Tag Archives: antibiotics

Johns Hopkins ABX Guides

Pharmacy Services has subscribed to Johns Hopkins ABX Guide for use by all associates at Centegra Health System to support our multidisciplinary approach to the Antimicrobial Stewardship Program Clinical Decision Support Tools and Education

Johns Hopkins ABX Guide is a comprehensive web source that provides regularly updated, evidence-based decision resources regarding antibiotics, diagnosis, pathogens, management of infections and vaccines.

Prior to the Guide, CHS did not have a specific detailed resource for antibiotics clinical decision support.

Johns Hopkins ABX Guide may be accessed through Unbound Medicine’s uCentral as follows:

What is a true penicillin allergy?

Did you know that most patients who give a history of “penicillin allergy” do not have a true allergy? Most of them will tolerate more effective and less expensive agents without issues.

For more information see the recently updated policy.

CHS 2015 antibiograms are now online

The 2015 CHS antibiograms are now available under Departments => Infection control => Antibiograms. The direct link is here.

List of antibiotics restricted to ID approval

  • Ceftaroline (TEFLARO) – Non formulary
  • Liposomal Amphotericin (AMBISOME) – Formulary
  • Daptomycin (CUBICIN) – Non formulary
  • Linezolid (ZYVOX) – Formulary
  • Voriconazole (VFEND) – Formulary
  • Imipenem (PRIMAXIN) – Formulary
  • Gancyclovir (CYTOVENE) – Non formulary
  • Tigecycline (TYGACIL) – Non Formulary
  • Doripenem (DORIBAX) – Non Formulary

Antibiograms updated

2014 updates to the antibiograms for both CHM and CHW are now posted here. Antibiograms provide information regarding local microbiologic susceptibility patterns.

Antibiotic usage in hospitalized patients

CDC reported in the March 7th 2014 issue of MMWR that based on a 2010 study conducted across the US that upto 30% of non ICU antibiotics used in hospitalized patients are unecessary. The most common overusage of antibiotics was for “UTI” and the use of vancomycin without proven positive cultures. Appropriate usage of antibiotics can reduce the incidence of clostridium difficile infections. [1]

Relative cost of antibiotics

A table featuring the relative daily cost of antibiotics is now available in a table under the Pharmacy menu.

Tygacil safety alert – FDA

Health care professionals should reserve Tygacil for use in situations when alternative treatments are not suitable.

This analysis showed a higher risk of death among patients receiving Tygacil compared to other antibacterial drugs: 2.5% (66/2640) vs. 1.8% (48/2628), respectively. The adjusted risk difference for death was 0.6% with corresponding 95% confidence interval (0.0%, 1.2%). In general, the deaths resulted from worsening infections, complications of infection, or other underlying medical conditions.

Reference:

Tygacil (tigecycline): Drug Safety Communication – Increased Risk of Death, Sept 27th 2013

FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection

The U.S. Food and Drug Administration (FDA) has required the drug labels and Medication Guides for all fluoroquinolone antibacterial drugs be updated to better describe the serious side effect of peripheral neuropathy. This serious nerve damage potentially caused by fluoroquinolones may occur soon after these drugs are taken and may be permanent.

The risk of peripheral neuropathy occurs only with fluoroquinolones that are taken by mouth or by injection. Approved fluoroquinolone drugs include levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), norfloxacin (Noroxin), ofloxacin (Floxin), and gemifloxacin (Factive). The topical formulations of fluoroquinolones, applied to the ears or eyes, are not known to be associated with this risk.

If a patient develops symptoms of peripheral neuropathy, the fluoroquinolone should be stopped, and the patient should be switched to another, non-fluoroquinolone antibacterial drug, unless the benefit of continued treatment with a fluoroquinolone outweighs the risk.

Reference

FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection

Surgical care improvement project (SCIP)

  • Prophylactic antibiotic within 1 hour prior to incision
  • Prophylactic antibiotic selection
  • Antibiotic discontinued within 24 hours after Anesthesia end time
  • Cardiac Surgery Patients with Controlled 6 A.M. Postoperative Blood Glucose (< or = to 200mg/dl). (Hint: Use post op order set in Paragon- Order set list).
  • Perioperative Temperature Management (equal to or greater than 96.8 Fahrenheit/36 Celsius recorded within the 30 minutes immediately prior to or the 15 minutes immediately after Anesthesia End Time)
  • Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2)
  • Surgery patients on Beta-Blocker therapy prior to arrival, who have received a Beta-Blocker during the perioperative period ( the day prior to surgery through POD 2 )
  • Venous Thromboembolism (VTE) Prophylaxis Order and administered within 24 hrs prior to or 24 hrs after surgery