Liposomal-Amphotericin B (L-AMB) may cause hypokalemia. This study was carried out to examine the occurrence of hypokalemia and its primary causes in 74 patients who were administered LAMB. They were divided into 2 groups regarding the severity of hypokalemia that occurred: Grade 0-2 group: 35 patients (47.3%), and Grade 3-4 group: 39 patients (52.7%). The results of a comparison of the Grade 0-2 group and Grade 3-4 group showed that causes for the Grade 3-4 group were significantly different from those in the Grade 0-2 group, which were a serum albumin level of more than 2.82 mg/dL at the start of the LAMB administration (p = 0.004, OR:8.711, 95%CI:2.273-45.823), and a history of hypokalemia before LAMB administration (p = 0.009, OR: 7.859, 95%CI: 1.844-44.109) in the Grade 3-4 group. While combination with trimethoprim-sulfamethoxazole resulted in significant avoidance of Grade 3-4 hypokalemia (p = 0.019, OR: 0.233, 95%CI: 0.063-0.750), administration of potassium for preventive or maintenance purposes did not affect the occurrence of hypokalemia (p = 0.137, p = 0.198). However, for 20 patients with an abnormal serum potassium level (Grade 1 and more) at the start of LAMB administration, our findings suggested that the preventive/maintenance administration of potassium was indeed effective (p = 0.011). It has been proven that LAMB causes hypokalemia frequently and the primary causes have been clarified. In this regard, it is important to regularly monitor serum potassium levels and adjust them depending on the situation of patients with hypokalemia.
In recent years, hospitals have routinely implemented antimicrobial stewardship (AS) programs, and it is important that these programs are eŠective. Consequently, we utilized a customized computer system to support infection management and implemented a pharmacist-driven AS program in our hospital. Using this computer system, a pharmacist monitored the daily usage of carbapenems and agents against anti-methicillin-resistant Staphylococcus aureus and generated a patient database. With the use of this computer system, we found that the patient database entry time signiˆcantly decreased from 24 to 12 min ( p<0.01). Subsequently, we were also able to monitor tazobactam/piperacillin usage owing to the increased e‹ciency of our AS program. As a result, the average number of monitored patients signiˆcantly increased from 51 to 72 per month ( p<0.01) and the number of proposed prescriptions increased from 189 to 238 per year. Additionally, the usage of carbapenems and tazobactam/piperacillin signiˆcantly decreased ( p<0.01) after implementation of this computer support system. In summary, we recommend that pharmacists utilize computer systems to implement AS programs because they increase the e‹ciency of interventions and monitoring of patients and promote appropriate antibiotic use.
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