Journal of pharmacy practice最新文献

Background: Urinary tract infections (UTI) are a disease of serious impact on every country in the world. Growing resistance has decreased the efficacy of many antimicrobial options. Aminoglycosides, like gentamicin, have long been used to treat gram-negative bacteria including UTIs.

Objectives: The goal of this study was to compare single dose gentamicin to standard oral seven-day treatment in the emergency department for uncomplicated cases of acute uncomplicated cystitis in premenopausal women.

Methods: This was a randomized, open-label clinical trial of women at least 18 years of age, that were premenopausal, non-pregnant, with clinical signs of UTI and nitrite positive urine in the emergency department. Patients received either single-dose gentamicin or standard care for 7 days. Patients were contacted by telephone at 7 and 30 days and asked about clinical resolution of their UTI. The primary outcome of this study was symptom resolution at 7 days.

Results: Among those with 7-day telephonic follow-up, self-reported symptom resolution was 83.3% (25/30) among gentamicin treated patients and 48.1% (13/27) in the standard care group (X² = 7.917, P = .005).

Conclusion: Single-dose gentamicin for acute uncomplicated cystitis in premenopausal, nitrite positive women was an appropriate UTI treatment and more effective than standard care for symptom resolution at 7-days in our patient population. This strategy has the potential to revolutionize treatment by offering an antibiotic with high sensitivities, high efficacy, simple administration in many different healthcare settings, 100% compliance, and increased patient satisfaction for acute cystitis treatment.

Methemoglobinemia typically presents as functional anemia and hypoxemia. It is often recognized by a discordance between the pulse oximeter reading and the oxygen saturation measured on arterial blood gas. Methemoglobinemia can be inherited or acquired, with some commonly-used medications recognized as causative agents. In patients with hemolytic anemia such as in glucose-6-phosphate dehydrogenase deficiency, hemolysis may be the main clinical presentation, with acquired methemoglobinemia after exposure to oxidizing agents. We present a case report of methemoglobinemia in the setting of hemolysis, with a new approach to coordinate with laboratory services to create a reflex lab to test for methemoglobinemia under certain conditions. This may improve time to recognition and treatment for patients with methemoglobinemia, as patient presentation as well as SpO2 and PaO2 discordance may be missed by less experienced providers.

Background: Asthma is one of the most common pediatric disease states. However, current literature about outpatient pharmacy appointment effectiveness on pediatric asthma control is not widely available. Objective: To determine whether outpatient pharmacist visits in pediatric patients with asthma result in a measurable difference in asthma control, utilizing the validated asthma control test (ACT) and childhood asthma control test (C-ACT) scoring tools. Methods: This study enrolled 16 children ages 6-17 years old at an outpatient primary care clinic (November 2023-April 2024). The patients visited the outpatient pharmacist 2 to 3 times over a 12-week period. The primary outcome was the change in the patient's ACT or C-ACT from the baseline to the final study visit. Additional outcomes of interest included improvement in inhaler technique using a Vitalograph AIM® device, medication adherence rates, and change in emergent interventions from 6 months before enrollment compared to 3 months after the final visit. Results: The median improvement in asthma control test was 3 at the final study visit (4 or 12 weeks after counseling), which was statistically significant (P = 0.0348). This was an improvement from 50% of patients controlled at baseline to 100% at the final visit (P = 0.0053). Emergent interventions including oral steroid courses, emergency department visits, and hospitalization for asthma were less common after pharmacist intervention than before enrollment (P = 0.0464). Improvements in technique were seen at the initial visit using Vitalograph AIM® to visualize counseling points. Conclusion: Our study supports that outpatient pharmacist visits can have a measurable impact on pediatric asthma control.

Objective: Levetiracetam (LEV) is a guideline-recommended antiepileptic that has been shown to be effective in the termination of status epilepticus. Traditionally, LEV is diluted in 100 mL of compatible fluid and administered as an intravenous (IV) piggyback over 15-60 minutes. Recent data supports the administration of LEV as an undiluted IV push. However, there is limited literature supporting the safety and tolerability of undiluted IV push administration of high dose LEV (2500 mg to 4500 mg). The purpose of this study was to further investigate safety and tolerability of IV push levetiracetam at doses 2500 mg and greater. Methods: A retrospective chart review was conducted to evaluate adverse drug reactions following IV push administration of levetiracetam at a dose of 2500 mg or greater between the dates 8/5/2021 to 6/30/2022. During chart review, each patient was evaluated for any adverse events that occurred utilizing provider documentation, significant event forms, and/or allergy list documentation following administration of IV push LEV. Results: Throughout the study period, 340 doses of LEV 2500 mg and greater were evaluated. Most common total dose was 3000 mg and weight-based dose was 50-59.99 mg/kg. 119 doses of 4000 mg or greater were evaluated. 338/340 (99.4%) doses were considered to be well-tolerated. One patient experienced erythema at the injection site and another patient was noted to have nystagmus. Significance: This study adds to the body of literature that rapid administration of undiluted LEV, including doses of 2500 mg to 4500 mg is safe and tolerable.

Background: There is a growing body of evidence to support that utilizing fixed dose vs weight-based dosing of Four-Factor prothrombin complex concentrate (4F-PCC) for Factor Xa inhibitor (FXaI) reversal is safe and efficacious. Objectives: The primary objective of this study was the rate of hemostatic efficacy of weight-based (50 units/kg) vs fixed dose (2000 units) 4F-PCC for FXaI reversal in patients presenting with a non-neurologic hemorrhage. Methods: This was a multi-center, retrospective chart review from January 21, 2020, to January 21, 2022. Patients were included if they were greater than or equal to 18 years of age and received one dose of 4F-PCC for FXaI reversal for a non-neurologic bleed. Hemostatic efficacy for this study was defined as the absence of hemorrhagic progression confirmed with imaging, >2 g/dl decrease in Hgb within 6 hours of 4F-PCC administration, reports of further significant bleeding in chart note documentation within 48 hours and a maintained or increased anti-factor Xa level from baseline. Results: Fifty-nine patients were included in this study (29 in the weight-based group and 30 in the fixed dose group). Rate of hemostatic efficacy was similar between fixed and weight-based dosing (93.3% vs 93.1% P = 1). Conclusions: This study adds to current evidence suggesting that a fixed dose 4F-PCC is both safe and efficacious for FXaI reversal in non-neurologic bleeds.

Purpose: To provide a summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2023. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2023. Article nominations included those pertaining to general ID and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy. Out of the 31 articles nominated by HIDN members, 22 pertained to general ID pharmacotherapy, and 9 pertained to HIV/AIDS pharmacotherapy. To aid selection of the most notable articles of 2023, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Of the 153 SIDP members who participated in the survey, there were 118 recorded votes for the top 10 general ID pharmacotherapy articles and 55 votes were recorded for the top HIV/AIDS article. The most notable publications are summarized. Conclusion: Advances in antimicrobial stewardship and infectious disease states continue to occur. Sustained growth in the publication of ID-related articles over the past year contributed to this review's aim to aid clinicians in remaining current on potentially practice-changing ID pharmacotherapy publications from 2023. This review provides a summary of recently published ID literature, including emphasis on antimicrobial stewardship, appropriate treatment durations, new antimicrobials, and drug-resistant organisms.

Introduction: Several studies have illustrated value in early patient contact following oral anticancer medication (OAM) initiation, particularly within the first 14 days of therapy, as adverse effects may lead to early discontinuation or poor adherence. Health-system specialty pharmacies (HSSPs) are optimally positioned to adopt this best practice through formalized protocols designed to identify and mitigate medication-related issues.

Objective: To outline an HSSP-led early check-in protocol for patients taking OAMs and to describe the subsequent interventions conducted by the HSSP team and their acceptance rate.

Results: HSSPs enacted a protocol in January 2021 requiring oncology pharmacists - to contact patients within 14 days of OAM initiation, aiming to optimize adverse effect management, offer supportive care, address adherence, and provide education. To evaluate the impact of the early check-in protocol, we conducted a retrospective, multicenter, observational study across CPS's health system clients from January 2022 to November 2023. HSSP pharmacists created 1698 interventions for 1184 patients from the early check-in. The cancer types most frequently associated with an intervention were breast (n = 431, 25.4%), gastrointestinal (n = 245, 14.4%), and prostate (n = 206, 12.1%). The most frequent intervention categories were adverse drug reactions (ADRs) (n = 1,548, 91.2%) and adherence (n = 55, 3.2%). Overall, 95.5% of pharmacist recommendations were accepted by patients and/or providers.

Conclusion: Implementing an early check-in protocol allows HSSP pharmacists to mitigate barriers to OAM adherence. This study emphasizes the importance of early check-in and illustrates the scope of the oncology pharmacist's role by evaluating critically meaningful interventions and quantifying pharmacist recommendations and acceptance rate.

Background: Piperacillin-tazobactam (PTZ) demonstrates time-dependent bactericidal activity, potentially increasing the need for higher dosing in obese and critically ill patients. However, limited information is available on the safety of higher dosing strategies. Objective: To evaluate the safety and clinical impact of high dose 6.75 g IV PTZ for the treatment of pneumonia in critically ill, obese (≥120 kg) patients vs standard dose 4.5 g IV PTZ. Methods: Retrospective, cohort study, multicenter in health-system consisting of four acute-care teaching hospitals. Adult patients weighing at least 120 kg on PTZ for pneumonia in the intensive care unit (ICU) from January 2013 to September 2018 were included. The primary outcome of the study was acute nephrotoxicity defined as initiation of renal replacement therapy and/or serum creatinine increase within 48 hours of last PTZ dose. Secondary outcomes included thrombocytopenia, 14-day all-cause mortality, and ICU length of stay (LOS). Results: One hundred thirty-six patients were included with 52 and 84 in 4.5 g PTZ and 6.75 g PTZ respectively. The rate of acute nephrotoxicity was comparable between cohorts (50% 4.5 g vs 40.5% 6.75 g, P = 0.277). High dose PTZ was not independently associated with acute nephrotoxicity after control for selected confounders. All secondary outcomes were similar. Concomitant vancomycin and calculated supratherapeutic vancomycin area under curve were not independently associated with increased nephrotoxicity. Conclusions: High dose PTZ was not associated with increased acute nephrotoxicity, thrombocytopenia, 14-day all-cause mortality, or ICU LOS. Additionally, more robust trials are needed to fully assess the clinical impact of 6.75 g PTZ dosing for critically ill, obese patients, for pneumonia.

Background: Initiation of sacubitril-valsartan and mineralocorticoid receptor antagonists (MRA) during hospitalization for acute decompensated heart failure (ADHF) may be an ideal time to optimize guideline-directed medical therapy. However, there is limited research assessing the safety of combining these agents in the hospital. Methods: This was a multi-center, retrospective, propensity-score matched cohort study performed at 7 acute-care hospitals within a large health care system. All adult patients admitted with ADHF between January 1, 2019 to December 31, 2021 who received sacubitril-valsartan with MRA (MRA group) or without MRA (non-MRA group) and had a left ventricular ejection fraction (LVEF) < 40% were included in the study. Results: 220 patients were screened during the study time frame with 179 meeting inclusion criteria. Following propensity-score matching, 50 patients in the MRA group were matched to 50 patients in the non-MRA group. The overall incidence of adverse drug reactions (ADRs) was 24% in the non-MRA group compared to 20% in the MRA group (P = .629). There was a significantly greater incidence of hyperkalemia in the MRA group (0% vs 10%; P = .022). None of the patients in the non-MRA group were readmitted within 30 days due to an ADR compared to 6% in the MRA group (P = .079). Conclusion: The addition of spironolactone to sacubitril-valsartan in the hospital setting following stabilization of ADHF did not lead to a significantly greater incidence of overall ADRs, but patients were more likely to develop hyperkalemia and there was a numerically higher incidence of 30-day readmissions due to ADRs.

Background: Amiodarone-induced anaphylaxis is seldom reported. The mechanism of this anaphylaxis is unknown. Methods: A literature search was carried out with keywords "Amiodarone" and "Anaphylaxis" and "polysorbate 80" or "hypotension." A search using "amiodarone" in the FDA Adverse Event Reporting System (FAERS) from 1969 to 2024 was also conducted. Results: There are a total of 10 cases of amiodarone-induced anaphylaxis in the literature. Six patients were male. Ages ranged from 15 to 86 years old. Nine cases were triggered by intravenous injection (IV) and one by oral administration. Eight patients did not have previous exposure to amiodarone. The trigger times for IV amiodarone were immediate to 90 minutes. All nine cases of IV amiodarone resulted in hypotension (90%), with an immeasurable blood pressure (70%). Presentations included bronchospasm or a skin rash (60%), angioedema (40%), and unconsciousness (20%). Only one patient had a history of allergy to penicillin and sulfonamide. An amiodarone skin test was positive on one patient. Increased blood tryptase (4 cases), positive basophil activation test to amiodarone (2 cases), increased eosinophil count (1 case), and increased serum IgE (1 case) were reported. Amiodarone was terminated in 80% of the patients. Epinephrine, norepinephrine, antihistamine-1, or steroids were used to rescue patients. Four patients were intubated. All patients fully recovered. In the FAERS database, 89 cases of amiodarone-associated anaphylaxis were reported, resulting in 14 deaths. Conclusions: Solvent polysorbate 80, amiodarone, and iodide may contribute to amiodarone-induced anaphylaxis. Prompt treatment is the key to saving patients.