Asymptomatic bacteriuria (ASB) is a common clinical finding characterized by the presence of bacteria in the urine of an individual without signs or symptoms suggestive of urinary tract infection. Despite available guidelines on the diagnosis and management of ASB, it is often managed inappropriately. We performed a systematic review of clinical trials evaluating antimicrobial therapy for ASB, identified translational barriers to evidence-based practice, and we offer strategies to optimize antimicrobial use for ASB. We conducted a systematic search of the PubMed, International Pharmaceutical Abstracts, Cumulative Index to Nursing and Allied Health databases, and the Cochrane Library. Randomized controlled trials, cohort trials, case-control studies, and meta-analyses published in the English language were included in this review if they addressed treatment of ASB with at least one antimicrobial agent in nonpregnant adults. Articles were excluded if they evaluated patients with indwelling urinary catheters or were not clinical trials. Of the 304 articles identified from the search, 287 were excluded; thus 17 articles met the inclusion criteria. Although treatment of ASB with antimicrobial therapy may improve short-term microbiologic outcomes, the clinical significance is diminished because the effect is not sustained, there is no measurable improvement in morbidity or mortality, and some data indicate that therapy is deleterious. Several translational barriers that preclude adoption of evidence-based practice are identified. Treatment guidelines may not achieve their desired effect and underscore the need for additional methods to translate clinical trial data into practice. Clinical pharmacists are a core member of the antimicrobial stewardship team and in an important position to participate in initiatives that promote appropriate antimicrobial use. We suggest a multifaceted approach consisting of education and frequent routine prospective audits with feedback coupled with appropriate process and outcome measures.

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Objective: Hyperglycemia is common among hospitalized patients, affecting approximately 40% of patients at the time of hospital admission, despite the fact that 1 in every 8 patients has no previous diagnosis of diabetes. Hyperglycemia has been associated with poor patient outcomes, including higher rates of morbidity and mortality across a range of conditions. This review discusses options for the effective management of hyperglycemia with a focus on the use of disposable insulin pens in the hospital. Methods: Literature, including guidelines for hospital management of hyperglycemia, and information regarding methods of insulin administration were reviewed. Results: Appropriate glucose control via administration of insulin within hospitals has been acknowledged as an important goal and is consistent with achieving patient safety. Insulin may be administered subcutaneously using a pen or vial and syringe or infused intravenously. Levels of patient and provider satisfaction are higher with pen administration than with vial and syringe. Insulin pens have many safety and convenience features including enhanced dose accuracy and autocover/autoshield pen needles. Conclusion: Use of insulin pens instead of vials and syringes can provide several advantages for hospitalized patients, including greater satisfaction among them and health care providers, improved safety, and reduced costs. These advantages can continue following patient discharge.

LTBA monotherapy is inferior to vancomycin and metronidazole for CDI. Some data indicate possible benefit in reducing recurrent CDI, but outcomes with adjunctive and/or sequential LTBAs are unavailable. Further studies are needed to investigate the role of LTBAs for CDI.

Summary What is Known and Objective Anaemia is a common clinical finding among patients with chronic kidney disease (CKD) and is associated with significant morbidity and healthcare costs. Iron deficiency is an important contributing factor, and adequate iron supplementation is essential to optimize the management of anaemia of CKD. Oral iron is convenient and inexpensive but is poorly absorbed and associated with gastrointestinal distress. Intravenous iron overcomes these limitations but is more expensive, requires additional clinical visits for administration and is associated with serious adverse events. Oral heme iron polypeptide (HIP) is a newer dosage form that has been reported to have higher bioavailability and fewer side effects when compared with non‐heme iron in healthy subjects, but data in patients with CKD are limited. The purpose of this review is to evaluate the safety and effectiveness of HIP for the management of CKD. Methods Searches for PubMed (1947–2015) and International Pharmaceutical Abstracts (1970–2015) were conducted using the following terms: heme iron, heme iron polypeptide, oral iron, anaemia and chronic kidney disease. The bibliography of each relevant article was evaluated for additional studies. Articles were selected for review if they were published in the English language and were randomized controlled trials evaluating the bioavailability, tolerability or efficacy of oral HIP in human subjects with CKD. Results and Discussion This search yielded three clinical studies. The safety and efficacy of HIP was evaluated in a total of 161 subjects with anaemia and various stages of CKD. HIP was consistently associated with lower ferritin values when compared with traditional iron supplementation. With few exceptions, the effect of HIP on haemoglobin, haematocrit, transferrin saturation and recombinant human erythropoietin dose, and adverse effects appeared similar to intravenous and oral non‐heme iron supplementation. The cost of HIP is substantially more than non‐heme iron and comparable to intravenous iron. What is New and Conclusion Heme iron polypeptide does not appear to confer benefit over traditional iron supplementation among patients with anaemia of CKD and is more expensive.