Journal of Pharmacy Technology最新文献

Background: The optimal treatment duration for uncomplicated vancomycin-resistant Enterococcus (VRE) bacteremia is unclear. Shorter courses may reduce adverse events (AEs) and hospital length of stay (LOS) without compromising clinical outcomes. Objective: To evaluate clinical outcomes associated with short-course (≤6 days) vs long-course (>6 days) therapy in hospitalized adults with uncomplicated VRE bacteremia. Methods: We conducted a single-center, retrospective study of adults with uncomplicated VRE bacteremia between 2014 and 2024. Patients who received ≤6 days of definitive antibiotic therapy were compared with those who received >6 days. The primary outcome was 30-day bacteremia recurrence. Secondary outcomes included infection-related readmission, 30- and 90-day all-cause mortality, post-bacteremia hospital LOS, and antibiotic-related AEs. Descriptive statistics, chi-square, and Fisher's exact tests were used. Results: Of the 48 patients included, 10 received short-course therapy and 38 received long-course, with median treatment durations of 5 days (interquartile range [IQR] 4-6) and 12 days (IQR 6-18), respectively. No recurrences were observed in either group. Infection-related readmissions occurred only in the long-course group (7.9%, n = 3; P = 0.49). Thirty-day mortality rates were 30% (short-course) vs 21.1% (long-course; P = 0.41), and the 90-day mortality rates were 30% vs 29%, respectively. Median post-bacteremia hospital LOS was shorter in the short-course group (10.5 vs 13 days; P = 0.68). The AEs were similar between groups. Conclusion: In this small exploratory cohort, short-course therapy (≤6 days) for uncomplicated VRE bacteremia was not associated with higher recurrence, readmission, or mortality than longer courses. These hypothesis-generating results support further studies on abbreviated treatments in carefully selected patients.

Background: There is currently a lack of evidence on the optimal loop diuretic dosing strategy in cases of acute decompensated heart failure (ADHF). Current consensus recommendations suggest starting with a dose of at least 2 times the patient's home loop diuretic dose. Objective: This study assessed whether higher initial loop diuretic doses are associated with faster time to decongestion in hospitalized ADHF patients. Methods: This was a retrospective, single-center cohort of patients ≥19 years of age with ADHF who received intravenous (IV) loop diuretics between September 2022 and August 2023. Patients were separated into groups based on receipt of greater than or equal to 2.5 times their home loop diuretic dose (high-dose) and <2.5 times their home loop diuretic dose (low-dose). Results: In total, 114 patients were included with 74 patients in the high-dose group and 40 patients in the low-dose group. For the primary outcome of time to decongestion, there was no difference between the high-dose and the low-dose -0.37 (95% confidence interval [CI] = -1.32 to 0.58), P = 0.44. There was a difference in the need for diuretic intensification beyond 24 hours in favor of the high-dose group (P = 0.0001). Conclusion: Higher initial doses of loop diuretics did not lead to a more rapid time to decongestion. The high-dose group did require less diuretic intensification beyond 24 hours, but this was not associated with a shorter hospital length of stay (LOS).

Objective: Itraconazole is recommended as the first-line oral treatment for pulmonary histoplasmosis. There is a paucity of data describing hypersensitivity reactions to itraconazole and lack of clarity on triazole antifungal cross-reactivity. Case: Approximately 9 hours after an initial dose of itraconazole 200 mg for treatment of chronic cavitary pulmonary histoplasmosis, a 72-year immunocompetent patient developed anaphylactic symptoms that abated with intervention. To resume histoplasmosis treatment in the setting of limited treatment options following nephrotoxicity that occurred while receiving amphotericin B, a single posaconazole 100 mg tablet was given and well tolerated by the patient. Subsequently a treatment course of posaconazole 300 mg began with confirmation of therapeutic drug levels prior to hospital discharge. Imaging after 2 months of posaconazole showed improvement in cavitation size. Conclusion: Posaconazole was a safe and effective alternative to itraconazole for chronic cavitary pulmonary histoplasmosis in this case. Further evaluation of mechanisms and management of triazole hypersensitivity reactions are warranted.

Background: Agitation in hospitalized older adults is common and can increase the risk of harm, mechanical ventilation duration, and prolonged hospital stays. Diagnosing and managing agitation in geriatric patients is especially complex due to overlapping symptoms with other conditions, altered pharmacokinetics, and increased sensitivity to adverse effects. This study aimed to evaluate the appropriateness of pharmacologic interventions for acute agitation in elderly inpatients and identify areas for improvement. Methods: A retrospective chart review was conducted at a public hospital in South Florida for patients ≥65 years old admitted between January 1 and June 30, 2024, who received medications for agitation management. Appropriateness was determined using Sedation-Agitation Scale (SAS) scores, medication administration patterns, and restraint use. Effectiveness, documentation quality, and adverse events were also assessed. Results: Among 72 encounters from 54 patients, 50% were classified as appropriate based on alignment with SAS scores and clinical restraint use. Effectiveness, defined as ≤1 as-needed dose per day, was observed in 68.1% of cases. Restraint use was significantly associated with appropriateness (χ² = 23.63, P < 0.0001), and although paradoxical, inappropriate regimens were more often effective (χ² = 5.39, P = 0.0203). Adverse effects were documented in only 6.9% of cases, and complete documentation was present in 27.8% of encounters. Conclusion: Findings reveal inconsistencies in agitation management and documentation, with frequent overtreatment and underreporting. There is a clear need for standardized, geriatric-focused treatment protocols and improved documentation practices to optimize safety and effectiveness.

Objective: To assess the clinical utility of clesrovimab-cfor (Enflonsia^®), a newly Food and Drug Administration (FDA)-approved monoclonal antibody, for the prevention of respiratory syncytial virus (RSV) lower respiratory tract infections in infants. Data Sources: A literature search was conducted using the key words clesrovimab, RSV, pediatric, infant, and nirsevimab. Data were also extracted from Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP), FDA prescribing information, and manufacturer data were reviewed. Study Selection and Data Extraction: English-language studies assessing the pharmacokinetics, pharmacodynamics, efficacy, and safety of clesrovimab were included. Key clinical trials (CLEVER and SMART) and cost-effectiveness models were reviewed. Data Synthesis: Clesrovimab binds to a conserved site on the RSV F protein, targeting both pre- and postfusion forms. In the CLEVER trial, it reduced RSV-associated medical visits by 60.4% and hospitalizations by 84.2%. The SMART trial showed comparable efficacy and safety to palivizumab. Adverse events were mild and injection-site related. No cross-resistance was observed with variants resistant to other monoclonal antibodies. Pharmacokinetics support single-dose administration with a half-life of 44 days. Conclusion: Clesrovimab offers simplified dosing, favorable safety, and potential cost savings compared with palivizumab and nirsevimab. While nirsevimab has a longer half-life, clesrovimab's unique binding site and room-temperature stability offer practical advantages. Lack of head-to-head comparisons and limited second-season data warrant further study. Clesrovimab is a promising addition to RSV prevention strategies, offering effective, safe, and accessible immunization for infants. Ongoing research will clarify its role in high-risk populations and broader clinical use.

Background: Piperacillin-Tazobactam (PTZ) is often used to treat community-acquired intra-abdominal infections (CA-IAIs) despite common causative pathogens being susceptible to more narrow-spectrum agents. However, susceptibility to PTZ among these predominant pathogens has been declining. Antibiotic de-escalation to non-antipseudomonal beta-lactams whenever possible is an important strategy to prevent the development of resistance to PTZ. Objective: The purpose of this study is to assess PTZ length of therapy in patients with CA-IAI, by comparing patients who received a pharmacist-led intervention involving the de-escalation of PTZ to narrow-spectrum regimens with those who did not receive the intervention. Methods: A retrospective analysis was conducted among patients >18 years old and admitted with CA-IAI empirically placed on PTZ between January 1, 2022, through June 30, 2022 (pre-intervention group), and January 1, 2024, through June 30, 2024 (post-intervention group). A total of 246 patients were included in the pre-intervention group and 129 patients in the post-intervention group. The utilization of PTZ, hospital length of stay (LOS), and treatment-associated complications were assessed using linear and logistic regression model, respectively. Results: Compared with patients in the pre-intervention group, those in the post-intervention group had a mean 1.2-day reduction in PTZ length of therapy (2.3 vs 1.2 days, P < 0.001). There was no difference in LOS, (β = 0.001, 98% confidence interval [CI] -1.29 to 1.29; P = 0.477), hospital readmission within 30 days due to IAI (odds ratio [OR] = 0.85, 98% CI = 0.51 to 1.44; P = 0.56), treatment-associated complications during current hospitalization (OR = 0.77, 98% CI = 0.45 to 1.32; P = 0.35), development of Clostridium difficile-associated diarrhea (OR = 3.29, 98% CI = 0.77 to 22.4; P = 0.14), or medication toxicity (OR = 2.07, 98% CI = 0.79 to 6.08; P = 0.15). Conclusion and relevance: The use of narrow-spectrum antibiotics for the empiric treatment of CA-IAI-reduced PTZ length of therapy and did not result in adverse clinical outcomes.

Background: Pharmacists play a vital role in diabetes education, including continuous glucose monitors (CGMs). However, formal CGM training within pharmacy education remains limited. To address this, a CGM wear activity using the FreeStyle Libre 3 system was integrated into a third-year (P3) pharmacy elective. Objective: To evaluate how a week-long educational CGM wear experience affects P3 students' knowledge and confidence in using CGMs and influences their empathy toward patients with diabetes. Methods: This was a prospective, single-center study. Students enrolled in the course attended a lecture on CGMs and were invited to wear a FreeStyle Libre 3 sensor for 1 week. During the sensor-wear period, students completed daily tasks simulating the management of a patient with diabetes. Preactivity and postactivity surveys were administered to evaluate changes in knowledge (9 items), confidence (5 items), and empathy (6 items) related to CGMs and diabetes care. Change in knowledge was assessed using a paired t test while change in confidence and empathy were assessed using Wilcoxon signed-rank test. Results: Seventeen students participated in the wear experience, completed the presurvey and postsurvey, and were included in the analysis. Statistically significant increases were noted in the knowledge assessment scores (54.4% vs 70%, P < 0.005), all self-reported confidence items (P < 0.05), and 2 empathy items related to wearing the CGM sensor (P < 0.05). Students reported being woken up by the alarms as the biggest challenge. Conclusions: Following this week-long CGM wear activity, students demonstrated improved knowledge, confidence, and empathy related to CGMs and diabetes care.

Background: Among health care professionals, burnout is of growing concern, affecting both personal well-being and professional performance. Burnout poses significant risks to patient care with diminished work quality and increased staff turnover. Factors contributing to burnout have been identified although specific preventative resources and accessibility data remain limited. Objective: This study aimed to evaluate burnout among emergency medicine and critical care pharmacists, and identify the availability and impact of employer-provided resources on burnout. Methods: This national survey aimed to describe burnout and preventative resource utilization among emergency medicine and critical care pharmacists. Responses were collected from December 20, 2024 to February 14, 2025 from self-identified critical care and emergency medicine pharmacists that accessed the survey from professional listserv posts or email invitations. Demographic information was collected, and burnout was assessed using the Oldenburg Burnout Inventory (range 16-64, with higher scores indicating more burnout). Descriptive statistics, Student's t tests, and analysis of variance (ANOVA) were used with statistical significance defined as P < 0.05. Multivariable linear regression models were used to understand the relationships among variables and burnout. Free text survey responses were reviewed and coded based on themes. Results: Among 346 completed surveys, 72.1% were submitted by female pharmacists, and 50% of respondents practice in emergency medicine. Moderate burnout was observed with a mean score of 39.1 (SD = 7.1). 46.4% of participants indicated using resources at least monthly with clinical support during shifts the most common. All multivariate models demonstrated an association between lack of peer support and burnout. The top resources pharmacists suggested for reducing burnout included improved scheduling, improved staffing ratios, and scheduled nonclinical time. Conclusions: Moderate burnout was observed among critical care and emergency medicine pharmacists with a strong desire for increased leadership support within staffing indicated. In addition, leaders should consider creating formal peer support programs to prevent or address burnout.

Hepatitis B virus (HBV) infection can lead to severe complications, including cirrhosis, hepatocellular carcinoma, and death. Entecavir, a guanosine nucleoside analogue, is recommended for chronic hepatitis B virus (CHB) and is rarely associated with myopathy. This report presents a 65-year-old woman with CHB who developed suspected entecavir-associated myopathy. The patient, with a history of hypertension, systemic lupus erythematosus, rheumatoid arthritis, seizures, stroke, polyneuropathy, cervical and lumbar myelopathy, bilateral lumbar radiculopathy, and alcohol use, was admitted for chest pain. Acute pathologies were ruled out; however, acute reactivation of CHB was identified. Entecavir was initiated, but the patient developed significant fatigue and muscle weakness within days, in the absence of acute liver failure. On discontinuation of entecavir and initiation of tenofovir disoproxil fumarate, the patient's symptoms improved. This case highlights the rare but serious adverse effects of entecavir, emphasizing the need for careful monitoring and consideration of alternative treatments in patients with CHB.