Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.
Pharmacoepidemiol Drug Saf. 2024 Aug;33(8):e5868. doi: 10.1002/pds.5868.
In clinical practice, a discrepancy may exist between the prescribed amount of a drug and the commercially available pack sizes in the pharmacy, potentially contributing to drug waste. This study aimed-as an example of this phenomena-to quantify leftover of amoxicillin suspension prescribed to children, due to discrepancies between physician-prescribed and pharmacy-dispensed amounts.
We performed a retrospective cohort study including amoxicillin suspension dispensations for patients aged 0-12 years between 2017 and 2019 utilizing the Dutch PHARMO database. Leftover amount of amoxicillin was estimated by assessing the discrepancy between the prescribed and dispensed amounts. Extrapolated amoxicillin weight and economic spillage estimates for the Netherlands were determined. The impact of two theoretical interventions on leftover amount was assessed: (1) introducing vials with half the volume of the current 100 and 30 mL vials and (2) a combination of the first intervention with a maximum of 10% round-down by the dispensing pharmacy of the prescribed dose.
We included 79 512 amoxicillin suspension dispensations for 62 252 patients. The mean leftover amount of amoxicillin suspension per dispensing was 27%. The yearly amount of amoxicillin leftover was 49.8 kg in the study cohort, equivalent to yearly 633 kg and €621 000 when extrapolated to the Netherlands. Employing the first theoretical intervention reduced the mean leftover per dispensing to 20%, reducing the yearly leftover to 31.6 kg amoxicillin in the study cohort, and to 400 kg and €400 000 extrapolated. The second theoretical intervention further reduced leftover to 17%, reducing the yearly leftover to 24.3 kg amoxicillin in the study cohort, and to 300 kg and €300 000 extrapolated.
Approximately a quarter of amoxicillin suspension remains as leftover per dispensing. Applying different theoretical intervention shows the potential for a significant reduction of amoxicillin leftover.
在临床实践中，医生开具的药物剂量与药房可供应的包装大小之间可能存在差异，这可能导致药物浪费。本研究旨在以这种现象为例，定量分析由于医生开具的剂量与药房分发的剂量之间的差异而导致儿童剩余的阿莫西林混悬剂。
我们进行了一项回顾性队列研究，纳入了 2017 年至 2019 年期间荷兰 PHARMO 数据库中年龄在 0 至 12 岁之间的阿莫西林混悬剂处方。通过评估规定剂量与分发剂量之间的差异来估计阿莫西林的剩余量。确定了荷兰的阿莫西林重量和经济溢出估计值。评估了两种理论干预措施对剩余量的影响：（1）引入体积为当前 100 和 30 毫升小瓶一半的小瓶；（2）药房将处方剂量的最大 10%向下取整的组合。
我们纳入了 79512 次阿莫西林混悬剂的处方，涉及 62252 名患者。每次处方的阿莫西林混悬剂剩余量平均为 27%。在研究队列中，每年剩余的阿莫西林量为 49.8 公斤，当外推到荷兰时，每年的剩余量为 633 公斤和 621000 欧元。采用第一种理论干预措施，每次处方的剩余量平均减少到 20%，研究队列中每年剩余的阿莫西林量减少到 31.6 公斤，外推到荷兰则为 400 公斤和 400000 欧元。第二种理论干预措施进一步减少了剩余量，降至 17%，研究队列中每年剩余的阿莫西林量减少到 24.3 公斤，外推到荷兰则为 300 公斤和 300000 欧元。
每次处方中约有四分之一的阿莫西林混悬剂剩余。应用不同的理论干预措施显示出减少阿莫西林剩余量的潜力。
