Comparison of antimicrobial dosing recommendations in patients receiving intermittent hemodialysis among drug information resources.

WHAT IS KNOWN AND OBJECTIVE: Tertiary drug information resources are frequently consulted for the optimal antimicrobial dosing in intermittent hemodialysis (IHD) patients. Yet, significant discrepancy may exist in dosing recommendations between resources. This study was to evaluate the consistency of antimicrobial dosing recommendations in IHD among four different drug information resources and the relevance of referenced pharmacokinetic studies. METHODS: Dosing recommendations of 29 commonly prescribed antimicrobials in IHD patients were collected from Micromedex, LexiComp, Clinical Pharmacology and Drug Prescribing in Renal Impairment to compare dosing categorization and the total daily dose (TDD). Significant dosing discrepancies were defined as ≥30% difference. Referenced pharmacokinetic studies were evaluated for their relevance in current practice, using sample size, hemodialyzer types, the use of optimal pharmacodynamic targets and the consideration of different interdialytic dosing periods. RESULTS AND DISCUSSION: A significant variation was found both in dosing categorization and recommended doses between resources. Seventeen drugs were compared for TDD with significant dosing discrepancy in 8 drugs. Among 42 referenced pharmacokinetic studies, 40 were evaluated. Mean patient numbers of pharmacokinetic studies were 13 ranging from 3 to 70. Sixty per cent of studies utilized contemporary hemodialyzers (e.g., high-flux and/or high efficiency). The optimal pharmacodynamic targets and the impact of different interdialytic intervals were assessed only in 27.5% and 7.5% respectively. WHAT IS NEW AND CONCLUSION: Inconsistent antimicrobial dosing recommendations for IHD patients exist among four well-established resources. Many referenced pharmacokinetic studies utilized outdated or less pharmacodynamically relevant study methods. Newer studies are warranted to reflect contemporary dialysis practice and assess its impact on optimal antimicrobial dosing.

Influence of Employment on the Positive Mental Health of Individuals with Schizophrenia Living in the Community.

Lower levels in emotional well-being have been observed in individuals with schizophrenia but well-planned direct comparisons in positive mental health between employed and unemployed persons with schizophrenia are lacking. This study is among the first to test differences in positive mental health between employed and unemployed persons with schizophrenia living in the community. Participants were 101 unemployed individuals with schizophrenia living in the community and 67 employed ones. Socio-demographic data sheet and Mental Health Continuum-Short Form (MHC-SF) were used to collect the data. Results revealed that emotional and psychological well-being were lower in the unemployed group compared to the employed group, however, there was no significant difference in social well-being between the groups. Emotional and psychological well-being was correlated with employment status in individuals with schizophrenia living in the community.