Arbekacin, an aminoglycoside antibiotic, has antibacterial activity against both Gram-positive and Gram-negative bacteria and is stable in the presence of aminoglycoside-inactivating enzymes produced by methicillin-resistant Staphylococcus aureus (MRSA). In this report, the antibacterial activity of arbekacin was compared with that of vancomycin, a glycopeptide antibiotic that also has potent antibacterial activity against MRSA. Arbekacin showed concentration-dependent bactericidal activity against MRSA strain 1936 (0.5-2 x MIC), but vancomycin showed only slight bactericidal activity, even at high concentrations of 19 x MIC. Arbekacin showed a longer post-antibiotic effect (2.3-3.8 h) than vancomycin (0-1.3 h) against MRSA strain 1936. Arbekacin induced marked morphological changes at 0.5 x MIC and the changes remained for 2 h after removal of the agent. When exposed to 0.5 x MIC of vancomycin, no notable morphological change was observed in the treated cells. Since arbekacin has broad-spectrum activity, these findings suggest that it may be a useful agent against MRSA infection, especially for polymicrobial MRSA infection with Gram-negative bacilli, such as Pseudomonas aeruginosa.

AS programs with pharmacist intervention improve mortality in patients with MRSA-B.

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The National Action Plan on Antimicrobial Resistance was implemented by the Ministry of Health, Labor and Welfare in Japan in 2016. The aim is to reduce the use of broad spectrum antibacterial drugs and optimize the use of oral antimicrobials. Ogaki Municipal Hospital has been promoting the use of cephalexin (CEX) and the combination of amoxicillin and clavulanate potassium (AMPC/CVA) since these drugs were added to the drug formulary in December 2012. In this study, we compared trends in oral antibiotic use in the emergency department before and after the addition of CEX and AMPC/CVA to the formulary. We observed a significant decrease in the average monthly consumption of third-generation cephalosporins (before: 264.3 ∓ 58.2 days; after: 108.5 ∓ 35.2 days; P < 0.01), and of macrolides (before: 52.7 ∓ 21.9 days; after: 18.9 ∓ 13.7 days; P < 0.01). Cost savings on oral antibiotics following the formulary revisions were calculated as 500,000 yen over three years. No difference in clinical effect was observed when comparing CEX, AMPC/CVA, and a third-generation cephalosporin. Therefore, we recommended the use of CEX and AMPC/CVA, according to the hospital formulary, in order to change trends in oral antibiotic use and achieve the objectives of the National Action Plan on Antimicrobial Resistance.

Existing recommendations regarding pharmaceutical interventions for patients with coronavirus disease 2019 (COVID-19) focus on outpatient, inpatient and post-discharge care. However, there are no studies examining the actual activities of pharmacists in relation to hospitalised patients. The present study aimed to identify pharmacists' roles by analysing cases of pharmaceutical interventions, particularly for patients admitted to high-care units. Pharmacological interventions were provided to patients with severe COVID-19 or patients at high risk of severe disease in 2021. These pharmaceutical interventions were analysed and evaluated. Pharmacists also developed a COVID-19 drug compatibility chart for use by care team members. In the present study, 54 patients were included, of which 33 were severe cases. A total of 28 patients (52%) received pharmacological interventions and 25 of them were severe cases. Out of 68 pharmacological interventions, interventions for antimicrobial agents were the most common (28 interventions), followed by nutrition and anti-COVID-19 drug-related interventions. In addition, the need for interventions relating to drug compatibility was reduced by ~43% after the drug compatibility chart was implemented. In conclusion, pharmacists have a responsibility to improve the quality of pharmacotherapy for patients with COVID-19. They should focus on creating specific pharmacotherapy tools for patients with COVID-19 and supporting appropriate antimicrobial use for secondary bacterial infections.

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