Complex issues affecting student pharmacist debt.

It is time for colleges and schools of pharmacy to examine and confront the rising costs of pharmacy education and the increasing student loan debt borne by graduates. These phenomena likely result from a variety of complex factors. The academy should begin addressing these issues before pharmacy education becomes cost-prohibitive for future generations. This paper discusses some of the more salient drivers of cost and student debt load and offers suggestions that may help alleviate some of the financial pressures.

Pharmacy student debt and return on investment of a pharmacy education.

OBJECTIVE: To describe the current landscape within the profession of pharmacy regarding student tuition, indebtedness, salaries, and job potential. METHODS: Pharmacy tuition and student debt data were obtained through the American Association of Colleges of Pharmacy Institutional Research website. Tuition was defined as average first-year tuition and fees for accredited schools. Debt was defined as the total average amount borrowed. Median salaries and numbers of jobs were obtained from the United States Department of Labor. RESULTS: In-state tuition at public schools rose an average of $1,211 ± 31 (r2 = 0.996), whereas out-of-state tuition at public schools rose significantly faster at $1,838 ± 80 per year (r2 = 0.988). The average tuition cost for pharmacy school has increased 54% in the last 8 years. The average pharmacist salary has risen from $75,000 to over $112,000 since 2002. The increase in salary has been nearly linear (r2 = 0.988) rising $4,409 ± $170 dollars per year. However, average salary in 2011 was $3,064 below the predicted value based upon a linear regression of salaries over 10 years. The number of pharmacist jobs in the United States has risen from 215,000 jobs in 2003 to 275,000 in 2010. However, there were 3,000 fewer positions in 2012 than in 2011. In 2011, average indebtedness for pharmacy students ($114,422) was greater than average first-year salary ($112,160). CONCLUSION: Rising tuition and student indebtedness is a multifaceted problem requiring attention from a number of parties including students, faculty members, universities, and accreditation and government entities.

Aerosolised antibiotics: a critical appraisal of their use.

Aerosolised antimicrobial agents have been used in clinical practice since the 1950s. The main advantage of this route of administration is the targeted drug delivery to the site of infection in the lung. Exploitation of this targeted delivery can yield high concentrations at the site of infection/colonisation while minimising systemic toxicities. It is important to note that the ability of a drug to reach the target area in the lung effectively is dependent on a number of variables, including the nebuliser, patient technique, host anatomy and disease-specific factors. The most convincing data to support the use of aerosolised antimicrobials has been generated with tobramycin solution for inhalation (TOBI, Chiron Corp.) for maintenance treatment in patients with cystic fibrosis. In addition to cystic fibrosis, the use of aerosolised antimicrobials has also been studied for the treatment or prevention of a number of additional disease states including non-cystic fibrosis bronchiectasis, ventilator-associated pneumonia and prophylaxis against pulmonary fungal infections. Key studies evaluating the benefits and shortcomings of aerosolised antimicrobial agents in these areas are reviewed. Although the theory behind aerosolised administration of antibiotics seems to be sound, there are limited data available to support the routine use of this modality. Owing to the gaps still existing in our knowledge base regarding the routine use of aerosolised antibiotics, caution should be exercised when attempting to administer antimicrobials via this route in situations falling outside clearly established indications such as the treatment of patients with cystic fibrosis or Pneumocystis pneumonia.