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Hospital-acquired pneumonia (HAP) is deˆned as pneumonia that occurs 48 hours or more after admission, and is an important factor in the high mortality seen in hospital-acquired infections. Recently, pharmacist intervention, such as adjustment of dosing and monitoring for adverse eŠects, has been reported to improve the eŠects of infectious disease therapy. The aim of this study was to evaluate the usefulness of early pharmacist intervention during antimicrobial therapy for severe HAP. We retrospectively investigated the reduction rate of C-reactive protein (CRP) levels and duration of antibiotics administration. Patients with severe HAP were classiˆed into 2 groups according to pharmacist intervention from the initial phase of therapy, with 15 in the intervention group and 23 in the control group (no pharmacist intervention). The reduction rate of CRP levels during the 7-day period after initiating antimicrobial therapy was 66.5±17.3 % in the intervention group and 35.9±53.9% in the control group, which was signiˆcantly diŠerent ( p<0.05). In addition, the average duration of antibiotics administration in the intervention group was signiˆcantly decreased as compared to the control group: the decreased period was 8 days. Our results suggest that pharmacist intervention contributed to reduce in‰ammation in the early phase and to shorten the duration of antimicrobial therapy.
Hospital-acquired pneumonia (HAP) is deˆned as pneumonia that occurs 48 hours or more after admission, and is an important factor in the high mortality seen in hospital-acquired infections. Recently, pharmacist intervention, such as adjustment of dosing and monitoring for adverse eŠects, has been reported to improve the eŠects of infectious disease therapy. The aim of this study was to evaluate the usefulness of early pharmacist intervention during antimicrobial therapy for severe HAP. We retrospectively investigated the reduction rate of C-reactive protein (CRP) levels and duration of antibiotics administration. Patients with severe HAP were classiˆed into 2 groups according to pharmacist intervention from the initial phase of therapy, with 15 in the intervention group and 23 in the control group (no pharmacist intervention). The reduction rate of CRP levels during the 7-day period after initiating antimicrobial therapy was 66.5±17.3 % in the intervention group and 35.9±53.9% in the control group, which was signiˆcantly diŠerent ( p<0.05). In addition, the average duration of antibiotics administration in the intervention group was signiˆcantly decreased as compared to the control group: the decreased period was 8 days. Our results suggest that pharmacist intervention contributed to reduce in‰ammation in the early phase and to shorten the duration of antimicrobial therapy.
Pharmacists are providing pharmaceutical care in general wards, but it is still not common in the intensive care unit (ICU). However, we have worked in ICU, and recommended the rational dosage regimen of the antibiotics to the physicians during the treatment period. Especially, the patients who were infected with methicillin-resistant Staphylococcus aureus (MRSA) in ICU should be provided appropriate antibiotic therapy, otherwise they have a poor prognosis. The aim of this study is to evaluate usefulness of the pharmacists' intervention on the antibiotic therapy for MRSA infectious diseases in the ICU. We investigated retrospectively the period of anti MRSA drugs administration, the medical cost, which includes cost of anti MRSA drugs and hospital charge, and the initial trough concentration of vancomycin (VCM). The patients with MRSA pneumonia were classiˆed into two groups according to the pharmacists' intervention. The number of the patients who the pharmacists performed dosage regimen of anti MRSA drug was 11 (intervention group) and that of the patients who the pharmacists performed no intervention was 47 (control group). The average period of administration of anti MRSA drugs in the intervention group was signiˆcantly decreased in 5 days. Furthermore, if the pharmacists performed dosage regimen of anti MRSA drug to the patients in control group, the medical cost of 10 million yen would be saved. The initial trough concentrations of VCM were not signiˆcantly diŠerent between two groups. However, the achievement rates are 75.0% in intervention group and 66.7% in control group, if the goal of trough level of VCM is set from 5 to 15 mg/ml. Moreover, there are 75.0% in intervention group and 20.8% in control group, if the goal of trough level of VCM is set from 10 to 20 mg/ml, which is signiˆcantly diŠerent between the two groups. Therefore, it was suggested that the pharmacists in the ICU contributed to optimize the anti MRSA therapy and reduce the medical cost.
Teicoplanin (TEIC) is active against Gram positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp.. TDM studies have indicated that serum TEIC concentrations are important for determining e‹cacy in patients. TEIC is known to be extensively bound to serum proteins such as human serum albumin. Therefore, the clinical pharmacokinetics of TEIC are expected to be considerably aŠected by protein binding with albumin. This study evaluated protein binding of TEIC in human serum, and determined the albumin dependent relationship between the unbound and total serum TEIC concentrations in hypoalbuminemic patients. Consequently, more accurate and eŠective trough concentration ranges of TEIC were established, with eŠective unbound concentration over the minimum inhibitory concentration against MRSA (MIC 90). The eŠective loading doses of TEIC are proposed, especially in hypoalbuminemic patients on the basis of the unbound serum concentrations.
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