Vancomycin and daptomycin stability in heparin or sodium citrate lock solutions.

BACKGROUND: We investigated physical and chemical stability of daptomycin and vancomycin in heparin or sodium citrate lock solutions. The aim of this study was to find the optimal combination of antimicrobials and additives for lock solutions, which maximized patient safety. METHODS: Vancomycin and daptomycin were diluted with heparin or sodium citrate to achieve final concentrations of vancomycin-heparin 2.5 mg/mL-833.33 U/mL, vancomycin-citrate 2.5-33.3 mg/mL, daptomycin-heparin 5 mg/mL-800 U/mL, and daptomycin-citrate 5-32 mg/mL and they were stored at room temperature (+25°C), 4°C, -20°C, and 37°C. Physical and chemical stability were analyzed for each antibiotic-anticoagulant combination in all conditions immediately after preparation, at 24, 48, 72 h and at different time points until unstable concentrations were obtained. Daptomycin-sodium citrate microbiological activity was also studied by evaluating two Staphylococcus aureus cultures in a calcium enriched medium with a daptomycin E test, with and without sodium citrate. RESULTS: After incubation at 37°C vancomycin and daptomycin combined with heparin retained at least 90% of the initial concentration over 48 h. Vancomycin-sodium citrate solution stored at 37°C reduced more than 10% of the initial concentration at 24 h. On the other hand, daptomycin-sodium citrate preparation was stable at 37°C for 72 h but the microbiological activity of daptomycin was lower in the presence of sodium citrate. CONCLUSIONS: The purpose is to prepare vancomycin and daptomycin lock solutions combined with heparin. They should be changed at 48 h and its stability is over 3 days at 25°C and 7 days at 4°C, which allow Hospital Pharmacy Services to manage their stocks. Daptomycin-sodium citrate combination is more stable for extended periods but its bioactivity has not been demonstrated.

Beta-lactam allergy in patients: an antibiotic stewardship challenge.

BACKGROUND: Patients are commonly reported as being allergic to beta-lactam (BL) antibiotics. However, many patients with this reported allergy are able to receive BL treatments because they do not have true allergies. In many cases these are simply intolerances due to side effects reported as an allergy. Delabelling these patients leads to better clinical outcomes, optimal antibiotic usage, decreased bacterial resistance and reduced healthcare costs. Therefore, the aims of this study were to identify incorrectly labelled BL allergies in hospitalised patients and to assess antibiotic use in delabelled patients in order to establish a quality indicator to optimise antimicrobial treatments. METHODS: A prospective study was conducted in which hospitalised patients treated with antimicrobial drugs and labelled as 'BL-allergic' were identified by clinical pharmacists. An allergist assessed whether patients were suitable candidates for a skin test or oral challenge. The Allergy Service removed 'BL-allergic' labels if negative results were obtained. Delabelled patients were followed up by clinical pharmacists to study the use of BL antibiotics as a result of the delabelling programme. RESULTS: A total of 176 suspected allergic patients were identified and 91 (51.7%) were tested either by a skin test or oral challenge based on the patient indicators. Seven (16.4%) patients tested were allergic to BL antibiotics, 76 (83.5%) were totally delabelled and eight (0.1%) were partially delabelled. Thirty-two (38.1%) delabelled patients required antibiotic treatment in another inpatient or outpatient setting, of whom 27 (84.3%) patients with a new infectious episode received BL treatments while five (15.7%) continued to receive antimicrobial treatments without BL. CONCLUSION: After the implementation of a protocol to detect incorrect BL allergy labels, 83.5% of the patients in this cohort were completely delabelled. This shows that there is a clear opportunity to optimise the use of antibiotics by delabelling 'BL-allergic' patients.

Mapping the clinical pharmacokinetics and pharmacogenetic units operating in Spanish hospitals.

OBJECTIVE: The goal of this article is to analyze the situation of  harmacokinetics and pharmacogenetics units in the pharmacy departments of  Spanish hospitals, evaluate their development both in the clinical and educational areas, and draw up a map reflecting their current status.  Method: A 29-item survey structured in five blocks was designed with general questions about the respondents' hospital and the clinical and educational activities carried out by their pharmacy department, in the fields of both pharmacokinetics and pharmacogenetics. RESULTS: Sixty-nine  hospitals answered the survey. The highest response rates corresponded to  Catalonia, the Valencia region and Andalusia. The drug families subject to closest monitoring were classic antibiotics (93%), digoxin (57%), classic antiepileptics  (51%) and biologicals (43%). The most frequently used computer programs  included PKS and NONMEM (93% and 22% of hospitals, respectively).  Regarding training in pharmacokinetics, second year residents were those who  most frequently rotated through the pharmacokinetics unit (40%), while 44%  of those units allowed external residents. As far as pharmacogenetics is  concerned, in 42% of hospitals that engaged in pharmacogenetic work, the  department in charge was pharmacy. The most frequent specialties covered  were hemato-oncology (72%) and psychiatry (15%). Twenty-four percent of  hospitals offered rotations through their pharmacogenetics unit but only seven of them allowed external residents. CONCLUSIONS: The results of the survey showed an increase in the  erformance of pharmacokinetic and pharmacogenetic activities by Spanish hospital pharmacies as compared with the data from a 2009 baseline  survey, with many hospitals introducing the performance of therapeutic drug monitoring of non-classical antibiotics, immunosuppressants and biologics. However, the percentage of hospitals that follow the ideal model based on analytical determinations and pharmacokinetic reporting has decreased the data obtained served as a basis to create an updated map of the  harmacokinetics and pharmacogenetics units operating in Spanish hospital  pharmacy departments. This map, available at http://bit.ly/mapaPKGen, will be very useful to facilitate the training of residents in these disciplines and will  help promote the development of pharmacokinetic and pharmacogenetic activities among hospital pharmacists.

OBJETIVO: Dar a conocer la actividad asistencial y docente de las unidades de  farmacocinética y farmacogenética de los servicios de farmacia hospitalaria  españoles y elaborar un mapa que refleje la situación actual. Método: Se  diseñó una encuesta de 29 preguntas estructuradas en cinco bloques: datos  enerales del hospital e información sobre la actividad asistencial y docente,  tanto en el área de farmacocinética como de farmacogenética en los servicios  de farmacia hospitalaria. RESULTADOS: Respondieron la encuesta 69 hospitales. Las regiones geográficas  con mayor número de respuestas fueron Cataluña, Comunidad   Valenciana y Andalucía. Los grupos farmacológicos que más se monitorizaron fueron los antibióticos clásicos (vancomicina y aminoglucósidos)  (93%), digoxina (57%), antiepilépticos clásicos (51%) y biológicos (43%). Los  programas informáticos que con más frecuencia se utilizaban fueron PKS y NONMEM, con un 93% y 22%, respectivamente. Respecto a la docencia en  farmacocinética, fue el segundo año de residencia cuando la mayoría de los farmacéuticos internos residentes rotaban por el área (40%) y un 44% de las  unidades permitían rotantes externos. El responsable de la farmacogenética era el servicio de farmacia hospitalario en un 43% de los  casos. Los ámbitos más frecuentes fueron oncohematología (72%) y  psiquiatría (15%). Un 24% de los hospitales ofrecían rotación por la unidad de  farmacogenética y sólo 7 servicios de farmacia ofertaron rotaciones externas. Conclusiones: Los resultados de la encuesta mostraron un incremento en la  realización de actividades de farmacocinética y farmacogenética en los servicios de farmacia hospitalaria comparados con los datos de la encuesta  basal de 2009. Se inició la realización de monitorización terapéutica de biológicos, inmunosupresores y antibióticos no clásicos. Sin embargo, ha disminuido el porcentaje de hospitales que aplican el modelo ideal basado en la  realización de determinación analítica e informe farmacocinético desde  farmacia. Los datos obtenidos permiten disponer de un mapa actualizado de  las unidades de farmacocinética y farmacogenética clínicas en los servicios de  farmacia hospitalaria españoles. Esta información se encuentra disponible en  http://bit.ly/mapaPKGen y será de gran utilidad para facilitar la formación de  nuestros residentes en estas disciplinas y ayudará a promocionar su desarrollo  entre los farmacéuticos de hospital.

Mapa de unidades de farmacocinética y farmacogenética clínica en España / Mapping the clinical pharmacokinetics and pharmacogenetic units operating in Spanish hospitals

Objetivo: Dar a conocer la actividad asistencial y docente de las unidades de farmacocinética y farmacogenética de los servicios de farmaciahospitalaria españoles y elaborar un mapa que refleje la situación actual.Método: Se diseñó una encuesta de 29 preguntas estructuradas encinco bloques: datos generales del hospital e información sobre la actividad asistencial y docente, tanto en el área de farmacocinética como defarmacogenética en los servicios de farmacia hospitalaria.Resultados: Respondieron la encuesta 69 hospitales. Las regiones geográficas con mayor número de respuestas fueron Cataluña, ComunidadValenciana y Andalucía. Los grupos farmacológicos que más se monitorizaron fueron los antibióticos clásicos (vancomicina y aminoglucósidos) (93%),digoxina (57%), antiepilépticos clásicos (51%) y biológicos (43%). Los programas informáticos que con más frecuencia se utilizaban fueron PKS yNONMEM, con un 93% y 22%, respectivamente. Respecto a la docenciaen farmacocinética, fue el segundo año de residencia cuando la mayoría delos farmacéuticos internos residentes rotaban por el área (40%) y un 44%de las unidades permitían rotantes externos. El responsable de la farmacogenética era el servicio de farmacia hospitalario en un 43% de los casos.Los ámbitos más frecuentes fueron oncohematología (72%) y psiquiatría(15%). Un 24% de los hospitales ofrecían rotación por la unidad de farmacogenética y sólo 7 servicios de farmacia ofertaron rotaciones externas. Conclusiones: Los resultados de la encuesta mostraron un incremento enla realización de actividades de farmacocinética y farmacogenética en losservicios de farmacia hospitalaria comparados con los datos de la encuesta basal de 2009. (AU)

Objective: The goal of this article is to analyze the situation of pharmacokinetics and pharmacogenetics units in the pharmacy departmentsof Spanish hospitals, evaluate their development both in the clinical andeducational areas, and draw up a map reflecting their current status.Method: A 29-item survey structured in five blocks was designed withgeneral questions about the respondents’ hospital and the clinical andeducational activities carried out by their pharmacy department, in thefields of both pharmacokinetics and pharmacogenetics.Results: Sixty-nine hospitals answered the survey. The highest response ratescorresponded to Catalonia, the Valencia region and Andalusia. The drugfamilies subject to closest monitoring were classic antibiotics (93%), digoxin(57%), classic antiepileptics (51%) and biologicals (43%). The most frequentlyused computer programs included PKS and NONMEM (93% and 22% ofhospitals, respectively). Regarding training in pharmacokinetics, second yearresidents were those who most frequently rotated through the pharmacokinetics unit (40%), while 44% of those units allowed external residents. Asfar as pharmacogenetics is concerned, in 42% of hospitals that engaged inpharmacogenetic work, the department in charge was pharmacy. The mostfrequent specialties covered were hemato-oncology (72%) and psychiatry(15%). Twenty-four percent of hospitals offered rotations through their pharmacogenetics unit but only seven of them allowed external residents.Conclusions: The results of the survey showed an increase in the performance of pharmacokinetic and pharmacogenetic activities by Spanishhospital pharmacies as compared with the data from a 2009 baseline survey, with many hospitals introducing the performance of therapeutic drugmonitoring of non-classical antibiotics, immunosuppressants and biologics. (AU)