UTI
Antibiotics for urinary tract infections in ELDERLY patients
As a clinical pharmacist, you will be asked more, which antibiotics should be recommended for urinary tract infections in elderly patients? It depends on whether it's a "complicated" UTI or not. We know all UTIs in older MEN are considered complicated due to possible prostate involvement. UTIs in women can also be complicated due to a catheter, obstr…
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Respiratory and Allergy
Treating serious STREP infections
As a clinical pharmacist, The uptick in severe cases will raise questions about how to treat Group A strep . We generally think of this bug causing strep throat, or skin infections. Most cases are mild, or some patients are asymptomatic carriers. But there’s a rise in serious infections, such as necrotizing fasciitis and toxic shock syndrome. The increase may be due…
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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…
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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…
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UTI
Empiric antibiotics for pyelonephritis
As an infectious disease pharmacist, you will hear controversy over the best way to treat patients hospitalized with pyelonephritis . There's limited evidence to guide empiric antibiotic choices in these patients and growing concerns about resistance to commonly used antibiotics, such as quinolones. Use your antibiogram to choose an antibiotic with good empiric c…
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Trimethoprim
Think carefully before prescribing Septazole with potassium-boosting drugs
AS A PHARMACIST, you will hear more about possible harm when TMP/SMX ( Bactrim, Septrin, Septazole , etc) is combined with medications that increase potassium ( ACEIs , spironolactone , etc). This interaction is more risky than previously thought and is popping up on more drug interaction software . Trimethoprim decreases urinary excre…
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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. …
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Warfarin
Drug interactions between WARFARIN and many antimicrobials
Questions often come up about how to handle alerts for drug interactions between warfarin and many antimicrobials. The risk of an interaction varies, but it can be significant, especially when the antimicrobial affects warfarin metabolism. For more details, see Table (1) below . Follow these rules of thumb... TMP/SMX ( Septazole, Septrin…
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Pregnancy and Breastfeeding
Antibiotics use in pregnancy
INTRODUCTION ㅡ During pregnancy, untreated sexually transmitted or urinary tract infections are associated with significant morbidity, including low birth weight, preterm birth, and spontaneous abortion. Antibiotic exposures during pregnancy have been associated with both short‐term (e.g., congenital abnormalities) and long‐term effects (e.g., changes in gut microbi…
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