medical University, Chief Freelance Specialist – Clinical Pharmacologist of the Ministry of Health of the Russian Federation, Honored Scientist of the Russian Federation, Honored Doctor of the Russian Federation

1, Pavshikh Bortsov Sq., Volgograd, Russia, 400131

brain@sprintnet.ruhttps://orcid.org/0000-0002-4778-5015РязановаА. Ю.RyazanovaA. Yu.

кандидат медицинских наук, доцент кафедры клинической фармакологии и интенсивной терапии

400131, Россия, г. Волгоград, пл. Павших Борцов, д. 1

Candidate of Sciences (Medicine), Associate Professor of the Department of Clinical Pharmacology, Intensive Care

1, Pavshikh Bortsov Sq., Volgograd, Russia, 400131

nastasyakus@mail.ruhttps://orcid.org/0000-0002-2578-6228ПривальцеваН. С.PrivaltsevaN. S.

аспирант кафедры клинической фармакологии и интенсивной терапии 

400131, Россия, г. Волгоград, пл. Павших Борцов, д. 1

Postgraduate student, Department of Clinical Pharmacology and Intensive Care

1, Pavshikh Bortsov Sq., Volgograd, Russia, 400131

nata5847@yandex.ruhttps://orcid.org/0000-0002-1722-011XНекрасовД. А.NekrasovD. A.

аспирант кафедры клинической фармакологии и интенсивной терапии 

400131, Россия, г. Волгоград, пл. Павших Борцов, д. 1

 

Postgraduate student, Department of Clinical Pharmacology and Intensive Care

1, Pavshikh Bortsov Sq., Volgograd, Russia, 400131

dmitiynekrasov@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияVolgograd State Medical UniversityRussian Federation202224072022103267277Copyright © Петров В.И., Рязанова А.Ю., Привальцева Н.С., Некрасов Д.А., 20222022Петров В.И., Рязанова А.Ю., Привальцева Н.С., Некрасов Д.А.Petrov V.I., Ryazanova A.Y., Privaltseva N.S., Nekrasov D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmpharm.ru/jour/article/view/1119Цель

Цель. Выявить случаи полипрагмазии и разработать пути оптимизации фармакотерапии пациентов с СOVID-19, госпитализированных в инфекционные отделения.

Материалы и методы

Материалы и методы. Для оценки объёма и структуры потребления ЛС в инфекционных отделениях Волгоградской области, перепрофилированных для лечения больных СOVID-19 в 2020 и 2021 гг., был проведен АТС/DDD-анализ с расчётом показателей DDD/100 койко-дней и выборочный анализ 500 листов назначений.

Результаты

Результаты. Одновременно 5 и более ЛС принимали 96,8% пациентов. Антибактериальные ЛС встречались в 74,3% проанализированных врачебных назначений в 2020 г. и в 73,5% в 2021 г., суммарный объём потребления составил 102,9 DDD/100 койко-дней в 2020 г. и 95,7 DDD/100 койко-дней в 2021 г. Были выявлены случаи множественных введений ГИБП и применение циклофосфамида. В 73,6% врачебных назначений 2020 г. и 85,4% в 2021 г. применялся омепразол в дозе 40 мг в сутки (77,3 и 84,6 РDD/100 койко-дней соответственно). В 2021 г. были выявлены случаи одновременного назначения ацетилцистеина под торговым наименованием «Флуимуцил®» внутривенно с таблетированными формами амброксола и ацетилцистеина под наименованием «АЦЦ®». Суммарное потребление гепатотоксичных ЛС составило 269,2 DDD/100 койко-дней в 2020 г. и 401,5DDD/100 койко-дней в 2021 г.

Заключение

Заключение. Отсутствие препаратов с доказанной эффективностью для лечения COVID-19, отработанных алгоритмов лечения, наличие высокой летальности пациентов в стационаре привели к полипрагмазии, избыточному назначению ЛС в стационаре. Назначение антибактериальных ЛС, омепразола, муколитиков, гепатотоксичных препаратов, иммуносупрессоров в инфекционных стационарах должно быть ограничено и проводиться под контролем клинического фармаколога.

The aim

The aim. To identify polypharmacy cases and develop the ways to optimize pharmacotherapy of patients with COVID-19 hospitalized in infectious disease facilities.

Materials and methods

Materials and methods. ATC/DDD analysis with calculation of DDDs/100 bed days and a sample analysis of 500 patients’ prescriptions were performed for presenting drug utilization statistics in the infectious disease facilities of Volgograd region, which had been reassigned to treat patients with COVID-19 in 2020 and 2021.

Results

Results. Five or more drugs were administered simultaneously in 96.8% of patients. Antibacterial drugs were in 74.3% of the analyzed prescriptions in 2020 and in 73.5% in 2021. The total consumption of antibiotics was 102.9 DDDs/100 bed-days in 2020 and 95.7 DDDs/100 bed-days in 2021. The cases of multiple administrations of biological disease modifying antirheumatic drugs and the use of cyclophosphamide have been identified. In 73.6% of prescriptions in 2020 and 85.4% of 2021, omeprazole at the dose of 40 mg per day was used (77.3 and 84.6 DDDs/100 bed-days, respectively). In 2021, there were cases of concomitant intravenous prescribing of acetylcysteine under the trade name of Fluimucil® with tableted forms of ambroxol and acetylcysteine under the name of ACC®. The cumulative consumption of hepatotoxic drugs was 269.2 DDDs/100 bed-days in 2020 and 401.5 DDDs/100 bed-days in 2021.

Conclusion

Conclusion. Lack of drugs with proven effectiveness for treatment of COVID-19, worked-out treatment algorithms, a high mortality of patients in the hospitals led to polypragmasy, excessive prescribing of drugs in the hospitals. The prescription of antibacterial drugs, omeprazole, mucolytics, hepatotoxic drugs, immunosuppressors in infectious hospitals should be monitored by clinical pharmacologist.

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The authors declare that there are no conflicts of interest present.