Drug information

02/09/2020

Acute arterial thromboembolism in patients with COVID-19 in the New York City area
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In 12,630 hospitalized patients with COVID-19.

A total of 49 patients with arterial thromboembolism and confirmed COVID-19 were identified.

Median age was 67 years (58-75) and 37 (76%) were male.

The most common preexisting conditions were hypertension (53%) and diabetes (35%). Median D-dimer level was 2673 ng/mL (723-7139).

The distribution of thromboembolic events included:

⭕upper 7 (14%)
⭕lower 35 (71%) extremity ischemia,
⭕bowel ischemia 2 (4%),
⭕cerebral ischemia 5 (10%).

⭕Six patients (12%) had thrombus in multiple locations.

⭕Concomitant deep vein thrombosis was found in 8 patients (16%).

⭕Twenty-two (45%) patients presented with signs of acute arterial ischemia and were subsequently diagnosed with COVID-19.

⭕The remaining 27 (55%) developed ischemia during hospitalization.

Revascularization was performed in 13 (27%) patients, primary amputation in 5 (10%), administration of systemic tissue plasminogen activator in 3 (6%), and 28 (57%) were treated with systemic anticoagulation only.

The rate of limb loss was 18%. Twenty-one patients (46%) died in the hospital. Twenty-five (51%) were successfully discharged and 3 patients are still in the hospital.

Source: Ann Vasc Surg. 2020 Aug 28

19/09/2019

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel
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A Randomized Clinical Trial
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Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.

These data support the recommendation to use facemasks for routine care of patients with suspected or confirmed influenza.

Source: JAMA, September 3, 2019

19/09/2019

Bacterial community in short-term indwelling urinary catheters by duration of catheterization and subsequent urinary tract infection
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Using quantitative polymerase chain reaction,

Enterococcus spp were found on virtually all catheters and lactic acid bacteria in most catheters regardless of duration,

but neither genus was associated with UTI development during follow-up.

Enterococcus, Streptococcus, and Staphylococcus were the most commonly identified genera in the taxonomic screen but were not associated with subsequent UTIs.

Although the most common cause of UTI following catheter removal was Escherichia coli, detectable E coli on the catheter surface was not associated with subsequent UTIs.

This analysis does not suggest that the presence of bacteria on the surface of catheters placed for < 3 days leads to subsequent UTIs.

Other aspects of catheter care are likely more important than preventing bacterial colonization of the catheter surface for preventing UTIs following short-term catheter placement.

Source: American Journal of Infection Control,17 September 2019.

10/05/2019

Ticagrelor in Conventional Antiplatelet Dosages Affect Antibiotic-Resistant Gram-Positive Bacteria without selecting for resistant mutants
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Ticagrelor and and its metabolite AR-C124910 had bactericidal activity against all gram-positive strains tested, including drug-resistant strains glycopeptide intermediate S aureus (GISA), MRSE, MRSA, and VRE.

The minimal bactericidal concentration was 20 μg/mL against MSSA, GISA, MRSA, and VRE; 30 μg/mL against MRSE; and 40 μg/mL against E faecalis and S agalactiae.

Although a dosage of 5 μg/mL delayed growth of MRSA, ticagrelor was ineffective against gram-negative strains in concentrations up to 80 μg/mL.

At minimal bactericidal concentration, ticagrelor was superior to vancomycin, with rapid killing of late-exponential-phase cultures of MRSA (time to kill 99.9% of the initial inoculum, 2 hours).

Bactericidal activity was similar to the bactericidal cyclic lipopeptide daptomycin, recently introduced against resistant strains of S aureus.

A subminimal bactericidal concentration of ticagrelor (10 μg/mL) combined with vancomycin (4 μg/mL) killed approximately 50% of the initial MRSA inoculum, depicting synergistic activity.

Ticagrelor also increased the bactericidal activity of rifampicin, ciprofloxacin, and vancomycin in a disk diffusion assay.

It displayed bactericidal activity against MRSE and VRE, with superiority over vancomycin for killing MRSE.

At 24 hours, its ability to kill MRSE and VRE was similar to daptomycin.

Ticagrelor inhibited MRSA, MRSE, and VRE biofilm formation in a dose-dependent manner;

biofilm mass was reduced by more than 85% after exposure to 20 μg/mL ticagrelor.

Finally, in mice, conventional oral antiplatelet dosages of ticagrelor (3 mg/kg loading dose, then 1.5 mg/kg twice daily) inhibited biofilm growth on S aureus–preinfected implants and dissemination of bacteria to surrounding tissues.

Source: JAMA Cardiol, May 8, 2019

24/03/2019

Scoping Review of Interventions Associated with Cost Avoidance Able to Be Performed in the Intensive Care Unit and Emergency Department
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New review was conducted to identify, aggregate, and qualitatively describe the highest quality evidence for cost avoidance generated by clinical pharmacists on interventions performed in an ICU or ED.

Source: Pharmacotherapy, March 2019.
Full Article: bit.ly/2CvoFGT

21/03/2019

Thrombocytopenia in Septic Shock
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Among Septic Shock patients with incident thrombocytopenia, the median time from ICU admission to thrombocytopenia was 2 days (interquartile range, 1–3 d).

Among survivors, the median time from incident thrombocytopenia to platelet recovery was 6 days (interquartile range, 4–8 d).

The median time from liberation of vasopressors to recovery of platelets concentration (≥ 100 × 109/L) was 2 days (interquartile range, 0–4 d).

Source: Critical Care Medicine: April 2019

15/03/2019

Antibiotic prophylaxis (400 mg of oral doxycycline and 400 mg of oral metronidazole) before miscarriage surgery did not result in a significantly lower risk of pelvic infection

Source: NEJM, March 14, 2019.

25/05/2018

Are Contact Precautions Still Necessary to Reduce Transmission in ESBL Positive Patients?
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New study found that discontinuing the use of contact precautions for patients with ESBL positive organisms did not lead to an increased rate of hospital-associated ESBL transmission.
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The incidence of hospital-associated ESBL positive infections from January 2014 through October 2015 was 0.21/1000 patient days.

The incidence from November 2015 through August 2017 was 0.16/1000 patient days. This rate change was statistically signifcant (P = .022).

Lab ID incidence also demonstrated a slight decrease during the same time periods, although it was not statistically signifcant.
Overall, neither method demonstrated an increase in hospital-associated transmission.

Source: American Journal of Infection Control, June 2018.

04/05/2018

Only 12 chapters
https://www.dropbox.com/sh/h8wmnh13s7w2esd/AAAjb7_aI8BlM02u7NE0LEhpa?dl=0

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12/01/2018

Role of Salivary Concentrations of Antituberculosis Drugs in Therapeutic Drug Monitoring.
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For gatifloxacin and linezolid, salivary therapeutic drug monitoring is likely possible due to a narrow range of saliva–plasma and saliva–serum ratios.

For isoniazid, rifampicin, moxifloxacin, ofloxacin, and clarithromycin, salivary therapeutic drug monitoring might be possible;

however, a large variability in saliva–plasma and saliva–serum ratios was observed. Unfortunately, salivary therapeutic drug monitoring is probably not possible for doripenem and amoxicillin/clavulanate, as a result of very low salivary drug concentrations.

Source:Therapeutic Drug Monitoring, February 2018

30/11/2017

Asthma: diagnosis, monitoring and chronic asthma management.
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NICE guideline
Published: 29 November 2017
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https://www.nice.org.uk/guidance/ng80/resources/asthma-diagnosis-monitoring-and-chronic-asthma-management-pdf-1837687975621

Special Thanks Dr.Mahmoud Hassieb

13/11/2017

Enteral versus parenteral early nutrition in ventilated adults with shock
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a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2).
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In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition.

Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72-1·09]; p=0·25).

Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62-2·20]; p

09/11/2017

Scheduled Intravenous Acetaminophen Postcraniotomy.
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IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control.

Source:J Neurosurg Anesthesiol. 2017 Nov 7.

09/11/2017

Effect of Dexmedetomidine on Lactate Clearance in Patients with Septic Shock.
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Among mechanically ventilated patients with septic shock, sedation with dexmedetomidine resulted in increased lactate clearance compared with sedation without dexmedetomidine.

The lactate clearance at 6 hours was higher in the dexmedetomidine group, although this was not statistically significant (23.3 ± 29.8 vs. 11.1 ± 54.4)

There was no statistically significant difference in the 28-day mortality between the dexmedetomidine and the non-dexmedetomidine groups.

Source:Shock. 2017 Nov 7.

26/08/2017

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)
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Full Version :Bit.ly/MI2017ESC

24/08/2017

Discontinuation of contact precautions (CPs) did not adversely impact endemic MRSA and VRE infection rates.
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There remain limited data on the use of contact precautions (CPs) and its effect on hospital-acquired infections (HAIs) of resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).

There were 36,907 and 40,439 patients hospitalized during the two 12-month periods: CPs and no CPs.

Infection rates in the CPs and no-CPs periods were as follows:

(1) MRSA infections: VAP, 0.13 versus 0.11 (P = .84);
CLABSI, 0.11 versus 0.19 (P = .45); SSI, 0 versus 0.14 (P = .50);
and CAUTI, 0.025 versus 0.033 (P = .84);

(2) VRE infections: CAUTI, 0.27 versus 0.13 (P = .19) and CLABSI, 0.29 versus 0.3 (P = .94); and (3) HA-MRSAB rates: 0.14 versus 0.11 (P = .55), respectively.

Discontinuing CPs did not adversely affect the endemic MRSA and VRE HAI rates in our institution.

Source:American Journal of Infection Control, 24 August 2017.

23/08/2017

Early Addition of Vasopressin to Norepinephrine in Septic Shock.
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Early initiation of vasopressin in patients with septic shock may achieve and maintain goal MAP sooner and resolve organ dysfunction at 72 hours more effectively than later or no initiation.

Patients started on early vasopressin achieved and maintained goal MAP sooner (6.2 vs 9.9 hours, P = .023), experienced greater reductions in SOFA scores at 72 hours (−4 vs −1, P = .012), and had shorter hospital durations (343 vs 604 hours, P = .014). Not initiating early vasopressin trended toward an association with increased time to goal MAP (P = .067).

Source:Journal of Intensive Care Medicine, August 18, 2017.

19/01/2017

https://www.dropbox.com/s/sampvow7al1l7ad/SSC%20Guidelines%202016.pdf?dl=0

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