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…
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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
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... …
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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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Sepsis
How to identify SEPTIC patients
There will be confusion about how to identify septic patients due to new Sepsis-3 criteria from the Society of Critical Care Medicine. For years, we've identified sepsis as suspected infection plus at least two systemic inflammatory response syndrome (SIRS) criteria ; heart rate > 90, white blood cell count > 12,000/mm 3 or < 4,000/mm 3 , etc. But SIRS …
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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…
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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…
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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 …
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Sepsis
Consider LACTATED ringer's over normal saline for fluid resuscitation
As a hospital pharmacist, you'll hear debate over using Lactated Ringer's or other balanced fluids instead of normal saline for fluid resuscitation. Balanced fluids, such as Lactated Ringer's (LR) or Plasma-Lyte , are touted as having electrolyte content similar to plasma, while normal saline has higher levels of chloride. The concern is that large volum…
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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…
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