Systemic Absorption Resulting from Tobramycin-Loaded Antibiotic Cement Spacers Used in the Treatment of Prosthetic Joint Infection.

Purpose: Antimicrobial cement spacer (ACS) placement has been a cornerstone of two-stage management of prosthetic hip and knee infection. Pharmacokinetic modelling has described peak systemic antibiotic concentrations within the first 24-48 h post-operatively, followed by rapid clearance. A few studies have, however, identified detectable tobramycin levels in patients with a post-operative decline in creatinine clearance.

Safety and efficacy of cefiderocol for off-label treatment indications: A systematic review.

Purpose: Cefiderocol is a siderophore cephalosporin recently approved by the United States Food and Drug Administration for the treatment of hospital- and ventilator-acquired bacterial pneumonia and complicated urinary tract infections. However, there is potential for cefiderocol utility for a variety of other infections. The purpose of this systematic review was to identify literature examining the safety and efficacy of cefiderocol for off-label indications.

Xylazine poisoning: a systematic review.

Purpose: Xylazine is an alpha-2-adrenergic agonist used for its sedative and analgesic properties in veterinary medicine. While not approved by the Food and Drug Administration for use in humans, anecdotal evidence suggests that exposures in humans is on the rise. We sought to systematically review and synthesize the evidence on xylazine exposure in humans focusing on the clinical presentation, management, and outcomes.

Voriconazole-associated periostitis: Pathophysiology, risk factors, clinical manifestations, diagnosis, and management.

Voriconazole use has been associated with osteoarticular pain and periostitis, likely due to high fluoride content in the drug formulation. This phenomenon has been described primarily with high dosage or prolonged course of voriconazole therapy in immunocompromised and transplant patient populations. Patients typically present with diffuse bony pains associated with elevated serum alkaline phosphatase and plasma fluoride levels in conjunction with radiographic findings suggestive of periostitis.

Clinical use of lefamulin: A first-in-class semisynthetic pleuromutilin antibiotic.

Lefamulin is a novel antibiotic agent within the pleuromutilin derivative class approved for the treatment of community-acquired bacterial pneumonia (CABP) by the United States Food and Drug Administration and the European Commission in 2019 and 2020, respectively. The objective of this article is to provide a summary of clinically relevant data underlying lefamulin and to provide recommendations for its place in therapy. In vitro data establish lefamulin's activity against a number of Gram-positive, Gram-negative and atypical organisms relevant in the treatment of CABP, including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Legionella pneumophila, Mycoplasma pneumoniae and Chlamydophila pneumoniae.

Health-system implementation of a collaborative core curriculum for advanced pharmacy experiential education during the COVID-19 pandemic.

Purpose: A collaborative advanced pharmacy practice experience (APPE) education model established within a healthcare institution during the coronavirus disease 2019 (COVID-19) pandemic is described.

Summary: The COVID-19 pandemic caused a nationwide disruption of APPE pharmacy education. Healthcare institutions faced the challenge of educating APPE students while attempting to simultaneously de-densify work areas and reduce transmission risk for employees and patients.

Safety and Efficacy of Rivaroxaban and Apixaban in Patients with Increased Body Mass: a Systematic Review.

Background And Objective: Rivaroxaban and apixaban are direct oral anticoagulants increasing in popularity as convenient alternatives to warfarin. However, current guidelines recommend against use in patients with a BMI > 40 kg/m or bodyweight > 120 kg unless drug-specific levels are measured, which may not be feasible across all clinical practices. Accordingly, the objective of this study was to broadly examine literature evaluating the clinical outcomes of rivaroxaban and/or apixaban in patients with increased body mass.

Safety and efficacy of intravenous hydralazine and labetalol for the treatment of asymptomatic hypertension in hospitalised patients: A systematic review.

Background: Current guidelines for the management of asymptomatic hypertension (HTN) in the inpatient setting recommend the use of oral antihypertensives. However, in clinical practice, intravenous (IV) antihypertensives are commonly utilised with little supporting evidence. The objective of this study was to evaluate literature examining the safety/efficacy of IV hydralazine and labetalol in hospitalised patients with non-emergent, asymptomatic HTN.

Comparison of Vancomycin Area-Under-the-Curve Dosing Versus Trough Target-Based Dosing in Obese and Nonobese Patients With Methicillin-Resistant Bacteremia.

A vancomycin target of area under the curve to minimum inhibitory concentration (AUC:MIC) ratio ≥400 is recommended for treatment of methicillin-resistant (MRSA) bacteremia. To evaluate vancomycin total daily dose (TDD) achieving trough targets versus a calculated strategy achieving AUC targets based on body mass index (BMI). A retrospective cohort study was performed within a large hospital network.

Retrospective Analysis of Adverse Drug Events Between Nafcillin Versus Cefazolin for Treatment of Methicillin-Susceptible Infections.

Nafcillin or cefazolin are drugs of choice for methicillin-susceptible (MSSA) infections. Prior studies indicate a higher incidence of acute kidney injury (AKI) with nafcillin, although AKI classification and time to occurrence is not well described. To characterize the incidence and time to adverse drug events for nafcillin versus cefazolin in the inpatient setting.

Tetracycline Allergy.

Despite the widespread use of tetracycline antibiotics since the late 1940s, tetracycline hypersensitivity reactions have rarely been described in the literature. A comprehensive PubMed search was performed, including allergic and serious adverse reactions attributed to the tetracyclines class of antibiotics. Of the evaluated tetracycline analogs, minocycline was attributed to the greatest overall number and severity of serious adverse events reported in the literature, with notable reactions primarily reported as respiratory and dermatologic in nature.

Prescribing trends and revisit rates following a pharmacist-driven protocol change for community-acquired pneumonia in an emergency department.

Objective: To compare pharmacist-led prescribing changes and associated 30-day revisit rates across different regimens for patients discharged from an emergency department (ED) with a diagnosis of community-acquired pneumonia (CAP).

Methods: An observational, retrospective cohort analysis was conducted of patients who were discharged from an ED over a 4-year period with a diagnosis of CAP. Patient demographics, clinical characteristics, antibiotic selection and comorbidity and condition severity scores were collected for two cohorts: 2012-13 (before protocol change) and 2014-15 (post-protocol change).

Lefamulin: a promising new pleuromutilin antibiotic in the pipeline.

Community-acquired bacterial pneumonia (CABP) represents a significant clinical and financial burden within infectious disease. In the advent of increasing resistance from bacteria such as Streptococcus pneumoniae to available antibiotic therapies, there is a need for new drugs with novel mechanisms to treat such infections. Areas covered: Lefamulin, the first semi-synthetic pleuromutilin for systemic administration, is nearing completion of Phase III studies for CABP; the manufacturer plans to file for a new drug application (NDA) in Q4 2018.

Evaluation of students' perceptions of the Socrative application versus a traditional student response system and its impact on classroom engagement.

Background And Purpose: Student response systems (SRSs) or "clickers" are common tools that lecturers can implement into didactic lectures. Socrative is a convenient and free SRS application that can be downloaded on personal handheld devices and used by faculty and students. It is unknown if students prefer using this application and what advantages or disadvantages can be seen with Socrative's use.

Development of a Statewide Antibiogram to Assess Regional Trends in Antibiotic-Resistant ESKAPE Organisms.

Background:: Hospitals and other facilities utilize antibiograms as tools for optimal antibiotic selection. Currently, no measures compare broad trends on the regional level, despite interest for more comprehensive data, particularly for antibiotic-resistant ESKAPE organisms.

Objective:: To collect and compare regional health-care facility antibiogram data for ESKAPE organisms to form a cumulative antibiogram.

Development and Implementation of a Global Health Elective with a Drug Discovery Game for Pharmacy Students.

Interest in global health education within the pharmacy curriculum has increased significantly in recent years. However, discussion of different models and methods to evaluate course structures are limited. The overall objective was to (1) describe the structure of our global health elective for pharmacy students, and (2) assess educational outcomes related to perceived/formal knowledge and attitudes associated with global health.

The intersection of antimicrobial stewardship and microbiology: educating the next generation of health care professionals.

With the alarming rise of antibiotic resistance, clinical professionals are called upon to manage antibiotic therapies using the most relevant and recent clinical and laboratory data. To this end, antimicrobial stewardship (AMS) programs aim to reduce unnecessary or suboptimal use of antibiotics while maximizing outcomes for the patient. For AMS programs to succeed, the active participation of clinical professionals at all levels of patient care is required.

A multidimensional antimicrobial stewardship intervention targeting aztreonam use in patients with a reported penicillin allergy.

Background: Local antimicrobial susceptibility patterns should be considered for antimicrobial therapy decisions. Antibiogram data can guide beta-lactam antibiotic use in the presence of a penicillin allergy, particularly when allergic cross-reactivity among antibiotic agents is unlikely.

Objective: To evaluate the effect of a multidimensional antimicrobial stewardship intervention to improve antibiogram-driven antibiotic selection for patients with a reported penicillin allergy receiving aztreonam.

Review of the new delayed-release oral tablet and intravenous dosage forms of posaconazole.

The triazole antifungal posaconazole was first approved as an oral suspension formulation. Despite pharmacokinetic target attainment and clinical efficacy in premarketing trials, postmarketing analyses indicated unpredictable bioavailability resulting in subtherapeutic concentrations and reports of breakthrough fungal infections. The newly approved posaconazole delayed-release tablet and intravenous formulations display more consistent bioavailability in the presence of concomitant disease states, medications, and dietary considerations that classically alter drug concentrations of the oral suspension.

Ebola virus disease: roles and considerations for pharmacists.

Ebola virus disease (EVD) poses significant clinical care implications for pharmacists. Emergency preparedness efforts should be undertaken to ensure vital response to EVD. Pharmacists should consider factors such as enhanced use of resources for front-line EVD patient care along with procurement of investigational medications.

Guillain-Barré syndrome in an older man following influenza vaccination.

OBJECTIVE To report an atypical case of Guillain-Barré syndrome (GBS) after administration of the 2012-13 influenza vaccine. SETTING Urban tertiary hospital. PATIENT DESCRIPTION An 81-year-old man was admitted to the hospital after he began experiencing numbness and tingling in both feet that began ascending toward the waistline.