Medication Usage Evaluation in Patients Prescribed with Ganciclovir in Bone Marrow Transplantation
Background: Cytomegalovirus (CMV) is one of the leading risks in bone marrow transplantation for which Ganciclovir is choice of therapy requiring monitoring due to its cytotoxic potential.
Study objectives: The aim of this study was to assess the use of Ganciclovir in the management of CMV in hemato-oncologic patients.
Methods: The study was designed to assess the usage pattern of Ganciclovir in concordance with the predefined assessment criteria. The medical record of patients was extracted by a senior clinical pharmacist from the specialty of hematology-Oncology in a hospital located in Karachi, Pakistan. Patients’ records of 2016-2017 (24 months) were collected both retrospectively and prospectively to review with CMV positive infection; the nurses’ performance regarding drug storage, handling, and preparation for administration was also observed. Assessment criteria were developed to evaluate the appropriateness of Ganciclovir use by applying standard treatment guidelines adapted from the Lexicomp drug monograph specifying its usage details, USP 800 (United States Pharmacopeia) and NIOSH Guidelines The collected data were categorized and analyzed by using Statistical Package for Social Sciences software, version 16.0.
Results: For this study, 42 cases with CMV positive infection were observed. Out of n= 42 cases, n= 23 (54.76%) had drug interaction with mycophenolate mofetil and n= 1 (2.38%) case had drug interaction with imipenem cilastatin. Ganciclovir was stopped in n= 8 (19.04%) patients due to development of adverse drug reaction (febrile neutropenia). It was observed by the senior clinical pharmacist that neither the pharmacists nor the nurses were aware of protocol for Ganciclovir handling as per standard treatment guidelines.
Conclusion: Ganciclovir was inappropriately managed by the Nurses and Pharmacists which can be improved by developing and implementing local guidelines according to standard protocol.
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