Extended infusion versus intermittent infusion of Piperacillin/ tazobactam: altering current methods to optimize future outcome

Due to worldwide bacterial resistance, researchers and clinicians were required to optimize existing antimicrobials by influencing the pharmacokinetics and pharmacodynamics (PK/PD) features. Piperacillin/tazobactam (PIP/TZB) is one of the most frequently empirical antibiotics prescribed globally. The aim of the review was to evaluate the use of an extended infusion (EI) versus an intermittent infusion (II) of PIP/TZB in hospital settings in terms of patient safety and efficacy. Several PK/PD studies assessed the use of an extended infusion of PIP/TZB to reach different minimum inhibitory concentration (MIC) levels for many microorganisms including Pseudomonas aeruginosa. One of the main parameters to define the size of the effect of PIP/TZB to various microorganisms is the percentage of time the free drug concentration above MIC (%fT > MIC). Many studies have compared extended infusion (EI) versus intermittent infusion (II) in terms of mortality rate, clinical cure or efficacy, length of stay whether in an intensive care unit (ICU) or hospital, duration of therapy, and cost. The clinical data reviewed in this article include PK/PD studies, prospective trials, systematic reviews, and meta-analysis. The review emphasized the role of an extended infusion in a population with altered pharmacokinetics including patients on continuous renal replacement therapy (CRRT), critically ill patients with augmented renal clearance, and patients with cystic fibrosis. Our review reports a positive trend when using an extended infusion of PIP/TZB which encourages the adoption and implementation of the extended infusion to achieve positive patient outcomes. Nevertheless, more studies are required to attain generalizable and reliable data to determine whether an extended infusion improves patient outcomes. (AU)

Quality of Clinical Counseling About Lifestyle-Related Diseases: An Analysis of Daily Practice From the National Guard Primary Health Care Center at Jeddah, Saudi Arabia.

BACKGROUND:  Unhealthy lifestyle behaviors are the main reason for the worldwide epidemic of chronic diseases. Changes in lifestyle, such as physical activity, healthy diet, and non-smoking, require preventive strategies at the national and individual levels. Clinical counseling is one of these strategies which helps patients to be motivated and enhance their self-management. The present study aimed to improve clinical counseling practice at the National Guard Primary Health Care Center, Jeddah, Saudi Arabia. Objective:To assess the quality of counseling from the patient's perspective in the primary care center of the National Guard (specialized polyclinic center) using a modified counseling quality instrument (CQI). Subjects and methods: In a cross-sectional study and through a convenient sampling technique from the patients visiting the National Guard Primary Health Care Center (specialized polyclinic center), 358 patients completed a self-administered questionnaire regarding their experiences of clinical counseling. The Kruskal-Wallis test was used to record the statistically significant differences between the ordinal variable of participants' quality scores and their demographic characteristics. RESULTS:  The mean age of participants was 35± 8 years, ranging between 22 to 69 years. Most of the participating patients were women (63%). Slightly more than half the patients obtained clinical counseling during their appointments, and physicians at the clinic gave 57% of these clinical counseling sessions. The patients were generally satisfied with the counseling. They rated the counseling sessions as good in terms of content, the process of counseling, the way of interaction, and the degree of goal-oriented discussion. In addition to receiving counseling from physicians, older participants and those with postgraduate education were found to significantly positively affect patient perceptions of counseling quality. CONCLUSION: This study found that half of the participants did not get clinical counseling during their visits, indicating no standardization in clinical counseling services for all patients. Although patients were generally satisfied with the counseling session provided to them, time constraint was the highest dissatisfaction item among two-thirds of the patients in the present study.