Pharmacotherapy
-
To assess the pharmacokinetics of levofloxacin during continuous venovenous hemodiafiltration (CVVHDF) and continuous venovenous hemofiltration (CVVH). ⋯ Marked extracorporeal elimination of levofloxacin occurs, requiring a dosage adjustment that can be calculated from the characteristics of CVVH and CVVHDF.
-
The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. ⋯ Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.
-
Case Reports
Use of thrombolytic therapy to treat heparin-refractory pulmonary embolism in a menstruating patient.
A 26-year-old woman developed an acute pulmonary embolism at the beginning of her menstrual cycle and was admitted to the hospital. When she failed initial standard treatment with heparin, the only other therapeutic option was a thrombolytic agent such as recombinant tissue plasma activator (rt-PA). ⋯ Our patient responded well to rt-PA therapy Her hemoglobin levels remained stable, and she experienced no bleeding complications. Careful monitoring and caution are recommended when administering thrombolytic agents to menstruating patients.
-
Linezolid, a fluorinated oxazolidinone, is the first of a new class of antimicrobials designed to target resistant gram-positive cocci. Hematologic adverse effects, including reversible thrombocytopenia, were reported during phase III comparator-controlled trials. A 66-year-old man developed sternal osteomyelitis due to methicillin-resistant Staphylococcus aureus after undergoing coronary artery bypass graft surgery. ⋯ Oral linezolid 600 mg twice/day was begun; 17 days later, a complete blood count revealed that his hematocrit had decreased from 37.4% to 24.8%, and his platelet count had decreased from 234 x 10(3)/mm3 to 149 x 10(3)/mm3. Both values returned to normal after linezolid was discontinued. Complete blood counts should be monitored closely in patients taking linezolid, especially if therapy continues for more than 14 days.
-
Meta Analysis
Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials.
To evaluate efficacy and safety of intravenous amiodarone for conversion of recent-onset atrial fibrillation. ⋯ The efficacy and safety profile of intravenous amiodarone is similar to that of other antiarrhythmics for cardioversion of recent-onset atrial fibrillation. Intravenous amiodarone is significantly more effective than placebo but is associated with significantly higher frequency of adverse events, although most were not considered to be dose limiting.