Sepsis
Update your SEPSIS protocols
As a critical care pharmacist, you will hear ongoing debate about MANAGING SEPSIS IN ADULTS. Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Update your protocols using the latest data... Fluids Verify your sepsis order set includes balanced fluids ( Lactated Ringer's, Plasma-Lyte, etc…
قراءة المزيد
Sepsis
Meronem dose is easier than Tienam in renal failure
As a clinical pharmacy specialist, doctors will often ask you about the difference between Meronam and Tienam . And how to adjust the doses of each in patients with kidney impairment... Imipenem ( Tienam ) is the first carbapenem, was marketed in 1987. It is more active against Gram-positive cocci. While meropenem ( Meronem ) is more a…
قراءة المزيد
Sepsis
Update your MSSA bacteremia protocols
As a clinical pharmacist, you will see more interest in utilizing Staphylococcus aureus bacteremia protocols. It's the most common nosocomial bacteremia and may lead to death in up to 40% of patients. Now new evidence suggests that closer adherence to the guidelines is associated with reduced in-hospital mortality. Follow these steps... …
قراءة المزيد
Sepsis
Meronem NOT Tienam is favored in the setting of seizures
Meropenem ( Meronem ) is the second antipseudomonal carbapenem antibiotic to hit the market promoted by AstraZeneca, after imipenem/cilastatin ( Tienam ). Both Meronem and Tienam have similar antibacterial coverage, broad gram-positive and gram-negative aerobic and anaerobic coverage. But both drugs have "holes" in their coverage for MRSA (methicillin resi…
قراءة المزيد
Vancomycin
The optimal treatment for MRSA bacteremia in adults
As a hospital pharmacist, you will ask yourself questions about the optimal treatment for methicillin-resistant Staph aureus (MRSA) bacteremia in adults. Consider these strategies when treating your patients... Continue to use vancomycin first. Daptomycin is also first-line, but there's no good evidence it works better, and it co…
قراءة المزيد
Vancomycin
Monitor VANCOMYCIN with AUC/MIC goals
As a hospital pharmacist, you will see a shift toward monitoring vancomycin using AUC/MIC calculations instead of trough levels. Clinical pharmacists normally aim for troughs of 15 to 20 mg/L for serious MRSA infections, to increase the likelihood of AUC/MIC over 400. But it turns out these troughs can overshoot AUC/MIC goals and are linked to more nephrotoxicity. …
قراءة المزيد
Sepsis
Wait to RENALLY adjust antibiotics in septic patients
Questions continue to come up about how to initially dose antibiotics in severe sepsis or septic shock . Use the following as a guide for individualizing therapy... What is the optimal time to start antibiotics? Exact timing is debated, but keep aiming for early antibiotic administration. For further information see note, Update your SEPSIS protocols and Optim…
قراءة المزيد
Sepsis
Optimize INITIAL antibiotic dosing in septic patients
Sepsis is now the leading cause of 30-day hospital readmissions, spurring hospitals to continue improving care of sepsis patients. Updated sepsis guidelines will also help lead this charge... Continue "tried and true" therapies, 30 mL/kg of crystalloid within 3 hours, broad-spectrum antibiotics started within one hour , etc. But fine-tune fluid and …
قراءة المزيد
Sepsis
Empiric antimicrobial management of sepsis
DEFINITIONS ㅡ Bacteremia is simply the presence of bacteria in the blood. Systemic inflammatory response syndrome ( SIRS ) is denoted by two or more of the following clinical symptoms, (1) Body temperature > 38°C or < 36°C, (2) heart rate > 90 beats per minute, (3) respiratory rate > 20 breaths per minute or PaCO2 (partial pressure of carbon dioxide i…
قراءة المزيد
Nephrology and Urology
Antibiotic dosing requirements in patients with chronic kidney disease and dialysis
OVERVIEW ― We're getting questions about how to dose oral antibiotics with dialysis since medication labels and references may conflict or be murky. KEY POINTS Recommend usual doses of antibiotics that aren't renally cleared including azithromycin, clindamycin, and doxycycline. But advise adjusting other antib…
قراءة المزيد
Social Plugin