Objective: To describe the characteristics and management of asthma in clinical practice in the Czech Republic in the context of international guidelines and clinical realities.Methods: Data were collected over four seasons from summer 2016 to spring 2017 and are mostly presented using descriptive statistics.Results: We obtained valid data for 4557 adult patients with asthma, including detailed phenotyping (71% eosinophilic allergic, 10% eosinophilic non-allergic, 19% non-eosinophilic non-allergic asthma) from 58 allergologists and 56 pulmonologists. The average time to diagnosis was 3 years. In more than half of the subjects, bronchodilator testing (BDT) results were available at primary diagnosis. More than 10% of physicians did not test for mold allergy. Occupational asthma was diagnosed in 0.7% of subjects. According to the attending physician, 68% of patients had well-controlled and 10% had uncontrolled asthma. Ninety-four percent of patients were on preventive treatment, with 91% using an inhaled corticosteroids (ICS) at an average dose of 705 µg/day budesonide equivalent. Approximately 75% of patients were on an ICS/LABA, with 91% using fixed combinations. Among patients using ICS/formoterol, a maintenance and reliever therapy regime was prescribed in 67%.Conclusions: The quality of asthma management in the Czech Republic is comparable to that of other developed countries and better in some respects (frequent BDT, phenotyping, and use of preventive treatment). Nevertheless, there is unnecessary delay in diagnosis and lack of research on possible environmental causes (workplace, molds). Pharmacotherapy shows good adherence to guidelines. Although 10% of patients show poor control, there is concurrently a trend for overtreatment.

• Klíčová slova
• Epidemiological survey, allergologists, allergy, asthma diagnosis, eosinophilia; pulmonologists, medical overuse, phenotyping,
• MeSH
• agonisté beta-2-adrenergních receptorů aplikace a dávkování   MeSH
• alergologie a imunologie normy   statistika a číselné údaje   trendy   MeSH
• antiastmatika aplikace a dávkování   MeSH
• aplikace inhalační MeSH
• bronchiální astma diagnóza   farmakoterapie   MeSH
• budesonid aplikace a dávkování   MeSH
• dodržování směrnic statistika a číselné údaje   trendy   MeSH
• dospělí MeSH
• fixní kombinace léků MeSH
• formoterol fumarát MeSH
• glukokortikoidy aplikace a dávkování   MeSH
• kombinovaná farmakoterapie metody   statistika a číselné údaje   MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• opožděná diagnóza statistika a číselné údaje   MeSH
• pneumologie normy   statistika a číselné údaje   trendy   MeSH
• průřezové studie MeSH
• senioři MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• společnosti lékařské normy   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• agonisté beta-2-adrenergních receptorů MeSH
• antiastmatika MeSH
• budesonid MeSH
• fixní kombinace léků MeSH
• formoterol fumarát MeSH
• glukokortikoidy MeSH

OBJECTIVE: Combined hormonal contraceptives (CHC) exhibit differing risks for cardiovascular and thrombotic events (VTE). A European referral process confirmed higher VTE risks for 3rd generation gestagens and drospirenone. CHC are now grouped in risk classes (RC) I, II, and III, with RC III having a higher risk than RC I and X (risk not yet known). Marketing authorization holders were obliged to implement pharmacovigilance measures and risk minimization measures including changes of prescribing information. The study assessed whether these activities induced changes in prescription patterns. METHODS: German prescription data for 1.1 million women below 20 years of age were used to analyze the effects of interventions and potential influence factors using logistic regression. Descriptive statistics were calculated for prescriptions for 3.3 million women from January 2011 to March 2016. RESULTS: Shares of RC I and RC X recipients rose substantially over the observation period, while RC III recipient share showed a steady decrease. The referral induced a slightly faster decrease in RC III and increase in RC X. The implementation of pharmacovigilance measures manifested no additional effect. CONCLUSION: The decrease in RC III share already observed before the referral process can be explained with pre-existing discussions around CHC. The effect attributable to the referral was statistically significant, although very small. While evidence for a connection between interventions and prescription change is only indirect, the study shows that routine data are suitable for impact analyses, and monitoring prescribing patterns can be recommended as feedback after regulatory or political interventions. This is being followed up.

• Klíčová slova
• ARIMA, Claims data, Combined hormonal contraceptives, Germany, Intervention analysis, Pharmacoepidemiology, Thromboembolism,
• MeSH
• dospělí MeSH
• farmaceutický průmysl zákonodárství a právo   MeSH
• hodnocení rizik * MeSH
• kontraceptiva orální kombinovaná * MeSH
• lékové předpisy * normy   statistika a číselné údaje   MeSH
• lidé MeSH
• mladý dospělý MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Německo MeSH
• Názvy látek
• kontraceptiva orální kombinovaná * MeSH

INTRODUCTION: The importance of rational drug therapy is increasing with the aging of the population. Since one of the main reasons for inappropriate drug prescribing is also the "age-blind" approach, which results in ageist practices, this narrative literature review focuses on the description of the main barriers related to insufficient individualization of drug regimens associated with such age-blind approaches. METHODOLOGY: A narrative literature review using the PubMed, WoS, Embase, and Scopus databases was conducted by the EU COST Action IS1402. Experts in different scientific fields from six countries (the Czech Republic, Spain, Portugal, Hungary, Serbia, and Turkey) worked in four specific areas: (1) underrepresentation of older adults in clinical trials and clinical and ethical consequences; (2) insufficient consideration of age-related changes and geriatric frailty in the evaluation of the therapeutic value of drugs; (3) frequent prescribing of potentially inappropriate medications (PIMs); and (4) frequent underuse of highly beneficial nonpharmacological strategies (e.g., exercise). RESULTS: Older patients are underrepresented in clinical trials. Therefore, rigorous observational geriatric research is needed in order to obtain evidence on the real efficacy and safety of frequently used drugs, and e.g. developed geriatric scales and frailty indexes for claims databases should help to stimulate such research. The use of PIMs, unfortunately, is still highly prevalent in Europe: 22.6% in community-dwelling older patients and 49.0% in institutionalized older adults. Specific tests to detect the majority of age-related pharmacological changes are usually not available in everyday clinical practice, which limits the estimation of drug risks and possibilities to individualize drug therapy in geriatric patients before drug prescription. Moreover, the role of some nonpharmacological strategies is highly underestimated in older adults in contrast to frequent use of polypharmacy. Among nonpharmacological strategies, particularly physical exercise was highly effective in reducing functional decline, frailty, and the risk of falls in the majority of clinical studies. CONCLUSION: Several regulatory and clinical barriers contribute to insufficient knowledge on the therapeutic value of drugs in older patients, age-blind approach, and inappropriate prescribing. New clinical and observational research is needed, including data on comprehensive geriatric assessment and frailty, to document the real efficacy and safety of frequently used medications.

• Klíčová slova
• Age-related changes, Ageism, Drug prescribing, Frailty, Observational studies, Older patients, Polypharmacy, Potentially inappropriate medications, Randomized controlled trials,
• MeSH
• geriatrické hodnocení MeSH
• lékové předpisy normy   statistika a číselné údaje   MeSH
• lidé MeSH
• nevhodné předepisování statistika a číselné údaje   MeSH
• polypharmacy * MeSH
• prevalence MeSH
• randomizované kontrolované studie jako téma statistika a číselné údaje   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• seznam potenciálně nevhodných léčiv statistika a číselné údaje   MeSH
• věkové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH
• Turecko MeSH

INTRODUCTION: In the Czech Republic, patients with diabetes mellitus (DM) are followed and treated predominantly by specialists (approx. 80% at a specialist diabetology clinic), a minor part by general practitioners (up to 20%). Long-term development of the changes in prescribing metformin and sulfonylurea in the Czech Republic and its concordance with recommended procedures has not been evaluated until now. GOAL: Comparison of the development of metformin (MET) and sulfonylurea (SU) prescriptions in the period of 2002-2006 with that of 2010-2014 in a representative sample of the patient population with DM kept in the database of the General Health Insurance Company of the Czech Republic (VZP) which provided health care coverage for 63% of Czech Republic population in 2014. METHODOLOGY: We identified all individuals in the VZP database who had a record of DM diagnosis (E10-E16 based on ICD 10) or who had any antidiabetic therapy prescribed (ATC group A10) in the periods of 2002-2006 and 2010-2014. A cohort of patients was extracted for analysis, who had an agent from A10 group prescribed at least once in a relevant year (n=308,962 in 2002; n=426,695 in 2014). A number of patients was evaluated for each year, who had at least once MET or SU prescribed. The number of patients treated with MET or SU was then expressed as a percentage of all who had any therapy from A10 group prescribed in the year in question. RESULTS: Metformin prescriptions have linearly risen from 43% to 77%, while sulfonylurea prescriptions have linearly decreased from 65% to 37%. CONCLUSION: The analysis presents the first evaluation of the development of metformin prescriptions conducted in the Czech Republic and evaluation of its concordance with the recommended procedures for the treatment of DM. The amount of metformin prescribed in the Czech Republic increased from 43% to 77% while the amount of SU prescribed decreased from 65% to 37% between 2002 and 2014. This development and the current ratio between the prescribed amounts of MET and SU demonstrate the implementation of the recommended procedures into practice and prove the high quality of care for patients with DM2T in specialists--diabetologists surgeries.

• MeSH
• časové faktory MeSH
• diabetes mellitus 2. typu farmakoterapie   MeSH
• dospělí MeSH
• hypoglykemika terapeutické užití   MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metformin terapeutické užití   MeSH
• sulfonylmočovinové sloučeniny terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• hypoglykemika MeSH
• metformin MeSH
• sulfonylmočovinové sloučeniny MeSH

We assessed antibiotic prescribing in practical dentistry in the Czech Republic, as antibiotics are widely prescribed by dental practitioners and warning signals of their overuse can be observed. The individual antibiotic prescriptions were extracted from the database of the General Health Insurance Company and further analysed. The proportion of dentists' prescription within the whole primary health-care sector and the rate of prescriptions of particular antibiotics were both in defined daily doses per 1,000 insurees and day (DID) and in number of prescriptions calculated. The proportion of antibiotic use in dentistry increased from 0.63 DID in 2006 to 0.75 DID. We found a decline in use of narrow-spectrum penicillins by 4.8%, tetracyclines by 3.5% and macrolides by 3.6%, accompanied by increasing rate of prescription of aminopenicillins combined with beta-lactamase inhibitor by 8.9% and lincosamides by 8.5%. The consumption of clindamycin and amoxicillin combined with clavulanate in DID has increased by approximately 60% since 2006 thanks to the exclusive prescribing of two commercial oral products only. Factors contributing to this unfavourable trend are commercial influence or defensive medicine practice.

• Klíčová slova
• General dental practitioners, antibiotics, database study, prescribing,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• databáze faktografické MeSH
• inhibitory beta-laktamasy MeSH
• klindamycin terapeutické užití   MeSH
• kombinace amoxicilinu a kyseliny klavulanové terapeutické užití   MeSH
• kyselina penicilanová analogy a deriváty   terapeutické užití   MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé MeSH
• linkosamidy terapeutické užití   MeSH
• makrolidy terapeutické užití   MeSH
• metronidazol terapeutické užití   MeSH
• peniciliny terapeutické užití   MeSH
• sektor zdravotní péče statistika a číselné údaje   MeSH
• tetracykliny terapeutické užití   MeSH
• všeobecné zubní lékařství statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• aminopenicillanic acid MeSH Prohlížeč
• antibakteriální látky MeSH
• inhibitory beta-laktamasy MeSH
• klindamycin MeSH
• kombinace amoxicilinu a kyseliny klavulanové MeSH
• kyselina penicilanová MeSH
• linkosamidy MeSH
• makrolidy MeSH
• metronidazol MeSH
• peniciliny MeSH
• tetracykliny MeSH

UNLABELLED: Drug interactions are important potential causes of adverse drug reactions. However, studies of their occurrence in children are almost entirely lacking. This study evaluates the incidence of potential drug interactions (PDIs) in medication prescriptions for children. The study was performed at the University Hospital in Olomouc. PDIs in each patient's prescriptions were identified. Multivariate analysis was performed in order to assess the risk factors confounding the potential interactions. Univariate analysis was used to assess which diagnostic groups and medication groups significantly increase or lower the odds of a potential drug-drug interaction. A total of 6,078 patients meeting the inclusion criteria entered the study. They received 19,522 prescriptions. PDIs were identified in 3.83 % of patients (moderate-to-severe cases in 0.47 %). Patient age (p = 0.008), the average number of prescriptions per visit (p < 0.0001), and the number of visits per year (p < 0.0001) were found to increase the risk of drug interaction. The presence of epilepsy, leukemia, or rheumatoid arthritis and related disease diagnoses were discovered to increase the risk of PDIs significantly. CONCLUSION: The risk of PDIs in children is low, but it increases significantly with age and the number of drugs prescribed, particularly antiepileptics and immunosuppressants. The finding of a potential interaction in 0.47 % of all children in whom any medication was prescribed should not be underestimated since it means a significant risk for one child out of every 200, and it is also substantially higher in the chronically ill. Pediatricians should be aware of relevant interactions and should prevent them by therapeutic drug monitoring or appropriate clinical and laboratory monitoring.

• MeSH
• dítě MeSH
• hodnocení rizik MeSH
• incidence MeSH
• kojenec MeSH
• lékové interakce * MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• monitorování léčiv MeSH
• nemocnice univerzitní MeSH
• předškolní dítě MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVES: Both, obesity as well as anorexia may be associated with infertility and other complications of pregnancy. Weight loss during pregnancy is therefore considered a risk factor. Weight loss and appetite suppressant are contraindicated during pregnancy, but the unintended exposure is probably not associated with higher risk. Our work was focused on trends in the appetite suppressants use in the Czech Republic and their embryotoxicity. METHODS: The pregnancies exposed to various appetite suppressants were followed prospectively in the years 1997-2012. The study group was compared to the comparison group which enrolled pregnant women exposed to non-teratogenic drugs. Drugs used as appetite suppressants were sibutramine and phentermine. RESULTS: Number of calls for this type of exposure was rare till 2005. Their number started to increase until 2009. Later, number of calls decreased because both drugs were withdrawn from the market. This finding reflects increasing tendency for the weight control in the group of fertile women in the Czech Republic. In our study, we did not reveal differences in pregnancy outcomes between study and comparison groups. CONCLUSIONS: However, we should be aware of the increasing food supplements exposure, that could be used as alternative to the appetite suppressants. Their potential risk results from the limited or completely absent control of their origin. Some of them have probably only placebo effect, but some of them could represent the risk.

• MeSH
• anorektika škodlivé účinky   terapeutické užití   MeSH
• cyklobutany škodlivé účinky   terapeutické užití   MeSH
• databáze faktografické statistika a číselné údaje   MeSH
• fentermin škodlivé účinky   terapeutické užití   MeSH
• komplikace těhotenství farmakoterapie   epidemiologie   MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé MeSH
• mnohočetné abnormality epidemiologie   MeSH
• obezita farmakoterapie   epidemiologie   MeSH
• prevalence MeSH
• prospektivní studie MeSH
• první trimestr těhotenství MeSH
• rizikové faktory MeSH
• samovolný potrat epidemiologie   MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• anorektika MeSH
• cyklobutany MeSH
• fentermin MeSH
• sibutramine MeSH Prohlížeč

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• databáze faktografické statistika a číselné údaje   MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé MeSH
• peniciliny terapeutické užití   MeSH
• praktičtí lékaři statistika a číselné údaje   MeSH
• spotřeba léčiv statistika a číselné údaje   MeSH
• zdravotní pojištění statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• dopisy MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• antibakteriální látky MeSH
• peniciliny MeSH

Geriatric pharmacotherapy represents one of the biggest achievements of modern medical interventions. However, geriatric pharmacotherapy is a complex process that encompasses not only drug prescribing but also age-appropriate drug development and manufacturing, appropriate drug testing in clinical trials, rational and safe prescribing, reliable administration and assessment of drug effects, including adherence measurement and age-appropriate outcomes monitoring. During this complex process, errors can occur at any stage, and intervention strategies to improve geriatric pharmacotherapy are targeted at improving the regulatory processes of drug testing, reducing inappropriate prescribing, preventing beneficial drug underuse and use of potentially harmful drugs, and preventing adverse drug interactions. The aim of this review is to provide an update on selected recent developments in geriatric pharmacotherapy, including age discrimination in drug trials, a new healthcare professional qualification and shared competence in geriatric drug therapy, the usefulness of information and communication technologies, and pharmacogenetics. We also review optimizing strategies aimed at medication adherence focusing on complex elderly patients. Among the current information technologies, there is sufficient evidence that computerized decision-making support systems are modestly but significantly effective in reducing inappropriate prescribing and adverse drug events across healthcare settings. The majority of interventions target physicians, for whom the scientific concept of appropriate prescribing and the acceptability of the alert system used play crucial roles in the intervention's success. For prescribing optimization, results of educational intervention strategies were inconsistent. The more promising strategies involved pharmacists or multidisciplinary teams including geriatric medicine services. However, methodological weaknesses including population and intervention heterogeneity do not allow for comprehensive meta-analyses to determine the clinical value of individual approaches. In relation to drug adherence, a recent meta-analysis of 33 randomized clinical trials in older patients found behavioural interventions had significant effects, and these interventions were more effective than educational interventions. For patients with multiple conditions and polypharmacy, successful interventions included structured medication review, medication regimen simplification, administration aids and medication reminders, but no firm conclusion in favour of any particular intervention could be made. Interventions to optimize geriatric pharmacotherapy focused most commonly on pharmacological outcomes (drug appropriateness, adverse drug events, adherence), providing only limited information about clinical outcomes in terms of health status, morbidity, functionality and overall healthcare costs. Little attention was given to psychosocial and behavioural aspects of pharmacotherapy. There is sufficient potential for improvements in geriatric pharmacotherapy in terms of drug safety and effectiveness. However, just as we require evidence-based, age-specific, pharmacological information for efficient clinical decision making, we need solid evidence for strategies that consistently improve the quality of pharmacological treatments at the health system level to shape 'age-attuned' health and drug policy.

• MeSH
• farmakoterapie metody   normy   statistika a číselné údaje   MeSH
• geriatrie metody   normy   statistika a číselné údaje   MeSH
• hodnocení adherence k farmakoterapii MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé MeSH
• medicína založená na důkazech metody   normy   MeSH
• nežádoucí účinky léčiv MeSH
• samoléčba statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

AIM: Antimicrobials are often prescribed by dental practitioners for various dental conditions. However, non-adherence to standard prescribing guidelines is common in day to day dental practice. The aim of this paper was to investigate the types of antimicrobials used for various orofacial infections by primary care dental practitioners and to verify their adherence to standard prescribing guidelines. METHODS: Clinical data was analyzed from random electronic files of patients for whom antimicrobials were prescribed at two Dental Practices in UK between January 2009 and December 2010. British National Formulary (60th Edn), guidelines of Scottish Dental Clinical Effectiveness Programme and UK National Institute for Health and Clinical Excellence (NICE) Guidelines were used to identify adherence to prescribing guidelines. RESULTS: A total of 200 cases were analyzed. Amoxicillin (52%) was the commonest antimicrobial prescribed followed by metronidazole (43.5%). Mean age of the patients was 37.2 (+/- 15.1) years. Mean duration of antimicrobial prescription was for 4.3 (+/- 1.4) days. Non-adherence to the standard prescribing guidelines was observed in 116 (58%) prescriptions. CONCLUSION: Amoxicillin continues to be the commonest antimicrobial preferred by primary care dental practitioners. Non-adherence to standard antimicrobial prescribing guidelines still remains high among primary care dentists.

• MeSH
• antiinfekční látky terapeutické užití   MeSH
• bakteriální infekce farmakoterapie   epidemiologie   MeSH
• dítě MeSH
• dodržování směrnic MeSH
• dospělí MeSH
• lékové předpisy statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• nevhodné předepisování statistika a číselné údaje   MeSH
• předškolní dítě MeSH
• primární zdravotní péče statistika a číselné údaje   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• spotřeba léčiv statistika a číselné údaje   MeSH
• stomatologické nemoci farmakoterapie   epidemiologie   MeSH
• zubní lékaři statistika a číselné údaje   MeSH
• Check Tag
• dítě MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Spojené království epidemiologie   MeSH
• Názvy látek
• antiinfekční látky MeSH