Gabexate mesilate and acute pancreatitis: an experience of evidence based drug information for improving rational drug use.
BACKGROUND
Gabexate mesylate is a drug marketed only in Italy and Japan and it is considered an essential drug in the treatment of acute pancreatitis. A periodic revision and evaluation of drug utilization in our hospital demonstrated that the dosages and indications of Gabexate mesilate (GM) did not follow those settled by the National Health System and by our Hospital Formulary. We therefore promoted and conducted a program of drug information and meetings with the physicians in order to improve the correct utilisation of GM and identify potential problems.


METHODS
GM prescriptions in 1999 were analysed for indications and dosages. Scheduled meetings with the medical staff were successively started in order to debate current therapies and treatments of acute pancreatitis using the criteria of evidence-based medicine (EBM). Follow-up was done in 2000, 2001 and 2002 to evaluate the efficacy of our intervention.


RESULTS
The hospital board and 20 physicians were involved in this program of evidence-based drug information. The follow-up and the monitoring of GM prescriptions showed a reduction in the utilisation of GM in the subsequent period.


CONCLUSIONS
GM is one of the most expensive drugs in our hospital, but its benefits are not very evident. Moreover, the international guidelines and literature ascribe to GM only a marginal role in the treatment of acute pancreatitis. Evidence-based medicine strengthens clinical experience with the evidence from the literature and underlines that essential drugs are used worldwide.
Banfi
Roberto
R
Pharmacy Department, Hospital Mugello, Viale della Resistenza 2, 50032 Borgo San Lorenzo, Florence, Italy. Roberto.banfi@asf.toscana.it
Borselli
Giovanna
G
Cappelletti
Silvia
S
Mari
Leonardo
L
Aiazzi
Massimo
M
Taddei
Vittorio
V
D000208:Acute Disease; D000925:Anticoagulants / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004346:Drug Information Services / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000592:standards / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005500:Follow-Up Studies; D016670:Gabexate / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D010195:Pancreatitis / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000592:standards; D013997:Time Factors
D000925:Anticoagulants; D016670:Gabexate