Journal of pharmacy practice最新文献

We describe a 47-year-old treatment-experienced African-American man co-infected with human immunodeficiency virus (HIV) and chronic hepatitis C virus (HCV) who took sofosbuvir-velpatasvir-voxilaprevir (SOF/VEL/VOX) for approximately 4 weeks and achieved sustained virologic response 12 weeks post-treatment (SVR12). Prior to initiating SOF/VEL/VOX, the patient completed 10 weeks of treatment with SOF/VEL. After 1 month of SOF/VEL/VOX, the patient was lost to follow-up for 3 months. This case report illustrates that SVR12 may be achieved in treatment-experienced patients living with HIV/HCV who complete a shortened duration of triple-direct acting antiviral therapy. Healthcare professionals should consider obtaining an HCV-RNA to assess if SVR12 was achieved prior to re-initiating treatment in patients lost to follow-up or who did not complete therapy.

Background: While traditional mail-order pharmacies have overcome some barriers to adherence, there is minimal evidence to indicate whether a novel prescription delivery program (PDP) can impact clinical endpoints in common disease states. The use of integrated pharmacy technicians, a local courier service, and hospital-owned pharmacies contributes to a comprehensive continuum of care. This study's purpose was to assess the impact of a novel PDP on glycemic control in patients with diabetes mellitus (DM). Objectives: The primary objective of this study was to identify the change in glycated hemoglobin level (HbA1c) of DM patients at enrollment in the PDP to approximately one-year post-enrollment. Secondary objectives were to describe the percentage of patients achieving therapeutic goals, characterize enrolled population, and identify medication classes utilized in the PDP. Methods: This was a retrospective quasi-experimental study to evaluate whether implementation of an internally owned and operated PDP would improve HbA1c control for DM patients throughout primary care and specialty networks. Results: A total of 1223 patients were screened for inclusion. A convenience sample of 100 patients were evaluated. The outcome of change in HbA1c of patients with diabetes improved significantly from baseline at enrollment in a PDP to one-year post-enrollment (pre-PDP 8.2% vs post-PDP 7.4%, P < 0.001). Of the patients included in the study, 30% achieved goal HbA1c pre-enrollment in PDP. One-year post-PDP the percentage of patients who achieved goal HbA1c increased to 48% (P = 0.002), which was statistically significant. Conclusion: Among the studied population, enrollment in the PDP was associated with a significant reduction in HbA1c.

Purpose: To provide a summarization of the most significant infectious diseases (ID) pharmacotherapy articles published in peer-reviewed literature in 2024. Summary: Members of the Houston Infectious Diseases Network (HIDN) nominated notable articles providing significant contributions to ID pharmacotherapy in 2024. Article nominations included those pertaining to general ID and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) pharmacotherapy in 2024. To aid selection of the most significant articles in 2024, a survey was created and distributed to members of the Society of Infectious Diseases Pharmacists (SIDP). Out of the 21 total articles nominated by HIDN/SIDP members, 19 pertained to general ID pharmacotherapy, and 2 had pertained to HIV/AIDS pharmacotherapy. Of the SIDP members who participated in the survey, 185 voted for the top 10 general ID pharmacotherapy articles and 46 votes were recorded for the top HIV/AIDS article. The most notable publications are summarized. Conclusion: This review provides a summary of the most recently published ID literature with aims to update clinicians on the current potential practice changing ID pharmacotherapy publications from 2024.

Introduction: Type 1 diabetes mellitus (T1DM) is a condition requiring lifelong insulin therapy and specialized care. Access to endocrinologists remains limited, leaving many primary care providers (PCPs) to manage insulin therapies and diabetes technologies. Pharmacists have demonstrated effectiveness in type 2 diabetes management, yet their role in T1DM within primary care remains underexplored. This study evaluated the impact of a pharmacist-led intervention for adults with T1DM in a primary care setting lacking in-house endocrinology services. Methods: This retrospective cohort study reviewed electronic health records of adults with T1DM referred to a clinical pharmacist in 2023. Individuals with ≥2 PCP visits, ≥2 A1c results, and ≥1 pharmacist consultation were included. The pharmacist provided individualized assessments, insulin adjustments, and technology counseling under a collaborative practice agreement. The primary outcome was change in A1c at 3-6 months post-consultation. Secondary outcomes included subgroup analyses by insulin delivery methods, visit frequencies and A1c comparison with non-referred T1DM patients. Results: Thirty-eight patients met inclusion criteria. Referred patients experienced a mean A1c reduction from 8.8% to 8.2% (-0.6%, 95% CI: -1.00 to -0.12; P = .013) at 3-6 months. No significant differences were observed in continuous glucose monitoring metrics or visit frequency. Compared with 49 non-referred patients, referred individuals initially had poorer glycemic control but showed convergence over time. Discussion: Pharmacist integration into primary care significantly improved glycemic outcomes for adults with T1DM, particularly in underserved regions with limited endocrinology access. This collaborative model may offer a scalable solution to expand advanced diabetes management in primary care.

Klebsiella pneumoniae carbapenemases (KPCs) are the most common carbapenemases in the United States. The Infectious Disease Society of America (IDSA) recommends meropenem-vaborbactam, ceftazidime-avibactam, or imipenem-cilastatin-relebactam as preferred options with cefiderocol as an alternative, all of which are also alternative options for CTX-M Enterobacterales. Bacillus species, comprising 22 different species, are not commonly pathogenic, but can cause invasive nosocomial infections typically in immunocompromised hosts commonly treated with vancomycin or carbapenems. This case report illustrates the treatment course of CTX-M and KPC-producing Klebsiella pneumoniae, and Bacillus species bacteremia that included cefiderocol, followed by vancomycin and meropenem-vaborbactam, and then meropenem-vaborbactam monotherapy. The patient was a 74-year-old female who had a prolonged hospital course and several courses of intravenous antimicrobials prior to the multidrug resistant (MDR) Klebsiella pneumoniae, and Bacillus species bloodstream infection. The IDSA does not have treatment recommendations for Bacillus species, though the Clinical & Laboratory Standards Institute (CLSI) reports breakpoints for vancomycin and meropenem. In our case, the patient's Bacillus isolate was susceptible meropenem-vaborbactam (0.023 mcg/mL) based on a meropenem breakpoint of 4 mcg/mL. In our report, an immunocompetent patient developed a polymicrobial bloodstream infection caused by an MDR Klebsiella pneumoniae, and Bacillus species, which was successfully treated with meropenem-vaborbactam. This unusual infection and treatment course also serves to promote awareness of another treatment option for invasive Bacillus species infection and furthermore encourages providers to request testing & sensitivities to consolidate therapy, particularly in cases of polymicrobial infection.

BackgroundUrinary 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.ObjectivesThe 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.MethodsThis 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.ResultsAmong 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).ConclusionSingle-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.

Introduction and Objective: Cefazolin-induced encephalopathy and seizures are possibly related to excessive dosing; especially in those with renal dysfunction. This report aims to highlight the importance of dose adjustments of cefazolin in patients with diminished renal function. Case Presentation: An 87-year-old female with a history of cognitive impairment, remote cerebellar infarcts, hypertension, and hypothyroidism presented with acute delirium associated with a urinary tract infection. Her condition worsened and she was found to have a methicillin-sensitive Staphylococcus aureus bacteremia for which she was started on cefazolin 2 grams intravenously every 4 hours. Based on her renal function, recommended dosing would have been 2 grams intravenously every 12 hours. After 3 days on this regimen her mentation declined and she suffered a tonic-clonic seizure. She did not regain consciousness and was transitioned to comfort care prior to her death. Discussion: Supratherapeutic dosing of cefazolin may have led to significant neurotoxic effects. Neurotoxicity and seizures can occur with drug accumulation from an increase in excitatory neurotransmitters along with a decrease in inhibitory neurotransmitter activity. The effect is potentiated by older age, pre-existing central nervous system conditions, and renal failure. Therapeutic drug monitoring is a potential strategy to limit the risk of drug toxicity. Conclusion: This case outlines a poor outcome in the context of high-dose cefazolin. It serves as a reminder to clinicians for ongoing pharmacovigilance in adhering to treatment guidelines.

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.

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.

Patients with diabetes often self-monitor their blood sugars to assess whether their blood sugar levels are within goal, above goal (hyperglycemia), or below goal (hypoglycemia) based on provider or guideline recommendations. With advancements in diabetes technologies such as wearable glucose biosensors and continuous glucose monitors (CGM), many patients can reduce the number of times they must lance their fingers. The first over-the-counter wearable glucose biosensors for patients with diabetes who do not use insulin or for healthy adults wanting to track their health became available for purchase in 2024. Pharmacists must be equipped to answer patient questions regarding these new methods of self-monitoring blood sugars with wearable glucose biosensors whether the product is OTC or a prescription CGM. This commentary describes the landscape of wearable glucose biosensors with prescription and OTC devices.