Improving medication use – ESCP Day 3 Highlights

Therapeutic advances in lung cancer 

Molecular testing before the start of treatment is good clinical practice (GCP) and confers considerable benefits in survival, according to Professor Joanna Chorostowska-Wynimko (National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland). “The combination of science, genetics and clinical pharmacology really improves survival in lung cancer”, she said

She traced the discovery of treatable mutations in lung cancer and showed how progressive improvements in the treatment of non-small cell lung cancer (NSCLC) had led to impressive improvements in overall survival.

Antimicrobial stewardship

In most European countries more than 25% of E. coli isolates are now fluorquinolone-resistant and in some countries the rate is over 50%, explained Dr Marina Odalović (University of Belgrade, Serbia)  Antibiotic usage patterns vary considerable across Europe. She noted that national recommended targets by 2030 include:

• A reduction in the total consumption of antibiotics by 3-27%
• 65% of antibiotics used should be in the Access group as defined by the WHO AWaRe classification
• A reduction in the incidence of MRSA bloodstream infections by 3-18%

Dr Odalović emphasised the role of pharmacists in the optimisation of antimicrobial use and reduction of antimicrobial resistance. Finally, she reminded the audience that antibacterial agents in the clinical pipeline combined with those approved in the past six years are still insufficient to tackle the ever-growing threat of the emergence and spread of drug-resistant infections.

Delirium and dementia 

Professor Anita Weidmann (University of Innsbruck, Austria) described the challenging problem of delirium superimposed on dementia (DSD). Older adults with dementia are five times more likely to develop delirium when hospitalised and for many this can persist after discharge.

There are many diagnostic tools for delirium but only three are suitable for DSD. A number of risk factors, including diabetes mellitus, pain and treatment with benzodiazepines, have been identified. Anti-psychotic drugs are recommended for treatment but there is no evidence to support this, said Professor Weidmann. In closing she described how a consensus guideline (Consensus Guideline on Medication Factors in Delirium – COMeD) had been developed to combat the shortage of information about medication and prescribing in DSD.

Point-of-care screening interventions

In recent years Portuguese community pharmacists have been involved in a multinational project for early detection of atrial fibrillation. Dr Carolina Ferreira (Health Solutions Manager, Ezfy, Portugal) described how pharmacists had been trained to check pulses, record results and make referrals when irregular pulses were detected. In total 56 participating pharmacies had made 1699 pulse checks and identified 77 cases with irregular pulses. Of these, 24 received confirmed diagnoses and treatment.

Another project had involved screening of people aged 50-79 years for colorectal cancer. In total 143 people had positive faecal occult blood tests and were instructed to make appointments to see their doctors. At the time of follow up information was available for 65 participants; 53 had doctors’ appointments of whom 28 had further tests, six were diagnosed with benign polyps and two with adenomatous polyps.