Frequency of hospitalization after exposure to known drug-drug interactions in a Medicaid population.

A matched-pair case-control analysis of Medicaid claims was performed to determine the risks of hospitalization associated with drug-drug interactions. Patients were hospitalized and controls were not. They were randomly matched based on contemporaneous eligibility for Medicaid benefits. Odds ratios for hospitalization in patients exposed to known drug-drug interactions were compared with those in patients exposed to one of the interacting agents. When confidence intervals did not overlap, the odds ratio was considered to be significantly increased. Odds ratios were significantly increased for many interacting drug pairs, and were associated with commonly recognized interactions as well as less widely recognized ones. Cimetidine interactions achieved significance only with theophylline. In the Medicaid population, exposure to a number of drug-drug interactions was associated with a significantly increased risk of hospitalization.

Gastrointestinal effects of sorbitol as an additive in liquid medications.

Certain sugar alcohols, notably sorbitol, are widely used as a vehicle for drugs in liquid oral dosage forms. Gastrointestinal side effects due to osmotically active excipients have been described, but remain an underappreciated cause of diarrhea. Quantitating amounts of sorbitol is difficult due to a lack of compendial listings of such information. A computer search of Physicians' Desk Reference monographs was conducted to identify products that listed or potentially contained sorbitol as an inert ingredient. Standard form letters and telephone calls were used to collect information on the sorbitol content of products identified. Data were compiled for 142 products, and each value was converted to mg/mL as crystalline sorbitol. Some difficulty occurred obtaining requested information from some manufacturers in their effort to maintain product formulation confidentiality. Pharmaceutical manufacturers should recognize that technically inert ingredients are not necessarily pharmacologically inactive. Manufacturers should therefore comply with requests for, and more openly publish, quantitative information regarding such ingredients, to facilitate the assessment and treatment of patient symptoms.

Drug dispensing by physicians: promoter's claims examined.

Experience in private pediatric practice is used to illustrate some potential advantages and disadvantages to patients and physicians of drug dispensing by physicians. Projections were based on the prescribing trends in the practice, the extent of patients' insurance reimbursement for prescriptions, the laws regarding dispensing, and the costs incurred when physicians purchase selected medications from a repackager or when patients procure them at a community pharmacy. Patients without insurance for prescriptions can potentially save money by purchasing medication at the physician's office but, in general, only if the physician's dispensing fee is minimal. Potential profits to physicians would be cut by an estimated 50% because of third-party enrollees choosing to have prescriptions filled at a pharmacy because of cost savings. Net profits are further reduced and may even be eliminated when the cost of physician and staff time to prepare, label, reorder, and maintain necessary records regarding dispensed medication are considered. Although it may be convenient for the patient to obtain initial supplies of medication at the time of an office visit, obtaining refills may be less convenient. The time and paperwork involved in dispensing by a physician cannot be considered as minimal interruptions in normal office procedure. The broad, attractive claims made in support of physician dispensing by physicians clearly overstate the benefits both to patients and to physicians.

A prevalence survey of infections in a combined acute and long-term care hospital.

A prevalence survey of infections among 572 acute and long-term care patients in the Albany Veterans Administration Medical Center was conducted in September 1979. Presence of infection was determined by patient examination and chart review. Urine specimens from 94% of patients were cultured. The total number of clinically significant infections was 178; 117 were nosocomial (20.5 per 100 patients). The prevalence rate of nosocomial infections was highest on the Intermediate Service (long-term medical care) followed by the Surgical and Medical Services. Sites with the highest nosocomial infection rates were urinary tract (10.7), skin and subcutaneous tissues (5.1), and surgical wounds (3.0) per 100 patients. Nosocomial infections increased with age and length of hospital stay which partially explained the higher rate on the Intermediate Service. Patients using condom drainage and Foley catheters showed similarly high rates of bacteriuria. Antimicrobial drug use was 17% for acute care patients and 4% for long-term and psychiatry patients. Excepting Providencia stuartii urinary tract infection confined to the Intermediate Service, the bacterial isolates and their antibiotic susceptibilities were similar for the acute and long-term care services.

Pharmacokinetics of moxalactam in elderly subjects.

The pharmacokinetics of moxalactam were studied in 19 male volunteers 60 years of age or older with normal liver function tests and a creatinine clearance of greater than or equal to 60 ml/min. Moxalactam was administered in single or multiple intravenous or intramuscular doses. Rapid and complete intramuscular bioavailability was demonstrated in a subgroup of the study population. The mean plasma half-life was 2.9 +/- 0.8 h for intravenous doses and 3.5 +/- 0.9 h for intramuscular doses. Average renal clearances of 0.04 liters/kg per h accounted for 74.0 +/- 15.0% of total plasma clearance. Moxalactam plasma clearance showed a statistically significant (P less than 0.01) correlation with measured and calculated creatinine clearance. The major differences in moxalactam pharmacokinetics seen in the elderly appear to be related to diminishing renal function and highly variable nonrenal elimination. Creatinine clearance can be used in estimating moxalactam doses in the elderly without significant renal impairment, but recommendations for the use of serum creatinine as an estimation of renal function or drug half-life are not valid in this population group.

The prevalence survey as an infection surveillance method in an acute and long-term care institution.

A point prevalence survey of infections was done in 22 patients areas at the Albany VA Medical Center between September 17 and 28, 1979. The study was designed by a consultant epidemiologist, two infectious disease physicians, a biostatistician, two infection control nurses, a microbiologist, and a clinical pharmacist. A 16-page worksheet was designed for rapid and complete data collection, with computer codes and programming cross references incorporated. A total of 572 patients were seen and evaluated for signs and symptoms of infection; cultures were taken if indicated, and charts were reviewed. Urine cultures were obtained in 95% of patients. Data available for analysis will allow for a description of the characteristics of the patient population, identification of the most prevalent sites of infection and causative organisms, an analysis of antimicrobial agent use, and a description of the risk factors and their interactions that may influence the acquisition of infection.