Evaluation of First-Dose, Intravenous Push Penicillins and Carbapenems in the Emergency Department

Practice-enhancing publications about the medication-use process in 2022

PURPOSE

This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2022 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles evaluating at least one step of the MUP were assessed for their usefulness toward practice improvement.

SUMMARY

A PubMed search was conducted in January 2023 for articles published in calendar year 2022 using targeted Medical Subject Headings (MeSH) keywords, and searches of the table of contents of selected pharmacy journals were conducted, providing a total of 6,213 articles. A thorough review identified 69 potentially practice-enhancing articles: 13 for prescribing/transcribing, 13 for dispensing, 5 for administration, and 38 for monitoring. Practice trends discussed in the articles are briefly summarized, with a mention of their importance within health-system pharmacy. The articles are listed and summarized in tables for further review and evaluation.

CONCLUSION

It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article assists in identifying and summarizing the most impactful publications. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.

Ertapenem combined with metronidazole for treatment of complex abdominal infections: Efficacy and impact on serum inflammatory indicators and T lymphocyte subsets

BACKGROUND

Complex intra-abdominal infections (cIAIs), often associated with abdominal trauma, have a complex etiology, are acute and severe, and have a high risk. They are an important cause of death in patients with abdominal trauma. Safe and effective treatment strategies are the factors affecting the prognosis of such patients.

AIM

To investigate the efficacy and safey of ertapenem combined with metronidazole in the treatment of cIAIs as well as the impact on serum inflammatory markers and T lymphocyte subsets, recovery status, and treatment costs.

METHODS

A total of 92 patients with cIAIs treated at our hospital from June 2021 to January 2023 were randomly divided into a control group and a study group, with 46 cases in each group. After admission, both groups received puncture drainage, continuous double-cannula irrigation, anti-infection therapy, organ function support, nutritional support, and other treatments. On this basis, the control group was treated with piperacillin/tazobactam combined with metronidazole, while the study group was treated with ertapenem combined with metronidazole. The therapeutic effects, recovery conditions, treatment costs, serum inflammatory indicators [procalcitonin (PCT), Toll-like receptor 4 (TLR-4), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP)], T lymphocyte subsets (CD3⁺, CD4⁺, and CD4⁺/CD8⁺ ratio), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, adverse reactions, and bacterial culture results were compared between the two groups.

RESULTS

The total effective rate of the study group was 93.48%, significantly higher than that of the control group (78.26%; P < 0.05). After 3 d and 7 d of treatment, the levels of serum PCT, TLR-4, TNF-α, and CRP in the study group were significantly lower and the levels of serum CD3⁺ and CD4⁺ T lymphocytes and CD4⁺/CD8⁺ ratio were significantly higher than those of the control group (P < 0.05). The APACHEⅡ score and SOFA score of the study group were significantly lower than those of the control group after 3 d and 7 d of treatment (P < 0.05). The time to fever resolution, ICU stay duration, and hospital stay in the study group were significantly shorter than those of the control group, and the costs of drugs and other resources were less than those of the control group (P < 0.05). The incidence of adverse reactions in the study group was 4.35%, significantly lower than that of the control group (17.39%; P < 0.05). There was no significant difference in the distribution of pathogenic bacteria between the two groups before and after treatment (P > 0.05).

CONCLUSION

Ertapenem combined with metronidazole is effective in the treatment of cIAIs, which can reduce inflammation, improve immune function, control disease progression, reduce the risk of organ failure, reduce the economic burden of patients, and improve treatment safety.

Pushing the agenda for intravenous push administration in outpatient parenteral antimicrobial therapy

Intravenous push (IVP) antimicrobial administration refers to rapid bolus infusion of medication. This drug delivery method offers improved patient convenience, superior patient and nursing satisfaction, and cost savings when used in outpatient parenteral antimicrobial therapy (OPAT). Antimicrobial agents must demonstrate optimal physiochemical and pharmacologic characteristics, as well as sufficient syringe stability, to be administered in this manner. Additionally, impacts on medication tolerability, patient safety, and effectiveness must be considered. This narrative review summarizes the available data and practical implications of IVP administration of antimicrobials in the OPAT setting.

Evaluation of Intravenous Push Piperacillin-Tazobactam on Time to Antibiotic Administration in Emergency Department Patients with Sepsis

Purpose: The purpose of this study was to determine if intravenous push (IVP) administration of piperacillin-tazobactam reduced the time to antibiotic administration compared to intravenous piggyback (IVPB) in emergency department (ED) patients who present with sepsis. Methods: This was a retrospective cohort study of patients with sepsis who received piperacillin-tazobactam before and after implementation of an IVPB to IVP conversion protocol. Results: A total of 486 charts were reviewed and the final analysis included 127 patients in each group. The mean time to administration of piperacillin-tazobactam was 67 (± 48) minutes and 58 (± 36) minutes in the IVPB and IVP cohorts, respectively (P = NS). The time to administration of secondary antibiotics was reduced by 38 minutes in patients who received piperacillin-tazobactam by IVP (105 min ±69 vs 67 min ±37; P < .001). Nurse administration time was reduced by 11 min for piperacillin-tazobactam (54 min ±46 vs 43 min ±33; P = .034) and 40 min for secondary antibiotics (90 min ±67 vs 50 min ±32; P = < .001) in the IVP group. There was no difference in hypersensitivity reactions, hospital length of stay, or mortality. Conclusion: Conversion from piperacillin-tazobactam IVPB to IVP was associated with a reduction in time to piperacillin-tazobactam and secondary antibiotic administration in emergency department patients with sepsis. Further prospective research is needed to evaluate clinical outcomes associated with IVP administration.