Anticonvulsant hypersensitivity syndrome (AHS) is a delayed adverse drug reaction associated with the use of aromatic anticonvulsant drugs. It has been most commonly reported with the use of phenytoin, carbamazepine, and phenobarbital. Although its occurrence is rare, 1 in every 1000-10,000 exposures, AHS is a serious adverse event often resulting in hospitalization and even death. The clinical manifestations of AHS include a triad of symptoms consisting of dermatologic rashes, fever, and evidence of systemic organ involvement. Diagnosis is most frequently based on the recognition of this triad of symptoms and clinical judgment. The exact mechanism of AHS remains to be determined but is thought to have at least three components: deficiency or abnormality of the epoxide hydroxylase enzyme that detoxifies the metabolites of aromatic amine anticonvulsants, associated reactivation of herpes-type viruses, and ethnic predisposition with certain human leukocyte antigen subtypes. Arene oxides, the toxic intermediaries in the metabolism of anticonvulsant drugs, can accumulate and directly bind to macromolecules, causing cell death, as well as act as prohaptens that bind to T cells, initiating an immune response and systemic reactions. Management of AHS primarily includes discontinuation of the associated anticonvulsant drug. Systemic corticosteroids are usually required for full recovery. An important issue regarding AHS is the cross-sensitivity among aromatic anticonvulsant drugs, which has been reported to be 40-80%. This means that patients with a history of AHS should avoid further use of any aromatic anticonvulsant drug. In addition, a familial association with AHS exists, and family members of the patient with AHS should be educated that they may be at increased risk for developing AHS if they use aromatic anticonvulsant drugs. Anticonvulsant drugs that are generally considered safe are valproic acid and benzodiazepines. Other nonaromatic anticonvulsant drugs should also be acceptable. Pharmacists as health care providers can play an important role in the diagnosis, treatment, and prevention of AHS.

Delafloxacin is a novel anionic fluoroquinolone (FQ) approved for treatment of acute bacterial skin and skin structure infections (ABSSSIs) caused by a number of Gram-positive and Gram-negative organisms including MRSA and Pseudomonas aeruginosa. The unique chemical structure of delafloxacin renders it a weak acid and results in increased potency in acidic environments. In Phase III studies, delafloxacin had similar outcomes to comparator regimens for treatment of ABSSSIs, and was well tolerated overall. Similar to other FQs, delafloxacin is available in both intravenous and oral formulations, but differs in that delafloxacin exerts a minimal effect on cytochrome P450 enzymes and on the corrected QT interval. This novel FQ has the potential to be utilized across a wide variety of clinical settings; however, post-marketing surveillance and long-term safety and resistance data will be essential to identify optimal use scenarios.

Determining the most appropriate journal for manuscript submission for pharmacy and pharmaceutical science researchers can be difficult for young and experienced faculty alike and may be the most crucial step to promote successful publication. Although journals are ranked using traditional citation metrics such as the journal impact factor (JIF) and more novel altmetrics, researchers need to consider and prioritise various factors, such as the journal’s aims and scope, intended audience members, and ease of access to promote readership and further studies. Authors also need to be mindful of predatory journals, realistic expectations for acceptance and rejection, as well as promotion and tenure guidelines. The purpose of this article is to give direction and provide resources for academic pharmacists and pharmaceutical scientists around the world on how to select an appropriate journal for their work to promote a successful publication experience.

Background: Variation in providers' education and training may contribute to potential antibiotic overprescribing in outpatient settings. Providers in rural settings may not be exposed to or have similar resources readily available as those in urban settings, or be affiliated with academic medical centers. Thus, we sought to evaluate providers' knowledge and perceptions towards antibiotic stewardship (AS) and antibiotic prescribing in rural primary care clinics. Methods:A cross-sectional, multicenter, electronic survey assessing providers' knowledge and perceptions towards AS and antibiotic prescribing was distributed to family medicine and internal medicine clinic providers in rural New York and Pennsylvania.Results: Seventy responses were included resulting in a survey response rate of 33.5% (70/209) with 42.9%, 30%, and 27.1% of responses from physicians, advanced practice providers, and resident physicians, respectively. The most common barrier to improving antibiotic prescribing was patient demands (54.3%). Providers felt more pressured to prescribe antibiotics based on appointment visits of ≤20 minutes compared with >20 minutes (46.4% vs 7.1%, P = .006), as well as those that encountered ≥50 patients in a week compared with <50 patients (55% vs 16.7%, P = .001). All providers strongly agreed or agreed that antibiotics are overprescribed and inappropriate antibiotic use can lead to resistance. However, only 42.9% of providers selected correctly that 90% to 98% of rhinosinusitis are viral and only 5.7% recommended supportive care without antibiotics. Ten percent of providers never heard of AS, yet most providers (84.3%) were interested in receiving more AS education. Importantly, most providers (57.1%, 40/70) indicated that pharmacists were useful resources to assist in appropriate antibiotic prescribing. Conclusions: Variability exists among providers' knowledge and perceptions towardsAS and antibiotic prescribing in rural primary care clinics, yet most providers are interested in additional AS education. Pharmacists are well-positioned to educate providers and implement initiatives related to AS and appropriate antibiotic prescribing.

BackgroundRural outpatient clinics serve the healthcare needs of many individuals, especially for acute sick visits and infectious processes. A better understanding of providers’ knowledge and attitudes toward antibiotic stewardship in the outpatient rural setting is needed to facilitate more effective education regarding appropriate antibiotic prescribing.MethodsA cross-sectional, multi-center, 28-item survey assessing providers’ knowledge and attitudes toward antibiotic prescribing and antibiotic stewardship in the rural setting was distributed to providers from Guthrie and United Health Services primary care clinics in rural New York and Pennsylvania.ResultsSixty-five providers participated (31% response rate) with 43%, 29%, and 28% of responses from physicians, resident physicians, and advanced practice providers, respectively. More than half of respondents practiced for ≤5 years since terminal training. The most significant barrier to improving antibiotic prescribing was patient demands (55%) followed by uncertain diagnosis of bacterial infection (22%) and short appointment visit times (11%). Providers that spent ≤20 minutes per visit were more likely to feel pressured to prescribe antibiotics for upper respiratory tract infections (URI) to ensure patient satisfaction than those who spent >20 minutes (41% vs. 7%, P = 0.024). Additionally, providers who saw >50 patients per week were more likely to feel pressured to prescribe antibiotics for URIs than those who saw ≤50 patients (50% vs. 18%, P = 0.009). Only 42% of providers selected the correct answer that 90–98% of URIs are viral. The majority of providers strongly agreed that antibiotics are overused (71%) and inappropriate antibiotic use can lead to resistance (82%). Thirty-eight percent of providers never heard the term antibiotic stewardship or heard the term but were unsure about the definition. However, more than 75% of providers strongly agreed or agreed that they were interested in receiving more education regarding antibiotic stewardship.ConclusionVariability exists among providers’ knowledge and attitudes toward antibiotic stewardship and antibiotic prescribing in rural outpatient settings. Increased educational efforts are warranted to increase consistency of these concepts and practices.Disclosures All authors: No reported disclosures.