著者

丹羽 隆 篠田 康孝 鈴木 昭夫 大森 智史 太田 浩敏 深尾 亜由美 安田 満 北市 清幸 松浦 克彦 杉山 正 村上 啓雄 伊藤 善規

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.38, no.5, pp.273-281, 2012-05-10 (Released:2013-05-10)

参考文献数

38

被引用文献数

1 15

---

Antimicrobial resistance in hospitals is increasingly becoming a major problem worldwide, thus appropriate use of antimicrobial agents should be promoted. Since August 2009, our hospital has established a review system for checking prescriptions in all patients receiving antimicrobial injections according to the intervention and feedback of antimicrobial stewardship (AMS) guideline. The antimicrobial use density (AUD), duration of administration, length of hospital stay, and antimicrobial resistance in a year were compared before and after starting the intervention into AMS. Suggestions made by members of the infection control team (ICT) to the prescribers were for the major part the choice and dose elevation of antimicrobials. Most of the proposals (91%) were accepted by the prescribers. Although AUD was not changed after AMS intervention, the proportion of prolonged antimicrobial use (over 2 weeks) was significantly reduced from 5.2% to 4.1% (p=0.007), which led to the saving of costs for antibiotics (4.48 million yen/ year). The incidence of MRSA tended to decrease after AMS intervention (p=0.074). The median length of hospital stay was ultimately shortened by 1.0 day (p=0.0005), which led to an estimated saving of medical costs by 520 million yen/year. We consider that our intervention profoundly affects this cost saving. These findings suggest that the extensive intervention into AMS is effective in reducing the frequency of inappropriate use of antimicrobials, suppressing the occurrence of antimicrobial resistance, and saving medical expenses.

著者

伊藤 善規 千堂 年昭 大石 了三

出版者

公益社団法人 日本薬理学会

雑誌

日本薬理学雑誌 (ISSN:00155691)

巻号頁・発行日

vol.127, no.6, pp.425-432, 2006 (Released:2006-08-01)

参考文献数

62

被引用文献数

5 7

---

薬剤の投与により,肺間質組織へのマクロファージ,好中球,好酸球およびリンパ球などの炎症性細胞の浸潤によって炎症を呈し,肺胞壁の肥厚によって呼吸困難などの症状を呈するのが薬剤性間質性肺炎である.間質性肺炎や肺線維症,さらには肺水腫や急性呼吸不全症候群といった肺障害を引き起こす可能性がある薬剤は極めて多い.薬剤性肺障害は発症機序から肺組織に対する直接的な障害作用に基づくものとアレルギー反応に基づくものに分類されるが,多くの場合は両機序が相伴って発症すると考えられている.直接的な細胞障害作用を引き起こしやすい薬剤として,抗癌薬や抗不整脈薬(アミオダロン)があり,肺障害の発現頻度は投与量に依存する.一方,アレルギー性肺障害を引き起こしやすい薬剤としては,抗生物質,抗リウマチ薬,インターフェロン(IFN),顆粒球コロニー刺激因子製剤,小柴胡湯などが挙げられ,この場合の発現は投与量に依存しない.アレルギー性肺障害は予測が困難であり,かつ,症状の進行が早く,発症後,数日以内に呼吸不全に陥ることもある.本稿では,肺障害を起こしやすい代表的な薬剤を取り上げ,その発症機序と対策について述べる.

著者

原田紗希 西田承平 小林亮 鈴木昭夫 伊藤善規

出版者

医薬ジャーナル社

巻号頁・発行日

pp.687-692, 2017-02-01

---

医療過誤の減少に向けてさまざまな取り組みが行われており,薬剤師はその職能を生かして医療安全に貢献することがさらに強く求められている。薬剤に関連する過誤(メディケーションエラー)は最も典型的な医療過誤であり,指示伝達ミス等のコミュニケーションエラーは過誤の主な発生原因の一つである。実際に岐阜大学医学部附属病院において発生したメディケーションエラーを解析したところ,インスリンスライディングスケール(SSI)に関連する過誤の多くに,指示伝達ミス等のコミュニケーションエラーが関与していた。そこでSSIに関連する過誤の減少を目指して,薬剤部,糖尿病代謝内科および医療安全管理室が協働で院内統一の指示記載様式(テンプレート)を作成した。本報告ではSSIの院内統一テンプレート導入までの経緯と導入後の効果について紹介する。

著者

大石 了三 江頭 伸昭 伊藤 善規 江頭 伸昭 伊藤 善規

出版者

九州大学

雑誌

基盤研究(C)

巻号頁・発行日

2007

---

ポリエン系抗真菌薬のアムホテリシンBは、腎細胞膜のコレステロールに結合してポアを形成し、細胞内へのNa^+流入ならびに、小胞体およびミトコンドリア由来のCa^<2+>上昇を引き起こすことで、腎細胞にネクローシスを引き起こすことが明らかとなった。加えて、アムホテリシンBによる腎細胞内のCa^<2+>上昇およびミトコンドリア機能障害には、MAPキナーゼの活性化が重要な役割を担っていることが明らかとなった。

著者

岡元 律子 伊藤 善規 馬場 安里 村田 雄介 大石 了三 美根 和典

出版者

一般社団法人 日本臨床薬理学会

雑誌

臨床薬理 = JAPANESE JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS (ISSN:03881601)

巻号頁・発行日

vol.35, no.1, 2004-01-31

著者

平川 雅章 立石 真理 牧野 和隆 千堂 年昭 伊藤 善規 大石 了三

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.29, no.1, pp.20-27, 2003-02-10 (Released:2011-03-04)

参考文献数

10

---

Although the standards for the quality of rubber closures on injectable glass vials were specified in USP 24 in the U.S. and BP 2001 in the U.K., no such guidelines for quality control exist in Japan. In the present study, we investigated the quality of rubber closures on glass vials of frequently-used anti-biotic and anti-viral injections in our hospital, according to the quality control method of rubber closures for aqueous infusion that was standardized in JP14. Sufficiently washed rubber closures were immersed in distilled water, and test solutions were prepared after gently shaking them for 5 min or heating them at 121°C under high-pressure steam for 60 min. The optic transmittance in the resultant solutions was measured at 430nm and 650nm, and the findings were compared with those for the standard values in JP14 for rubber closures on aqueous infusions. Of 23 different rubber closures tested, only one showed a lower transmittance at 430nm when the solution was prepared by gentle shaking. Under the condition of heating with high-pressure steam, 15 products did not reach the criteria at both wavelengths, 3 did not meet the standards set at either of the wavelengths, but 5 had no qualitative problems. We also checked the materials stuffed in 0. 45μm membranes after filtration with an injection by microscopic observations using scanning electron microscopy and by an element analysis with an X-ray energy dispersive microanalyzer. A number of micro-particles were observed and they were found to be composed of silicon, aluminium and titanium.These results indicate that the quality of rubber closures of injectable glass vials varies among products. Therefore, the standards and guidelines for the quality control of rubber closures of injectable glass vials should be established in JP.

著者

吉田 実 平川 雅章 堤 千秋 立石 真理 中島 和博 岡部 昌之 末安 正典 吉川 学 中尾 泰史 伊藤 善規 大石 了三

出版者

一般社団法人日本医療薬学会

雑誌

医療薬学 (ISSN:1346342X)

巻号頁・発行日

vol.29, no.2, pp.189-195, 2003-04-10 (Released:2011-03-04)

参考文献数

11

被引用文献数

1 1

---

We examined the procedures for dispensing tablets or capsules that are not approved for crushing after checking the basis for such non-approval regarding 108 medicines introduced in our hospital. The problems are summarized as 1) a reduction in the pharmacological efficacy, 2) lowering the compliance due to a bitter taste or unpleasant odor, 3) dispersing hazardous powder, and 4) a disappearance of the efficacy of improved formulation such as for enteric coating.The taste of the ground tablets or capsules that are indicated to not be crushed was examined and compared with various concentrations of quinine hydrochloride powder in 8 healthy volunteers who showed a normal response to a bitter taste. Thirty-one out of 43 drugs were found to be tolerable to the taste, in which 13 drugs were less bitter than 0.5% quinine hydrochloride powder. However the other drugs either induced numbness or had a pungent taste and unpleasant odor, which were also considered to become the major reasons for nonapproval for crushing. Therefore, we found that several tablets have no serious problems, when they are dispensed after grinding. On the other hand, a number of hygroscopic medicines and anticancer agents tended to easily disintegrate in water. As a result, they can be prescribed by suspending them in water immediately before taking them. Our findings suggest that several tablets or capsules that are non-approved for crushing may thus be dispensed without any serious problems after crushing or disintegrating them in water. Therefore, our present findings may offer some useful information on the countermeasures for dispensing tablets and capsules that are not approved for crushing.