No abstract

Four strains of Heikobacter pylori were subjected to an in vitro serial passage technique to compare the propensity of the organisms to develop resistance to seven classes of antibacterial agents. The passages were made on serially doubling concentrations of antibacterial agents incorporated into agar starting at one-half the base-line MIC. The frequency of spontaneous resistance was also determined for each strain at four and eight times the MIC of each antibacterial agent. Strains resistant to ciprofloxacin, metronidazole, erythromycin, and tobramycin were isolated. The experiments failed to select organisms resistant to bismuth subsalicylate, furazolidone, or amoxicillin, although the MIC of amoxicillin was increased 4-to 16-fold. With the exception of erythromycin, organisms with the selected resistance were stable after at least three passages on antibacterial agent-free medium. Spontaneous resistance rates were generally of a low magnitude and were not predictive of the serial passage results.Helicobacter pylori (formerly Campylobacter pylori) is accepted as the most common and most important cause of chronic active gastritis and represents one of the common chronic infections of humans. H. pylori infection and gastritis are also associated with the vast majority of cases of chronic, recurrent duodenal ulcer, with a growing body of data supporting an important etiologic role for the organism in that disease (4, 7).Antibacterial therapy resulting in the clearance of H. pylori from the gastric mucosa has led to histologic improvement or normalization of chronic active gastritis (5,17,19). In patients with duodenal ulcers associated with H. pylori infections, effective eradication of the organism has resulted in improved healing of ulcers (12) and significantly lower rates of ulcer relapse (3, 12). These findings support a role for antibacterial therapy in the treatment of H. pyloriassociated upper gastrointestinal diseases.Two major problems have been encountered in the treatment of H. pylori infections, despite its in vitro susceptibility to a wide array of antibacterial agents. First, relapse of H. pylori is common following what appears to be successful treatment (5,17,19). Relapse is presumably due to incomplete eradication of the organism. The second major problem has been the emergence of resistant strains during singleagent treatment. The development of resistance has been reported during treatment with several quinolones (10, 16; Y. Glupczynski, M. Labbe, A. Burette, M. Delmee, V. Avesani, and C. Bruck, Letter, Lancet i:1096, 1987; J. W. Stone, R. Wise, I. A. Donovan, and J. Gearty, Letter, J. Antimicrob. Chemother. 22:92-93, 1988), nitroimidazoles (6, 10), and rifampin (10).The purpose of this in vitro study was to compare the propensity of H. pylori strains to develop resistance to several antibacterial agents by using a serial passage technique (22) and to investigate the rates of spontaneous resistance to the study drugs.

No abstract

The standard dose of enoxaparin recommended for the prevention of VTE following multiple trauma provides unreliable and highly variable anti-Xa activity in critically ill trauma patients, and is strongly affected by the presence of significant peripheral edema.

Positive outcomes of antimicrobial stewardship programs in the inpatient setting have been well documented, but the benefits for patients not admitted to the hospital remain less clear. This report describes a retrospective case-control study of patients discharged from the ED with subsequent positive cultures conducted to determine if integrating antimicrobial stewardship responsibilities into practice of the dedicated emergency medicine clinical pharmacist (EPh) decreased times to positive culture follow-up, patient or primary care provider (PCP) notification, and appropriateness of empiric or final antimicrobial therapy for patients discharged from the emergency department (ED). Pre-and post-implementation groups of an EPh-managed antimicrobial stewardship program were compared. Data were collected from medical records and the ED culture database. Continuous data were analyzed using Wilcoxon Rank Sum test and categorical data using Chi-squared analysis. Positive cultures were identified in 177 patients, 104 and 73 in pre and post-implementation groups, respectively. Median time to culture review in the pre-implementation group was 3 days (range 1–15) and 2 days (range 0–4) in the post-implementation group (p=0.0001). There were positive cultures that required notification in 74 (71.2%) and 36 (49.3%) on pre- and post-implementation groups, respectively. Median time to patient or PCP notification was 3 days (range 1–9) in the pre-implementation group and 2 days(range 0–4) in the Eph managed program (p = 0.01). No difference in appropriate antimicrobial therapy was seen.

No abstract

Acute inflammation after elective surgery was associated with a significant decline in cytochrome P450 3A4 activity, which is predictive of clinically important changes in the metabolism of commonly used drugs that are substrates for this enzyme.

The field of critical care medicine began to flourish only within the last 40 years, yet it provides some of the best examples of collaborative pharmacy practice models and evidence for the value of pharmacist involvement in interdisciplinary practice. This collaborative approach is fostered by critical care organizations that have elected pharmacists into leadership positions and recognized pharmacists through various honors. There is substantial literature to support the value of the critical care pharmacist as a member of an interdisciplinary intensive care unit (ICU) team, particularly in terms of patient safety. Furthermore, a number of economic investigations have demonstrated cost savings or cost avoidance with pharmacist involvement. As the published evidence supporting pharmacist involvement in patient care activities in the ICU setting has increased, surveys have demonstrated an increase in the percentage of pharmacists performing clinical activities. In addition, substantial support of pharmacists has been provided by other clinicians, safety officers, and administrative personnel who have been involved with the initiation and expansion of critical care pharmacy services in their own institutions. Although there is still room for improvement in the range of pharmacist involvement, particularly with respect to interdisciplinary activities related to education and scholarship, pharmacists have become essential members of interdisciplinary care teams in ICU settings.