The Annals of pharmacotherapy
-
To review the literature regarding false-positive urine opiate screens associated with the use of fluoroquinolones. ⋯ Fluoroquinolones can cause false-positive urine opiate screens. Clinicians should be aware of this potential interaction and may need to verify positive results.
-
The increasing antimicrobial resistance of common respiratory pathogens has led to a reevaluation of the selection of antimicrobial dosing regimens in terms of their pharmacokinetic (PK) and pharmacodynamic (PD) properties. Pharmacokinetics, when considered as part of a specific dosing regimen, can help determine the time course of drug concentrations in the serum, tissues, body fluids, and at the site of infection. Pharmacodynamics provides surrogate markers for clinical and bacteriologic efficacy based on the relationships between the serum and tissue concentrations of selected antimicrobial agents relative to the mean inhibitory concentrations of causative bacteria over time. ⋯ Various antibiotics and bacterial pathogens are used as models to demonstrate the utility of PK/PD parameters in predicting the in vivo efficacy of antimicrobial therapy. The use of computer modeling with Monte Carlo population simulations can further enhance the predictability of antimicrobial efficacy when using PK/PD parameters. This article also provides a reevaluation of bacterial susceptibility breakpoints defined by the National Committee for Clinical Laboratory Standards contrasted with the use of PK/PD parameters.
-
Comparative Study
Clinical and economic analysis of methicillin-susceptible and -resistant Staphylococcus aureus infections.
The rate of methicillin-resistant Staphylococcus aureus (MRSA) has increased significantly over the last decade. Previous cohort studies of patients with MRSA bacteremia have reported higher mortality rates, increased morbidity, longer hospital length of stay (LOS), and higher costs compared with patients with methicillin-susceptible S. aureus (MSSA) bacteremia. The clinical and economic impact of MRSA involving other sites of infection has not been well characterized. ⋯ Patients with MRSA infections had worse clinical and economic outcomes compared with patients with MSSA infections.
-
To describe an intentional topiramate ingestion by an adolescent and warn of the potential for topiramate abuse. ⋯ Due to the multifactorial effects topiramate may have upon the central nervous system and its anorectic effect, abuse of this drug by adolescents should be considered upon presentation of an adolescent with mental status changes.
-
To report a case of hepatotoxicity probably caused by pioglitazone, summarize case reports of hepatotoxicity induced by rosiglitazone or pioglitazone, and make recommendations regarding routine liver enzyme measurement in patients taking these agents. ⋯ Although the timeline and extent of liver enzyme elevation in this case are unclear, the Naranjo probability scale suggests that a causal relationship between pioglitazone and liver disease is probable. Patients with previous TZD-induced hepatotoxicity should not be rechallenged. Cases of hepatotoxicity with second generation TZDs, although clearly linked, have been few in number and less severe in consequence when compared to troglitazone. We agree with current package labeling that requires baseline and then periodic measurement of liver enzymes in patients taking pioglitazone or rosiglitazone.