Benzodiazepines are the drug of choice for alcohol withdrawal syndrome (AWS); however, phenobarbital is an alternative agent used with or without concomitant benzodiazepine therapy. In this systematic review, we evaluate patient outcomes with phenobarbital for AWS. Medline, Cochrane Library, and Scopus were searched from 1950 through February 2017 for controlled trials and observational studies using ["phenobarbital" or "barbiturate"] and ["alcohol withdrawal" or "delirium tremens."] Risk of bias was assessed using tools recommended by National Heart, Lung, and Blood Institute. From 294 nonduplicative articles, 4 controlled trials and 5 observational studies (n = 720) for AWS of any severity were included. Studies were of good quality (n = 2), fair (n = 4), and poor (n = 3). In 6 studies describing phenobarbital without concomitant benzodiazepine therapy, phenobarbital decreased AWS symptoms ( < .00001) and displayed similar rates of treatment failure versus comparator therapies (38% vs 29%). A study with 2 cohorts showed similar rates of intensive care unit (ICU) admission (phenobarbital: 16% and 9% vs benzodiazepine: 14%) and hospital length of stay (phenobarbital: 5.85 and 5.30 days vs benzodiazepine: 6.64 days). In 4 studies describing phenobarbital with concomitant benzodiazepine therapy, phenobarbital groups had similar ICU admission rates (8% vs 25%), decreased mechanical ventilation (21.9% vs 47.3%), decreased benzodiazepine requirements by 50% to 90%, and similar ICU and hospital lengths of stay and AWS symptom resolution versus comparator groups. Adverse effects with phenobarbital, including dizziness and drowsiness, rarely occurred. Phenobarbital, with or without concomitant benzodiazepines, may provide similar or improved outcomes when compared with alternative therapies, including benzodiazepines alone.

Fifty doctors completed a questionnaire which assessed their knowledge of the basic National Health Service cost of 15 commonly prescribed medications. Nearly half the estimates exceeded twice the actual cost of the drug. Correspondence: Dr. J. ROWC, D e p m e n r of Geriatric Medicine, University of Birmingham, Hayward Building, Selly Oak Hospital, Raddlebam Road, Birmingham B29 6JD, U.K.

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Background National vaccination rates remain below goals. Given the geographic availability of community pharmacies, pharmacists are uniquely positioned to provide immunizations. However, many pharmacists may not be proactively recommending vaccinations to patients. Objective The objective of this project was to assess recommendation acceptance rates among patients who attended a pharmacy student–driven statewide free health screening. Methods A brief algorithm addressing 4 routine adult vaccinations was created for use by student pharmacists to initiate conversations regarding potentially indicated vaccines with patients. This algorithm was employed at statewide screenings in 2014 and 2015 with expert users available for further discussion. Follow-up to determine recommendation acceptance and identify barriers to immunization occurred 3 to 12 months after screening. The primary end point of change in immunization recommendation acceptance rates between 2014 and 2015 was analyzed using a chi-square test; secondary objectives included changes in consent rates and thematic analysis of reported barriers. Results A total of 1016 patients were screened. Of these, 403 (39.7%) patients gave consent for student pharmacists to follow-up on vaccine recommendations. The overall recommendation acceptance rate was 27%, with approximately 46% of patients accepting at least 1 recommendation. Acceptance rates significantly decreased in the second year (36.5% vs 23.5%, P < .001), while consent for follow-up significantly increased (20% vs 64%, P < .001). Commonly reported barriers to immunization included resistance to vaccines, forgetfulness, and cost. Conclusion This algorithm provided a method for novice users to initiate conversations with patients about immunizations and may allow novices to act as pharmacist extenders to improve immunization rates.

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