Annals of Pharmacotherapy最新文献

{"title":"Pharmacist's Guide to Common Intracranial Bleeding Terms and Treatments.","authors":"Aaron M Cook, Madi Harris, Christopher Michas","doi":"10.1177/10600280251358676","DOIUrl":"https://doi.org/10.1177/10600280251358676","url":null,"abstract":"<p><strong>Objective: </strong>Pharmacists care for patients with intracranial bleeding such as those with subarachnoid hemorrhage (SAH) or subdural hematoma (SDH), although these bleeding events are often generically termed \"head bleed.\" This over-simplified term refers to a heterogeneous group of life-threatening intracranial hemorrhages, each with a distinctive etiology and treatment paradigm.</p><p><strong>Data sources: </strong>Common intracranial hemorrhage types were reviewed to identify the scope of this narrative review.</p><p><strong>Study selection and data abstraction: </strong>Relevant studies and guidelines pertinent to the selected topic were considered.</p><p><strong>Data synthesis: </strong>Various hemorrhage types such as intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and SDH fall into the colloquialism of \"head bleed.\" However, these and other hemorrhage types are radiographically distinct and often require different management strategies. Surgical management is helpful in some of these situations (SDH, SAH) and limited in scope for others (ICH). Pharmacotherapy for reversal of coagulopathy and treatment of elevated intracranial pressure may be considered similar across the spectrum of intracranial bleeding pathologies, while other factors such as seizure prophylaxis and blood pressure control depend on the bleeding type.</p><p><strong>Relevance to patient care and clinical practice: </strong>Differences in the need for surgical intervention, neurologic monitoring, cerebral perfusion changes, risk of seizure, optimal blood pressure, and other clinical characteristics make each type of intracranial bleeding unique.</p><p><strong>Conclusions: </strong>Pharmacists should be aware of the differences in surgical and pharmacotherapy strategies among these intracranial hemorrhages to optimize care for this neurocritical care population.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251358676"},"PeriodicalIF":2.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726613","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":"Levothyroxine Absorption in Patients With Celiac Disease: Challenges and Therapeutic Strategies.","authors":"Maha Saad, Nicole M Maisch","doi":"10.1177/10600280251361914","DOIUrl":"https://doi.org/10.1177/10600280251361914","url":null,"abstract":"<p><p>Celiac disease can significantly impair levothyroxine absorption, complicating hypothyroidism management despite appropriate dosing. While a gluten-free diet often improves absorption, some patients continue to require high doses. Switching to liquid or softgel formulations can enhance levothyroxine bioavailability and symptom control. Optimizing therapy requires individualized approaches, including dietary intervention, formulation changes, and close monitoring, to achieve and maintain a euthyroid state. Relevant studies were reviewed and incorporated into this commentary to support evidence-based recommendations and highlight clinical considerations.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251361914"},"PeriodicalIF":2.3,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726612","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":"Comparative Efficacy of High- and Low-Dose Ceftriaxone Regimens: A Systematic Review and Meta-Analysis.","authors":"Lindsay Brust-Sisti, Gwang-Yee Hu, Matthew Bridgeman, Luigi Brunetti, Jimmy Gonzalez","doi":"10.1177/10600280251346777","DOIUrl":"https://doi.org/10.1177/10600280251346777","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy and safety of ceftriaxone (CRO) 1 g intravenously (IV) daily to higher doses for treating non-central nervous system (CNS) infections in adults.</p><p><strong>Data sources: </strong>PubMed, Embase, Scopus, and Web of Science were used. A search was run from database inception to August 8, 2023 and rerun May 12, 2025. Search terms were CRO, Rocephin, pneumonia, intra-abdominal infections, appendicitis, typhlitis, pyelonephritis, bacteremia, and sepsis.</p><p><strong>Study selection and data extraction: </strong>Articles included had to compare CRO 1 g IV daily to higher dosing for the outcomes of interest: clinical cure (CC), hospital length of stay (LOS), mortality, and toxicity. Randomized controlled trials (RCTs) or observational studies were included. Studies including pediatric, pregnant, and outpatient administration were excluded. Clinical cure was evaluated using a Mantel-Haenszel random-effects model with Peto odds ratios (pORs), and 95% confidence intervals (CIs) were calculated. Heterogeneity was identified using Cochrane <i>I</i>² statistic.</p><p><strong>Data synthesis: </strong>Eight studies (5145 patients) were included. No statistically significant difference was found for CC (pOR 0.958; 95% CI [0.525-1.749]; <i>I</i>² = 60.23; <i>P</i> = .888); LOS (Std difference in means, 0.052; 95% CI [-0.418, 0.523]; <i>I</i>² = 96.047; <i>P</i> = .828); or mortality (pOR 0.932; 95% CI [0.789-1.100]; <i>I</i>² = 0.000; <i>P</i> = .405).</p><p><strong>Relevance to patient care and clinical practice: </strong>Ceftriaxone dosing ranges from 1 to 2 g IV daily for treating non-CNS infections. Optimal dosing remains controversial, as RCTs have used different doses. This meta-analysis showed no difference between high and low CRO dosing for efficacy and safety. Because infection type and pharmacokinetic factors were not accounted for, findings may not be applicable to certain high-risk infections or situations where CRO pharmacokinetics are altered, such as hypoalbuminemia. Prospective studies can compare regimens and confirm findings.</p><p><strong>Conclusions: </strong>Ceftriaxone doses greater than 1 g IV daily did not improve CC, LOS, or mortality.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251346777"},"PeriodicalIF":2.3,"publicationDate":"2025-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939575","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":"Therapeutic Drug Monitoring of Voriconazole: Unbound Concentration With Clinical Efficacy and Adverse Events.","authors":"Tiantian Zhang, Zhicong Qiu, Wenhao Chu, Wenli Li, Xikun Wu, Yuxin Wang, Yishuo Zhai, Wei Zhang, Zhiqing Zhang","doi":"10.1177/10600280251352876","DOIUrl":"https://doi.org/10.1177/10600280251352876","url":null,"abstract":"<p><strong>Background: </strong>Voriconazole is widely used for patients with fungal infections, but the correlations between the unbound concentration (C_free) of voriconazole in plasma and clinical outcomes remains unclear.</p><p><strong>Objective: </strong>The aim of this study was to analyze the correlation between C_free and clinical outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted at the Second Hospital of Hebei Medical University from February 2021 to March 2024 (Shijiazhuang, China). Patients who received voriconazole with at least one measured concentration in our center were enrolled. Based on determined the C_free of voriconazole, factors that might affect C_free were analyzed in conjunction with patient characteristics, and the correlations between voriconazole C_free and the clinical efficacy as well as AEs in patients were investigated.</p><p><strong>Results: </strong>A total of 60 blood samples were collected from 56 patients. Voriconazole C_free was positive correlation with creatinine, while negative correlation with creatinine clearance. The C_free of patients in the clinical effective group was significantly higher than that in the clinical ineffective group, and the C_free of patients in the group with AEs was significantly higher than that in the group without AEs (<i>P</i> = 0.006, 0.025). Voriconazole C_free (odds ratio [OR] = 2.617, 95% confidence interval [CI]:1.142-6.000, <i>P</i> = 0.023) and albumin level (OR = 1.085, 95% CI: 1.000-1.177, <i>P</i> = 0.050) were independent influencing factors of clinical efficacy, the receiver operating characteristic (ROC) cut off for C_free and efficacy was 0.8 μg·mL^-1. Voriconazole C_free (OR = 1.979, 95% CI: 1.008-3.888, <i>P</i> = 0.048) was an independent risk factor for AEs, the ROC cut off for C_free and AEs was 1.2 μg·mL^-1.</p><p><strong>Conclusions and relevance: </strong>Voriconazole C_free was positively correlated with clinical efficacy and the incidence of AEs in patients.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251352876"},"PeriodicalIF":2.3,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697437","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":"Early Clinical Response is Associated With a Decreased Risk of Recurrent <i>Pseudomonas aeruginosa</i> Ventilator-Associated Pneumonia.","authors":"Alex S Huang, Jing J Zhao, Ryan Gumbleton, Marco R Scipione","doi":"10.1177/10600280251355630","DOIUrl":"https://doi.org/10.1177/10600280251355630","url":null,"abstract":"<p><strong>Background: </strong>Current data suggest that short-course therapy for <i>Pseudomonas aeruginosa</i> ventilator-associated pneumonia (PA-VAP) may increase the risk of recurrent pneumonia. To decrease antibiotic exposure without adversely impacting clinical outcomes, risk stratification based on clinical response may identify optimal candidates for short-course therapy.</p><p><strong>Objective: </strong>The purpose of this study was to determine whether early response to therapy correlated with the risk of recurrence in patients with PA-VAP.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with PA-VAP admitted to the Detroit Medical Center from January 2020 to July 2022. Those with improvements in at least 2 out of 3 objective measures of clinical response (PaO₂/FiO₂, fever, and leukocyte count) at 72 hours after therapy initiation were classified as early responders. The primary outcome was PA-VAP recurrence within 28 days of initial VAP onset.</p><p><strong>Results: </strong>A total of 73 patients were included in the analysis: early response (n = 43) and delayed response (n = 30). Patients with an early response had a significantly decreased risk of 28-day PA-VAP recurrence compared to those with a delayed response (21% vs 43%, <i>P</i> = 0.04). Multivariable logistic regression found that PaO₂/FiO₂ > 240 mm Hg at 72 hours was associated with a decreased risk of 28-day PA-VAP recurrence (odds ratio [OR] = 0.25, 95% confidence interval [CI] = 0.07 to 0.90), whereas duration of antibiotics ≤8 days was associated with an increased risk of 28-day PA-VAP recurrence (OR = 4.74, 95% CI = 1.31 to 17.18).</p><p><strong>Conclusion and relevance: </strong>This study found that early clinical response and improvement in PaO₂/FiO₂ were associated with a decreased risk of PA-VAP recurrence. Individualized treatment durations based on clinical response may allow clinicians to safely utilize shorter antibiotic courses for PA-VAP.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251355630"},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625278","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":"What's Your C. diff-erential? Evaluating Clinical Management of Discordant <i>Clostridioides difficile</i> Two-Step Testing.","authors":"Adam Siddique, Nicolas Daoura, Punit J Shah","doi":"10.1177/10600280251357424","DOIUrl":"https://doi.org/10.1177/10600280251357424","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251357424"},"PeriodicalIF":2.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615797","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":"Roflumilast and the Changing Landscape of Seborrheic Dermatitis Treatment.","authors":"Jimmy Dhillon, Aryan Mahajan, Joy Xie, Madeline Tchack, Babar K Rao","doi":"10.1177/10600280251355662","DOIUrl":"https://doi.org/10.1177/10600280251355662","url":null,"abstract":"<p><strong>Objective: </strong>This article reviews clinical trial data that assess the safety, efficacy, and clinical application of roflumilast, a phosphodiesterase-4 inhibitor, for the treatment of seborrheic dermatitis.</p><p><strong>Data sources: </strong>A review of the literature was conducted in MEDLINE (Pubmed) and Clinicaltrials.gov from January 1, 1950 to April 13, 2025 using the search terms: \"Roflumilast\" and \"seborrheic dermatitis.\"</p><p><strong>Study selection and data extraction: </strong>Relevant articles in English relating to the safety, efficacy, pharmacodynamics, and pharmacokinetics were included.</p><p><strong>Data synthesis: </strong>In one phase IIa clinical trial, 73.8% of patients treated with roflumilast achieved Investigator Global Assessment (IGA) success, compared with 40.9% in the vehicle group at 8 weeks (<i>P</i> < 0.001). A phase III trial found 79.5% of patients in the roflumilast group achieved IGA success at week 8, compared with 58.0% in the vehicle group (<i>P</i> < 0.001). Furthermore, there were statistically significant reductions in erythema, scaling, and itch severity in the roflumilast group. Roflumilast was well tolerated, with adverse events comparable with vehicle foam.Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs:Roflumilast is the first phosphodiesterase-4 inhibitor approved by the Food and Drug Administration for the treatment of seborrheic dermatitis. Based on 2 clinical trials, roflumilast has a positive safety profile, is efficacious, and is easy to apply, highlighting its utility in treating seborrheic dermatitis.</p><p><strong>Conclusion: </strong>Roflumilast is effective in treating seborrheic dermatitis. Future trials should compare its safety and efficacy with other drugs.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251355662"},"PeriodicalIF":2.3,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599177","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":"Hydrocortisone Dosing Frequency in Intensive Care Unit Patients With Septic Shock: A Comparison of 2 Regimens.","authors":"Abigail Danos, Alyssa Lear, Erin Roach, Nicholas J Quinn","doi":"10.1177/10600280251355619","DOIUrl":"https://doi.org/10.1177/10600280251355619","url":null,"abstract":"<p><strong>Background: </strong>In patients with septic shock, intravenous (IV) hydrocortisone is recommended when there is an ongoing vasopressor requirement. Guidelines recommend IV hydrocortisone 200 mg/day administered as a continuous infusion or 50 mg every 6 hours. To prevent waste during a hydrocortisone shortage and reduce cost, our institution implemented a dosing regimen of 100 mg every 12 hours.</p><p><strong>Objectives: </strong>The primary objective of this study was to compare the impact of hydrocortisone 100 mg IV every 12 hours vs 50 mg IV every 6 hours on clinical outcomes in patients with septic shock.</p><p><strong>Methods: </strong>This was a retrospective, multicenter study that evaluated patients admitted from April 2022 to September 2023 to a Greater Charlotte Atrium Health facility. Adult patients diagnosed via the <i>International Statistical Classification of Diseases and Related Health Problems 10th Revision</i> (ICD-10) codes with sepsis, severe sepsis, or septic shock receiving ≥15 mcg/min of norepinephrine equivalents requiring ≥ 24 hours of hydrocortisone were included. The primary outcome was time to shock reversal. Secondary outcomes included in-hospital mortality, hospital and intensive care unit (ICU) length of stay, and hyperglycemia.</p><p><strong>Results: </strong>Of 446 screened patients, 111 were included. Median Sequential Organ Failure Assessment scores and Charlson Comorbidity Index were similar among groups. The median time to shock reversal was 56 [34-81] hours in the every 12 hours group compared to 65 [39-101] hours in the every 6 hours group (<i>P</i> = 0.21). In-hospital mortality was comparable between the every 6 hours group and the every 12 hours group (51.9% vs 45.6%, <i>P</i> = 0.51). There was no difference in hospital or ICU length of stay nor in incidence of hyperglycemic episodes between groups.</p><p><strong>Conclusion and relevance: </strong>There was no difference in the primary outcome of time to shock reversal or any secondary outcome between hydrocortisone groups. This alternative hydrocortisone dosing strategy may warrant further evaluation in large, prospective studies.</p>","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251355619"},"PeriodicalIF":2.3,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567003","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: Impact of Remdesivir on Heart Rate and Bradycardia Incidence Among Hospitalized Adults With COVID-19.","authors":"Wesley D Kufel, Robert W Seabury, Sarah A Spinler","doi":"10.1177/10600280251354862","DOIUrl":"https://doi.org/10.1177/10600280251354862","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251354862"},"PeriodicalIF":2.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567004","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: Impact of Remdesivir on Heart Rate and Bradycardia Incidence Among Hospitalized Adults With COVID-19.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1177/10600280251354855","DOIUrl":"https://doi.org/10.1177/10600280251354855","url":null,"abstract":"","PeriodicalId":7933,"journal":{"name":"Annals of Pharmacotherapy","volume":" ","pages":"10600280251354855"},"PeriodicalIF":2.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567001","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}