Pharmacodynamics in the evaluation of drug regimens.

We believe, especially in an era of increasing antimicrobial resistance, that the integration of PK/PD models and stochastic techniques provides a powerful new tool to clinicians, researchers, and regulatory agencies alike. By using techniques such as these, we can begin to level the playing field so that PK/PD measures for therapeutic agents can be more accurately compared with greater certainty, and not be limited to discussions of susceptibility method variation or comparisons of MIC results.

Benchmarking in health-system pharmacy: current research and practical applications.

The application of benchmarking techniques to hospital pharmacy practice is discussed. Benchmarking is a process designed to discover best practices through a comparison of various competing methods aimed at achieving a particular goal. Benchmarking antimicrobial drug utilization and rates of bacterial resistance through comparison with a multitude of similar hospitals can be used by an institution both to identify potential problem areas in its pharmacy practice and to aid in establishing appropriate and attainable goals.

Area under the inhibitory curve and a pneumonia scoring system for predicting outcomes of vancomycin therapy for respiratory infections by Staphylococcus aureus.

Treatment factors predictive of clinical and microbiological outcomes and the relationship between a pneumonia scoring system and clinical outcomes in vancomycin-treated patients with a Staphylococcus aureus-associated lower-respiratory-tract infection (LRTI) were studied. A computer database review identified patients for whom S. aureus was isolated from a respiratory-tract specimen between January 1 and December 31, 1998, and who had antimicrobials ordered within 72 hours of isolation of that organism.

New agents for Gram-positive bacteria.

Infections caused by multiple-resistant Gram-positive organisms continue to occur at an alarming rate worldwide. Two new and unique antimicrobial agents targeted specifically against such organisms, quinupristin/dalfopristin and linezolid, have been approved for use in the USA in the past year and will play an important role in the treatment of life-threatening infections. In addition, several new fluoroquinolones have been approved recently or will be available in the near future to aid in the treatment of infections caused by resistant strains of Streptococcus pneumoniae.

A nationwide, multicenter, case-control study comparing risk factors, treatment, and outcome for vancomycin-resistant and -susceptible enterococcal bacteremia.

National Nosocomial Resistance Surveillance Group participants from 22 hospitals across the United States reviewed medical records for hospitalized patients with vancomycin-resistant enterococcal (VRE) or vancomycin-susceptible enterococcal (VSE) bacteremia to identify risk factors associated with the acquisition of VRE bacteremia, describe genetic traits of VRE strains, and identify factors predictive of clinical outcome. VRE cases were matched to VSE controls within each institution. Multiple logistic regression (LR) and classification and regression tree (CART) analysis were used to probe for factors associated with VRE bacteremia and clinical outcome.

Influence of fluoroquinolone purchasing patterns on antimicrobial expenditures and Pseudomonas aeruginosa susceptibility.

The influence of using ofloxacin in place of ciprofloxacin on hospital fluoroquinolone expenditures, total antimicrobial expenditures, and susceptibility of Pseudomonas aeruginosa to fluoroquinolones was studied. Hospitals with fluoroquinolone expenditures of at least $1 per occupied bed per year were administered annual surveys covering the years 1993 through 1996. The two most recent consecutive years of data were compared among hospitals that used ciprofloxacin as their primary fluoroquinolone during both years (group 1), hospitals whose ofloxacin purchases increased from accounting for < or =25% of total fluoroquinolone expenditures during year 1 to accounting for >25% during year 2 (group 2), and hospitals whose ofloxacin purchases accounted for at least 25% of total fluoroquinolone expenditures for both years (group 3).

Pharmacodynamic evaluation of factors associated with the development of bacterial resistance in acutely ill patients during therapy.

The selection of bacterial resistance was examined in relationship to antibiotic pharmacokinetics (PK) and organism MICs in the patients from four nosocomial lower respiratory tract infection clinical trials. The evaluable database included 107 acutely ill patients, 128 pathogens, and five antimicrobial regimens. Antimicrobial pharmacokinetics were characterized by using serum concentrations, and culture and sensitivity tests were performed daily on tracheal aspirates to examine resistance.

Antipsychotic agents: a survey of the prevalence, severity and burden of side effects.

We prospectively studied 64 male veteran out-patients with psychotic illnesses receiving one of six antipsychotic agents grouped by potency (low, mid, high, atypical) to determine: (1) prevalence of side effects; (2) cumulative side effect burden; and (3) relationship between side effects and patient-perceived burden. Patients were administered a questionnaire which included: (1) demographic information; (2) prevalence of 49 side effects; (3) visual analog scales (VAS) rating the severity of 10 selected side effects; and (4) overall side effect burden scale. Outcome measures included comparison of the prevalence, severity and overall burden of side effects among the potency groups (Part A); and association between side effect prevalence and burden, the correlation between severity and burden of certain side effects and demographic variables for the entire population (Part B).

Monitoring of intravenous quinidine infusion in the treatment of Plasmodium falciparum malaria.

Objective: To report a case of Plasmodium falciparum malaria in which intravenous quinidine was used, resulting in a prolonged QT interval.

Case Summary: P. falciparum malaria was diagnosed in a woman visiting from Nigeria.