Concentrations of vancomycin in bones of 14 patients undergoing total hip arthroplasty (group 1) and 5 patients with osteomyelitis (group 2) were studied. Group 1 received vancomycin, 15 mg/kg intravenously, 1 h prior to anesthesia. Group 2 received doses adjusted to achieve peak levels in serum of 20 to 30 ,ug/ml and trough levels of <12 ,Ig/ml; bone specimens were collected during surgical debridement. The specimens were pulverized and eluted into phosphate buffer, and the supernatants were analyzed for vancomycin content by fluorescence polarization immunoassay. In group 1, vancomycin was detectable in all cancellous specimens with a mean concentration of 2.3 ± 4.0 ,ug/g (range, 0.5 to 16 ,ug/g); 10 of 14 cortical specimens had detectable vancomycin; the mean cortical concentration was 1.1 ± 0.8 ,ug/g (range, not detectable to 2.6 ,ug/g). In group 2, vancomycin was detectable in only two of five cortical bone specimens (mean concentration, 5.9 ± 3.5 ,ug/ g). Cancellous bone was obtained in one patient; the vancomycin concentration was 3.6 ,ug/g. In most patients the vancomycin levels in bones were higher than the MIC for susceptible staphylococci following single prophylactic doses. In the few infected patients studied, penetration was variable and deserves further study.Vancomycin is often recommended for the treatment of osteomyelitis caused by methicillin-resistant staphylococcal species, as well as for all forms of gram-positive staphylococcal and streptococcal osteomyelitis in patients with allergies to beta-lactam antibiotics. Nonetheless, no studies of vancomycin penetration into human bone have been reported. Therefore, we measured concentrations in noninfected bone specimens from humans following a single preoperative intravenous dose of vancomycin and in infected bone specimens following multiple-dose therapy for osteomyelitis. MATERIALS AND METHODSStudy groups. Nineteen adult patients were studied. Group 1 consisted of 14 patients undergoing total hip arthroplasty for osteoarthritis. Group 2 consisted of five patients with osteomyelitis undergoing surgical bone debridement.(i) Group 1. Vancomycin (15 mg/kg of total body weight, to a maximum dose of 1 g) was administered intravenously over 60 min beginning approximately 1 h prior to induction of anesthesia. A 2-to 3-g sample of cortical and cancellous bone was obtained from the femoral neck intraoperatively.Blood was collected for vancomycin assay 15 min after the end of the infusion and at the time of bone sampling.(ii) Group 2. Patients in group 2 had been receiving vancomycin for at least 48 h for treatment of sternal (four patients) or tibial (one patient) osteomyelitis. Doses were adjusted to achieve peak levels of 20 to 40 jig/ml of serum and trough levels of -12 ,ug/ml. Peak levels were obtained 15 min after the end of a 60-min infusion. Bone debrided intraoperatively was collected for analysis. On the day of bone sampling, blood was obtained simultaneously and at the nadir of the dosing interval. * Corresponding author. Specimen analysis. Se...

The preprofessional pharmacy curriculum provides the foundation for the professional curriculum. Basic requirements are noted in the ACPE Standards and Guidelines, but there is considerable variation in the preprofessional curriculum requirements for entry into doctor of pharmacy programs in the United States. Changes in higher education, pharmacy practice, and health care continue to drive the need to evaluate the preprofessional curriculum. The objectives of this white paper were to create model preprofessional curricula that would enable students to be successful during and after entry into the professional curriculum. Using an evidence-based approach where possible, a number of factors were found to be associated with academic success during a pharmacy program and on licensing examinations. These data and other information were used to create 2 preprofessional curricular models that include the development of general and discipline-specific abilities. Challenges remain in accurately evaluating the abilities and attributes of applicants and the impact of those abilities and attributes on their success as a student and a practitioner. Colleges and schools of pharmacy should consider adopting a more consistent preprofessional curriculum on a national level. This preprofessional curriculum should be multi-dimensional, based on needs for future practice, and revised over time.

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