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At least 343 records · Page 19Linked to original sources
PubMed2004

Impact of an electronic antibiotic advice and approval system on antibiotic prescribing in an Australian teaching hospital.

The impact of a computer-based infectious diseases electronic antibiotic advice and approval system ("IDEA(3)S") was assessed as an alternative to a labour-intensive, phone-based approval system. IDEA(3)S-based approvals replaced 48% of all approvals for the most frequently requested antimicrobial agents (ceftriaxone/cefotaxime, vancomycin) and were associated with stable overall rates of antimicrobial use. Antibiotic prescribing for community-acquired pneumonia was 76% concordant with IDEA(3)S recommendations, and clinical acceptance of IDEA(3)S was excellent. Successful implementation required a coordinated, evidence-based approach between clinicians, pharmacists and hospital administration, together with ongoing staff education and feedback of results. IDEA(3)S is a useful new adjunct to routine clinician consultation to support appropriate antibiotic prescribing for a number of common indications in hospitals.

Anti-Bacterial Agents↗
PubMed2001

Antibiotic resistance in the intensive care unit.

Antimicrobial resistance has emerged as an important determinant of outcome for patients in the intensive care unit (ICU). This is largely due to the administration of inadequate antimicrobial treatment, which is most often related to bacterial antibiotic resistance. In addition, the escalating problem of antimicrobial resistance has substantially increased overall health care costs. This increase is a result of prolonged hospitalizations and convalescence associated with antibiotic treatment failures, the need to develop new antimicrobial agents, and the implementation of broader infection control and public health interventions aimed at curbing the spread of antibiotic-resistant pathogens. Intensive care units are unique because they house seriously ill patients in confined environments where antibiotic use is extremely common. They have been focal points for the emergence and spread of antibiotic-resistant pathogens. Effective strategies for the prevention of antimicrobial resistance in ICUs have focused on limiting the unnecessary use of antibiotics and increasing compliance with infection control practices. Clinicians caring for critically ill patients should consider antimicrobial resistance as part of their routine treatment plans. Careful, focused attention to this problem at the local ICU level, using a multidisciplinary approach, will have the greatest likelihood of limiting the development and dissemination of antibiotic-resistant infections.

Anti-Bacterial Agents↗
PubMed1990

Achieving rational therapeutics through consensus-based protocols and follow-up.

In this exclusive Hospital Formulary interview, three key members of the therapeutics committee at Hartford Hospital, an 861-bed, private teaching hospital, discuss some of the techniques that they have used to ensure the development of a sound and effective formulary system within their institution. The committee emphasizes a policy-making approach that incorporates, up front, the expertise of key clinicians together with the best available information from the medical literature. Once committee policy has been set, implementation of drug use guidelines is largely automatic, and compliance is carefully monitored and reviewed.

Connecticut↗
PubMed1990

P&T Committee review of nifedipine GITS: new modality for angina and hypertension.

The nifedipine gastrointestinal therapeutic system (GITS) was recently approved for use in the treatment of angina and hypertension. According to the experts in this roundtable discussion, the GITS formulation provides continuous delivery of nifedipine, ensuring relatively constant drug levels and 24-hour efficacy with a once-daily dosage regimen. Nifedipine GITS also has a favorable side-effects and drug-interaction profile. This formulation will be useful for both inpatients and outpatients and may benefit patients in whom therapeutic levels previously could not be reached due to side effects.

Angina Pectoris↗
PubMed1990

P&T Committee review of fluconazole: an effective alternative to antifungal therapy.

Fluconazole is a new antifungal agent available in both oral and parenteral formulations. According to the experts in this roundtable discussion, fluconazole represents a major clinical advance in the treatment of candidiasis and cryptococcosis in cancer patients, patients with AIDS, organ transplant recipients, and other patients at risk for opportunistic mycoses. The pharmacokinetic profile for fluconazole permits infrequent dosing and also makes it ideal for tissue site infections. Fluconazole's low toxicity gives it an advantage over currently available antifungal therapy and will permit prompt presumptive treatment of selected infections.

Antifungal Agents↗
PubMed1990

P & T Committee perspectives: maintaining a successful formulary system in a private community hospital.

Institution of an effective formulary and P & T Committee is a difficult but critical task for many private hospitals. In this exclusive Hospital Formulary interview, Drs. Benner, Mykita, and Brown, members of Sutter Memorial Hospital's Pharmacy, Formulary, and Therapeutic Review Committee (their name for the P & T Committee) emphasize the need for a sound formulary system in order to survive the current changes in health care. Sutter Memorial is sophisticated in its delivery of healthcare services, which include advanced neonatology and state-of-the-art heart transplantation. Although good patient care remains the foremost concern, these committee members acknowledge that care must be affordable as well as therapeutically sound. Key to their committee's success is the cooperative effort among the pharmacy, nursing, and medical staff. They foresee the issue of rational therapeutics as a major challenge in the 1990s.

California↗
PubMed1990

Eliminating the printed formulary: a cost-effective alternative.

This article discusses the use of an in-house computer system to replace a printed formulary listing, parenteral guidelines, notification of cytotoxic or hazardous drugs, and a listing of formulary equivalents. Advantages of the system include availability of current information for physicians and nurses and cost savings for the hospital.

Computer Systems↗
PubMed1990

Generics still a favorite Rx for savings.

Despite recent scandals at generic drug companies that raised questions about quality and supply, few hospitals have shunned the off-brand products altogether. With stepped-up scrutiny of the industry by the Food and Drug Administration and purchasing groups, hospitals continue to show confidence in generics as a prescription for savings.

Drug Industry↗
PubMed1990

In-hospital anaerobic susceptibility testing: an aid to formulary decision making.

In this study, the susceptibility of 116 recent anaerobic isolates, including the Bacteroides fragilis group (n = 22), Bacteroides spp (n = 65), gram-positive cocci (n = 13), Clostridium spp (n = 10), and Fusobacterium spp (n = 6) were tested by agar dilution against a variety of agents suggested for prophylaxis or therapy. These agents included ampicillin sodium and sulbactam sodium, cefotaxime, cefoxitin, ceftizoxime, clindamycin, imipenem-cilastatin, metronidazole, and ticarcillin and clavulanate potassium. All anaerobes demonstrated 100% susceptibility to imipenem-cilastatin, metronidazole, ampicillin sodium and sulbactam sodium, and ticarcillin and clavulate potassium. Varying degrees of susceptibility (ranging from 60% to 100%) of Bacteroides spp to the selected panel of antibiotics were seen. Fusobacterium spp and the gram-positive cocci were inhibited by all agents tested. Clostridium spp was 90% susceptible to cefoxitin, 80% susceptible to clindamycin, and 100% susceptible to the other six agents. Due to the varying activity of these agents, local susceptibility patterns, antimicrobic spectrum, and cost effectiveness must be considered in the choice of agents used for empiric therapy.

Anti-Bacterial Agents↗
PubMed1990

Challenges of a P & T Committee in a community teaching hospital.

Lutheran General Hospital, a 650-bed, tertiary care and trauma center in Park Ridge, Illinois, has had a P & T Committee in place for 11 years. In this exclusive Hospital Formulary interview, David Cooke, MD, and Jackie Kessler, MS, the respective chairman and secretary of that committee, discuss the challenges their committee faces. Somewhat unique to a community hospital, this committee manages a relatively restricted formulary. They attribute their success to dedicated P & T Committee members and a committed pharmacy. Among the more difficult issues still to be resolved at Lutheran General are relationships between pharmaceutical companies and P & T members and the possible institution of a conflict-of-interest disclosure policy, as well as the never-ending battle of evaluating drug use in their institution.

Drug Industry↗
PubMed1990

Concerns of a pediatric hospital's P & T Committee: quality care emphasized over cost considerations.

One of the greatest challenges faced by the P & T Committee at Children's Hospital of Denver--a full-service, regional pediatric referral center--is the absence of pharmacologic and pharmacokinetic data for many drugs that are on the market for the treatment of adults but are unapproved for pediatric use. To acquire the needed information, Children's Hospital will rely on its P & T Committee to conduct numerous drug usage evaluations. In addition, the committee is undertaking a cooperative data-exchange venture with other children's hospitals across the U.S. and Canada. Although cost issues must be addressed at Children's Hospital, issues such as quality of care--and even how various formulations taste--are top priorities at this hospital.

Child↗
PubMed1991

Achieving an effective committee through reorganization: the Ohio State University Hospital's experience.

The P & T Committee at Ohio State University (OSU) Hospitals, Columbus, is unique in that it accomplishes the bulk of its tasks through subcommittees. Four subcommittees are currently in place: a formulary subcommittee, a policy and surveillance subcommittee, an antibiotic subcommittee, and a therapeutic drug monitoring subcommittee. An advantage to this method of organization is that it allows for much more medical staff involvement in P & T Committee activities. Other unique aspects of this P & T Committee are that it is responsible for maintaining both an inpatient and outpatient formulary, and it provides decision-making services for a specialty cancer hospital. Expansion of their drug usage evaluation program, further development of their therapeutic monitoring program, and improved communication with the medical staff are future goals of this P & T Committee.

Drug Industry↗