Objective : To examine past and present status of polypharmacy, multiple drug therapy, and drug utilization survey of the antibiotics.
Design : Drug utilization survey using the database of the Kagoshima University Hospital information system.
Methods : Data of the presriptions issued during every May between 1985 and 1997 were extracted from the database. Monthly prescriptions were classified by the number of the drugs they included. And the doses of the antibiotics were summed up yaerly.
Results : During thirteen years between 1985 and 1997, the proportion of patients receiving ten drugs or more also increased from 1.50% to 4.89%. The annual utilization doses of the antibiotics are gradually decreased. For the drug utilization review the database of the hospital information system are the useful resources.
Conclusion : The billing and acounting database in the hospital information system have a few problems as the reseach data sources. On the other hand, the drug history database to which are individually transfered from the prescription order entry database in hospital information system, are able to be adaptated to the research in pharmacoepidemiology.
The hospital information system including the clinical subsystems are routinely operated and a large amount of the clinical patient data are daily archieved. For this reason the drug history database are able to combine and link to the other clinical database in the hospital information system such as the clinical laboratory results or the diagnosis data. These linkage database in hospital information system are virtual pharmacoepidemiology database and the useful research resources in pharmacoepidemiology.

Objective : To examine past trend and present status of polypharmacy, multiple drug therapy, which can be a cause of serious adverse events induced by drug interactions.
Design : Drug utilization survey using a database of the Kagoshima University Hospital Information System.
Methods : Data of the prescriptions issued during every May between 1985 and 1994 were extracted from the database. Monthly prescriptions were classified by the number of drugs they included.Furthermore, the data were sorted by patients' ID to obtain the age distribution of patients observed in each year and the distribution of the number of drugs per prescription was analyzed in each age group.
Results : The average number of medicines per prescription was increased from 3.07±2.16 (average±S.D.) in 1985 to 3.46±2.61 in 1994. During 10 years between 1985 and 1994, the proportion of patients receiving ten drugs or more also increased from 1.50%to 3.90%. There was a clear tendency that a large number of drugs were given to old patients and comparatively few drugs to young patients.Proportion of the old patients over 59 years of age increased linearly from 25.71%in 1985 to 35.37% in 1994.
Conclusion : The average number of medicines per prescription was increased during 10 years. This trend is considered to be attributable in part to the increase in the proportion of the old patients. The concomitant use of so many drugs is a problem and a rule for diminishing returns recently adopted as a reimbursement policy of health insurance system has been applied to prescriptions with ten drugs or more. Further studies are needed to examine possible adverse outcomes and other characteristic features of multiple therapy.

A 78-year-old woman was referred to our hospital because of progressive exertional dyspnea due to nonrheumatic severe aortic valve stenosis and moderate mitral valve stenosis with mitral annular calcification. We subsequently performed aortic valve replacement and mitral anterior leaflet decalcification. During surgery, we found that the cause of mitral valve stenosis was calcification of A2 aortic curtain-medial trigon through aortic valve annulus and resected calcification with SONOPET. The postoperative echocardiography revealed good mitral valve motion with mild mitral valve stenosis.

Objective: The use of generic products is a solution to the increasing healthcare cost in Japan. The pharmaceutical companies are trying to develop several generic products suitable to patient’s taste. The contribution of pharmacist by selecting generic product to each patient and a collection of patient’s opinion for products may accelerate the development of generic products improved usability for patients and medical workers. The present study examined the storage of generic products of sennoside in pharmacies and the patient preference for selection of generic products in 2003 and 2016 in Kumamoto, Japan.Methods: Sennoside was selected as a model drug, since it developed several generic products for long period. The survey on storage of sennoside pharmaceutics and the questionnaire survey for its generic products to patients were conducted at ethical pharmacies. The appearance and the dissolution of sennoside from generic tablets were compared with original product, Pursennid.Results: Thirteen sennoside products were stored in 2003 and 2016. The number of pharmacies that stored generic products increased from 33 to 54% in 13 years. The largest number of patients preferred Pursennid in 2003. In contrast, two generic products were more preferred than Pursennid in 2016. Interestingly, the reasons for preferring products were almost the same between 2003 and 2016, and their majority was color and size of tablet. The generic products tend to have a thinner thickness and larger diameter than Pursennid. The most preferred generic product in 2016 showed a faster dissolution of sennoside than Pursennid. However, the use of generic products is mainly related to their tablet appearances due to unrelation between the pharmacological effect of sennoside and its dissolution in GI tract.Conclusion: In the development of generic products of sennoside, as well as quality, the appearance is an important factor.