Pharmacokinetics of fluconazole in young infants.

Intravenous fluconazole is used in the treatment of fungal infections in infants. Little is known, however, about the pharmacokinetics of fluconazole after oral administration in premature infants. Oral fluconazole was administered at a dose of 6 mg/kg. The peak serum concentration (Cmax), area under the serum concentration-time curve (AUC), and apparent clearance ranged from 6.0-13.5 micrograms/ml, 340-636 micrograms.h/ml, and 0.16-0.29 ml/min/kg, respectively. The Cmax and AUC were comparable after oral and intravenous doses of fluconazole. Oral fluconazole was well absorbed and tolerated. The use of oral fluconazole may offer an important alternative to the intravenous therapy; it may improve patient convenience, reduce the need for venous access and decrease complications and the cost of health care.

Positive impact of a follow-up phone call to community pharmacies in a medicaid drug utilization program.

OBJECTIVE: To evaluate the impact of including community pharmacists in strategies to alter excessive prescribing of antiulcer medications (AUMs) in a statewide drug utilization review (DUR) program. Mailing educational materials to physicians is a common intervention strategy of retrospective DUR programs. However, pharmacists are typically left out of this process, ignoring a possibly influential healthcare provider. METHODOLOGY: Patients without gastroesophageal reflux disease who received > or = 1.0 normalized therapeutic equivalents (e.g., 1.0 NTE = ranitidine 300 mg/d or omeprazole 20 mg/d) for five of six prior months were included. The pharmacists and physicians of these patients were divided into one of three geographically distinct groups: group 1 physicians received mailed materials only (pharmacists were not contacted); group 2 physicians and pharmacists received mailed materials only; and group 3 physicians and pharmacists received mailed materials, and the pharmacists were contacted by phone. Mean NTE and AUM costs were analyzed six months before and six months following the intervention. RESULTS: One hundred thirty-eight, 329, and 248 patients were included in G1, G2, and G3, respectively. There was a 12.4%, 8.0%, and 14.0% reduction in NTE for G1, G2, and G3, respectively. G1 AUM cost decreased 7.7% ($7710); G2 decreased 6.8% ($14 037); G3 decreased 20.5% ($26722). The total decrease in AUM cost for the entire cohort from before to after the intervention was $48469 (p < 0.05) in the six months following the intervention. CONCLUSIONS: A follow-up phone call to pharmacists in a statewide DUR intervention enhances the effectiveness of DUR interventions under the conditions studied. Enlisting the support of community pharmacists may improve the cost savings of these interventions.

Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations.

Although it is the second most common vaginal infection in North America, vulvovaginal candidiasis is a non-notifiable disease and has been excluded from the ranks of sexually transmitted diseases. Not surprisingly, vulvovaginal candidiasis has received scant attention by public health authorities, funding agencies, and researchers. Epidemiologic data on risk factors and pathogenic mechanisms remain inadequately studied. Most important, standards of care, including diagnosis and therapy, remain undefined. A conference was held in April 1996 to define and summarize what is known and supported by scientific data in the areas of epidemiology, diagnosis, and treatment of vulvovaginal candidiasis; but, more important, the conference aimed at defining what is not known, poorly studied, and controversial. Guidelines for the treatment and diagnosis of the different forms of vulvovaginal candidiasis are suggested.