The Annals of pharmacotherapy最新文献

{"title":"Serotonergic and adrenergic drug interactions associated with linezolid: a critical review and practical management approach.","authors":"Tasha D Ramsey,&nbsp;Tim Ty Lau,&nbsp;Mary Hh Ensom","doi":"10.1345/aph.1R604","DOIUrl":"https://doi.org/10.1345/aph.1R604","url":null,"abstract":"OBJECTIVE To describe the evidence for serotonergic and adrenergic drug interactions with linezolid and discuss clinical management strategies. DATA SOURCES A literature search of PubMed (1947–November 2012), MEDLINE (1946–November 2012), EMBASE (1974–November 2012), and International Pharmaceutical Abstracts (1970–November 2012) was conducted using the terms linezolid, drug interaction, serotonin syndrome, serotonin toxicity, sympathomimetic, serotonergic agents, and adrenergic agents. Citations of retrieved articles were also reviewed. STUDY SELECTION AND DATA EXTRACTION English-language articles describing coadministration of serotonergic or adrenergic agents with linezolid to humans were included. Studies published only in abstract form were excluded. DATA SYNTHESIS One prospective study, 6 retrospective studies, and 24 case reports were identified describing a serotonergic or adrenergic drug interaction. Incidence of serotonin syndrome in patients on linezolid and serotonergic agents ranged between 0.24% and 4%. Serotonergic agents determined to have probable (according to the Horn Drug Interaction Probability Scale) linezolid interactions in case reports included meperidine, citalopram, escitalopram, fluoxetine, paroxetine, sertraline, duloxetine, and venlafaxine. Serotonergic agent dose and duration of coadministration with linezolid did not appear to influence the occurrence of serotonin syndrome. Adrenergic medication coadministration was associated with a possible drug interaction as determined by the Horn Drug Interaction Probability Scale but did not appear to result in clinically significant drug interactions with linezolid. CONCLUSIONS Linezolid-associated serotonergic drug interactions occur more commonly than adrenergic interactions. Serotonergic interactions considered probable according to the Horn Drug Interaction Probability Scale do not appear to correlate with drug dosage; time of onset ranges from <1 to 20 days, and effect resolves in <1 to 5 days after discontinuation of offending agents. If coadministration of linezolid and a serotonergic agent cannot be avoided, clinicians should be aware of the symptoms and management of serotonergic toxicity; close monitoring is recommended and additional serotonergic agents should not be used. While adrenergic drug interactions with linezolid are less common in clinical practice, monitoring for signs of hypertension remains important.","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"543-60"},"PeriodicalIF":2.9,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40240730","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}

{"title":"Evidence for therapeutic uses of nebulized lidocaine in the treatment of intractable cough and asthma.","authors":"Rachel M Slaton,&nbsp;Rachel H Thomas,&nbsp;Joseph Wallace Mbathi","doi":"10.1345/aph.1R573","DOIUrl":"https://doi.org/10.1345/aph.1R573","url":null,"abstract":"<p><strong>Objective: </strong>To summarize the efficacy and safety data for use of nebulized lidocaine in intractable cough and asthma.</p><p><strong>Data sources: </strong>A literature search was conducted using PubMed (through November 2012), International Pharmaceutical Abstracts (1970-December 2012), and Cochrane Library (up to 2012) with the search terms nebulization, nebulized or nebulised; administration, inhalation; cough; asthma; and lidocaine. Results were limited to human studies published in the English language. Referenced citations from relevant publications were also reviewed.</p><p><strong>Study selection and data extraction: </strong>All articles identified from the data sources were reviewed for inclusion. Clinical trials and descriptive studies that discussed use of nebulized lidocaine for treatment of intractable cough and asthma were included in the review.</p><p><strong>Data synthesis: </strong>Seventeen studies were identified for review. Seven studies (6 descriptive studies and 1 clinical trial) evaluating the use of nebulized lidocaine in intractable cough reported efficacy in doses ranging from 10 mg to 400 mg. Five clinical trials in asthma showed conflicting results regarding improvement in pulmonary function and glucocorticoid-sparing effects. General improvements in pulmonary function as well as the initial bronchoconstriction induced by nebulized lidocaine in subjects with baseline bronchial hyperreactivity were investigated in 5 studies. Overall, the available evidence does not appear to preclude the use of lidocaine as a treatment option for intractable cough after failure of traditional cough suppressants. Data on its use for short-term glucocorticoid-sparing effects in asthma are conflicting. Study limitations, including design, small sample size, and inconsistencies in method and adjunctive therapies, should be considered. Nebulized lidocaine is well tolerated; however, reports of initial bronchoconstriction have occurred.</p><p><strong>Conclusions: </strong>Although nebulized lidocaine is not first-line therapy in intractable cough and asthma, it may provide an alternative treatment option in patients who cannot tolerate or are unresponsive to other treatments. Appropriate monitoring precautions should be used to ensure patient safety.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"578-85"},"PeriodicalIF":2.9,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R573","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40242328","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}

{"title":"Evaluating second-line treatment options for type 2 diabetes: focus on secondary effects of GLP-1 agonists and DPP-4 inhibitors.","authors":"Cassie L Boland,&nbsp;Michelle Degeeter,&nbsp;Donald S Nuzum,&nbsp;Maria Tzefos","doi":"10.1345/aph.1R444","DOIUrl":"https://doi.org/10.1345/aph.1R444","url":null,"abstract":"<p><strong>Objective: </strong>To discuss the controversy surrounding selection of second-line type 2 diabetes mellitus (T2DM) therapy by reviewing available data regarding secondary effects of glucagon-like peptide-1 receptor (GLP-1) agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, which include low hypoglycemia risk, weight loss, and cardiovascular (CV) and β-cell function benefits.</p><p><strong>Data sources: </strong>A MEDLINE search (1966-March 2013) was conducted using the following key terms: β-cell protection, blood pressure, DPP-4 inhibitors, exena tide, exenatide extended-release, GLP-1 agonists, hypoglycemia, lina glip tin, lipid, liraglutide, pancreatitis, saxagliptin, sitagliptin, and type 2 diabetes.</p><p><strong>Study selection and data extraction: </strong>Identified articles published in English were evaluated for inclusion, with priority given to randomized controlled trials in humans receiving incretin monotherapy or incretin combination therapy with metformin. References identified in these articles were reviewed for additional trials.</p><p><strong>Data synthesis: </strong>Most patients with T2DM use combination therapy; however, determination of the second-line agent that is most appropriate is debatable. Prior to the use of incretin therapies, traditional second-line agents included sulfonylureas, thiazolidinediones, and basal insulin, all of which demonstrate undesirable adverse effects. In addition to improving glycemic control, incretin therapies have demonstrated benefits concerning hypoglycemic risk and weight loss in addition to potential improvements in CV risk factors and β-cell function. While there are risks associated with using incretins, most patients with T2DM are good candidates for incretins and could benefit from their potential secondary effects. Cost remains a barrier to initiating these agents.</p><p><strong>Conclusions: </strong>Demonstrated secondary benefits in addition to efficacy may make GLP-1 agonists and DPP-4 inhibitors a more favorable option than other second-line T2DM therapies.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"490-505"},"PeriodicalIF":2.9,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R444","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40242330","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}

{"title":"Carfilzomib: a second-generation proteasome inhibitor for the treatment of relapsed and refractory multiple myeloma.","authors":"Jennifer L Thompson","doi":"10.1345/aph.1R561","DOIUrl":"https://doi.org/10.1345/aph.1R561","url":null,"abstract":"<p><strong>Objective: </strong>To review and summarize data on carfilzomib, which was approved by the Food and Drug Administration (FDA) in July 2012 for the treatment of patients with relapsed and refractory multiple myeloma (MM) who received prior bortezomib and thalidomide or lenalidomide.</p><p><strong>Data sources: </strong>A literature search through PubMed was conducted through October 2012 using the terms carfilzomib, PR-171, proteasome inhibitor (PI), and MM. Data were also obtained through the American Society of Clinical Oncology and American Society of Hematology abstracts and FDA briefing documents.</p><p><strong>Study selection and data extraction: </strong>The literature search was limited to human studies published in English. Priority was placed on trials of carfilzomib in relapsed and refractory MM.</p><p><strong>Data synthesis: </strong>Carfilzomib is a new PI that differs in pharmacology and pharmacokinetics from bortezomib, the first-in-class PI. The FDA approval was based on efficacy data from a Phase 2 study of carfilzomib in patients with relapsed and refractory MM (n = 266). All patients had received prior bortezomib and 80% were refractory or intolerant to both bortezomib and lenalidomide. Patients were treated with intravenous carfilzomib 20 mg/m(2) (cycle 1) followed by 27 mg/m(2) (cycles ≥2) on days 1, 2, 8, 9, 15, and 16 of each 28-day cycle. The overall response rate was 23.7% (18.7-29.4), with a median duration of response of 7.8 (5.6-9.2) months. Safety data from an integrated analysis reported thrombocytopenia, anemia, fatigue, nausea, and diarrhea as the most common adverse events, with minimal dose-limiting neutropenia or peripheral neuropathy (PN) (n = 526). The incidence of grade 3 or higher thrombocytopenia was 24.9%, while that of neutropenia was 11.9%, and the incidence of all grades of treatment-emergent PN was 13%.</p><p><strong>Conclusions: </strong>Carfilzomib is a safe and effective new treatment option for patients with relapsed MM refractory to bortezomib and thalidomide or lenalidomide. Randomized head-to-head trials with bortezomib will assist in formulary and treatment decisions in the context of PIs as a drug class.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"56-62"},"PeriodicalIF":2.9,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40220974","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}

{"title":"Erythematous rash following romiplostim administration in a patient with autoimmune lymphoproliferative syndrome.","authors":"Lisa Biondo,&nbsp;Megan Bodge,&nbsp;Stephan R Paul","doi":"10.1345/aph.1R361","DOIUrl":"https://doi.org/10.1345/aph.1R361","url":null,"abstract":"<p><strong>Objective: </strong>To report a case of erythematous rash induced by romiplostim administration in a patient with autoimmune lymphoproliferative syndrome (ALPS).</p><p><strong>Case summary: </strong>A 19-year-old female with ALPS-related thrombocytopenia (platelet count 4 × 10(3)/μL) successfully treated with romiplostim 500 μg weekly for 9 months presented with a grade 3 maculopapular rash. Symptoms on presentation included purpuric, erythematous pustules confined to the trunk following romiplostim administration the previous day. A punch biopsy of skin from the patient's right lower abdomen revealed perivascular chronic inflammation with numerous eosinophils consistent with drug reaction. The patient had received romiplostim 500 μg weekly with no other reports of rash until this time. Romiplostim was discontinued, the patient was monitored, and the rash resolved within 1 week. Romiplostim was then restarted at 200 μg weekly. The patient has achieved platelet normalization at a current romiplostim dose of 250 μg weekly with no further adverse reactions.</p><p><strong>Discussion: </strong>ALPS is a rare autoimmune disorder with approximately 500 known cases worldwide. Pharmacotherapy for ALPS patients generally targets autoimmune cytopenias associated with the disorder. When standard therapies for ALPS-related cytopenias fail, clinicians are often forced to consider novel treatment options. Our patient had ALPS-related thrombocytopenia that was treated with romiplostim, which resulted in grade 3 maculopapular rash after almost 1 year of treatment. The likelihood that this patient's erythematous rash was due to romiplostim administration was determined to be possible based on the Naranjo probability scale. The reaction was reported to the drug manufacturer and to the Food and Drug Administration's MedWatch program.</p><p><strong>Conclusions: </strong>This is the first documented case, to our knowledge, of severe maculopapular rash occurring less than 24 hours after romiplostim administration for treatment of ALPS-related chronic thrombocytopenia. Rash has been reported as an adverse event of romiplostim therapy at higher doses (750 μg), but not at a dose of 500 μg. This report also describes successful rechallenge of romiplostim after resolution of the rash.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"e7"},"PeriodicalIF":2.9,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40220972","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}

{"title":"Nilotinib-associated acute pancreatitis.","authors":"Tal Engel,&nbsp;Dan Justo,&nbsp;Michal Amitai,&nbsp;Yulia Volchek,&nbsp;Haim Mayan","doi":"10.1345/aph.1R334","DOIUrl":"https://doi.org/10.1345/aph.1R334","url":null,"abstract":"<p><strong>Objective: </strong>To report a case of acute pancreatitis in a patient receiving nilotinib for chronic myelogenous leukemia (CML).</p><p><strong>Case summary: </strong>A 69-year-old man recently diagnosed with chronic phase CML received nilotinib 300 mg twice daily and was admitted with acute pancreatitis that appeared the day after the first dose. The patient had normal levels of triglycerides and denied alcohol use. Serum pancreatic enzymes were within normal limits the day before nilotinib initiation. Abdominal computed tomography demonstrated a normal liver, bile duct without stones, and findings that were consistent with focal pancreatitis. The patient's history was significant for concomitant use of enalapril and simvastatin; both have been associated with pancreatitis, but the patient had been taking these medications for at least 5 years without adverse effects. Nilotinib was immediately discontinued. Abdominal pain resolved and serum pancreatic enzymes levels returned to normal 2 weeks later.</p><p><strong>Discussion: </strong>One of the adverse effects of some tyrosine kinase inhibitors is increased levels of serum pancreatic enzymes. Accordingly, nilotinib labeling includes \"high lipase levels in serum\" as an adverse event. There are few case reports of acute pancreatitis associated with nilotinib in the literature and some are incomplete. We present a well-documented case of nilotinib-associated acute pancreatitis. Consistent with Badalov's new classification system for drug-induced acute pancreatitis and with the Naranjo probability scale, this case represents a possible adverse reaction of pancreatitis associated with nilotinib therapy. As rechallenge is unethical, treatment with nilotinib has not been resumed.</p><p><strong>Conclusions: </strong>This case demonstrates a possible association between acute pancreatitis and nilotinib use. Although a rare phenomenon, clinicians should be alert for signs and symptoms of pancreatitis, as treatment with nilotinib for CML is becoming more common.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"e3"},"PeriodicalIF":2.9,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40220973","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}

{"title":"Efavirenz severe hypersensitivity reaction: case report and rapid desensitization protocol development.","authors":"Hossein Khalili,&nbsp;Maryam Farasatinasab,&nbsp;Mahboobeh Hajiabdolbaghi","doi":"10.1345/aph.1Q773","DOIUrl":"https://doi.org/10.1345/aph.1Q773","url":null,"abstract":"<p><strong>Objective: </strong>Long-term efavirenz desensitization protocols have been reported; however, publication of a rapid desensitization protocol has not been noted to date. We report a case of severe hypersensitivity reaction that was successfully managed using a rapid desensitization protocol.</p><p><strong>Case summary: </strong>In a 52-year old HIV-positive woman, antiretroviral therapy was started with lamivudine 150 mg twice daily, zidovudine 300 mg twice daily, and efavirenz 600 mg daily. Nine days after starting antiretroviral therapy, she developed a generalized maculopapular rash. Despite concomitant chlorpheniramine administration, the rash did not improve. With suspicion of efavirenz hypersensitivity reaction, efavirenz was discontinued for 5 days and when the patient's rash resolved, the drug was restarted at 600 mg daily. The patient developed a severe generalized pruritic rash the next day and all antiretroviral agents were discontinued. One week later, lamivudine and zidovudine were restarted and were well tolerated. An</p><p><strong>Objective: </strong>20,000 solution of the target therapeutic dose, was successful. The patient was followed for 6 weeks and had no further signs or symptoms of a hypersensitivity reaction.</p><p><strong>Discussion: </strong>Efavirenz hypersensitivity reactions typically include cutaneous reactions that are observed in the first 2 weeks of treatment, are often mild to moderate without systemic manifestation, and improve with continued therapy. Previously, successful desensitization protocols have been described in patients receiving efavirenz who developed rash without systemic symptoms, but these protocols were carried out over 7 or 14 days. This case report indicates a rapid desensitization protocol that may be an available option for some patients.</p><p><strong>Conclusions: </strong>Considering that efavirenz can be the cornerstone of many antiretroviral therapy regimens and hypersensitivity reactions can restrict regimen options, effective desensitization protocols are valuable, especially in the developing countries with limited available antiretroviral drugs.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"e12"},"PeriodicalIF":2.9,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q773","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185294","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}

{"title":"Levofloxacin-induced tendinopathy of the hip.","authors":"Corrine M Ganske,&nbsp;Kristin K Horning","doi":"10.1345/aph.1Q635","DOIUrl":"https://doi.org/10.1345/aph.1Q635","url":null,"abstract":"<p><strong>Objective: </strong>To describe what we believe to be the first reported possible case of tendinopathy of the hip in a patient receiving levofloxacin.</p><p><strong>Case summary: </strong>A 58-year-old male with recurrent otitis media was admitted for left lateral hip pain of 10 on a scale of 10. He had started a 5-day course of levofloxacin 750 mg/day 10 days before he began experiencing pain. He also took simvastatin 20 mg/day and walked 90 minutes each day. He was treated with oxycodone with acetaminophen and physical therapy. His pain had improved significantly at a 10-day recheck.</p><p><strong>Discussion: </strong>Fluoroquinolone-induced tendinopathy has been well-reported in the literature, but most cases involve pefloxacin and affect the Achilles tendon. Only 11 cases of tendinopathy have been reported with levofloxacin based on a MEDLINE search (1966-December 2011). This is the first known case reported that involved tendinopathy of the hip believed to be caused by fluoroquinolones. The Naranjo probability scale revealed a possible adverse reaction of levofloxacin-induced tendinopathy of the hip. Contributing factors likely included the high dose of levofloxacin, concomitant use of a statin, and strenuous physical activity.</p><p><strong>Conclusions: </strong>Health care professionals should be aware of the possibility of tendinopathy of the hip in patients who receive fluoroquinolones. Thorough history for possible risk factors should be obtained. Patients on fluoroquinolones at risk for tendinopathy should be counseled to avoid strenuous physical activity.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"e13"},"PeriodicalIF":2.9,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q635","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185292","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}

{"title":"The pharmacists' role in the Patient-Centered Medical Home (PCMH): a white paper created by the Health Policy Committee of the Pennsylvania Pharmacists Association (PPA).","authors":"Hildegarde Berdine,&nbsp;Tanya Dougherty,&nbsp;Jonathan Ference,&nbsp;Kelly Karpa,&nbsp;Jacqueline Klootwyk,&nbsp;Melinda Kozminski,&nbsp;Nicholas Leon,&nbsp;Maria Osborne,&nbsp;Adam C Welch,&nbsp;Vincent J Willey,&nbsp;Andrew Peterson,&nbsp;Lauren A Stanchak,&nbsp;Allen G Whisler","doi":"10.1345/aph.1R189","DOIUrl":"https://doi.org/10.1345/aph.1R189","url":null,"abstract":"Thefollowing are contributors to the writing of this paper (in alphabetical order): Hildegarde Berdine, PharmD, BCPS,CDE Associate Professor ofPharmacy Practice, Duquesne University, Mylan School of Pharmacy; Tanya Dougherty, PharmD, BCPS, Clinical Pharmacy Coordinator, Penn Presbyterian Medical Center; Jonathan Ference, PharmD, BCPS, Associate Professor, Wilkes University School ofPharmacy and Nursing; Kelly Karpa, PhD, RPh, Director, Medical Pharmacology Instruction, Penn State University College ofMedicine; Jacqueline Klootwyk, PharmD, BCPS, Assistant Professor, Thomas Jefferson University School ofPharmacy; Melinda Kozminski, PharmD, BCACP, Clinical Pharmacist, Gateway Health Plan; Nicholas Leon, PharmD, BCPS, BCACP, Thomas Jefferson University School of Pharmacy; Maria Osborne, PharmD, Clinical Pharmacist-Family Practice, UPMC St. Margaret; Adam C. Welch, PharmD, MBA, BCACP, Associate Professor, Wilkes University School of Pharmacy and Nursing; and Vincent J. Willey, PharmD, Associate Professor and Vice Chair, Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences.","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"723-50"},"PeriodicalIF":2.9,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1R189","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40185291","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}

{"title":"Prophylaxis and treatment of respiratory syncytial virus in adult immunocompromised patients.","authors":"Lauren M Hynicka,&nbsp;Christopher R Ensor","doi":"10.1345/aph.1Q553","DOIUrl":"https://doi.org/10.1345/aph.1Q553","url":null,"abstract":"<p><strong>Objective: </strong>To review the literature regarding current strategies and strategies under active development for the prevention and treatment of respiratory syncytial virus (RSV) infections in immunocompromised adults.</p><p><strong>Data sources: </strong>The MEDLINE/PubMed, EMBASE, and Cochrane databases were queried from January 1980 to December 2011 for articles in English using these associated search terms: respiratory syncytial virus, ribavirin, intravenous immunoglobulin, IVIG, palivizumab, motavizumab, lung, pneumonia, transplantation, bone marrow, cancer, malignancy, and vaccine.</p><p><strong>Study selection and data extraction: </strong>All relevant original studies, meta-analyses, systematic reviews, and review articles were assessed for inclusion. References from pertinent articles were examined for additional content not found during the initial search.</p><p><strong>Data synthesis: </strong>RSV in the immunocompromised adult can lead to significant morbidity and mortality. Treatment of RSV-infected adults is limited to antiviral therapy with ribavirin (aerosolized, oral, intravenous) and immunomodulation with intravenous immunoglobulins, corticosteroids, and palivizumab. Existing literature is predominantly case reports, small trials, and retrospective reviews of patients infected with RSV who have undergone lung or hematopoietic stem cell transplantation (HSCT). Palivizumab may be a viable option for prophylaxis against RSV in high-risk adults. Ribavirin is the most studied treatment option and should remain the backbone of multidrug regimens. Of the routes of administration, aerosolized ribavirin carries the preponderance of evidence and, though challenging, is preferred to limit systemic toxicities in the infected patient. Addition of an immunomodulator to ribavirin may provide a survival benefit over ribavirin alone; however, this has only been studied in a subset of HSCT patients with lower respiratory tract RSV infection.</p><p><strong>Conclusions: </strong>Research most strongly supports the use of aerosolized ribavirin as the treatment strategy for immunocompromised adults with RSV. Addition of an immunomodulator may provide a survival benefit over ribavirin alone. Strategies and supportive data for the prevention of RSV infection in the high-risk adult are critically needed.</p>","PeriodicalId":512049,"journal":{"name":"The Annals of pharmacotherapy","volume":" ","pages":"558-66"},"PeriodicalIF":2.9,"publicationDate":"2012-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1345/aph.1Q553","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40145473","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}