DOCSLIB.ORG

Linezolid and Clindamycin Improve the Outcome of Severe, Necrotizing

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Linezolid and Clindamycin Improve the Outcome of Severe, Necrotizing Le Infezioni in Medicina, n. 1, 42-44, 2011 Casi clinici Linezolid and clindamycin improve the outcome of Case reports severe, necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) L’associazione di linezolid e clindamicina migliora la prognosi delle gravi polmoniti necrotizzanti da Staphylococcus aureus meticillino-resistente di comunità (CA-MRSA) Laura Soavi 1, Liana Signorini 2, Roberto Stellini 2, Annamaria Acquarolo 3, Bertilla Fiorese 2, Silvia Magri 2, Annalisa Pantosti 4, Fredy Suter 1, Giampiero Carosi 2 1U.S.C. Malattie Infettive, Ospedali Riuniti di Bergamo, Bergamo, Italy; 2Istituto di Malattie Infettive e Tropicali, Spedali Civili di Brescia, Brescia, Italy; 3Dipartimento di Anestesia e Rianimazione, Spedali Civili di Brescia, Brescia, Italy; 4Dipartimento di Malattie Infettive, Parassitarie ed Immuno-mediate, Istituto Superiore di Sanità, Rome, Italy n INTRODUCTION tibiotics have different effects on the expression of staphylococcal toxins. Linezolid and clin - ethicillin-resistant Staphylococcus aureus damycin markedly suppress PVL production in (MRSA) is a major cause of nosocomial MRSA, whereas nafcillin and vancomycin stim - Minfection. The emergence of MRSA as a ulate continued PVL expression [5]. cause of life-threatening, invasive infections in the We here report a case of CA-MRSA necrotizing community in patients who never had healthcare pneumonia and septic shock, in which patient’s contacts is a recent, important public health prob - outcome was strongly influenced by the choice lem [1]. Such infections include, among others, of antibiotic therapy, providing clinical support septic shock and necrotizing pneumonia, which is to the findings of in vitro studies. rapidly progressive, haemorrhagic and often fatal (mortality rate: 60-75%) [2, 3]. The high virulence potential of CA-MRSA is as - n CASE REPORT sociated with the production of the Panton- Valentine leukocidin (PVL), a toxin that creates A previously healthy, caucasian, 49-year-old lytic pores in cells membranes of neutrophils woman became ill with fever and productive and induces release of neutrophil pro-inflam - cough on January 1 st , 2008. The next days her matory chemotactic factors which, in turn, symptoms worsened and, on January 6 th , she cause widespread tissue necrosis [4]. was taken to our Emergency Department (ED) A recent in vitro study evaluating the effect of in respiratory distress. On examination, she had vancomycin, nafcillin, clindamycin and linezol - a temperature of 38.5°C, an oxygen saturation of id on clinical isolates of Methicillin-susceptible 90% on room air, a blood pressure of 160/90 S. aureus (MSSA) and MRSA has shown that an - mmHg, a hearth rate of 86 beats per minute and 42 2011 tericin B-liposomal were replaced by van - comycin, rifampin and caspofungin. Four days thereafter, her lung oxygenation and haemody - namic parameters worsened, and chest X-ray re - vealed widespread bilateral alveolar infiltrates with multiple cavities in the upper right lobe. Doses of inotropes were increased and antibiot - ic therapy was changed: linezolid and clin - damycin replaced vancomycin and rifampin, caspofungin was continued. The patient’s con - dition progressively improved: she rapidly be - came afebrile, arterial blood gases, as well as leukocyte and platelet count, CRP and procalci - tonin, returned to normal values. On January 20 th , CVVH and mechanical ventilation were Figura 1 - CT scan of the thorax shows bilateral pul - discontinued and, after 5 more days, antibiotic monary infiltrates with one small cavitary lesion in therapy was stopped. the inferior, left lobe and enlargement of mediasti - nal lymph nodes. The patient was discharged on day 72: she is currently healthy with complete recovery of respiratory function. a respiratory rate of 35 breaths per minute. Ar - terial blood gases revealed a pH of 7.429, a PaO 2 of 57 mmHg and a PaCO 2 of 37 mmHg. Blood n DISCUSSION exams showed a creatinine of 1.4 mg/dl and a pro-inflammatory state (leukocyte count 13110 In the patient we described, the finding of lung cells/ µl, CRP 270 mg/l, procalcitonin 128.2 necrosis was consistent with the production of ng/ml). A CT scan revealed bilateral multiple PVL, later confirmed by PCR. We observed a alveolar infiltrates in all lung fields with a small clear relationship between different antibiotic cavitary lesion and enlargement of mediastinal regimens and clinical conditions of the patient, lymph nodes (Figure 1). She was started on in that ampicillin-sulbactam and vancomycin ampicillin-sulbactam and amphotericin B-lipo - were associated with worsening of respiratory somal. The patient worsened, failed to respond function and pulmonary infiltrates, whereas to oxygen supplementation and was admitted resolution of pneumonia was achieved only af - to the intensive care unit (ICU), where she was ter starting two toxin-suppressing agents, clin - intubated and put on mechanical ventilation. damycin and linezolid. Within hours, she became hypotensive, requir - The main reasons that explain why beta-lac - ing inotropic support, and developed pancy - tams and glycopeptides may fail in infections topenia (leukocyte count 3400 cells/ µl, platelet associated with toxin-producing organisms are count 95000/ µl) with multi-organ failure (MOF) that these cell-wall-active agents, in contrast to requiring continuous veno-venous hemofiltra - protein-synthesis inhibitors, do not suppress tion (CVVH). Because of septic shock, hydrocor - toxin production and that lysis of the bacteria tisone was added to the antimicrobial treatment. increases the release of intracellular toxins [5]. Bronchoscopy was performed, which showed These data suggest that, for treatment of MRSA abundant white secretions covering an edema - strains producing potent extracellular toxins, tous bronchial mucosa with focal necrosis and linezolid and clindamycin demonstrate a clear mild bleeding. On day 2, broncho-alveolar advantage over vancomycin. Linezolid, more - lavage (BAL) cultures were reported as growing over, has an excellent lung tissue penetration, S. aureus (>5 x 10 6 CFU/ml), later referred as which is approximately 6 times higher than that MRSA, and Aspergillus fumigatus . Antibiotic of vancomycin [6, 7]. therapy was immediately modified and linezol - Starting early appropriate antibiotic treatment id and levofloxacin were started, while continu - is considered essential to ensure a favourable ing liposomal amphotericin B. After 3 days of outcome, and highlights the importance of sus - therapy, while the clinical conditions of the pa - pecting CA-MRSA in previously healthy pa - tient seemed to improve, platelet count dropped tients presenting to ED with severe respiratory to 29000/ µl. Linezolid, levofloxacin and ampho - illness, especially when associated with pul - 43 2011 monary necrosis, septic shock, high fever, Key words: CA-MRSA, pneumonia, Panton-Va - haemoptysis and leucopoenia [8]. lentine leukocidin (PVL), linezolid, clindamy - Unlike the American counterpart, the latest Eu - cin ropean guidelines on CAP management do not take in consideration potential occurrence of Acknowledgements CA-MRSA [9, 10]. We believe that there is the The authors thank Dr. Alberto Matteelli for his crit - case to review them now. Surveillance of com - ical comments and his precious suggestions. munity acquired S. aureus and optimal treat - ment strategies are also required. Potential conflicts of interest: none declared. SUMMARY The last decade has been characterized by the septic shock caused by CA-MRSA, in which early emergence of CA-MRSA strains associated with recognition of the syndrome and appropriate treat - the production of Panton-Valentine leukocidin. ment with two toxin-suppressing antibiotics im - We report a case of necrotizing pneumonia and proved the patient’s outcome. RIASSUNTO Nell’ultimo decennio si è osservato un progressivo au - shock settico da CA-MRSA, in cui la diagnosi precoce e mento nell’incidenza di gravi infezioni causate da ceppi la terapia di associazione con antibiotici entrambi in di CA-MRSA associati alla produzione della leucocidi - grado di inibire la sintesi proteica (quindi anche la sin - na di Panton-Valentine. tesi della leucocidina) hanno determinato la pronta riso - Riportiamo un caso clinico di polmonite necrotizzante e luzione dell’infezione. n REFERENCES [6] Boselli E., Breilh D., Rimmelé T., et al. Pharmaco - kinetics and intrapulmonary concentrations of line - [1] Deresinski S. Methicillin-resistant Staphylococcus zolid administered to critically ill patients with ven - aureus : an evolutionary, epidemiologic and thera - tilator-associated pneumonia. Crit. Care Med. 33, 7, peutic odyssey. Clin. Infect. Dis. 40, 562-573, 2005. 1529-1533, 2005. [2] Lina G., Piémont Y., Godail-Gamot F., et al. In - [7] Kollef M.H. Limitations of vancomycin in the volvement of Panton-Valentine leukocidin-produc - management of resistant staphylococcal infections. ing Staphylococcus aureus in primary skin infections Clin. Infect. Dis. 45, S191-S195, 2007. and pneumonia. Clin. Infect. Dis . 29, 1128-1132, 1999. [8] The Center for Disease Control and Prevention. [3] Gillet Y., Issartel B., Vanhems P., et al. Association Four pediatric deaths from community-acquired me - between Staphylococcus aureus strains carrying genes thicillin-resistant Staphylococcus aureus - Minnesota for Panton-Valentine leukocidin and highly lethal and North Dakota, 1997-1999. JAMA 282, 1123-1125, necrotizing pneumonia in young
Load more

Recommended publications
  • Antibiotic Practice Change to Curtail Linezolid Use in Pediatric Hospitalized Patients in Hawai‘I with Uncomplicated Skin and Soft Tissue Infections
    Antibiotic Practice Change to Curtail Linezolid Use in Pediatric Hospitalized Patients in Hawai‘i with Uncomplicated Skin and Soft Tissue Infections Cheryl Okado MD and Tori Teramae BS Abstract MRSA coverage, clindamycin became a widely-used antibi- otic for treating uncomplicated SSTIs in children. Following Antimicrobial resistance affects health care providers’ choice of antibiotics increasing clindamycin use, increasing clindamycin resistance in the treatment of skin and soft tissue infections (SSTIs). Based on local was soon noted, particularly in MRSA isolates.2 Prior to 2010, antibiotic susceptibility data showing high clindamycin resistance and high MRSA predominance appeared to peak, and since then it has MRSA prevalence, a change in antibiotic regimen for children hospitalized for 3 uncomplicated SSTIs was instituted in an attempt to curb the use of linezolid. been decreasing. The prevalence of clindamycin-resistant GAS A retrospective chart review was performed on 278 pediatric patients with has been known to vary with time and location with US rates uncomplicated SSTIs hospitalized at Kapi‘olani Medical Center for Women ranging from 4%-41% since the early 2000s.4 and Children in Hawai‘i from May 2014 to April 2015 and November 2015 to October 2016. Data consisted of 12 months of baseline data and 12 In Hawai‘i, methicillin and clindamycin resistance patterns of months of data post-implementation of an antibiotic combination regimen of SA initially followed similar increasing trends. Antibiograms 2 widely-used antibiotics: high-dose cefazolin and high-dose clindamycin. at Hawai‘i’s children’s hospital, Kapi‘olani Medical Center for Practitioners were encouraged to use cefazolin alone if clinical suspicion was high for single-organism infection with group A streptococcus.
    [Show full text]
  • Drug News Nov Issue 25
    D r u g N e w s 藥 物 情 報 Issue No. 25 : November 2011 This is a monthly digest of local and overseas drug safety news and information released in the previous month. For the latest news and information, please refer to public announcements or the website of the Drug Office of the Department of Health (http://www.drugoffice.gov.hk). Safety Update US: Updated information about drug Canada and FDA released similar alerts on the interaction of Zyvox (linezolid) and interaction between methylene blue and serotonin Methylene Blue with serotonergic reuptake inhibitors. At the same time, FDA also released alert on the interaction between linezolid psychiatric medications and serotonin reuptake inhibitors. The news had 20 October 2011 – The Food and Drug been reported in Issue No. 17 and 22 of Drug News Administration (FDA) provided additional respectively. In addition, the Department of Health information about the possible serotonin syndrome (DH) issued press statement on 18 February 2011 in patients taking serotonergic psychiatric and letters were also sent to healthcare professionals medications and linezolid/ methylene blue. It was in February 2011 and July 2011. found that not all serotonergic psychiatric drugs had The product certificate holders of the an equal capacity to cause serotonin syndrome with pharmaceutical products containing methylene blue, use of linezolid/ methylene blue. According to the linezolid and serotonergic psychiatric medications FDA's Adverse Event Reporting System (AERS), have been requested to update the sales pack and/or most cases of serotonin syndrome with linezolid or package insert of these products to include methylene blue occurred in patients taking specific information about the potential drug interactions.
    [Show full text]
  • Treatment of Drug-Resistant Tuberculosis an Official ATS/CDC/ERS/IDSA Clinical Practice Guideline Payam Nahid, Sundari R
    AMERICAN THORACIC SOCIETY DOCUMENTS Treatment of Drug-Resistant Tuberculosis An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline Payam Nahid, Sundari R. Mase, Giovanni Battista Migliori, Giovanni Sotgiu, Graham H. Bothamley, Jan L. Brozek, Adithya Cattamanchi, J. Peter Cegielski, Lisa Chen, Charles L. Daley, Tracy L. Dalton, Raquel Duarte, Federica Fregonese, C. Robert Horsburgh, Jr., Faiz Ahmad Khan, Fayez Kheir, Zhiyi Lan, Alfred Lardizabal, Michael Lauzardo, Joan M. Mangan, Suzanne M. Marks, Lindsay McKenna, Dick Menzies, Carole D. Mitnick, Diana M. Nilsen, Farah Parvez, Charles A. Peloquin, Ann Raftery, H. Simon Schaaf, Neha S. Shah, Jeffrey R. Starke, John W. Wilson, Jonathan M. Wortham, Terence Chorba, and Barbara Seaworth; on behalf of the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America THIS OFFICIAL CLINICAL PRACTICE GUIDELINE WAS APPROVED BY THE AMERICAN THORACIC SOCIETY, THE EUROPEAN RESPIRATORY SOCIETY, AND THE INFECTIOUS DISEASES SOCIETY OF AMERICA SEPTEMBER 2019, AND WAS CLEARED BY THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION SEPTEMBER 2019 Background: The American Thoracic Society, U.S. Centers for was judged to be very low, because the data came Disease Control and Prevention, European Respiratory Society, and from observational studies with significant loss to follow-up Infectious Diseases Society of America jointly sponsored this new and imbalance in background regimens between comparator practice guideline on the treatment of drug-resistant tuberculosis groups. Good practices in the management of MDR-TB are (DR-TB). The document includes recommendations on the described. On the basis of the evidence review, a clinical strategy treatment of multidrug-resistant TB (MDR-TB) as well as tool for building a treatment regimen for MDR-TB is also isoniazid-resistant but rifampin-susceptible TB.
    [Show full text]
  • Frequently Asked Questions on The
    Frequently asked questions on the WHO treatment guidelines for isoniazid-resistant tuberculosis Version: 24 April 2018 The advice in this document has been prepared by the Global TB Programme of the World Health Organization (WHO) and is to be read alongside the WHO treatment guidelines for isoniazid-resistant tuberculosis and its online annexes. See Further reading ​ ​ at end for additional resources. Who are the new WHO treatment guidelines for isoniazid-resistant tuberculosis intended for ? ​ ​ The WHO treatment guidelines for isoniazid-resistant tuberculosis are targeted at health care ​ professionals (doctors, nurses) and other staff involved in TB care in both low and high resource settings. The possibility of drug-resistant disease now needs to be entertained whenever treating TB patients. These guidelines provide technical detail which is helpful in making the best-informed decision in clinical practice and programme management. The answers to the frequently asked questions (FAQ) in this document intend to help implementers with common, practical issues that arise when adopting the new guidance. This document complements the WHO guidelines by elaborating further on certain aspects of ​ implementation that were beyond the scope of the guideline itself. What are the main recommendations of these new guidelines ? The new guidelines recommend that patients with confirmed isoniazid-resistant and rifampicin susceptible tuberculosis (abbreviated to Hr-TB) are treated for 6 months with a regimen composed of ​ ​ rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin (Lfx). The exclusion of rifampicin resistance ahead of start of this regimen is critical. It is further recommended not to add streptomycin (S) or other injectable agents to the treatment regimen.
    [Show full text]
  • Medications to Be Avoided Or Used with Caution in Parkinson's Disease
    Medications To Be Avoided Or Used With Caution in Parkinson’s Disease This medication list is not intended to be complete and additional brand names may be found for each medication. Every patient is different and you may need to take one of these medications despite caution against it. Please discuss your particular situation with your physician and do not stop any medication that you are currently taking without first seeking advice from your physician. Most medications should be tapered off and not stopped suddenly. Although you may not be taking these medications at home, one of these medications may be introduced while hospitalized. If a hospitalization is planned, please have your neurologist contact your treating physician in the hospital to advise which medications should be avoided. Medications to be avoided or used with caution in combination with Selegiline HCL (Eldepryl®, Deprenyl®, Zelapar®), Rasagiline (Azilect®) and Safinamide (Xadago®) Medication Type Medication Name Brand Name Narcotics/Analgesics Meperidine Demerol® Tramadol Ultram® Methadone Dolophine® Propoxyphene Darvon® Antidepressants St. John’s Wort Several Brands Muscle Relaxants Cyclobenzaprine Flexeril® Cough Suppressants Dextromethorphan Robitussin® products, other brands — found as an ingredient in various cough and cold medications Decongestants/Stimulants Pseudoephedrine Sudafed® products, other Phenylephrine brands — found as an ingredient Ephedrine in various cold and allergy medications Other medications Linezolid (antibiotic) Zyvox® that inhibit Monoamine oxidase Phenelzine Nardil® Tranylcypromine Parnate® Isocarboxazid Marplan® Note: Additional medications are cautioned against in people taking Monoamine oxidase inhibitors (MAOI), including other opioids (beyond what is mentioned in the chart above), most classes of antidepressants and other stimulants (beyond what is mentioned in the chart above).
    [Show full text]
  • Serotonin Syndrome Due to Co-Administration of Linezolid and Methadone
    Le Infezioni in Medicina, n. 3, 263-266, 2017 CASE REPORT 263 Serotonin syndrome due to co-administration of linezolid and methadone Antonio Mastroianni1, Gianfranco Ravaglia2 1U.O. Malattie Infettive, Presidio Ospedaliero, “G.B. Morgagni - L. Pierantoni”, Forlì, Italy; 2U.O. Farmacia, Presidio Ospedaliero “G.B. Morgagni - L. Pierantoni”, Forlì, Italy SUMMARY Serotonin syndrome (SS), a potentially life-threatening verity from mild to life-threatening. To our knowledge, adverse drug reaction caused by excessive serotoner- we present the first reported case of SS associated with gic agonism in central and peripheral nervous system linezolid and methadone with a brief review of the lit- serotonergic receptors, may be caused by a single drug erature. or a combination of drugs with serotonergic activity. The syndrome results in a variety of mental, autonom- Keywords: serotonin syndrome, linezolid, methadone, ic and neuromuscular changes, which can range in se- methicillin-resistant Staphylococcus aureus. n INTRODUCTION methadone. This serious adverse interaction be- tween linezolid and methadone inducing SS was erotonin syndrome (SS) is a toxic state caused reported in a drug-addict HIV-positive man with Smainly by excessive serotonergic activity in sepsis, osteomyelitis and multiple muscle abscess- the nervous system, nearly always caused by a es and metastatic skin abscesses caused by meth- drug interaction involving two or more “seroto- icillin-resistant Staphylococcus aureus (MRSA), un- nergic” drugs [1]. These include serotonin pre- der combined antibiotic treatment. cursors, serotonin agonists, serotonin releasers, serotonin reuptake inhibitors, monoaminoxidase inhibitors (MAOIs) and some herbal medicines. n CASE REPORT Linezolid is a weak, nonselective, reversible in- hibitor of MAOIs, and potentially may interact A 39-year-old drug-addict male was admitted to with MAOIs and adrenergic and serotonergic our department with fever (up to 39.5°C) and a agents.
    [Show full text]
  • ZYVOX (Linezolid) Injection (Linezolid) Tablets (Linezolid) for Oral Suspension
    ® ZYVOX (linezolid) injection (linezolid) tablets (linezolid) for oral suspension To reduce the development of drug-resistant bacteria and maintain the effectiveness of ZYVOX formulations and other antibacterial drugs, ZYVOX should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. DESCRIPTION ZYVOX I.V. Injection, ZYVOX Tablets, and ZYVOX for Oral Suspension contain linezolid, which is a synthetic antibacterial agent of the oxazolidinone class. The chemical name for linezolid is (S)-N-[[3-[3-Fluoro-4-(4-morpholinyl)phenyl]-2-oxo-5-oxazolidinyl] methyl]-acetamide. The empirical formula is C16H20FN3O4. Its molecular weight is 337.35, and its chemical structure is represented below: O O O N N O C C H N 3 F H ZYVOX I.V. Injection is supplied as a ready-to-use sterile isotonic solution for intravenous infusion. Each mL contains 2 mg of linezolid. Inactive ingredients are sodium citrate, citric acid, and dextrose in an aqueous vehicle for intravenous administration. The sodium (Na+) content is 0.38 mg/mL (5 mEq per 300-mL bag; 3.3 mEq per 200-mL bag; and 1.7 mEq per 100-mL bag). ZYVOX Tablets for oral administration contain 400 mg or 600 mg linezolid as film-coated compressed tablets. Inactive ingredients are corn starch, microcrystalline cellulose, hydroxypropylcellulose, sodium starch glycolate, magnesium stearate, hypromellose, polyethylene glycol, titanium dioxide, and carnauba wax. The sodium (Na+) content is 1.95 mg per 400-mg tablet and 2.92 mg per 600-mg tablet (0.1 mEq per tablet, regardless of strength).
    [Show full text]
  • Tuberculosis Drug Information Guide, 2Nd Edition
    Tuberculosis Drug Information Guide 2ND EDITION Edmund G. Brown Jr, Governor STATE OF CALIFORNIA Diana S. Dooley, Secretary CALIFORNIA HEALTH & HUMAN SERVICES AGENCY Ron Chapman, MD, MPH, Director DEPARTMENT OF PUBLIC HEALTH Tuberculosis Drug Information Guide 2ND EDITION Edmund G. Brown Jr, Governor STATE OF CALIFORNIA Diana S. Dooley, Secretary CALIFORNIA HEALTH & HUMAN SERVICES AGENCY Ron Chapman, MD, MPH, Director DEPARTMENT OF PUBLIC HEALTH DrugInfo_2ndEd_v9.indd 3 12/5/12 3:55 PM Tuberculosis Drug Information Guide, 2nd edition was created through a collaboration of the Curry International Tuberculosis Center (CITC) and the State of California Department of Public Health, Tuberculosis Control Branch (CDPH). CITC is a project of the University of California, San Francisco, funded by the Centers for Disease Control and Prevention (CDC). The development of this Guide was funded through CDC Cooperative Agreement U52 CCU 900454. Permission is granted for nonprofit educational use and library duplication and distribution. Suggested citation: Curry International Tuberculosis Center and California Department of Public Health, 2012: Tuberculosis Drug Information Guide, 2nd edition. This publication is available on the CITC website: http://www.currytbcenter.ucsf.edu/ tbdruginfo/ Design: Edi Berton Design DrugInfo_2ndEd_v9.indd 4 12/5/12 3:55 PM Contributors Acknowledgments Ann M. Loeffler, MD John S. Bradley, MD Pediatric Infectious Diseases Attending and Director of Pediatric Rady Children’s Hospital San Diego, San Diego, California Hospitalists at Randall Children’s Hospital at Legacy Emanuel, Daniel Deck, Pharm.D. Portland, Oregon Department of Pharmaceutical Services, Pediatric Tuberculosis Consultant, San Francisco General Hospital, California Curry International Tuberculosis Center, San Francisco, California David Forinash, RPh Randall Children’s Hospital at Legacy Emanuel, Portland, Oregon Charles A.
    [Show full text]
  • Formulary and Program Updates Effective 8/1/18
    Formulary and Program Updates Effective 8/1/18 Pharmacy & Therapeutics Committee Meeting May 22, 2018 6:30 – 8:00 PM Role Call VOTING MEMBERS NON-VOTING MEMBERS • David Konanc, MD • Carl Antolick III, PharmD • Matthew K. Flynn, MD • Tracy Linton, MPH • Jennifer Burch, PharmD • Dee Jones • Peter Robie, MD • Lucy Barreto, DDS, MHA • Tony Gurley, RPh, JD • Renee Jarnigan, RPh • Michael Spiritos, MD • Stephanie Morrison, PharmD • John B. Anderson, MD, MPH • John Engemann, MD • Joseph Shanahan, MD 2 Ethics Awareness & Conflict of Interest Reminder In accordance with the NC State Health Plan for Teachers and State Employees’ ethics policy, it is the duty of every member of the Pharmacy & Therapeutics Committee, whether serving in a vote casting or advisory capacity, to avoid both conflicts of interest and appearances of conflict. Does any Committee member have any known conflict of interest or the appearance of any conflict with respect to any manufacturers of any medication to be discussed at today’s meeting? Or, if during the course of the evaluation process if you identify a conflict of interest or the appearance of a conflict. If so, please identify the conflict or appearance of conflict and refrain from any undue participation in the particular matter involved. 3 Minutes from Previous Committee Meeting • Instead of having the Secretary read the minutes, copies have been distributed for your review. • They are located just after the conflict of interest statement in the P&T Booklet that was emailed out. • Are there any additions or corrections to the minutes? • If not, the minutes will stand approved as is.
    [Show full text]
  • Adverse Effects of Psychotropic Medication
    Adverse effects of psychotropic medication RACHEL BROWN CLINICAL LEAD PHARMACIST – CAMHS, MEDICINES ADVICE AND CLINICAL EFFECTIVENESS OXFORD HEALTH NHS FOUNDATION TRUST Antipsychotic-induced hyperprolactinaemia Serotonin Syndrome Antipsychotic-induced hyperprolactinaemia Hyperprolactinaemia with APs 4 Dopamine inhibits prolactin release via D2 stimulation; serotonin promotes prolactin release via 5HT2A stimulation All antipsychotics are D2 antagonists → block the effect of DA → prolactin levels rise In the case of (most) second generation (atypical) there is simultaneous inhibition of 5HT2A receptors so serotonin can no longer stimulate prolactin release – theoretically cancel effects out Low risk antipsychotics High risk antipsychotics Aripiprazole Amisulpride Quetiapine Risperidone Lurasidone Paliperidone Clozapine Sulpiride Asenapine “Typical” / first generation antipsychotics Olanzapine? Causes of elevated prolactin 6 Physiological causes: Pharmacological causes Pathological causes • Pregnancy • Lactation • Antipsychotics • Prolactinoma • Stress (PRL levels of up to about 700 • Antidepressants* • Other pituitary or hypothalamic mU/L in men and 900 mU/L in • Opiates tumours or lesions women) • Peripheral dopamine receptor blockers • Hypothyroidism • Circadian variation (levels are e.g. metoclopramide, domperidone • Polycystic ovary syndrome highest in morning) • Antihypertensives e.g. calcium channel • Severe renal or liver disease • Macroprolactin (large molecular blockers, methyldopa aggregates lacking biological • H2 antagonists
    [Show full text]
  • Linezolid (Zyvox®)
    Linezolid (Zyvox®) IV and PO Only Use requires formal ID Consult Activity: Coverage against Staphylococcus aureus (MSSA and MRSA), Streptococcus pneumoniae, VRE Criteria for Use: • Vancomycin (VAN) MIC ≥ 2 mg/L in MRSA pneumonia • Patient with allergy to beta-lactams/vancomycin and organism resistant to other antimicrobials • Significant VRE infections (i.e. isolated from a sterile site: blood, abscess) • Infections due to MRSA in patient with well documented intolerance to VAN (NOTE: Red man syndrome is not a serious intolerance to VAN) Formal ID consult for use in osteomyelitis or complicated skin and soft tissue infection and all indications that are not listed above Unacceptable Uses: • Empiric use when VRE has not been cultured or documented • Uncomplicated urinary tract infection • Positive respiratory culture for VRE • VRE colonization Dosing in Adults: • Standard dose: 600 mg PO or IV Q12H In patients tolerating PO medications, should be given orally Oral formulation is completely absorbed and has 100% availability • No renal or hepatic dose adjustment Monitoring: • CBC at baseline and weekly (MONITOR platelets at baseline and weekly) Considerations for Use: • Caution in patients with thrombocytopenia. 3 percent of patients were noted to have a platelet decrease <75% of baseline or lower limit of normal in controlled trials (therapy <28 days, most < 21 days). Thrombocytopenia is reversible upon discontinuation and is correlated with duration • Linezolid is a weak MAOI. Use in caution with decongestants (i.e. pseudoephedrine) and
    [Show full text]
  • UWHC Guidelines for the Use of Linezolid (Zyvox )
    UWHC Guidelines for the Use of Linezolid (Zyvox®) Guidelines developed by UWHC Center for Drug Policy (CDP) Authors: Deborah Dunham, MA, RPh; Sarah E. Bland, RPh Coordination: Lee Vermeulen, MS, RPh, Director, CDP Reviewed by: William Craig, MD; Barry Fox, MD; Dennis Maki, MD; George Mejicano, MD; Carol A. Spiegel, PhD Originally Approved by P&T Committee: July 2000 Last Revised: August 2009 Next Scheduled For Review: August 2011 A. Background Because of the increase in multi-drug-resistant strains of gram-positive bacteria, the development of new and novel-acting antimicrobial agents is at the forefront of pharmaceutical research. Currently, the prevalence of methicillin-resistant staphylococci (MRSA) and vancomycin-resistant enterococci (VRE) is a major clinical problem. Linezolid (Zyvox®-Pfizer) is an antimicrobial agent of the oxazolidinone class that possesses a wide spectrum of activity against gram-positive organisms, including MRSA and VRE. Because of linezolid’s novel mechanism of action, cross-resistance with other antimicrobial agents is not expected. Linezolid is therefore a viable option for certain types of infectious disease. B. Appropriate Indications Linezolid has limited therapeutic applications at UW Hospital and Clinics. Appropriate use of linezolid will require a culture/susceptibility test with positive identification of an organism that demonstrates definitive resistance to all other possible antimicrobial agents. Based on the potential for bacterial resistance associated with the use of linezolid, the UW Pharmacy and Therapeutics Committee has approved its use in the following conditions: 1.0 Vancomycin-resistant Enterococcus faecium infections (not colonization), including those with concurrent bacteremia. 2.0 Methicillin-resistant S aureus infections (MRSA) in patients unable to tolerate vancomycin therapy or with serious pneumonia with MRSA.
    [Show full text]