DOCSLIB.ORG

RPCC Pharmacy Forum: November 2016

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
RPCC Pharmacy Forum: November 2016 November 2016 RPCC Pharmacy Forum Issue 18 Calcium Channel Blocker Treatment with High Dose Insulin-Euglycemia Therapy in Overdose Special Interest Jessica Akin, Pharm. D. Candidate, 2017 Articles: Calcium channel blockers (CCBs) exert There are three main mechanisms of their therapeutic and toxic effects by the benefit for high-dose insulin-euglycemia • High Dose Insulin- direct blockade of L-type calcium therapy: increased inotropy, improved Euglycemia Therapy channels producing relaxation of the local microcirculation, and increased smooth muscle, with subsequent intracellular glucose and transport. The • Naloxone Kits vasodilation and in the case of verapamil primary goal of this therapy is to restore and diltiazem, inhibition of the sinoatrial hemodynamic stability. The major • Aczone (SA) and atrioventricular(AV)nodes. adverse effects associated with high-dose Calcium channel blockade provokes the insulin therapy are hypoglycemia and heart to switch into carbohydrate hypokalemia. Glucose concentrations metabolism as opposed to the free fatty should be regularly monitored and it is acid oxidation that occurs in the likely that supplementation of glucose will myocardium in a non-stressed state. be required throughout therapy and for up Calcium channel antagonism can also to 24 hours after discontinuation of high- Did you know? 2+ result in blockade of L-type Ca channels dose insulin. There is a shift of potassium located in the pancreas, inhibiting insulin from the extracellular to intracellular In the October 2016 secretion thus producing hyperglycemia. space rather than a decrease in total body issue of Pediatrics, The most common and life-threatening stores, which causes a change in serum finding in an acute CCB poisoning is potassium concentrations. The American hypotension, typically caused by a Academy of Pediatrics combination of bradycardia, decreased There are no official guidelines regarding inotropy, and peripheral vasodilation. the insulin dosing in CCB overdose, urged parents and Patients can also present asymptomatic however one of the most common and subsequently worsen rapidly to health care providers recommendations consists of a 1 unit/kg severe cardiogenic shock. bolus dose followed by a continuous to stop giving codeine infusion at 0.5-1 unit/kg per hour which High-dose insulin-euglycemia therapy, to children. Codeine is can be titrated to response. Insulin doses along with glucose supplementation, has up to 10 units/kg per hour have been converted to morphine emerged as an effective treatment for recommended. A healthcare professional calcium channel-blocker poisoning. Initial may want to consult with their local in the liver and “ultra- treatment is primarily supportive care Poison Center at 1-800-222-1222. A rapid metabolizers” including saline fluid resuscitation, which continuous dextrose infusion (0.5 is essential to correct vasodilation and low g/kg/hour) is also a common may experience cardiac filling pressures. Conventional recommendation for initiation. Blood severely slowed therapies such as atropine, calcium, and glucose should be checked every twenty glucagon may fail to improve the minutes during first hour, then can be breathing rates or hemodynamic status in severely poisoned checked hourly. The onset of high-dose even die after patients. The increased myocardial insulin-euglycemia therapy is around 15- oxygen demand that results from 60 minutes, but can be delayed for standard doses of vasopressors and catecholamines may be several hours. High-dose insulin therapy harmful in the setting of hypotension and should be continued until hemodynamic codeine. decreased coronary perfusion. stability is achieved. References 1. Woodward C, Pourmand A, Mazer-Amirshahi M. High dose insulin therapy, an evidence based approach to beta Laura Read RPh, CSPI blocker/calcium channel blocker toxicity.DARU Journal of Pharmaceutical Sciences. 2014;22(1):36. doi:10.1186/2008-2231-22-36 2. Engebretsen K, Kaczmarek K, Mogan J, Holger J. High-dose insulin therapy in beta-blocker and calcium channel- [email protected] blocker poisoning. Clinical Toxicology (15563650) [serial online]. April 2011;49 (4):277-283. Available from: Academic Search Premier, Ipswich, MA. (Accessed October 20, 2016). 3. Jang DH, DeRoos F. Calcium Channel Blockers. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank'sToxicologic Emergencies, 10e. New York, NY: McGraw-Hill; 2015.http://accesspharmacy.mhmedical.com.ezproxy.samford.edu/content.aspx?bookid=1163&Sectionid=6509637 6. (Accessed October 18, 2016). Page 2 of 3 Page 2 of 3 Naloxone Kits Available in Retail Pharmacies for the General Population Jordan Loper, Pharm. D. Candidate, 2017 Page 2 of 3 Naloxone is a pure opioid antagonist opioid addiction, and law enforcement that competes with and displaces or fire department personnel. It is opioids at opioid receptor sites. It is especially important to counsel used for the emergency treatment of patients who are purchasing naloxone known or suspected opioid overdose, on the proper administration of manifested by respiratory or CNS naloxone, as well as the opioid depression. Recently, there has been toxidrome that would signal that a push to make naloxone kits available someone has potentially overdosed. in retail pharmacies for the general The opioid toxidrome consists of CNS population to purchase and have on depression, respiratory depression, hand in the event of an opioid miosis, bradycardia, hypotension and overdose. In recent years, heroin and hypothermia. Furthermore, naloxone fentanyl overdoses have been on the has a very short duration of action (30- rise throughout the country. In 120 minutes depending on route of Jefferson County, there were 46 administration), so it is important that heroin deaths and 34 fentanyl deaths people know that in situations when between January 1 and June 30, naloxone is warranted, they still need 2016. Walgreens Pharmacy plans to to immediately seek medical treatment make naloxone available without a in a healthcare facility. If they do not “In Alabama prescription in 35 states by the end of seek medical attention, the naloxone the year, including Alabama. CVS will wear off and the person could specifically, recent Pharmacy made naloxone available in rapidly develop life-threatening laws have been 14 states. Some smaller chains and respiratory depression. passed that remove independent pharmacies also provide criminal and civil naloxone without a written There are two new FDA approved liability for prescription, based on their state’s naloxone products that are currently protocol. available, Narcan® nasal spray physicians, dentists, (4mg/0.1mL) and an auto-injector pharmacists, and Each state has the authority to pass called Evzio® (0.4mg/0.4mL).In nurses who laws about whether to sell naloxone October 2016, a new strength of Evzio administer or without a written prescription from a was approved by the FDA, physician. The sale of naloxone is 2mg/0.4mL, but it will not be available .” dispense naloxone available through either the state’s until early 2017. The difference in the collaborative practice agreement or concentrations of naloxone is due to through a standing order with a local differences in bioavailability among the physician. In Alabama specifically, different routes of administration. The recent laws have been passed that bioavailability of a drug delivered via remove criminal and civil liability for the nares will be less than that physicians, dentists, pharmacists, and delivered intramuscularly or nurses who administer or dispense intravenously, therefore, a larger dose naloxone. Furthermore, a layperson is is required. Narcan nasal spray has also immune to liability when they an onset of action of about 8-13 administer naloxone. minutes, while Evzio begins to work in 2-5 minutes. In recent years, the price The standing order in Alabama states of naloxone products has increased that naloxone can be sold without a exponentially due to increased prescription to patients who are at risk demand. At CVS, the cost of the of an opioid overdose, friends and injectable form is around $45, while family members of someone with an the nasal spray sells for $90. continued on page 3 Page 3 of 4 Continued from page 2 Under the standing order in Alabama, naloxone. These records must be kept pharmacists may dispense naloxone in by the pharmacy. The standing order a retail pharmacy via the following for naloxone will expire each year, but process. The requestor of naloxone can be renewed until it is approved as must complete a form stating the an over-the-counter medication. An factual basis for why they need the example of the standing order for naloxone and sign the form stating that Alabama can be found at the following they have been counseled. The website: pharmacist must provide basic http://c.ymcdn.com/sites/www.aparx.or instructions on how to recognize an g/resource/resmgr/Docs/NaloxoneStan opioid overdose and administer dingOrder.pdf naloxone. The pharmacist must also explain that once an opioid overdose has occurred the responder should call 911, begin rescue breathing, and administer References 1. Robinson, Carol. “Jeffco sees 25 heroin, Fentanyl deaths in June; 103 fatal overdoses so far in 2016.” The Birmingham News 11 July 2016: http://www.al.com/news/birmingham/index.ssf/2016/07/jeffco_sees_25_heroin_fentanyl.html .(Accessed October 18, 2016) 2. Lexicomp Online, Pediatric and Neonatal Lexi-Drugs Online, Hudson, Ohio: Wolters Kluwer Clinical Drug
Load more

Recommended publications
  • Folic Acid Antagonists: Antimicrobial and Immunomodulating Mechanisms and Applications
    International Journal of Molecular Sciences Review Folic Acid Antagonists: Antimicrobial and Immunomodulating Mechanisms and Applications Daniel Fernández-Villa 1, Maria Rosa Aguilar 1,2 and Luis Rojo 1,2,* 1 Instituto de Ciencia y Tecnología de Polímeros, Consejo Superior de Investigaciones Científicas, CSIC, 28006 Madrid, Spain; [email protected] (D.F.-V.); [email protected] (M.R.A.) 2 Consorcio Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina, 28029 Madrid, Spain * Correspondence: [email protected]; Tel.: +34-915-622-900 Received: 18 September 2019; Accepted: 7 October 2019; Published: 9 October 2019 Abstract: Bacterial, protozoan and other microbial infections share an accelerated metabolic rate. In order to ensure a proper functioning of cell replication and proteins and nucleic acids synthesis processes, folate metabolism rate is also increased in these cases. For this reason, folic acid antagonists have been used since their discovery to treat different kinds of microbial infections, taking advantage of this metabolic difference when compared with human cells. However, resistances to these compounds have emerged since then and only combined therapies are currently used in clinic. In addition, some of these compounds have been found to have an immunomodulatory behavior that allows clinicians using them as anti-inflammatory or immunosuppressive drugs. Therefore, the aim of this review is to provide an updated state-of-the-art on the use of antifolates as antibacterial and immunomodulating agents in the clinical setting, as well as to present their action mechanisms and currently investigated biomedical applications. Keywords: folic acid antagonists; antifolates; antibiotics; antibacterials; immunomodulation; sulfonamides; antimalarial 1.
    [Show full text]
  • Nitroaromatic Antibiotics As Nitrogen Oxide Sources
    Review biomolecules Nitroaromatic Antibiotics as Nitrogen Oxide Sources Review Allison M. Rice, Yueming Long and S. Bruce King * Nitroaromatic Antibiotics as Nitrogen Oxide Sources Department of Chemistry and Biochemistry, Wake Forest University, Winston-Salem, NC 27101, USA; Allison M. Rice , Yueming [email protected] and S. Bruce (A.M.R.); King [email protected] * (Y.L.) * Correspondence: [email protected]; Tel.: +1-336-702-1954 Department of Chemistry and Biochemistry, Wake Forest University, Winston-Salem, NC 27101, USA; [email protected]: Nitroaromatic (A.M.R.); [email protected] antibiotics (Y.L.) show activity against anaerobic bacteria and parasites, finding * Correspondence: [email protected]; Tel.: +1-336-702-1954 use in the treatment of Heliobacter pylori infections, tuberculosis, trichomoniasis, human African trypanosomiasis, Chagas disease and leishmaniasis. Despite this activity and a clear need for the Abstract: Nitroaromatic antibiotics show activity against anaerobic bacteria and parasites, finding usedevelopment in the treatment of new of Heliobacter treatments pylori forinfections, these conditio tuberculosis,ns, the trichomoniasis, associated toxicity human Africanand lack of clear trypanosomiasis,mechanisms of action Chagas have disease limited and their leishmaniasis. therapeutic Despite development. this activity Nitroaro and a clearmatic need antibiotics for require thereductive development bioactivation of new treatments for activity for theseand this conditions, reductive the associatedmetabolism toxicity can convert
    [Show full text]
  • Which Antibiotics for UTI?
    RESEARCH HIGHLIGHTS INFECTION PROSTATE CANCER Which antibiotics Surfaceome profiling for NEPC for UTI? target antigens Prostate adenocarcinoma and was enriched in NEPC. Comparison A multinational, open-label, analyst- blinded, randomized neuroendocrine prostate cancer of the genes to identify molecular clinical trial has shown that 5-day nitrofurantoin is more (NEPC) have distinct surfaceomes, functions showed that those enriched likely to result in clinical and microbiological resolution of which can be used to discriminate in NEPC were related to neural acute, uncomplicated lower urinary tract infection (UTI) than between the subtypes and might provide function, including synaptic signalling, single- dose fosfomycin. These results could influence future target antigens for immunotherapy. nervous system development, treatment decisions for managing UTI. The advent of CAR T cell therapy and neurotransmitter transport, This study included 513 women aged >18 years who were shows the potential of targeting whereas those of adenocarcinoma not pregnant and had at least one symptom of acute lower UTI treatment to cell-surface markers. were involved in secretion, immune (including dysuria, urgency, frequency, and/or suprapubic However, identifying target antigens response, and inflammatory response, tenderness), a positive urine dipstick test, and no known in prostate tumours — NEPC in enabling differentiation of the subtypes. colonization or previous infection with antibiotic-resistant particular — is problematic, as markers RNA sequencing (RNA- seq) uropathogens. Participants were randomly assigned 1:1 to upregulated in adenocarcinoma gene expression analysis of receive 100 mg nitrofurantoin orally three times a day for 5 days are often downregulated in human prostate cancer cell lines or 3 g fosfomycin orally as a single dose.
    [Show full text]
  • The Nitroimidazole Family of Drugs
    Br J Vener Dis: first published as 10.1136/sti.54.2.69 on 1 April 1978. Downloaded from British Journal of Venereal Diseases, 1978, 54, 69-71 Editorial The nitroimidazole family of drugs In 1955 an antibiotic complex isolated from a operative infection caused by susceptible anaerobes, strain of Streptomyces on the island of Reunion particularly in gynaecological surgery, appendi- was found by research workers of Rhone-Poulenc in cectomy, and colonic surgery. Paris to contain a trichomonacidal antibiotic- Real innovations in chemotherapy, such as azomycin. It had previously been isolated in Japan metronidazole, always attract attention from other (Maeda et al., 1953) and identified as 2-nitroimi- research groups. Although interest was slow to dazole (Ia see Table) (Nakamura, 1955). At the develop, research workers have sought analogous, time, and for some years after, this remarkably structurally-modified compounds which might afford simple compound defied synthesis, but it stimulated some advantage in clinical use-for example, the workers at Rhone-Poulenc to prepare and test greater potency, better tolerance and freedom from the activity of the more readily accessible isomeric side effects, a broader spectrum of action, a longer 5-nitroimidazoles (II). It was their good fortune in duration of action, or in some other characteristic. 1957 to find that these isomers were more active This effort has been concerned with important antiprotozoal agents than the natural product veterinary uses of 5-nitroimidazoles as well as the (Cosar and Julou, 1959). In a series of 150 related applications in human medicine. compounds, the one with a P-hydroxyethyl group Metronidazole has been a difficult target to in the 1-position gave the best compromise between improve upon, but several other drugs of this activity and toxicity and this brand of metroni- chemical family have been introduced to clinical dazole was introduced as Flagyl.
    [Show full text]
  • WHO Report on Surveillance of Antibiotic Consumption: 2016-2018 Early Implementation ISBN 978-92-4-151488-0 © World Health Organization 2018 Some Rights Reserved
    WHO Report on Surveillance of Antibiotic Consumption 2016-2018 Early implementation WHO Report on Surveillance of Antibiotic Consumption 2016 - 2018 Early implementation WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation ISBN 978-92-4-151488-0 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons. org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non- commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data.
    [Show full text]
  • Fosfomycin Drug Review
    THE NEBRASKA MEDICAL CENTER FOSFOMYCIN: REVIEW AND USE CRITERIA BACKGROUND Fosfomycin is a phosphonic acid derivative, which inhibits peptidoglycan assembly, thereby disrupting cell wall synthesis.1 Its uptake into the bacterial cell occurs via active transport, by the L-α-glycerophosphate transport and hexose phosphate uptake systems. Once inside the bacteria, it competes with phosphoenolpyruvate to irreversibly inhibit the enzyme enolpyruvyl transferase that catalyzes the first step of peptidoglycan synthesis.1,2 By irreversibly blocking this enzyme, cell wall synthesis is interrupted. Fosfomycin also decreases bacteria adherence to uroepithelial cells. Fosfomycin has been approved by the Food and Drug Administration (FDA) for the treatment of uncomplicated urinary tract infection (UTI) in adult women that is caused by Escherichia coli and Enterococcus faecalis.2 Oral fosfomycin has also been used for non-FDA approved indication such as complicated UTI without bacteremia. Intravenous fosfomycin, which is not available in the US, has also been used for a variety of infections including meningitis, pneumonia, and pyelonephritis.2 Fosfomycin does not have an indication for the treatment of pyelonephritis or perinephric abscess.2,3 Fosfomycin has broad spectrum of activity against aerobic gram positive and gram negative pathogens. It was shown in vitro and in clinical studies, to have activity against ≥90% of strains of E. coli, Citrobacter diversus, C. freundii, Klebsiella oxytoca, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, P. vulgaris, Providencia rettgeri, Pseudomonas aeruginosa, E. faecalis and E. faecium [including vancomycin resistant (VRE)] species, and Staphylococcus aureus [including Methicillin resistant Staphylococcus aureus (MRSA)] associated with UTI.2,3 Currently, the Clinical and Laboratory Standards Institute (CLSI) susceptibility breakpoints exist only for E.
    [Show full text]
  • Nitrofurantoin in Urinary Tract Infection: Old Is Gold Jayashree Konar, Indrani Bhattacharyya*, Sipra Saha, Dipankar Paul, Sourav Maiti and Gargi Bhattacharya
    American Journal of Advanced Drug Delivery www.ajadd.co.uk Original Article Nitrofurantoin in Urinary Tract Infection: Old is Gold Jayashree Konar, Indrani Bhattacharyya*, Sipra Saha, Dipankar Paul, Sourav Maiti and Gargi Bhattacharya Department of Microbiology, Calcutta School of Tropical Medicine, Kolkata Date of Receipt- 16/6/2014 ABSTRACT Date of Revision- 19/6/2014 Date of Acceptance- 28/6/2014 Objective of the study was to find out the Resistogram of the urinary isolates against different commonly prescribed antimicrobials according to CLSI guidelines. Out of total 319 test samples, in 56 cases bacterial pathogens were isolated. Among those 56 isolates only 13 were resistant to Nitrofurantoin (23.21%) where as resistance to Ciprofloxacin was found in 40 isolates(71.42%), resistance against Co-Trimoxazole was found in 27 isolates (48.21%) and surprisingly, resistance against Carbapenem antibiotics (Meropenem) was in 20 isolates (35.71%). Majority of the Nitrofurantoin resistant bacterial isolates were Klebsiella pneumoniae (4 out of 13 i.e, 30.76%). All Nitrofurantoin resistant isolates were sensitive to both Tigecycline Address for and Colistin and the isolated Escherichia coli (two in number) were Correspondence sensitive to Meropenem also. There were no other therapeutic options Department of like Fluroquinolones or Co-trimoxazole to manage the Nitrofurantoin Microbiology, Calcutta resistant isolates as all of them were resistant to them. Thus medical School of Tropical community should think twice before replacing Nitrofurantoin with Medicine, Kolkata Fluroquinolones or Co-Trimoxazoles as emperical therapy. E-mail: indranichaudhuri Keywords : Emperical Therapy, Nitrofurantoin, Resistogram, @yahoo.com Sensitive, UTI. INTRODUCTION Urinary tract infection (UTI) is one by damaging bacterial DNA, since its of the most common health problems in the reduced form is highly reactive.
    [Show full text]
  • Trend Analysis of Antibiotics Consumption Using WHO Aware Classification in Tertiary Care Hospital
    International Journal of Basic & Clinical Pharmacology Bhardwaj A et al. Int J Basic Clin Pharmacol. 2020 Nov;9(11):1675-1680 http:// www.ijbcp.com pISSN 2319-2003 | eISSN 2279-0780 DOI: https://dx.doi.org/10.18203/2319-2003.ijbcp20204493 Original Research Article Trend analysis of antibiotics consumption using WHO AWaRe classification in tertiary care hospital Ankit Bhardwaj*, Kaveri Kapoor, Vivek Singh Saraswathi institute of Medical Sciences, Pilakhuwa, Hapur, Uttar Pradesh, India Received: 21 August 2020 Accepted: 21 September 2020 *Correspondence: Dr. Ankit Bhardwaj, Email: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Aim of the study was to assess trend in antibiotics consumption pattern from 2016 to 2019 using AWaRe classification, ATC and Defined daily dose methodology (DDD) in a tertiary care hospital. Antibiotics are crucial for treating infectious diseases and have significantly improved the prognosis of patients with infectious diseases, reducing morbidity and mortality. The aim of the study is to classify the antibiotic based on WHO AWaRe classification and compare their four-year consumption trends. The study was conducted at a tertiary care center, Pilakhuwa, Hapur. Antibiotic procurement data for a period of 4 years (2016-2019) was collected from the Central medical store. Methods: This is a retrospective time series analysis of systemic antibiotics with no intervention at patient level. Antibiotic procurement was taken as proxy for consumption assuming that same has been used.
    [Show full text]
  • Antimicrobial Resistance in Bacteria
    Cent. Eur. J. Med. • 4(2) • 2009 • 141-155 DOI: 10.2478/s11536-008-0088-9 Central European Journal of Medicine Antimicrobial resistance in bacteria Review Article Katrijn Bockstael*, Arthur Van Aerschot** Laboratory for Medicinal Chemistry, Rega Institute for Medical Research, Katholieke Universiteit Leuven, 3000 Leuven, Belgium Received 9 July 2008; Accepted 17 November 2008 Abstract: The development of antimicrobial resistance by bacteria is inevitable and is considered as a major problem in the treatment of bacterial infections in the hospital and in the community. Despite efforts to develop new therapeutics that interact with new targets, resistance has been reported even to these agents. In this review, an overview is given of the many therapeutic possibilities that exist for treatment of bacterial infections and how bacteria become resistant to these therapeutics. Keywords: Antimicrobial agents • Resistance development • Efflux • Alteration of drug target • Antibacterials © Versita Warsaw and Springer-Verlag Berlin Heidelberg. 1. Introduction 2. Different mechanisms of resistance to antimicrobials The history of humankind can be regarded from a medical point of view as a struggle against infectious 2.1. Intrinsic resistance diseases. Infections were the leading cause of death Bacteria may be inherently resistant to an antimicrobial. th worldwide at the beginning of the 20 century. Since This passive resistance is a consequence of general the discovery of penicillin by Alexander Fleming in adaptive processes that are not necessary linked to a 1929 and the first introduction of the sulpha drugs by given class of antimicrobials. An example of natural Domagk in 1932, the number of new antimicrobials resistance is Pseudomonas aeruginosa, whose low available has increased tremendously between 1940 membrane permeability is likely to be a main reason for and 1960.
    [Show full text]
  • Nitrofurantoin Peripheral Neuropathy
    RxFiles Q&A Summary MARLYS LEBRAS PHARMD - www.RxFiles.ca - March 2017 What is the risk of peripheral neuropathy with nitrofurantoin (MACROBID)? BOTTOMLINE Nitrofurantoin-associated peripheral neuropathy is rare & has been reported in both cystitis tx and prophylaxis settings. Majority of cases are reported in patients receiving therapy for longer than 5 days (recommended duration for cystitis txIDSA). The absolute incidence of nitrofurantoin-associated peripheral toxicity is unknown due to limited data (e.g., reporting of exposure, comorbidities). Based on health region/authority-level cohort data the risk of peripheral neuropathy is neutral to 1 case in 200 nitrofurantoin courses (average duration 7-9 days). Based on population-level pharmacovigilance data the risk of peripheral neuropathy is 1 case in ~150,000 nitrofurantoin courses (average duration not reported). Risk appears greater as age increases. If Rxing nitrofurantoin for acute cystitis treatment: Instruct patient to report tingling, prickling, numbness or abnormal sensations in the extremities. Nitrofurantoin is not recommended as 1st line therapy for recurrent cystitis prophylaxis due to the risk of adverse events, including peripheral neuropathy, which can lead to permanent impairment in chronic users (see also: RxFiles Risk of Pulmonary Toxicity with Nitrofurantoin Q&A). If prescribing nitrofurantoin for recurrent cystitis prophylaxis: Instruct patient to report tingling, prickling, numbness or abnormal sensations in the extremities. Reassess nitrofurantoin’s indication at 6-12 month. Stop nitrofurantoin if the patient develops a UTI while on prophylaxis. If you suspect neuropathy: Discontinue nitrofurantoin. May trial neuropathic pain agents to treat symptoms. BACKGROUND1-17 While there is extensive clinical experience with nitrofurantoin, its overall safety profile is somewhat unclear, as it was approved by the FDA in 1953 prior to robust drug development requirements.
    [Show full text]
  • Guidelines on Urological Infections
    Guidelines on Urological Infections M. Grabe (Chairman), T.E. Bjerklund-Johansen, H. Botto, M. Çek, K.G. Naber, P. Tenke, F. Wagenlehner © European Association of Urology 2010 TABLE OF CONTENTS PAGE 1. INTRODUCTION 7 1.1 Pathogenesis of urinary tract infections 7 1.2 Microbiological and other laboratory findings 7 1.3 Classification of urological infections 8 1.4 Aim of guidelines 8 1.5 Methods 9 1.6 Level of evidence and grade of guideline recommendations 9 1.7 References 9 2. UNCOMPLICATED URINARY TRACT INFECTIONS IN ADULTS 11 2.1 Definition 11 2.1.1 Aetiological spectrum 11 2.2 Acute uncomplicated cystitis in premenopausal, non-pregnant women 11 2.2.1 Diagnosis 11 2.2.1.1 Clinical diagnosis 11 2.2.1.2 Laboratory diagnosis 11 2.2.2 Therapy 11 2.2.3 Follow up 12 2.3 Acute uncomplicated pyelonephritis in premenopausal, non-pregnant women 12 2.3.1 Diagnosis 12 2.3.1.1 Clinical diagnosis 12 2.3.1.2 Laboratory diagnosis 12 2.3.1.3 Imaging diagnosis 13 2.3.2 Therapy 13 2.3.2.1 Mild and moderate cases of acute uncomplicated pyelonephritis 13 2.3.2.2 Severe cases of acute uncomplicated pyelonephritis 13 2.3.3 Follow-up 14 2.4 Recurrent (uncomplicated) UTIs in women 16 2.4.1 Diagnosis 16 2.4.2 Prevention 16 2.4.2.1 Antimicrobial prophylaxis 16 2.4.2.2 Immunoactive prophylaxis 16 2.4.2.3 Prophylaxis with probiotics 17 2.4.2.4 Prophylaxis with cranberry 17 2.5 Urinary tract infections in pregnancy 17 2.5.1 Definition of significant bacteriuria 17 2.5.2 Screening 17 2.5.3 Treatment of asymptomatic bacteriuria 17 2.5.4 Duration of therapy 18 2.5.5 Follow-up 18 2.5.6 Prophylaxis 18 2.5.7 Treatment of pyelonephritis 18 2.5.8 Complicated UTI 18 2.6 UTIs in postmenopausal women 18 2.6.1 Risk factors 18 2.6.2 Diagnosis 18 2.6.3 Treatment 18 2.7 Acute uncomplicated UTIs in young men 19 2.7.1 Men with acute uncomplicated UTI 19 2.7.2 Men with UTI and concomitant prostate infection 19 2.8 Asymptomatic bacteriuria 19 2.8.1 Diagnosis 19 2.8.2 Screening 19 2.9 References 26 3.
    [Show full text]
  • Antibiotic Resistance Pattern of Urine Culture Isolates from Patients with Community Acquired UTI
    Original Research Article Antibiotic resistance pattern of urine culture isolates from patients with community acquired UTI Chandan Kumar1, Kiran H S2* 1Ex-Intern, Department of Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, INDIA. 2Associate Professor, Department of Internal Medicine, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, INDIA. Email: [email protected] Abstract Background: Urinary tract infections (UTI) are among the most common infections in outpatients and in-patients. In almost all cases, empirical antibiotic treatment is started before the results of urine culture are available. For this reason, knowledge of the causative agents of UTIs and their antibiotic resistance patterns in specific institutional settings and geographical areas may help clinicians in choosing the appropriate empirical antimicrobial treatment. The data will also help antibiotic stewardship policies of the hospital. The objective of this study was to determine the Antibiotic resistance pattern of urine culture isolates from patients with UTI (Community acquired). Materials and Methods: The study included adult subjects above 18 years who came to OPD with symptoms of UTI (dysuria, frequency, urgency and suprapubic tenderness with or without fever) and/or patients in whom physicians suspected Uncomplicated Community acquired UTI. Urine samples were processed in Microbiology Laboratory for Microscopy and Culture Identification and Antibiotic Susceptibility Test by VITEK COMPACT 2 method. Results: The total number of patients was 50. 31 (62%) were males and 19 (38%) were females. The commonest organism to be isolated was E. coli (72%) followed by Klebsiella pneumoniae (18%), Citrobacter koseri (4%), Pseudomonas aeruginosa (2%), Serratia marcescens (2%) and Enterobacter cloacae (2%). Resistance to Ampicillin, Cefuroxime axetil, and Ciprofloxacin was high.
    [Show full text]