Educational materials that guide prescribing, pharmacist interaction on patient care rounds, and pharmacist-conducted medication reconciliation significantly reduced the prescribing of non-indicated gastric acid suppressant medications after hospital discharge.

Gastric acid suppressant medications initially prescribed for stress ulcer prophylaxis are frequently prescribed inappropriately on discharge for patients who were initially admitted to the medical/surgical ICU.

There was a lack of published data regarding drug-nutrient interactions for a majority of the drugs commonly administered to patients receiving continuous enteral nutrition. Clinicians should recognize potential drug-nutrient interactions and use available evidence to optimize patients' drug therapy.

The patients' increased serum creatinine concentrations are likely to have resulted from exposure to propylene glycol as a result of lorazepam infusion. Serum osmolality and osmol gap may be useful markers for propylene glycol toxicity.

dDaptomycin use at our institution changed to ideal body weight dosing based on a published analysis of pharmacokinetic-pharmacodynamic efficacy target attainment, bacterial ecology, and a desire to reduce drug toxicity. The current study compared outcomes between actual body weight and ideal body weight dosing of daptomycin before and after this intervention. In the evaluable group, 69 patients received doses based on actual body weight and 48 patients received doses based on ideal body weight. Patients were treated for documented Enterococcus species, Staphylococcus aureus, or coagulase-negative Staphylococcus infections, including bloodstream, intraabdominal, skin and soft tissue, urinary, and bone. There was no statistically significant difference in clinical success between the groups (88.9% for actual body weight compared to 89.1% for ideal body weight, P ‫؍‬ 0.97). After we adjusted for gender, age, body mass index, concomitant 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, infection type, and organism type, clinical success rates remained similar between groups (adjusted odds ratio of 0.68 in favor of actual body weight, 95% confidence interval [CI] of 0.13 to 3.55). Microbiological outcomes, length of stay, mortality, and adverse effects were also similar between groups. Further studies are warranted to confirm that ideal body weight dosing provides similar outcomes to actual body weight dosing for all patients and types of infections and organisms. C onventional daptomycin doses, based on actual body weight (ABW), result in sufficient drug exposure to meet an effective area under the curve (AUC)-to-MIC ratio. Dvorchik and Damphousse demonstrated that a single dose of 4 mg of daptomycin/kg of body weight administered to nonobese patients resulted in an AUC of 418 Ϯ 25 g · h/ml (1). A 6-mg/kg dose resulted in AUC values of 726 Ϯ 79 g · h/ml in healthy, nonobese patients (2). In a mouse thigh infection model, Safdar et al. determined that the 24-h AUC/MIC parameters associated with bacteriostatic effect were 388 to 537 for four ATCC Staphylococcus aureus strains and 0.94 to 1.67 for two clinical isolates of Enterococcus faecium (3).Pharmacokinetic parameters may change in some patient populations, including the obese population. In two studies evaluating ABW-dosed daptomycin pharmacokinetics in the morbidly obese (1, 4), the AUC increased 30 to 60% compared to in normalweight individuals. Volume of distribution (V) and clearance (CL) were reduced when normalized for weight.Daptomycin dosing can be limited by toxicity, especially myositis and creatine phosphokinase (CPK) elevations with exposures exceeding 2 weeks of duration (5). In an examination of data from a randomized trial of daptomycin treatment of bacteremia and endocarditis, a direct relationship between minimum serum concentration (C min ) and incidence of CPK elevation was established. Patients weighing Ն111 kg had a significantly higher probability of elevated C min than patients weighing Ͻ111 kg. Using a Monte Carlo evaluation, d...