Annals of Pharmacotherapy最新文献

{"title":"Evaluation of Response to Weight-based Dosing Strategies of Continuous, Fixed-Rate Atracurium Infusions in Critically Ill, Obese Adults With Acute Respiratory Distress Syndrome.","authors":"Krishn S Patel, Gretchen L Sacha, Heather Torbic, Stephanie Bass, Lu Wang, Abhijit Duggal, Michael A Rudoni","doi":"10.1177/10600280241304406","DOIUrl":"10.1177/10600280241304406","url":null,"abstract":"<p><strong>Background: </strong>Fixed-rate infusions of weight-based neuromuscular blocking agents (NMBAs) were adopted during the COVID pandemic to limit caregiver exposure during titrations. Although fixed-rate infusions are supported in studies of acute respiratory distress syndrome (ARDS), the optimal scalar for weight-based NMBAs in patients with obesity remains controversial.</p><p><strong>Objective: </strong>This study sought to compare change in oxygenation using two weight-based dosing strategies for atracurium in obese patients with ARDS. Secondary outcomes included total atracurium dose, mortality, and intensive care unit (ICU) and ventilator-free days.</p><p><strong>Methods: </strong>Following an institutional practice update to use ideal body weight (IBW) for patients with obesity, we retrospectively compared adults (≥18 years) with ARDS and a body mass index (BMI) ≥ 30 kg/m² who received atracurium (15 µg/kg/min) based on actual body weight (ABW) with those using IBW. The primary outcome was change in PaO₂/FiO₂ ratio (P/F) 48 hours after atracurium initiation. Analysis-of-covariance compared change in P/F between groups after adjustment for confounders.</p><p><strong>Results: </strong>The IBW group (<i>n</i> = 123), compared with the ABW group (<i>n</i> = 133), had lower baseline P/F (85.0 [71.0, 118.3] vs 93.3 [76.0, 128.3], <i>P</i> = 0.025) and sequential organ failure assessment (SOFA) score (9.7 ± 2.6 vs 10.5 ± 2.6, <i>P</i> = 0.015), with greater use of steroids (96% vs 89%, <i>P</i> = 0.032) and prone positioning (72% vs 58%, <i>P</i> = 0.015). No difference was detected in change in P/F at 48 hours (adjusted least squares mean [95% confidence interval, CI]: 55.8 [37.0, 74.5] vs 56.9 [39.6, 74.1], <i>P</i> = 0.90). Atracurium doses were higher in the ABW group (97.4 mg/h [84.4, 110.3] vs 55.4 [47.2, 65.7], <i>P</i> < 0.001). There was no difference in hospital mortality, ICU mortality, and ICU-free days or ventilator-free days.</p><p><strong>Conclusion and relevance: </strong>In patients with obesity with ARDS receiving fixed-rate atracurium infusions, the change in P/F at 48 hours did not differ based on weight. Atracurium dosed on IBW may use less total drug without compromising ability to improve oxygenation. This is the first study comparing the dosing weight used for continuous infusion atracurium in hospitalized, critically ill ARDS patients with obesity. Additional studies are warranted to optimize dosing in obese patients.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"612-619"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SGLT2 Inhibitor-Induced Euglycemic Diabetic Ketoacidosis (EDKA) in Patients With Underlying Risk Factors.","authors":"Paul Joseph Solinsky, Amy Holstege, Glen Burnie","doi":"10.1177/10600280241294060","DOIUrl":"10.1177/10600280241294060","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"671-673"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Disproportionality Analysis of Treprostinil Based on FDA Adverse Event Reporting System Database.","authors":"Lingling Li","doi":"10.1177/10600280241299114","DOIUrl":"10.1177/10600280241299114","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"674-675"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Mifepristone and Misoprostol Compared to Misoprostol Alone for the Resolution of Miscarriage and Intrauterine Fetal Death: A Systematic Review and Meta-Analysis.","authors":"Rachael G Pirrami, Justin P Reinert","doi":"10.1177/10600280241289968","DOIUrl":"10.1177/10600280241289968","url":null,"abstract":"<p><strong>Objective: </strong>To determine the efficacy and safety of mifepristone and misoprostol together (intervention) compared to misoprostol alone (comparator) for the resolution of miscarriage and intrauterine fetal death.</p><p><strong>Data sources: </strong>A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology through July 2024 that evaluated the efficacy and safety of mifepristone and misoprostol together compared to misoprostol alone for the resolution of miscarriage and intrauterine fetal death through July 2024.</p><p><strong>Study selection and data extraction: </strong>Primary endpoints were overall delivery success, 24-hour delivery success, and incidence of safety outcomes. A <i>P</i>-value of <0.05 was considered statistically significant, and heterogeneity was reported as the I² value.</p><p><strong>Data synthesis: </strong>Twelve randomized controlled trials (RCTs) were included. Overall delivery success was higher in the intervention group (0.73 [CI 0.64-0.82], <i>P</i> < 0.01). Twenty-four-hour delivery rate was higher (1.54 [CI 1.32-1.77], <i>P</i> = 0.06), and a shorter time to delivery interval (9.22-18.78 vs 15.47-37.1 hours) was observed in the intervention group. Gastrointestinal adverse effects were more frequent in the intervention group (0.04 [CI -0.03 to 0.12], <i>P</i> < 0.01).</p><p><strong>Relevance to patient care and clinical practice: </strong>Mifepristone and misoprostol together demonstrated higher delivery success rates and comparable safety outcomes to misoprostol alone, demonstrating the potential of improving patient care and positively impacting the time to successful delivery for patients at the bedside.</p><p><strong>Conclusions: </strong>The use of mifepristone and misoprostol together for the resolution of miscarriage and intrauterine fetal death is warranted over the use of misoprostol alone.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"636-647"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142493077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Efficacy of Piperacillin/Tazobactam in Extended-Spectrum Beta-Lactamase-Producing <i>Enterobacteriaceae</i> Urinary Tract Infections: A Systematic Review of the Literature.","authors":"Samantha P Sutton, Justin P Reinert","doi":"10.1177/10600280241291604","DOIUrl":"10.1177/10600280241291604","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of piperacillin/tazobactam (PTZ) for the treatment of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE) urinary tract infections (UTIs).</p><p><strong>Data sources: </strong>A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards on PubMed, MEDLINE, Embase, Web of Science Core Collection, and Cochrane Central through July 2024.</p><p><strong>Study selection and data extraction: </strong>Studies providing efficacy data associated with PTZ in patients ≥18 years old experiencing an ESBL-PE UTI that documented clinical and microbiological cure data were included.</p><p><strong>Data synthesis: </strong>A total of 577 articles were obtained for screening. After applying the inclusion and exclusion criteria, 7 studies comparing PTZ with carbapenems comprised of 1156 patient cases were analyzed. Piperacillin/tazobactam was found to be noninferior to carbapenems in the treatment of both uncomplicated and complicated UTI's caused by ESBL-PE. The observed noninferiority encompassed clinical response, clinical cure, and microbiological cure outcome metrics. Although not specifically evaluated in this systematic review, adverse effects associated with PTZ were found to be minimal and lesser in incidence than with the carbapenem comparators in aggregate.</p><p><strong>Relevance to patient care and clinical practice: </strong>While a definitive dosing strategy remains elusive, a PTZ total daily dose of 13.5 g infused over 3 to 4 hours may be appropriate for this indication.</p><p><strong>Conclusion: </strong>Piperacillin/tazobactam may be an effective carbapenem-sparing agent for the treatment of ESBL-PE UTIs that show in-vitro susceptibility to PTZ. However, additional robust randomized clinical trials are still needed to validate the findings of this review and determine the best dosage regimen of PTZ for ESBL-PE UTIs.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"648-656"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing Theoretical Domains Framework to Determine Barriers to Evidence-Based Recommendations in Non-Valvular Atrial Fibrillation.","authors":"Evan White, Sandra L Kane-Gill, Sandeep Jain, Charles Medico, Nicole Ansani, James C Coons","doi":"10.1177/10600280241298947","DOIUrl":"10.1177/10600280241298947","url":null,"abstract":"<p><strong>Background: </strong>Implementation of evidence-based guidelines in patient care is inefficient. Only 14% of new research are routinely adopted into clinical practice. The atrial fibrillation (AF) practice guidelines recommend anticoagulation in men with a CHA₂DS₂-VASc score greater than or equal to 2 and in women with a CHA₂DS₂-VASc score greater than or equal to 3. Despite these recommendations, oral anticoagulation prescribing rates were found to be as low as 51%. Existing frameworks, such as the Theoretical Domain Framework (TDF), are used in implementation science to identify behavior changes to overcome barriers to guideline adoption.</p><p><strong>Objective: </strong>In this project, we explored behavioral themes and barriers that prevented clinician adherence to evidence-based recommendations for patients with non-valvular atrial fibrillation (NVAF) and developed interventions to overcome those barriers.</p><p><strong>Methods: </strong>Nine focused interviews were conducted with stakeholders across multiple disciplines involved with NVAF care. Interview questions were based on the TDF and designed to determine behavior changes necessary to increase appropriate anticoagulation prescribing and decrease unnecessary NVAF hospital admissions. The interviews were transcribed and coded using NVivo 12 qualitative data analysis software (released 2018). Themes were documented, and interventions were then developed to address the barriers.</p><p><strong>Results: </strong>TDF interviews yielded 4 main barrier themes regarding appropriate NVAF management in 2 theoretical domains. These themes were lack of knowledge, cost of anticoagulation, patient refusal to take anticoagulation, and social determinants of health. The theoretical domains were knowledge and environmental context and resources.</p><p><strong>Conclusion and relevance: </strong>Based on our limited interviews, the TDF framework informed potential barriers contributing to the underutilization of appropriate anticoagulation in patients with NVAF. Techniques for behavior change interventions may be applied to overcome the identified barriers.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"628-635"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Incidence of Nocardia Infection in Solid Organ Transplant Recipients on Trimethoprim-Sulfamethoxazole for Opportunistic Infection Prophylaxis.","authors":"Regina Jung, Jenny Au, Jacqueline Burnell, Adam Diamond, Ishani Shah, Christina Ruggia-Check","doi":"10.1177/10600280241302412","DOIUrl":"10.1177/10600280241302412","url":null,"abstract":"<p><strong>Background: </strong>Trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred prophylactic agent for <i>Pneumocystis jiroveci</i> pneumonia (PJP) and toxoplasmosis after solid organ transplant (SOT). Compared with other agents, it has additional activity against <i>Nocardia</i> species.</p><p><strong>Objective: </strong>The purpose of this study was to evaluate the incidence of <i>Nocardia</i> infection in SOT patients receiving TMP-SMX or an alternative agent for opportunistic infection (OI) prophylaxis.</p><p><strong>Methods: </strong>This retrospective analysis included transplant recipients at a large urban medical center over a period of 4 years. All patients received either TMP-SMX or an alternative agent for PJP prophylaxis. The primary outcome was the incidence of <i>Nocardia</i> infection within 24 months posttransplant. Secondary outcomes included resistance rates of <i>Nocardia</i> isolates, usage rates of alternative prophylactic agents, reasons for using alternative agents, and rate of conversion from an alternative agent back to TMP-SMX.</p><p><strong>Results: </strong>A total of 791 adult SOT recipients who received PJP or toxoplasmosis prophylaxis were included. Mean age at transplantation was 60.9 years with the majority of patients being male (67.3%) lung transplant recipients (63.6%). TMP-SMX was the most commonly used initial prophylactic agent (84.6%), followed by atovaquone (15.4%). Of the 791 SOT recipients, 16 (2.0%) were diagnosed with nocardiosis within 24 months posttransplant. Patients receiving alternative agents had a higher incidence of infection compared with those receiving TMP-SMX prophylaxis (<i>P</i> < 0.001).</p><p><strong>Conclusion and relevance: </strong>Our findings suggest that OI prophylaxis with TMP-SMX may be protective against nocardiosis in SOT recipients. If possible, patients who are switched to an alternative agent due to TMP-SMX intolerance should be re-challenged when the adverse effect resolves. Most patients in our study were able to tolerate re-initiation, suggesting that the adverse effects associated with TMP-SMX may be temporary and may not warrant discontinuation.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"604-611"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Glucagon-like Peptide-1 Receptor Agonists on Bowel Preparation for Colonoscopy: A Large, Matched Regional Cohort.","authors":"Jennifer L Cole, Jennifer E Stark","doi":"10.1177/10600280251349583","DOIUrl":"https://doi.org/10.1177/10600280251349583","url":null,"abstract":"<p><strong>Background: </strong>Poor colon preparation may negatively affect colonoscopy accuracy, result in cancelation, or need for repeat procedure. The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications delay gastric emptying, although the clinical impact of this on the quality of colon preparation is not known.</p><p><strong>Methods: </strong>This was a retrospective matched cohort study in a multi-center, outpatient setting. Colonoscopy reports for patients prescribed GLP-1RA at the time of procedure were compared to a cohort matched for diabetes and cirrhosis who were not prescribed GLP-1RA at the time of procedure. The primary endpoint was a composite of indicators for inadequate bowel preparation.</p><p><strong>Objective: </strong>The current study's objective is to analyze the effects of GLP-1RA medications on the quality of colonoscopy preparation.</p><p><strong>Results: </strong>There were 503 patients in each cohort and baseline characteristics were similar. Use of GLP-1RA at the time of colonoscopy was associated with a greater odds of the composite outcome (125 vs 56, odds ratio [OR] = 2.6; 95% CI, 1.9-3.7). There were also increased odds for individual outcome components including proceduralist documenting inadequate, suboptimal, or poor bowel preparation, narrative comments related to inadequate bowel preparation, and recommendation for extended bowel preparation with future colonoscopy. Repeat procedure was also more common in the GLP-1RA cohort (26 vs 9, OR = 3.0; 95% CI, 1.4-6.5).</p><p><strong>Conclusion and relevance: </strong>This study assessed the impact of the GLP-1RA class of medication on the quality of bowel preparation for lower endoscopies. Glucagon-like peptide-1 receptor agonist use increased the odds of inadequate bowel preparation and repeat procedure.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251349583"},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on Severe Acute Respiratory Failure Associated With Trimethoprim/Sulfamethoxazole Among Adolescent and Young Adults: An Active-comparator Restricted Disproportionality Analysis From the FDA Adverse Event Reporting System (FAERS) Database.","authors":"Maheshwari Periyasamy, Mirunalini Ravichandran","doi":"10.1177/10600280251350679","DOIUrl":"https://doi.org/10.1177/10600280251350679","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251350679"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply: Severe Acute Respiratory Failure Associated With Trimethoprim/Sulfamethoxazole Among Adolescent and Young Adults: An Active Comparator-Restricted Disproportionality Analysis From the FDA Adverse Event Reporting System (FAERS) Database.","authors":"Fatemeh Ahmadi, Niaz Chalabianloo, Flory T Muanda","doi":"10.1177/10600280251350681","DOIUrl":"https://doi.org/10.1177/10600280251350681","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251350681"},"PeriodicalIF":2.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}