JAPhA Pharmacotherapy最新文献

{"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}