Elmar R Alizadeh, Thierry Dervieux, Severine Vermeire, Marla Dubinsky, Geert D'Haens, David Laharie, Andrew Shim, Byron P Vaughn
BACKGROUND: Patients with Crohn's disease (CD) who lose response to biologics experience reduced quality of life (QoL) and costly hospitalizations. Precision-guided dosing (PGD) provides a comprehensive pharmacokinetic (PK) profile that allows for biologic dosing to be personalized. We analyzed the cost-effectiveness of infliximab (IFX) PGD relative to two other dose intensification strategies (DIS). METHODS: We developed a hybrid (Markov and decision tree) model of patients with CD who had a clinical response to IFX induction...
April 4, 2024: Pharmacotherapy
Hope H Brandon, David S Burgess, Katie L Wallace, Elizabeth B Autry, Katie B Olney
INTRODUCTION: The optimal dosing and monitoring of vancomycin in pediatrics is still unknown but has evolved to emphasize area under the curve over 24 h (AUC0-24 ) over minimum concentration (Cmin ) monitoring. Real-world data supporting the feasibility of two-concentration kinetics with first-order equations for the estimation of vancomycin AUC0-24 in pediatric patients are lacking. OBJECTIVES: To describe the interplay of vancomycin dose, AUC0-24 , and Cmin using first-order equations within four pediatric age groups...
March 27, 2024: Pharmacotherapy
Kathryn Sine, Thomas Lavoie, Aisling R Caffrey, Vrishali V Lopes, David Dosa, Kerry L LaPlante, Haley J Appaneal
INTRODUCTION: There are known disparities in the treatment of infectious diseases. However, disparities in treatment of complicated urinary tract infections (UTIs) are largely uninvestigated. OBJECTIVES: We characterized UTI treatment among males in Veterans Affairs (VA) outpatient settings by age, race, and ethnicity and identified demographic characteristics predictive of recommended first-choice antibiotic therapy. METHODS: We conducted a national, retrospective cohort study of male VA patients diagnosed with a UTI and dispensed an outpatient antibiotic from January 2010 through December 2020...
March 14, 2024: Pharmacotherapy
Zhiheng Yu, Rong Chen, Cheng Zhao, Renwei Zhang, Tianyan Zhou, Yangyu Zhao
BACKGROUND: Intravenous oxytocin is commonly used for labor induction. However, a consensus on the initial dosing regimen is lac with conflicting research findings and varying guidelines. This study aimed to develop a population kinetic-pharmacodynamic (K-PD) model for oxytocin-induced uterine contractions considering real-world data and relevant influencing factors to establish an optimal starting dosing regimen for intravenous oxytocin. METHODS: This retrospective study included pregnant women who underwent labor induction with intravenous oxytocin at Peking University Third Hospital in 2020...
February 29, 2024: Pharmacotherapy
Melissa N W Jackson, Wenjing Wei, Norman S Mang, Bonnie C Prokesch, Jessica K Ortwine
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia is associated with poor clinical outcomes and increased mortality. Clinical data regarding the optimal treatment of CRAB is limited, and combination therapy is often preferred. Eravacycline has demonstrated in-vitro activity against A. baumannii and has been considered for the treatment of pulmonary infections caused by CRAB. OBJECTIVE: The objective of this case series was to describe clinical outcomes associated with eravacycline when utilized as part of a combination regimen for the treatment of CRAB pneumonia at a county hospital...
January 25, 2024: Pharmacotherapy
Hala Halawi, Jesse E Harris, Ahmad Goodarzi, Simon Yau, Jihad G Youssef, Mena Botros, Howard J Huang
A growing body of evidence supports the use of bivalirudin as an alternative to unfractionated heparin (UFH) for the prevention of thrombotic events in patients on venovenous (VV) extracorporeal membrane oxygenation (ECMO). However, data in patients bridged to lung transplantation are limited. In this case series, we describe the outcomes of six patients who were transitioned from UFH to bivalirudin during their course of VV ECMO support as a bridge to lung transplantation. All six patients were on VV ECMO support until transplant, with a median duration of 73 days...
March 2024: Pharmacotherapy
Dana J Holger, Ali Althubyani, Taylor Morrisette, Nicholas Rebold, Marylee Tailor
Drug-resistant tuberculosis (TB) is a major public health concern and contributes to high morbidity and mortality. New evidence supports the use of shorter duration, all-oral regimens, which represent an encouraging treatment strategy for drug-resistant TB. As a result, the landscape of drug-resistant TB pharmacotherapy has drastically evolved regarding treatment principles and preferred agents. This narrative review focuses on the key updates of drug-resistant TB treatment, including the use of short-duration all-oral regimens, while calling attention to current gaps in knowledge that may be addressed in future observational studies...
March 2024: Pharmacotherapy
Tyler Chanas, Gabrielle Gibson, Elizabeth Langenstroer, David J Herrmann, Thomas W Carver, Kaitlin Alexander, Sai Ho Jason Chui, Lisa Rein, Michael Ha, Kaylee M Maynard, Kristen Bamberg, Mary O'Keefe, Marisa O'Brien, Mariela Cardona Gonzalez, Brandon Hobbs, Mehrnaz Pajoumand, William J Peppard
STUDY OBJECTIVE: Enoxaparin is standard of care for venous thromboembolism (VTE) prophylaxis in adult trauma patients, but fixed-dose protocols are suboptimal. Dosing based on body mass index (BMI) or total body weight (TBW) improves target prophylactic anti-Xa level attainment and reduces VTE rates. A novel strategy using estimated blood volume (EBV) may be more effective based on results of a single-center study. This study compared BMI-, TBW-, EBV-based, and hybrid enoxaparin dosing strategies at achieving target prophylactic anti-Factor Xa (anti-Xa) levels in trauma patients...
March 2024: Pharmacotherapy
Lisa T Hong, Kevin J Downes, Alireza FakhriRavari, Jacinda C Abdul-Mutakabbir, Joseph L Kuti, Sarah Jorgensen, David C Young, Mohammad H Alshaer, Matteo Bassetti, Robert A Bonomo, Mark Gilchrist, Soo Min Jang, Thomas Lodise, Jason A Roberts, Thomas Tängdén, Athena Zuppa, Marc H Scheetz
No abstract text is available yet for this article.
February 2024: Pharmacotherapy
Emily E Leppien, Erin E Pauling, Eric Smith, Brady Wisniewski, Abigayle Carpenter, Nicholas C Schwier
Concomitant pain syndromes and cardiovascular disease (CVD) and disorders are associated with significant morbidity, impaired quality of life, and neuropsychiatric disorders. There is an interplay between the mechanisms of pathophysiology of both CVD and pain syndromes. Patients with CVD (and/or disorders) as well as pain syndromes have an increased propensity for drug-drug/disease interactions. Therefore, an understanding of how to use pharmacotherapy to treat pain syndromes, in the context of patients who have diagnoses of CVD and/or disorders, is paramount to patients' success in achieving adequate pain control and appropriately managing CVD and/or disorders, all while decreasing the risk of adverse events (AEs) both from pharmacotherapy to treat pain and CVD (and/or disorders)...
February 2024: Pharmacotherapy
Jian Mei Li, Leon E Cosler, Elizabeth P Harausz, Courtney E Myers, Wesley D Kufel
Urinary tract infections (UTIs) commonly affect many patient populations. Recurrent UTIs (rUTIs) can be particularly problematic and lead to potential hospitalizations, multiple antibiotic courses, and have a potential negative impact on quality of life. To prevent UTIs, antibiotics are frequently used for prophylaxis; however, antibiotic prophylaxis has notable untoward consequences including but not limited to potential adverse effects and development of antibiotic resistance. Methenamine, an antiseptic agent initially available in 1967, has re-emerged as a potential option for UTI prophylaxis in various populations, including older adults and renal transplant recipients...
February 2024: Pharmacotherapy
Yingcong Tan, Cynthia Hubbard, Holly Owens, James Pitt, Christopher Giuliano, Bradley Haan, Thomas Breeden, Dumitru Sirbu, Kelsey Pena, Trevlyn Haddox, Stephanie B Edwin
STUDY OBJECTIVE: The purpose of this study is to provide evidence for the safety and efficacy of factor Xa inhibitors in patients with a weight ≤60 kg or BMI < 18.5 kg/m2 . DESIGN: Multicenter, retrospective, cohort study. SETTING: Twenty-two Ascension Health hospitals. PATIENTS: Low-body-weight adult patients (weight ≤ 60 kg or BMI < 18...
February 2024: Pharmacotherapy
Faiza Shahid, Ann Doherty, Emma Wallace, Sven Schmiedl, G Caleb Alexander, Tobias Dreischulte
The strength of evidence for specific ambulatory care prescribing cascades, in which a marker drug is used to treat an adverse event caused by an index drug, has not been well characterized. To perform a structured, systematic, and transparent review of the evidence supporting ambulatory care prescribing cascades. Ninety-four potential prescribing cascades identified through a previously published systematic review. Systematic search of the literature to further characterize prescribing cascades. (1) Grading of evidence based on observational studies investigating associations between index and marker drugs, including: Level I-strong evidence [i...
January 2024: Pharmacotherapy
Carlos Pascual-Morena, Vicente Martínez-Vizcaíno, Iván Cavero-Redondo, Irene Martínez-García, Nerea Moreno-Herráiz, Celia Álvarez-Bueno, Alicia Saz-Lara
This systematic review and meta-analysis aimed to assess the efficacy and safety of risdiplam on motor and respiratory function in spinal muscular atrophy (SMA). We systematically searched Medline, Scopus, Web of Science, and the Cochrane Library from inception to March 2023. We included pre-post studies that determined the effect of risdiplam on the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND), the 32-item Motor Function Measure (MFM32), the Revised Upper Limb Module (RULM), the Hammersmith Functional Motor Scale - Expanded (HFMSE), respiratory function, and the proportion of risdiplam-related adverse events in a population with SMA (phenotypes 1 and 2/3)...
January 2024: Pharmacotherapy
Kevin Lonabaugh, Galvin Li, Rhonda List, Reyna Huang, Amber James, Andrew Barros, Lindsay Somerville, Dana Albon
INTRODUCTION: The introduction of the highly effective modulator therapy elexacaftor-tezacaftor-ivacaftor (ETI) has revolutionized the care of persons with cystic fibrosis (PwCF) with major improvements seen in lung function and body mass index (BMI). Effects of ETI therapy in real-world cohorts on other parameters such as cholesterol levels are largely unknown. METHODS: A single-center, retrospective chart review study was conducted to assess the change in lipid panels before and after ETI initiation...
December 24, 2023: Pharmacotherapy
Kelly Powell, William Curtiss, Erin Sadek, Jason Hecht
INTRODUCTION: Falls are the leading cause of injury in older individuals, with intracranial hemorrhage (ICH) being a common complication. Anticoagulants, such as vitamin K antagonist and direct oral anticoagulants, are increasingly utilized, and clinicians may question the necessity of reversal in patients with minor ICH, especially in the setting of increased risk of adverse events. This study aimed to identify a population of patients with minor traumatic ICH at low risk for poor-neurologic status where anticoagulant reversal may not improve outcomes...
December 23, 2023: Pharmacotherapy
Christie Schumacher, Amanda Chorpash, Charlotte Bolch, Kellye Eagan, Sara Nimer, Elizabeth Van Dril
INTRODUCTION: Studies have demonstrated that sodium-glucose cotransporter-2 (SGLT2) inhibitors are kidney protective; however, their ability to cause hemodynamic changes may predispose patients to acute kidney injury (AKI). A United States Food and Drug Administration warning recommends evaluating for factors that predispose patients to AKI before initiating a SGLT2 inhibitor. OBJECTIVE: To identify risk factors that may predispose persons with diabetes to AKI when initiating SGLT2 inhibitor therapy...
December 22, 2023: Pharmacotherapy
John A Saunders, Sara R Vazquez, Joseph A Hill, Daniel M Witt
BACKGROUND: Most patients receiving Low-molecular-weight heparin therapy do not require routine coagulation monitoring, but due to uncertainty in certain populations, clinicians may feel compelled to perform anti-Xa monitoring. METHODS: This retrospective cohort study compared clinical outcomes in propensity-score matched adult inpatients from an academic health care system who did and did not receive anti-Xa monitoring of enoxaparin for venous thromboembolism prophylaxis...
December 13, 2023: Pharmacotherapy
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