No abstract

Tedizolid is an investigational oxazolidinone antibiotic for the treatment of multidrug-resistant gram-positive pathogens such as MRSA, Streptococcus pneumoniae, and VRE, including some linezolid-resistant strains.

In an era of emerging resistance and given the suboptimal efficacy and toxicity of currently available regimens for MDR-TB, bedaquiline represents a great addition to the existing armamentarium of anti-TB agents particularly in areas of the world where the disease is endemic.

Background Pharmacists' involvement in patient care has improved the quality of care and reduced medication errors. However, this has required a lot of work that could not have been accomplished without documentation of interventions. Several means of documenting errors have been proposed in the literature but without a consistent comprehensive process. Recently, the American College of Clinical Pharmacy (ACCP) recognized that pharmacy practice lacks a consistent process for direct patient care and discussed several options for a pharmaceutical care plan, essentially encompassing medication therapy assessment, development and implementation of a pharmaceutical care plan and finally evaluation of the outcome. Therefore, as per the recommendations of ACCP, we sought to retrospectively analyze interventions by grouping them according to medication related problems (MRP) and their nodes such as prescribing; administering; monitoring; documenting and dispensing. Objective The aim of this study is to report interventions according to medication error (ME) nodes and show the impact of pharmacy interventions in reducing MRPs. Setting The study was conducted at the cardiology and infectious diseases services at a teaching hospital located in Beirut, Lebanon. Methods Intervention documentation was completed by pharmacy students on infectious diseases and cardiology rotations then reviewed by clinical pharmacists with respective specialties. Before data analysis, a new pharmacy reporting sheet was developed in order to link interventions according to MRP. Then, MRPs were grouped in the five ME nodes. During the documentation process, whether MRP had reached the patient or not may have not been reported which prevented the classification to the corresponding medication error nodes as ME. Main outcome Reduction in medication related problems across all ME nodes. Results A total of n = 1174 interventions were documented. N = 1091 interventions were classified as MRPs. Interventions were analyzed per 1000 patient days and resulted in 340 medication related problem/1000 patient days. A 72 % reduction in MRP across all ME nodes was seen. The majority of interventions were in the field of cardiology followed by infectious disease related. When interventions per ME nodes were analyzed, a high percentage of intervention acceptance was noted across all nodes especially prescribing (68.30 %) monitoring (77.7 %) and in documenting errors (79.36 %). Conclusion The role of pharmacists in reducing preventable MRPs can be shown when pharmacy interventions are analyzed according to corresponding MRP and ME nodes.

Purpose The pharmacology, pharmacokinetics, pharmacodynamics, antimicrobial activity, efficacy, safety, and current regulatory status of a recently approved triple-drug therapy for complicated infections are reviewed. Summary Imipenem/cilastatin/relebactam is a newly approved anti-infective combination of a well-established β-lactam and a new β-lactamase inhibitor for the treatment of complicated urinary tract infections (cUTIs), including pyelonephritis, and complicated intra-abdominal infections (cIAIs) caused by susceptible gram-negative bacteria in patients 18 years of age or older with limited or no alternative treatment options; the medication is also indicated for use in treating hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP). The medication is active in vitro against a wide range of pathogens, including multidrug-resistant (MDR) Pseudomonas aeruginosa and carbapenemase-resistant Enterobacterales such as Klebsiella pneumoniae carbapenemase. The addition of relebactam does not restore the activity of imipenem against metallo-β-lactamase (MBL)–producing Enterobacterales and carbapenem-resistant Acinetobacter baumannii. Two phase 3 clinical trials of imipenem/cilastatin/relebactam were conducted. In the RESTORE-IMI 1 trial, the efficacy and safety of the triple-drug combination was found to be comparable to that of colistin/imipenem for treatment of infections caused by imipenem-nonsusceptible gram-negative bacteria in patients with HABP or VABP, cUTIs, and cIAIs, with a significantly lower incidence of nephrotoxicity reported with triple-drug therapy. The RESTORE-IMI 2 trial demonstrated the noninferiority of the triple-drug combination to piperacillin/tazobactam for the treatment of HABP and VABP. Commonly reported adverse events in clinical trials included anemia, elevated liver enzymes, electrolyte imbalances, nausea, vomiting, diarrhea, headache, fever, phlebitis and/or infusion-site reactions, and hypertension. Conclusion Imipenem/cilastatin/relebactam is a new β-lactam/β-lactamase inhibitor combination with activity against MDR gram-negative bacteria, including many CRE but not including MBL-producing Enterobacterales and carbapenem-resistant Acinetobacter isolates. It is approved for the treatment of cUTIs, cIAIs, HABP, and VABP.

Background There is limited published data in Lebanon evaluating the impact of supplemental education for anticoagulants use, especially DOACs, on clinical outcomes such as bleeding. The study aims to assess the impact of pharmacist-conducted anticoagulation education and follow-up on bleeding and readmission rates. Methods This study was a randomized, non-blinded interventional study conducted between August 2017 and July 2019 in a tertiary care teaching Lebanese hospital. Participants were inpatients ≥18 years discharged on an oral anticoagulant for treatment. Block randomization was used. The control group received the standard nursing counseling while the intervention group additionally received pharmacy counseling. Phone call follow-ups were done on day 3 and 30 post-discharge. Primary outcomes included readmission rates and any bleeding event at day 3 and 30 post-discharge. Secondary outcomes included documented elements of education in the medical records and reported mortality upon day 30 post-discharge. Results Two hundred patients were recruited in the study (100 patients in each study arm) with a mean age of 73.9 years. In the pharmacist-counseled group, more patients contacted their physician within 3 days (14% versus 4%; p = 0.010), received explicit elements of education (p < 0.001) and documentation in the chart was better (p < 0.05). In the standard of care group, patients were more aware of their next physician appointment date (52% versus 31%, p < 0.001). No difference in bleeding rates at day 3 and 30 post-discharge was observed between the groups. Conclusions Although pharmacist-conducted anticoagulation education did not appear to reduce bleeding or readmission rates at day 30, pharmacist education significantly increased patient communication with their providers in the early days post-discharge. Trial registration Lebanon Clinical Trial Registry LBCTR2020033424. Retrospectively registered. Date of registration: 06/03/2020.

Hyperkalemia, if left untreated, can lead to sudden death from cardiac arrhythmias. Hyperkalemia is defined as a serum potassium concentration greater than 5.5 mEq/L. It may develop when potassium intake exceeds excretion or when the transcellular distribution of potassium is disturbed. 1,2 At our institution, hyperkalemia was the most common adverse drug event (ADE).The clinical presentation of hyperkalemia is related to the effects of high potassium levels on neuromuscular, cardiac, and smooth muscle cells. Symptoms include generalized fatigue, muscle weakness, twitching, paresthesias, nausea, cramping, paralysis, palpitations, and cardiac abnormalities. 1 Thrombocytosis, leukocytosis, hemolysis, sickle cell disease, renal insufficiency or failure, Addison's disease, hyporenin aldosteronism, pseudohypoaldosteronism, insulin resistance or deficiency, hypertonicity, rhabdomyolysis, burns, and trauma are common causes of hyperkalemia. 3 Medications can also cause hyperkalemia through different mechanisms. Drug-induced hyperkalemia can result from the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), nonsteroidal antiinflammatory drugs (NSAIDS), aldosterone antagonists, potassium supplements, nonselective β-blockers, heparin (with prolonged use), tacrolimus, succinylcholine, penicillin G potassium, pentamidine, ketoconazole, cy-

Cethromycin appears to be a promising ketolide for the treatment of mild to moderate community-acquired pneumonia. It was denied approval by the FDA in 2009 pending more evidence to show its efficacy, with more recent studies showing its noninferiority to antibiotics for the same indication.