Implementing an automatic fluoroquinolone therapeutic interchange program in a community hospital.

A community hospital developed an automatic therapeutic interchange program for fluoroquinolone antibiotics. After considering efficacy, available formulations, and cost, this P&T Committee selected ciprofloxacin (Cipro) as the class representative for formulary use. The steps taken to implement this automatic therapeutic interchange policy are presented.

Altering aminoglycoside selection in a community hospital.

The aminoglycoside antibiotics make up a large part of the pharmacy budget. A method developed by the pharmacy department in conjunction with the P & T Committee for implementing usage guidelines at a community hospital is presented. The program was designed to promote cost-effective therapy while maintaining safety and efficacy. After the program was implemented, both aminoglycoside use and expenditures were altered. The data indicate that by incorporating current medical information into an institution-specific program, it is possible to bring about a decrease in the cost of antibiotic therapy. This study suggests that interventions may be effective in community hospitals as well as in large teaching institutions.

Sepsis from Flavobacterium meningosepticum, an uncommon pathogen with unusual susceptibility patterns.

Flavobacterium meningosepticum, because of its unusual susceptibility patterns and predilection for debilitated or immunocompromised hosts, can be a dangerous pathogen. Identification of the organism and proper susceptibility studies, which are essential in designing antibiotic therapy, helped in the selection of a regimen that proved curative in this case.

Combined therapy with captopril and potassium supplementation. A potential for hyperkalemia.

Captopril (Capoten), an angiotensin-converting enzyme inhibitor, is being used increasingly in the treatment of both hypertension and congestive heart failure. Many of the patients with these disease states have treatment regimens including potassium-sparing diuretics or potassium supplements. In monitoring of five such patients, a significant increase in serum potassium level (3.88 +/- 0.41 to 4.84 +/- 0.45 mEq/L) was noted once captopril was added to their therapy. Laboratory-diagnosed hyperkalemia occurred in three of these patients. Serum potassium levels remained elevated until potassium supplementation or captopril therapy was reduced or discontinued. The combination of captopril and potassium supplements or potassium-sparing diuretics represents a potentially important drug interaction. Patients should be closely monitored for possible hyperkalemia when using these drug combinations.