Susceptibility of Staphylococcus aureus to vancomycin: analysis of minimum inhibitory concentrations in two tertiary care hospitals in eastern South Dakota.

BACKGROUND: Vancomycin has been considered the accepted standard of therapy for methicillin-resistant Staphylococcus aureus (MRSA) and is commonly used as an alternative for methicillin-suceptible Staphylococcus aureus (MSSA) in cases of allergy or intolerance to other agents. MRSA strains exhibiting elevated vancomycin MICs (minimum inhibitory concentration) within the susceptible range have been associated with increased treatment failure and mortality. The aim of our study was to evaluate for evidence of elevated vancomycin MICs among S. aureus isolates associated with pneumonia or skin/soft tissue infection (SSTI) in our adult inpatient population. METHODS: S. aureus vancomycin MIC data was retrospectively reviewed for the period of July 1, 2008, to December 31, 2008. Adult inpatients were included in our analysis if treatment was initiated with an anti-staphylococcal agent for at least 48 hours for either pneumonia or SSTI. Patient demographics and susceptibilities to non-vancomycin antistaphylococcal agents were collected. RESULTS: A total of 272 patients met inclusion criteria. Only three patients were infected with S. aureus isolates found to have elevated vancomycin MICs within the susceptible range (> 1 mcg/mL to < or = 2 mcg/mL). This included two patients with pneumonia (one MRSA, one MSSA) and one patient with SSTI caused by MRSA. All S. aureus isolates were susceptible to linezolid and trimethoprim-sulfamethoxazole (TMP-SMX), with tetracycline susceptibility exceeding 90 percent in all subsets. CONCLUSIONS: Elevated vancomycin MICs were uncommon in our sample among adult inpatients with pneumonia or SSTI caused by S. aureus. Vancomycin appears to remain a viable option for the treatment of these infections in our patient population.

Impact of an introductory pharmacy practice experience on students' performance in an advanced practice experience.

OBJECTIVE: To determine the impact of an introductory pharmacy practice experience (IPPE) on students' clinical skills during their initial advanced pharmacy practice experience (APPE). DESIGN: A 4-week First Steps course that focused on students developing pharmacy practice skills, clinical communications skills, and effective use of reference materials was introduced in 2006 at the end of the third-year curriculum, prior to students beginning their APPEs. ASSESSMENT: During the third week of the first APPE, faculty members rated students' demonstration of 9 clinical skills on a 5-point Likert scale (1 being always and 5 being never). The evaluation was performed in 2005 prior to implementation of the course (control group) and again in 2006 after implementation of the course. Students who completed the First Steps course scored better on all 9 skills and had a better average clinical skills value (2.3) compared to the control group (2.6, p < 0.01). CONCLUSION: Completion of an IPPE course that focused on critical pharmacy practice aspects, clinical communication skills, and use of reference materials resulted in increased frequency of desired clinical behaviors on a subsequent APPE.

New advances in the treatment of Clostridium difficile infection (CDI).

Clostridium difficile infections (CDI) have increased in frequency throughout the world. In addition to an increase in frequency, recent CDI epidemics have been linked to a hypervirulent C. difficile strain resulting in greater severity of disease. Although most mild to moderate cases of CDI continue to respond to metronidazole or vancomycin, refractory and recurrent cases of CDI may require alternative therapies. This review provides a brief overview of CDI and summarizes studies involving alternative antibiotics, toxin binders, probiotics, and immunological therapies that can be considered for treatment of acute and recurrent CDI in severe and refractory situations.

Ramoplanin: a lipoglycodepsipeptide antibiotic.

OBJECTIVE: To review the pharmacology, antimicrobial activity, pharmacokinetics, clinical applications, and safety of ramoplanin, a lipoglycodepsipeptide antibiotic. DATA SOURCES: Information was obtained from MEDLINE and BIOSIS databases (1984-August 2004) and Oscient Pharmaceuticals using the key words ramoplanin, A 16686, A 16686A, and MDL 62198. STUDY SELECTION AND DATA EXTRACTION: Available English-based articles and abstracts were reviewed, along with information from Oscient Pharmaceuticals. DATA SYNTHESIS: Ramoplanin exerts its bactericidal activity against gram-positive aerobic and anaerobic bacteria by blocking peptidoglycan synthesis via lipid II. In vitro susceptibility reports have demonstrated efficacy against antibiotic-resistant gram-positive pathogens. Cross-resistance has not been documented with vancomyin and other glycopeptides. Clinical trials are investigating ramoplanin's oral administration for treatment of Clostridium difficile-associated diarrhea. Previous clinical trials had evaluated the suppression of colonization of vancomycin-resistant Enterococcus with ramoplanin. Adverse effects are minimal, and drug-drug interactions have not been documented. CONCLUSIONS: The completion of clinical trials will determine whether ramoplanin has a promising role as a treatment option for diarrhea due to C. difficile.

Esomeprazole: a clinical review.

The pharmacology, pharmacodynamics, pharmacokinetics, clinical efficacy, and adverse effects of esomeprazole are reviewed. Esomeprazole, a proton-pump inhibitor (PPI), is the S-isomer of omeprazole. Esomeprazole has FDA-approved labeling for use in the treatment of symptomatic gastroesophageal reflux disease (GERD), including healing and maintenance of healing of erosive esophagitis and as part of a triple-drug regimen for Helicobocter pylori infection. Esomeprazole is structurally similar to other PPIs but is the first PPI to include only the active isomer, which may lead to improved pharmacokinetic and pharmacodynamic characteristics. Esomeprazole maintains intragastric pH at a higher level and above 4 for a longer period than other PPIs. Clinical studies have shown that esomeprazole is at least equivalent in safety and efficacy to other drugs in the class. Esomeprazole has demonstrated efficacy in the treatment of erosive esophagitis, the maintenance of healing of erosive esophagitis, and the treatment of signs and symptoms of GERD. Effective dosages are 20 or 40 mg orally every day or as needed. Esomeprazole magnesium 40 mg once daily in combination with amoxicillin and clarithromycin is effective in eradicating H. pylori infection. The potential for interacting with other drugs is limited and is similar to that of omeprazole. The most common adverse effects are headache, respiratory infection, and abdominal symptoms. Esomeprazole has pharmacokinetic properties that may make it more effective than omeprazole in some patients.