Fisher's exact test was employed to analyze categorical data, while unpaired t-tests or Mann-Whitney U tests were used for continuous data, where appropriate. One hundred and thirty patients were included in the complete analysis. Implementation of the program resulted in a significant reduction in emergency department (ED) revisits for patients in the post-implementation group (n=70) compared to the pre-implementation group (n=60). Nine (129%) revisits were observed in the former group, compared to seventeen (283%) in the latter, with a statistically significant difference (p = .046). ED MDR culture program implementation was demonstrably associated with fewer ED revisits within 30 days, specifically attributed to reduced instances of antimicrobial treatment failures, hence strengthening the expanded role of ED pharmacists in outpatient antimicrobial stewardship.

The intricate management of the drug-drug interaction (DDI) between primidone, a moderate to strong cytochrome P-450 (CYP) 3A4 inducer, and apixaban, a direct oral anticoagulant (DOAC) and CYP3A4 substrate, presents a complex challenge, with limited evidence to guide treatment. This case report describes a 65-year-old male patient, taking primidone for essential tremor, who developed an acute venous thromboembolism (VTE), subsequently requiring oral anticoagulation. In contrast to vitamin K antagonists, DOACs are increasingly favored for swift treatment of acute venous thromboembolism. Considering patient-specific characteristics, physician preference, and the desire to avoid drug interactions, apixaban was the selected treatment. While apixaban's package insert advises against concomitant use with potent P-gp and CYP3A4 inducers, due to decreased apixaban levels, no recommendations exist for moderate to strong CYP3A4 inducers lacking P-gp effects. Phenobarbital being an active metabolite of primidone implies theoretical considerations when applying findings from this literature, but nonetheless provides crucial insights for the management of this multifaceted drug interaction. The inability to monitor plasma apixaban levels necessitated a management strategy of avoiding primidone, employing a washout period informed by pharmacokinetic calculations. More evidence is indispensable to accurately assess the extent and clinical meaningfulness of the drug-drug interaction observed between apixaban and primidone.

Intravenous anakinra, an off-label treatment for cytokine storm syndromes, is recognized for generating higher and quicker peak plasma concentrations than subcutaneous administration. The objective of this work is to present the off-label applications of intravenous anakinra, encompassing different dosages and associated safety profiles, especially throughout the coronavirus disease 2019 pandemic. At an academic medical center, a retrospective, single-cohort study investigated the application of intravenous anakinra in hospitalized pediatric patients (aged up to 21 years). In the opinion of the Institutional Review Board, the review was deemed exempt. The paramount endpoint was the primary manifestation(s) prompting the use of intravenous anakinra. Key secondary endpoints comprised the intravenous anakinra dosage regimen, prior immunomodulatory therapies employed, and any adverse events that manifested. In a group of 14 pediatric patients, 8 (57.1 percent) were administered intravenous anakinra to manage multisystem inflammatory syndrome in children (MIS-C) that had developed in association with COVID-19, 3 patients received the treatment for hemophagocytic lymphohistiocytosis (HLH), and 2 for exacerbations of systemic onset juvenile idiopathic arthritis (SoJIA). The initial intravenous anakinra dosage regimen for MIS-C linked to COVID-19 involved a median dose of 225 mg/kg per dose, administered at a median interval of 12 hours, for a median treatment duration of 35 days. MASM7 Prior immunomodulatory therapies, including intravenous immune globulin (10 patients, 714%) and steroids (9 patients, 643%), were received by 11 patients (786%). In the study, adverse drug events were not reported. Off-label use of anakinra addressed MIS-C associated with COVID-19, HLH, and SoJIA flares in critically ill patients, with no recorded adverse drug effects. This research helped determine the off-label uses of intravenous anakinra, and the corresponding characteristics of the individuals treated.

Subscribers to The Formulary Monograph Service receive, each month, 5 to 6 meticulously documented monographs on newly released or late-phase 3 trial drugs. Pharmacy & Therapeutics Committees are the intended users of the provided monographs. Subscribers gain access to monthly one-page summary monographs about agents, suitable for use in agenda planning and pharmacy/nursing in-service programs. In addition to other reports, a complete evaluation of target drug utilization and medication use (DUE/MUE) is delivered monthly. By subscribing, users gain online access to the monographs. Facilities can tailor monographs to their specific requirements. The Formulary's selection of reviews are published in this Hospital Pharmacy column. In order to access more information on The Formulary Monograph Service, please contact Wolters Kluwer's customer service department at 866-397-3433.

Five to six well-documented monographs on newly released or late-phase 3 trial drugs are delivered to The Formulary Monograph Service subscribers each month. These monographs are specifically designed for Pharmacy and Therapeutics Committees. medication safety For subscribers, monthly one-page summary monographs on agents provide crucial information for agenda planning and pharmacy/nursing staff development. Monthly, a thorough drug utilization evaluation/medication use evaluation (DUE/MUE) is undertaken as a targeted assessment. Online access to the monographs is provided to subscribers through a subscription. To meet facility requirements, monographs can be altered or adjusted. The Formulary's input allows Hospital Pharmacy to feature a selection of reviews in this dedicated column. Detailed information on The Formulary Monograph Service is available from Wolters Kluwer customer service, by dialing 866-397-3433.

As glucose-lowering agents, dipeptidyl peptidase-4 inhibitors (DPP-4i), or gliptins, represent a widely utilized category of medications. The accumulating evidence pointed towards a possible link between DPP-4 inhibitors and the induction of bullous pemphigoid (BP), an autoimmune skin blistering disease primarily affecting the elderly population. This article presents a case of blood pressure elevation associated with DPP-4i, accompanied by a comprehensive review of contemporary knowledge pertaining to this emerging medical entity. A notable increase in the risk of blood pressure was linked to the use of vildagliptin, specifically, among DPP-4i medications. Biomimetic peptides BP180 would be situated at the heart of the aberrant immune response. Male gender, mucosal involvement, and a milder inflammatory phenotype, especially in Asian populations, are believed to be associated with blood pressure increases induced by DPP-4i medications. Upon withdrawal of DPP-4i, patients seldom achieve complete remission and often require the addition of topical or systemic glucocorticoid therapies.

In the treatment of urinary tract infections (UTIs), ceftriaxone, an antibiotic, is frequently used, despite limited supporting evidence in the literature. Hospital settings frequently overlook opportunities for antimicrobial stewardship (ASP), such as transitioning from intravenous to oral medications (IV-to-PO conversions) and reducing antibiotic strength (de-escalation of therapy).
Hospitalized patients with UTIs in a major healthcare system were examined in this study to assess the use of ceftriaxone, with a focus on the possibility of converting intravenous antibiotic treatment to an oral form.
A retrospective, descriptive, multi-center study was undertaken to evaluate patient data in a large health system. Patients admitted to the facility from January 2019 through July 2019 who met specific criteria were included in the study. These criteria included being 18 years or older at the time of admission, a diagnosis of acute cystitis, acute pyelonephritis, or unspecified urinary tract infection, and having received two or more doses of ceftriaxone. The primary endpoint evaluated the percentage of hospitalized patients meeting criteria for a pharmacist-initiated change from intravenous ceftriaxone to oral antibiotics, as defined by the health system's protocols. Hospital records also included the percentage of urine cultures sensitive to cefazolin, the length of antibiotic treatments given during hospitalization, and an assessment of the oral antibiotics prescribed upon discharge.
The study cohort included 300 patients, of whom 88% qualified for the transition from intravenous to oral antibiotics; surprisingly, only 12% completed this transition during their hospitalization. Intravenous ceftriaxone was maintained in roughly 65% of patients until their discharge, with a subsequent switch to oral antibiotics, typically fluoroquinolones, followed by third-generation cephalosporins.
Hospitalized patients receiving ceftriaxone for urinary tract infections were not often transitioned from intravenous to oral therapy before discharge, despite the availability of an automatic pharmacist conversion policy. The findings indicate potential contributions to antimicrobial stewardship efforts throughout the healthcare network, along with the necessity of monitoring and reporting results to care providers at the bedside.
While the criteria for automatic pharmacist-directed intravenous-to-oral conversions of ceftriaxone therapy for urinary tract infections (UTIs) were met by the hospitalized patients, a low frequency of conversion to oral medication occurred before patient discharge. Opportunities for systemic antimicrobial stewardship programs are underscored by these findings, highlighting the critical role of monitoring and reporting results directly to healthcare professionals.

Purpose: New research highlights the substantial number of post-surgical opioid prescriptions that are not used.