Haemophagocytic lymphohistiocytosis (HLH) in an adult following treatment with trimethoprim/sulfamethoxazole.

Haemophagocytic lymphohistiocytosis (HLH) is an aggressive hyperinflammatory haematological condition often associated with malignancy, infection or rheumatological disorders. HLH has rarely been associated with medications, including antibiotics. We describe a case of a patient without significant medical history who presented with HLH following treatment with trimethoprim/sulfamethoxazole (TMP/SMX). Additionally, we will discuss the possible mechanism of medication-induced HLH as well as the successful use of dexamethasone as the sole treatment. Early diagnosis and treatment of this disease is critical and medication-induced HLH should be considered in cases without a clear aetiology. To our knowledge, this is the first case report of TMP/SMX-induced HLH that was successfully treated with steroid monotherapy and just the second case report of TMP/SMX-induced HLH.

Evaluation of a pharmacist-led antibiotic stewardship program and implementation of prescribing order sets.

BACKGROUND: It is established that pharmacists can play a role in antibiotic stewardship in inpatient settings; however, there remains a paucity of data regarding pharmacist impact on antibiotic stewardship in outpatient care. OBJECTIVES: The purpose of this study was to assess the impact of an outpatient pharmacist antimicrobial stewardship program involving the implementation of prescribing order sets on the rate of compliance with guideline-recommended antibiotic use. METHODS: This was a single-center, retrospective study conducted at a resident-run, adult medicine clinic evaluating the implementation of a pharmacist-led antimicrobial stewardship education program and prescribing order sets. Adult patients were included if they were treated for a diagnosis of urinary tract infection or Helicobacter pylori infection. The primary outcome was a composite of the proportion of antibiotic prescribing that was compliant with guideline-recommended treatment, including indication, antibiotic selection, dose, and duration. The secondary outcomes included an analysis of the individual components of the primary outcome and a subgroup analysis according to infection type. RESULTS: A total of 115 and 43 patients were included in the preintervention and intervention groups, respectively. No statistically significant difference was observed in the proportion of complete guideline-recommended antibiotic regimens after the implementation of the stewardship intervention (P = 0.703) or in any individual component of the composite outcome. However, a subgroup analysis of each infection type demonstrated statistically significant improvements in both complete H pylori regimens and antibiotic selection. CONCLUSIONS: Although the implementation of a pharmacist-led antimicrobial stewardship program at an adult medicine clinic did not lead to an improvement in complete guideline-recommended antibiotic prescribing, notable improvements were observed after subgroup analyses.