JAPhA Pharmacotherapy最新文献

{"title":"Safety of prolonged thrice-weekly high-dose daptomycin in a hemodialysis patient with prosthetic valve endocarditis","authors":"Michael Bosco,&nbsp;Nadeem Baalbaki","doi":"10.1016/j.japhar.2024.100008","DOIUrl":"10.1016/j.japhar.2024.100008","url":null,"abstract":"<div><h3>Background</h3><p>Daptomycin (DAP) is a cyclic lipopeptide antibiotic with in vitro, concentration-dependent bactericidal activity against many clinically relevant gram-positive organisms including <em>Staphylococcus</em> spp. and <em>Enterococcus</em> spp. High-dose DAP (i.e., &gt; 9 mg/kg) has been associated with improved survival outcomes in patients with invasive enterococci infections. Although generally well tolerated, DAP is associated with myopathy and rhabdomyolysis. Limited data regarding the safety of high-dose DAP in hemodialysis (HD) patients, especially with doses ≥ 12 mg/kg, are available. Here, we describe the safety outcomes in a HD patient who received prolonged, thrice-weekly, high-dose DAP. To the best of our knowledge, this is the first case report looking at the safety of long-term DAP doses up to 18 mg/kg.</p></div><div><h3>Case summary</h3><p>A 65-year-old male with a medical history significant for end-stage renal disease on intermittent HD was diagnosed as having prosthetic valve endocarditis secondary to vancomycin-resistant <em>Enterococcus faecium</em> (VRE)<em>.</em> He was deemed a poor surgical candidate and the decision was made for conservative management. DAP was continued for approximately 4 months at a dose of 12 mg/kg on 48-hour interdialytic days and 18 mg/kg on the 72-hour interdialytic day. Creatine phosphokinase (CPK) was monitored once or twice weekly. Average CPK during therapy was 92.3 U/L ± 38.9. Overall, DAP was well tolerated and the patient did not experience any signs or symptoms of myopathy or rhabdomyolysis based on daily review of systems.</p></div><div><h3>Practice implications</h3><p>Although more data are needed to assess the safety of this particular dosing strategy, our case findings suggest that prolonged DAP doses ≥ 12 mg/kg can be safely considered in those receiving intermittent HD, especially when aggressive treatment is needed for invasive VRE infection.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 3","pages":"Article 100008"},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949962324000044/pdfft?md5=80ed4a633d14b485f15364b5b943cdd8&pid=1-s2.0-S2949962324000044-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141416353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proportion of intensive care unit patients receiving sedation after rapid sequence intubation with rocuronium","authors":"Joanna Dukes,&nbsp;Preeyaporn Sarangarm,&nbsp;Nicole Murtagh,&nbsp;Kevin A. Kaucher","doi":"10.1016/j.japhar.2024.100007","DOIUrl":"10.1016/j.japhar.2024.100007","url":null,"abstract":"<div><h3>Background</h3><p>Rocuronium has a longer duration of action than the sedative effects of induction agents used during rapid sequence intubation (RSI), introducing a potential window for inadequate sedation. When rocuronium is used for paralysis in the emergency department, delays in sedation have been observed, but have not been described in intensive care units (ICUs).</p></div><div><h3>Objectives</h3><p>The primary objective is the proportion of patients in the ICU who received sedation within 15 minutes after intubation using rocuronium. Secondary objectives include (1) time to sedation (minutes), (2) time to sedation between ICUs (minutes), (3) time to sedation between provider specialties (minutes), (4) time to sedation by Glasgow coma scale (GCS), and (5) first-hour versus second-hour Sedation Intensity Score (SIS) after RSI.</p></div><div><h3>Methods</h3><p>This is a retrospective review at a single academic tertiary care center of patients intubated in an ICU between July 2019 and August 2020. Inclusion criteria were age 18 to 89 years, intubation using rocuronium, and intubation in an ICU. Exclusion criteria were sedative exposure before intubation, no charted induction agent or charting delays from paralytic, incomplete charting, intubation outside an ICU, intubation during cardiac arrest, pregnancy, or incarceration.</p></div><div><h3>Results</h3><p>A total of 192 intubations using rocuronium were included and 77 (40.1%) received sedation within 15 minutes of induction agent administration. There was no difference in proportion of patients receiving sedation by GCS ≤ 8 and GCS &gt; 8 before intubation (38.1% vs. 41.1%, <em>P</em> = 0.69). Using a SIS to describe amount of sedative administered, more sedation was administered in the second hour after intubation than the first hour (median score 5.5 [interquartile range {IQR} 0-20] vs. 4.5 [IQR 0-12.5], <em>P</em> &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>In this single-center analysis, a large proportion of patients intubated in ICUs with rocuronium did not receive additional sedation within 15 minutes of induction, exposing them to risk of awareness while paralyzed.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 3","pages":"Article 100007"},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949962324000032/pdfft?md5=52094e0f34a9dd0f3422885bcc7587bd&pid=1-s2.0-S2949962324000032-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of loperamide on heart rhythm: Randomized, double-blind, controlled study in healthy adults","authors":"Iolanda Cirillo,&nbsp;Jay Ariyawansa,&nbsp;Saberi Rana Ali,&nbsp;Evren Atillasoy","doi":"10.1016/j.japhar.2024.100006","DOIUrl":"https://doi.org/10.1016/j.japhar.2024.100006","url":null,"abstract":"<div><h3>Background</h3><p>Excessively high doses of loperamide (of up to 792 mg/day) have recently been associated with reports of cardiac events. However, no data currently demonstrate a direct effect of high doses of loperamide on the occurrence of cardiovascular abnormalities.</p></div><div><h3>Objectives</h3><p>This study aimed to assess the effects of loperamide on QT/corrected QT (QTc) intervals, electrocardiogram (ECG) morphology, and overall safety and tolerability at therapeutic and supratherapeutic exposures in healthy adults.</p></div><div><h3>Methods</h3><p>This randomized, double-blind, 4-way-crossover study enrolled 65 healthy adults to receive loperamide 8 mg (therapeutic dose), loperamide 48 mg (supratherapeutic dose), moxifloxacin 400 mg (positive control), and placebo. Least square (LS) mean difference in change from baseline in Fridericia-corrected QT (ΔQTcF) intervals between loperamide (8 mg and 48 mg) and placebo with the 2-sided 90% CI was calculated for each time point. A noninferiority criterion of mean difference in ΔQTcF of 10 ms evaluated whether loperamide was noninferior to placebo. Treatment safety was assessed throughout the study.</p></div><div><h3>Results</h3><p>Most participants were female (66.2%) and white (95.4%). The age was 36.4 years (SD 9.77). The highest upper limit of the 2-sided 90% CI for LS mean difference in ΔQTcF between loperamide and placebo was 3.39 ms for the therapeutic dose and 9.28 ms for the supratherapeutic dose of loperamide, which were below the 10 ms threshold, thereby demonstrating noninferiority of loperamide to placebo. There were no statistically significant morphologic ECG changes after loperamide administration. There were no deaths, serious adverse events, or severe treatment-emergent adverse events.</p></div><div><h3>Conclusion</h3><p>Single-dose loperamide at therapeutic (8 mg) and supratherapeutic (48 mg) doses do not show evidence of QTc prolongation of clinical concern in healthy participants. No new safety findings were identified.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 3","pages":"Article 100006"},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949962324000020/pdfft?md5=9cd0ee4479f64d543e4c8feaa9ec4bcd&pid=1-s2.0-S2949962324000020-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140633463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in recognizing, treating, and preventing mpox infection","authors":"C. Tyler Pitcock,&nbsp;Nicholas Van Sickels,&nbsp;Frank Romanelli","doi":"10.1016/j.japhar.2023.100004","DOIUrl":"https://doi.org/10.1016/j.japhar.2023.100004","url":null,"abstract":"<div><h3>Background</h3><p>Monkeypox (mpox) was first isolated in 1958, and since that time, only sporadic human cases have been reported. Mpox is a double-stranded DNA poxvirus of the Orthopox genus whose natural animal reservoir is small rodents. Classification of the virus is divided into clades I and II, with clade II being further subdivided into IIa and IIb. Transmission is most often accomplished through large respiratory droplets or skin-to-skin contact with infectious lesions. Infection typically proceeds in 3 distinct phases (incubation, prodrome, and rash), with the course of the illness extending 2 to 4 weeks. Lymphadenopathy is often a distinguishing finding.</p></div><div><h3>Objective</h3><p>The emergence and re-emergence of mpox infections in the United States and beyond have underscored the need for continued awareness of transmission patterns, clinical presentation, treatment, and preventative strategies.</p></div><div><h3>Methods</h3><p>A literature search was conducted for published literature using the keywords \"Mpox\", \"Monkeypox\" or \"Monkeypox virus\", between 1950 and 2023. All manuscript types were included and reviewed for relevant information related to Money pox and its management.</p></div><div><h3>Results</h3><p>In 2022 and after a span of decades, mpox cases re-emerged in the United States coinciding with reported outbreaks in Europe among men who have sex with men. The 2022 outbreak was distinguished by a pattern of rash where lesions were very commonly sequestered to genital and perianal regions. The clinical course of disease can be complicated by pre-existing immunocompromise including human immunodeficiency virus infection. Although no Food and Drug Administration–approved treatment for mpox exists, some antiviral options are available including tecovirimat. Other less studied but promising alternatives include brincidofovir and vaccinia immune globulin intravenous. Currently, 2 vaccine products are available for the prevention of mpox infection.</p></div><div><h3>Conclusion</h3><p>The appearance of new mpox infections in 2022 and lingering cases in 2023 underscore the need for continued vigilance against this and other zoonotic disease.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 2","pages":"Article 100004"},"PeriodicalIF":0.0,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949962323000049/pdfft?md5=34cf86bc4aed5efef987927ecf74e90a&pid=1-s2.0-S2949962323000049-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139999319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does phenobarbital reduce the hospital length of stay for patients suffering from severe alcohol withdrawal? A retrospective comparison of phenobarbital to lorazepam infusions","authors":"Vicente J. Jaramillo,&nbsp;Meghan L. Fletcher,&nbsp;Toby Chiu,&nbsp;Preeyaporn Sarangarm","doi":"10.1016/j.japhar.2023.100003","DOIUrl":"https://doi.org/10.1016/j.japhar.2023.100003","url":null,"abstract":"<div><h3>Introduction</h3><p>Data suggest that phenobarbital is as effective as benzodiazepines at managing withdrawal via its direct activation of the gamma-aminobutyric acid receptor and modulating glutamate-mediated stimulation of the N-methyl-D-aspartate receptor. There are little data evaluating the effect of phenobarbital on severe withdrawal syndromes.</p></div><div><h3>Objective</h3><p>The purpose of this study was to evaluate the effect of phenobarbital compared with protocolized, symptom-driven, benzodiazepine administration on hospital length of stay (LOS) in patients experiencing severe withdrawal.</p></div><div><h3>Methods</h3><p>This is a retrospective chart review of patients evaluated in the emergency department for the treatment of severe alcohol withdrawal syndrome, defined as a Clinical Institute Withdrawal Assessment for Alcohol – Revised score of 20 or greater during their visit. The primary outcome measure was the difference in hospital LOS between those receiving phenobarbital and those receiving continuous lorazepam infusions. Secondary outcomes include intensive care unit (ICU) admission, ICU LOS, need for mechanical ventilation, and incidence of oversedation.</p></div><div><h3>Results</h3><p>In all, 298 patients met inclusion, with 131 treated with phenobarbital and 167 initiated on a lorazepam infusion. Hospital LOS was found to be statistically significantly greater in the lorazepam infusion cohort (7.6 ± 5.3 vs. 5.2 ± 4.5 days, <em>P</em> &lt; 0.001) than the phenobarbital cohort. Patients treated with lorazepam were found to have increased admissions to the ICU (risk ratio [RR] 1.79 [95% CI 1.27–2.92]) and higher rates of oversedation (RR 1.71 [95% CI 2.09–4.25]). There were no differences in ICU LOS and need for mechanical ventilation.</p></div><div><h3>Conclusion</h3><p>Data from this study suggest that phenobarbital may be associated with a decrease in hospital LOS in severe alcohol withdrawal and should be considered as an alternative to benzodiazepine infusions in these patients.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 1","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2023-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949962323000037/pdfft?md5=d20c95744e78ee36c255063dec97770d&pid=1-s2.0-S2949962323000037-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in serum potassium with concomitant administration of renin-angiotensin system agents and potassium-sparing diuretics: U.S. cohort study using electronic health record data","authors":"M. Sakil Syeed,&nbsp;Ainhoa Gomez-Lumbreras,&nbsp;Malinda Tan,&nbsp;Daniel C. Malone","doi":"10.1016/j.japhar.2023.100002","DOIUrl":"https://doi.org/10.1016/j.japhar.2023.100002","url":null,"abstract":"<div><h3>Background</h3><p>Potassium-sparing diuretics (KSDs) and renin-angiotensin system (RAS) agents (including angiotensin-converting enzyme inhibitors [ACEIs] and angiotensin II receptor blockers [ARBs]) are commonly prescribed for the management of hypertension, cardiovascular diseases, and diabetic nephropathy. However, there is a concern of developing hyperkalemia when these drugs are concomitantly used. This study investigates the change in serum potassium during concomitant administration of RAS agents (ACEI or ARB) and KSD.</p></div><div><h3>Methods</h3><p>This is a retrospective observational study using the Cerner Health Facts database. Electronic health records from unique patient hospitalization encounters were used to compare change in the serum potassium among 5 different cohorts (ACEI, ARB, KSD, ACEI-KSD, and ARB-KSD) and a non-RAS non-KSD exposed one (acetaminophen [APAP] cohort). Descriptive data of the cohorts and the risk of increase in potassium serum were estimated by generalized linear regression.</p></div><div><h3>Results</h3><p>A total of 5816 patients’ unique encounters were analyzed. After admission, 5.2% (N = 303) had serum potassium greater than 5.5 mmol/L. Results showed a significant increase in serum potassium during concomitant use of KSD and RAS agents and when only using KSD compared with the control APAP group (all <em>P</em> &lt; 0.05). Other significant predictors of increased serum potassium levels included male (<em>P</em> = 0.002), black race (<em>P</em> &lt; 0.001), and individuals with low estimated glomerular filtration rate (<em>P</em> &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>This study found no evidence of hyperkalemia when combining KSD and other medications that may increase potassium levels, even when controlling for other potential factors that may affect serum potassium levels, for patients within institutional settings. Warnings concerning excessive potassium levels when a KSD is prescribed with a medication that may affect potassium should be limited to patients with pre-existing higher levels of potassium.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 1","pages":"Article 100002"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949962323000025/pdfft?md5=8cecf6b54898fbb1b76a15edb7693294&pid=1-s2.0-S2949962323000025-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92107577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of combination antibiotic therapy on clinical failure rate for skin and soft tissue infections","authors":"Colton Whiteside,&nbsp;Meghan L. Fletcher,&nbsp;Lauren A. Schluenz-Roehl,&nbsp;Preeyaporn Sarangarm","doi":"10.1016/j.japhar.2023.100001","DOIUrl":"https://doi.org/10.1016/j.japhar.2023.100001","url":null,"abstract":"<div><h3>Background</h3><p>Despite guideline recommendations for skin and soft tissue infection (SSTI) consisting of empirical single antibiotic therapy, multiple studies have evaluated the use of a first-generation cephalosporin and sulfamethoxazole-trimethoprim or clindamycin to optimize coverage for staphylococcal and streptococcal species. No studies have evaluated a tetracycline with a cephalosporin for this indication.</p></div><div><h3>Objective</h3><p>This study evaluated combination therapy with doxycycline plus cephalexin compared with cephalexin or doxycycline alone in SSTI.</p></div><div><h3>Methods</h3><p>This retrospective, single-center cohort study, conducted at an academic medical center, included consecutive adults who visited the emergency department (ED) with an SSTI, identified with ICD-10 codes, and received a prescription for cephalexin, doxycycline, or both. Admitted patients or those with antibiotics in the previous 30 days or wound care for chronic infections were excluded. The primary outcome was clinical failure defined as documented worsening of infection or incision and drainage (I&amp;D) on follow-up, change in antibiotic, or subsequent hospitalization. Chi-square test was used for the primary outcome.</p></div><div><h3>Results</h3><p>Patients (N = 419) were predominately white, Hispanic, males with a mean age of 46 ± 16 years, and consistent between groups. History of intravenous drug use was present in 23% of patients, most often in the doxycycline (30%) or combination groups (30%). Clinical failure occurred in 49 patients (12%). There was no difference in clinical failure between cephalexin and combination therapy (17 vs. 13, <em>P</em> = 0.45) or doxycycline versus combination therapy (19 vs. 13, <em>P</em> = 0.27). The predominant reason for clinical failure was worsening of infection (31), followed by change in antibiotic (18) and hospitalization (16). I&amp;D predominately occurred in the doxycycline (44%) and combination groups (30%), with methicillin-resistant <em>Staphylococcus aureus</em> being the most commonly identified organism (15).</p></div><div><h3>Conclusion</h3><p>In ED patients with SSTI, single antibiotic therapy did not result in increased incidence of clinical failure compared with combination therapy with a first-generation cephalosporin and tetracycline.</p></div>","PeriodicalId":100736,"journal":{"name":"JAPhA Pharmacotherapy","volume":"1 1","pages":"Article 100001"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71785391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}