Impact of obesity on acyclovir-induced nephrotoxicity

© 2018 by the authors. Licensee MDPI, Basel, Switzerland. Triamcinolone acetonide (TA), an intermediate acting corticosteroid, is used in the treatment of posterior ocular diseases, such as inflammation, posterior uveitis, and diabetic macular edema. The objective of this investigation was to prepare TA-loaded solid lipid nanoparticles (TA-SLNs) and in situ gel (TA-SLN-IG) formulations for delivery into the deeper ocular tissues through the topical route. TA-SLNs were prepared by hot homogenization and ultrasonication method using glyceryl monostearate and Compritol® 888ATO as solid lipids and Tween®80 and Pluronic® F-68 as surfactants. TA-SLNs were optimized and converted to TA-SLN-IG by the inclusion of gellan gum and evaluated for their rheological properties.In vitro transcorneal permeability and in vivo ocular distribution of the TA-SLNs and TA-SLN-IG were studied using isolated rabbit corneas and New Zealand albino rabbits, respectively, and compared with TA suspension, used as control (TA-C). Particle size, PDI, zeta potential, assay, and entrapment efficiency of TA-SLNs were in the range of 200–350 nm, 0.3–0.45, −52.31 to −64.35 mV, 70–98%, and 97–99%, respectively. TA-SLN-IG with 0.3% gellan gum exhibited better rheological properties. The transcorneal permeability of TA-SLN and TA-SLN-IG was 10.2 and 9.3-folds higher compared to TA-C. TA-SLN-IG showed maximum tear concentration at 2 h, indicating an improved pre-corneal residence time, as well as higher concentrations in aqueous humor, vitreous humor and cornea at 6 h, suggesting sustained delivery of the drug into the anterior and posterior segment ocular tissues, when compared to TA-SLN and TA-C. The results, therefore, demonstrate that the lipid based nanoparticulate system combined with the in situ gelling agents can be a promising drug delivery platform for the deeper ocular tissues

Fluoroquinolone versus nonfluoroquinolone treatment of bloodstream infections caused by chromosomally mediated ampc‐producing enterobacteriaceae

Objectives: Chromosomally mediated AmpC-producing Enterobacteriaceae (CAE) display high susceptibility to fluoroquinolones; minimal clinical data exist supporting comparative clinical outcomes. The objective of this study was to compare treatment outcomes between fluoroquinolone and nonfluoroquinolone definitive therapy of bloodstream infections caused by CAE. Methods: This retrospective cohort assessed adult patients with positive blood cultures for CAE that received inpatient treatment for 48 hours. The primary outcome was difference in clinical failure between patients who received fluoroquinolone (FQ) versus non‐FQ treatment. Secondary endpoints included microbiological cure, infection‐related length of stay, 90‐day readmission, and all‐cause inpatient mortality. Results: 56 patients were included in the study (31 (55%) received a FQ as definitive therapy; 25 (45%) received non‐FQ). All non‐FQ patients received a beta‐lactam (BL). Clinical failure occurred in 10 (18%) patients, with 4 (13%) in the FQ group and 6 (24%) in the BL group (p = 0.315). Microbiological cure occurred in 55 (98%) patients. Median infection‐related length of stay was 10 (6–20) days, with a significantly longer stay occurring in the BL group (p = 0.002). There was no statistical difference in 90‐day readmissions between groups (7% FQ vs. 17% BL; p = 0.387); one patient expired. Conclusion: These results suggest that fluoroquinolones do not adversely impact clinical outcomes in patients with CAE. When alternatives to beta‐lactam therapy are needed, fluoroquinolones may provide an effective option

Impact of Obesity in Patients with Candida Bloodstream Infections: A Retrospective Cohort Study

© 2020, The Author(s). Background: Candida species are responsible for 15% of bloodstream infections, leading to prolonged hospitalizations and increased mortality. With the rise in obesity, antifungal dosing is unclear. The purpose of this study was to determine differences in clinical outcomes between obese versus non-obese patients with Candida bloodstream infections. Methods: This retrospective cohort included adult patient’s first episode of Candida bloodstream infection treated with ≥ 48 h of antifungal therapy between 1 June 2013 and 31 August 2019. Patients were excluded for: dual systemic antifungal therapy, polymicrobial infections, or chronic candidiasis. The primary outcome was infection-related length of stay. Secondary outcomes included: time to candidemia resolution, 30-day readmission rates, and in-hospital mortality. Results: Eighty patients were included (28 obese; 52 non-obese). Most were male (55%); median age was 54 years. Median BMI and weight were 36.3 kg/m2 and 103 kg versus 20.4 kg/m2 and 61 kg, respectively (p \u3c 0.01). Baseline characteristics were comparable. C. albicans was isolated in 37.5% of cultures and C. glabrata in 30%. Micafungin was utilized empirically in 72.5% of patients; obese patients received definitive micafungin more frequently (57.1% vs. 21.2%; p \u3c 0.01) and were treated longer (13 versus 10 days; p = 0.04). Infection-related length of stay was 19 days in the obese patients and 13 days in the non-obese patients (p = 0.05). Non-obese patients had a shorter duration of candidemia (5 versus 6 days; p = 0.02). In-hospital mortality was numerically higher in obese patients (21.4% versus 13.5%; p = 0.36). There were no differences in 30-day readmissions between groups. Conclusions: Worse clinical outcomes were observed for obese versus non-obese patients. Further clinical research is warranted

Assessment of Antimicrobial Pharmacokinetics Curricula Across Schools and Colleges of Pharmacy in the United States

Introduction Advances in technology and understanding of pharmacokinetic/pharmacodynamic relationships have prompted guideline updates and advances in precision dosing, but the role of clinical pharmacokinetics (PK) in pharmacy education remains inconsistent. Previous surveys of pharmacy school PK curricula revealed large variations in content, integration, and teaching tools but did not focus on antimicrobials or details of andragogy used. Objective Identify how antimicrobial PK is taught in pharmacy curricula across the United States, as well as instructor perceptions of current practices. Methods An online survey was distributed to 118 pharmacy programs across the United States in 2018. This 30-minute questionnaire covered curriculum content, teaching strategies, assessment modalities, and perceptions. Results Completed surveys were received from 53 programs (45% response rate) via relevant course coordinators. Among 35 traditional progressive curriculum programs (TPC), antimicrobial PK was taught in basic science (33, 94%), clinical PK (15, 43%), pharmacology (8, 23%), therapeutics (28, 80%), and skills lab courses (21, 65%). Among 18 integrated block curriculum programs (IBC), it was taught in foundations/principles (17, 94%), organ systems (12, 67%), and skills lab courses (9, 50%). On average, TPC programs had more courses with antimicrobial PK than IBC programs. Vancomycin and aminoglycosides were the most common antimicrobials taught (100%), while didactic lecturing was the predominant andragogy. Multiple choice was the primary assessment modality, being frequently used in 64% of TPC and 68% of IBC courses, respectively. Among respondents, 72% believed more time was needed to teach PK and 53% believed students were adequately prepared at the start of APPEs. Conclusion Antimicrobial PK instruction remains highly inconsistent in U.S. pharmacy schools and colleges. IBC programs may provide less opportunity for antimicrobial PK instruction, which conflicts with the desire for more instruction time. As clinical applications of antimicrobial PK change and expand, it is crucial that pharmacy education prioritizes PK education appropriately

A Baker\u27s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2017

With an increasing number of antimicrobial stewardship-related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an actionable intervention for 2017. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for training and teaching and identify potential intervention opportunities within their institutions

A Baker’s dozen of top antimicrobial stewardship intervention publications in 2019

© The Author(s) 2020. Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one’s institution

Less Common Bacterial, Fungal and Viral Infections: Review of Management in the Pregnant Patient

This review is a comprehensive summary of treatment options for pregnant patients with less common bacterial, fungal, and viral infections. It offers guidance to clinicians based on the most recently published evidence-based research and expert recommendations. A search of MEDLINE (inception to March 2021) and the CDC website was performed. Liposomal amphotericin B is the preferred therapy for cryptococcosis, histoplasmosis, oesophageal candidiasis, and coccidioidomycosis, especially during the first trimester due to teratogenic concerns with azole antifungals. For oral candidiasis, clotrimazole troches or miconazole mucoadhesive buccal tablets are recommended. A β-lactam antimicrobial is preferred over doxycycline for various manifestations of Lyme disease and the drug of choice for pneumonia is trimethoprim/sulfamethoxazole. Acyclovir is the preferred antiviral for varicella zoster virus. Fluoroquinolones, macrolides, and aminoglycosides should be avoided if possible and there are alternate agents available for an effective treatment regimen. There is a scarcity of clinical data in pregnant patients with less common bacterial, fungal and viral infections. This population lacks definitive recommendations in many clinical practice guidelines. The key to optimizing therapy is a comprehensive review of the available evidence and a careful balance of risks and benefits before final treatment decisions

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one’s institution

A Baker\u27s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training and to identify potential intervention opportunities within one\u27s institution