The Annals of pharmacotherapy
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Randomized Controlled Trial
A randomized trial of loading vancomycin in the emergency department.
Optimizing vancomycin dosing may help eradicate bacteria while avoiding resistance. The guidelines recommend loading doses; however, there are no data to demonstrate that this may result in a more rapid achievement of therapeutic troughs. ⋯ A loading dose of 30 mg/kg of vancomycin achieved a higher percentage of therapeutic levels at 12 hours when compared with the traditional dose of 15 mg/kg, without increased nephrotoxicity or adverse events.
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Adjunctive medications to manage alcohol withdrawal syndrome (AWS) in patients not adequately responding to escalating doses of benzodiazepines (BZDs) are limited. The use of the N-methyl-d-aspartate antagonist ketamine, may serve as an effective adjunct agent; however, no published data currently exist for this practice. ⋯ Ketamine appears to reduce BZD requirements and is well tolerated at low doses. Prospective dose range evaluations in the management of AWS would be helpful in determining its place as an adjunctive agent.
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Proton pump inhibitors (PPIs) are inappropriately prescribed in up to 50% of users. Systematic medication review and cessation of inappropriate medications or deprescribing may improve patient outcomes and reduce costs. ⋯ The patient-centered deprescribing process can safely reduce inappropriate PPI prescribing in a small proportion of people. Although the process was acceptable to participants, difficulties in accessing complete medical histories, time limitations, and minimal evidence to support effectiveness in certain indications were barriers to implementation of the process in clinical practice.
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Nonsteroidal anti-inflammatory drug (NSAID) use is recognized as a key component of the Enhanced Recovery After Surgery protocols and is systematically recommended in colorectal surgery to optimize perioperative care. However, a red flag about this practice has been raised because clinical studies have recently pointed out an increased risk of anastomotic leak after colorectal surgery following NSAID administration. Therefore, we used the Bradford Hill criteria to examine this potential relationship and concluded that use of perioperative NSAIDs in colorectal surgery should be evaluated carefully and on an individual basis considering the potentially increased risk of anastomotic leak and its consequences.
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To describe emerging evidence for the pharmacological treatment of idiopathic pulmonary fibrosis (IPF). ⋯ Limited options have existed for the treatment of IPF. New evidence suggests that safe and efficacious treatment options for IPF are on the horizon in the form of pirfenidone and nintedanib, although both agents await FDA decisions.