scholarly journals Drug-Drug Interaction Associated with Mold-Active Triazoles among Hospitalized Patients

2016 ◽  
Vol 60 (6) ◽  
pp. 3398-3406 ◽  
Author(s):  
David Andes ◽  
Nkechi Azie ◽  
Hongbo Yang ◽  
Rachel Harrington ◽  
Caroline Kelley ◽  
...  
Keyword(s):  
At Risk ◽  
Drug Interactions ◽  
Drug Information ◽  
Fungal Infections ◽  
Hospitalized Patients ◽  
First Line ◽  
Antifungal Stewardship ◽  
Recent Developments ◽  
Moderate Interaction

The majority of hospitalized patients receiving mold-active triazoles are at risk of drug-drug interactions (DDIs). Efforts are needed to increase awareness of DDIs that pose a serious risk of adverse events. Triazoles remain the most commonly utilized antifungals. Recent developments have included the mold-active triazoles (MATs) itraconazole, voriconazole, and posaconazole, which are first-line agents for the treatment of filamentous fungal infections but have the potential for DDIs. This objective of this study was to evaluate the prevalence of triazole DDIs. Hospitalized U.S. adults with MAT use were identified in the Cerner HealthFacts database, which contained data from over 150 hospitals (2005 to 2013). The severities of DDIs with MATs were categorized, using drug labels and the drug information from the Drugdex system (Thompson Micromedex), into four groups (contraindicated, major, moderate, and minor severity). DDIs of minor severity were not counted. A DDI event was considered to have occurred if the following two conditions were met: (i) the patient used at least one drug with a classification of at least a moderate interaction with the MAT during the hospitalization and (ii) there was a period of overlap between the administration of the MAT and that of the interacting drug of at least 1 day. A total of 6,962 hospitalizations with MAT use were identified. Among them, 88% of hospitalizations with voriconazole use, 86% of hospitalizations with itraconazole use, and 93% of hospitalizations with posaconazole use included the use of a concomitant interacting drug. A total of 68% of hospitalizations with posaconazole use, 34% of hospitalizations with itraconazole use, and 20% of hospitalizations with voriconazole use included the use of at least one drug with a DDI of contraindicated severity. A total of 83% of hospitalizations with posaconazole use, 61% of hospitalizations with itraconazole use, and 82% of hospitalizations with voriconazole use included the use of at least one drug that resulted in a severe DDI. The findings of this study demonstrate that a majority of hospitalized patients receiving MAT are at risk for severe drug-drug interactions and highlight the need for antifungal stewardship.

scholarly journals Epidemiological data and antifungal susceptibility in invasive fungal infections - a Romanian infectious diseases tertiary hospital’s experience. Preliminary report

2017 ◽  
Vol 25 (4) ◽  
pp. 345-353
Author(s):  
Radu Agrosoaie ◽  
Adrian Streinu-Cercel ◽  
Doina Azoicai ◽  
Codrina Bejan ◽  
Olga Dorobat ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Epidemiological Data ◽  
Healthcare Services ◽  
Invasive Fungal Infections ◽  
First Line ◽  
Antifungal Stewardship

Abstract Introduction: Invasive fungal infections have stood as an important research subject for the past 20 years, being considered as a crucial effect of advancing healthcare services. Low identification rates of invasive fungal infections in blood cultures and low sensibility of biomarkers determine empiric treatments which lead to a change in epidemiological data and antifungal susceptibility. The aim: The epidemiological evaluation of invasive fungal infections and the assessment of antifungal resistance related to this condition. Methods and material: An “antifungal stewardship” retrospective study was developed between January 2010 and April 2016. An epidemiological analysis was performed on 79 cases with proven invasive fungal infections in bloodstream, catheter, and cerebrospinal fluid. We considered: age, gender, HIV status, place of residence, and first option in medical practice of antifungal treatment. The laboratory analysis was performed by the Microbiology Laboratory at “Prof. Dr. Matei Bals” National Institute for Infectious Diseases, Bucharest. Minimum inhibitory concentrations (MIC’s) of 15 isolates were identified using colorimetric micro broth dilution panel YEASTONE ®YO10 and compared with susceptibilities obtained by VITEK2®C system. Candida parapsilosis ATCC 22019 was used as reference. Results: The incidence of invasive fungal infections was 3.7 on 1000 hospitalized patients. The age of the study population ranged between 12 and 83 years, and most were male (59%). The majority of subjects were from an urban area (84%), and 27% of them were HIV positive. The results obtained in VITEK2C® were similar with those from YEASTONE® YO10 for fluconazole, voriconazole, amphotericin B (100%), without any minor, major or very major errors. The fluconazole was the first option of treatment, followed by voriconazole, caspofungin, anidulafungin. In 37% of cases the first treatment option was replaced with a secondary antifungal therapy accordingly with antifungal breakpoints obtained by Vitek ®. Conclusions: No rates of resistance to fluconazole, amphotericin B, voriconazole were obtained. Fluconazole was the major first line antifungal therapy. Conclusions: No rates of resistance to fluconazole, amphotericin B, voriconazole were obtained. Fluconazole was the major first line antifungal therapy.

scholarly journals Analysis of Potential Interaction between Antiretrovirals and Comorbid Medications of HIV Patients at a Top Referral Hospital in Indonesia

2020 ◽  
Vol 14 (1) ◽  
pp. 68-74
Author(s):  
Nafrialdi Nafrialdi ◽  
Syelvia Moulita ◽  
Instiaty Instiaty ◽  
Evy Yunihastuti
Keyword(s):  
Fungal Infections ◽  
Potential Interaction ◽  
Close Monitoring ◽  
Hiv Patients ◽  
Serious Adverse Event ◽  
Comorbid Diseases ◽  
Clinically Significant ◽  
Moderate Interaction ◽  
Hiv Aids

Background: HIV/AIDS usually present with comorbid diseases such as tuberculosis, pneumonia, toxoplasmosis, fungal infections, etc., that need multiple medications. Potential interaction between ARV and comorbid drugs is unavoidable. Objective: This study aimed to investigate the potential interaction between ARV drugs and medications used to treat comorbid diseases among HIV patients at the Dr. Cipto Mangunkusumo Hospital, Jakarta. Methods: This was an observational study using medical record data of 121 HIV/AIDS patients treated at the CM Hospital between January 2016 and July 2017. Potential interaction was classified as “major” if it could lead to increase or decrease of plasma drug levels which potentially result in either drug toxicity or treatment failure, or clinically significant harm to the patient; “moderate” if the interaction is not major, but with the recommendation of close monitoring. National, European, Australian, and Liverpool iChart guidelines were used for the classification of drug interactions. Results: Major interactions were noted in 17 (14.05%)patients. Fourteen of them received rifampicin, which potentially decreases plasma level of nevirapine (9 patients), rilpivirine (1 patient), and lopinavir/ritonavir (4 patients). Potential increase of ARV level was found in 3 patients involving interaction between voriconazole-efavirenz (2) and omeprazole-rilpivirine (1). Moderate interaction with the potential decrease of ARV level occurred in 46 patients (38.01%); consisting of a combination of rifampicin with efavirenz (38 pts), rifampicin with zidovudine (6 pts), and phenytoin with efavirenz or nevirapine (2 patients). Conclusion: Potential major interaction occurred in 17 (14.05%), which mostly attributed to rifampicin use; while moderate interaction occurred in 46 (38.01%) of patients. Although no serious adverse event was observed in this study, special care should be taken when the drugs with potential major interaction are to be administered

The Accuracy of ACR TI-RADS Classification of Neck Ultrasound as a First-Line Diagnostic Approach for Thyroid Neoplasms in Pediatric Patients: A Retrospective Study

2018 ◽  
Vol 5 (1) ◽  
pp. 13-23
Author(s):  
Nikolai S. Grachev ◽  
Elena V. Feoktistova ◽  
Igor N. Vorozhtsov ◽  
Natalia V. Babaskina ◽  
Ekaterina Yu. Iaremenko ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Pediatric Patients ◽  
Thyroid Neoplasms ◽  
Diagnostic Methods ◽  
Diagnostic Approach ◽  
First Line ◽  
Neck Ultrasound

Background.Ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) is the gold standard in diagnosing the pathological nature of undetermined thyroid nodules. However, in some instances limitations and shortcomings arise, making it insufficient for determining a specific diagnosis.Objective.Our aim was to evaluate the effectiveness of ACR TI-RADS classification of neck ultrasound as a first-line diagnostic approach for thyroid neoplasms in pediatric patients.Methods.A retrospective analysis was made of FNA and US protocols in 70 patients who underwent the examination and treatment at Dmitry Rogachev National Research Center between January 2012 and August 2017. In the retrospective series 70% (49/70) of patients undergone FNA and 43% (30/70) of them undergone repeated FNA. All US protocols were interpreted according to ACR TI-RADS system by the two independent experts. The clinical judgment was assessed using the concordance test and the reliability of preoperative diagnostic methods was analized.Results.According to histologic examination protocols, benign nodules reported greater multimorbidity 29% (20/70), compared with thyroid cancer 17% (12/70), complicating FNA procedure. A statistically significant predictor of thyroid cancer with a tumor size ACR TI-RADS showed a significant advantage of ACR TI-RADS due to higher sensitivity (97.6 vs 60%), specificity (78.6 vs 53.8%), positive predictive value (87.2 vs 71.4%), and negative predictive value (95.7 vs 41.2%). Concordance on the interpreted US protocols according to ACR TI-RADS classification between two experts was high, excluding accidental coincidence.Conclusion.The data support the feasibility of US corresponding to the ACR TI-RADS classification as a first-line diagnostic approach for thyroid neoplasm reducing the number of unnecessary biopsies for thyroid nodules.

scholarly journals Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 44
Author(s):  
Mary Beth Babos ◽  
Michelle Heinan ◽  
Linda Redmond ◽  
Fareeha Moiz ◽  
Joao Victor Souza-Peres ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Clinical Studies ◽  
Drug Information ◽  
Case Reports ◽  
Full Information ◽  
Information Need ◽  
Herbal Products ◽  
Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

Cardiovascular, Dermatological, Gastrointestinal, Hematological, Hormonal, and Immunosuppressant Agents

2002 ◽  
Vol 37 (10) ◽  
pp. 1113-1126 ◽  
Author(s):  
Joyce A. Generali
Keyword(s):  
At Risk ◽  
Adverse Events ◽  
Drug Interactions ◽  
Prescription Drugs ◽  
Hospital Pharmacy ◽  
Safety Data ◽  
Black Box ◽  
Information Monitoring ◽  
Black Box Warnings ◽  
Wall Chart

“Black-box” warnings report valuable postmarketing safety data about prescription drugs, keeping practitioners informed about potential adverse events, drug interactions, key dosing information, monitoring and administration requirements, and at-risk patient populations. They are especially crucial for newly approved agents. A list of agents with black-box warnings does not currently exist; however Hospital Pharmacy will be publishing comprehensive lists by drug category in this column until November 2002. At that time, a complete list in wall chart form will be released. Hospital Pharmacy will update the data as salient information becomes available.

scholarly journals 562. Tocilizumab for the Treatment of Severe COVID-19: A Retrospective, Multi-Center, Case-Matched Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S346-S346
Author(s):  
Sarah Norman ◽  
Sara Jones ◽  
David Reeves ◽  
Christian Cheatham
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Primary Outcome ◽  
Fungal Infections ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Matched Design ◽  
Median Hospital

Abstract Background At the time of this writing, there is no FDA approved medication for the treatment of COVID-19. One medication currently under investigation for COVID-19 treatment is tocilizumab, an interleukin-6 (IL-6) inhibitor. It has been shown there are increased levels of cytokines including IL-6 in severe COVID-19 hospitalized patients attributed to cytokine release syndrome (CRS). Therefore, inhibition of IL-6 receptors may lead to a reduction in cytokines and prevent progression of CRS. The purpose of this retrospective study is to utilize a case-matched design to investigate clinical outcomes associated with the use of tocilizumab in severe COVID-19 hospitalized patients. Methods This was a retrospective, multi-center, case-matched series matched 1:1 on age, BMI, and days since symptom onset. Inclusion criteria included ≥ 18 years of age, laboratory confirmed positive SARS-CoV-2 result, admitted to a community hospital from March 1st – May 8th, 2020, and received tocilizumab while admitted. The primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay, total mechanical ventilation days, mechanical ventilation mortality, and incidence of secondary bacterial or fungal infections. Results The following results are presented as tocilizumab vs control respectively. The primary outcome of in-hospital mortality for tocilizumab (n=26) vs control (n=26) was 10 (38%) vs 11 (42%) patients, p=0.777. The median hospital length of stay for tocilizumab vs control was 14 vs 11 days, p=0.275. The median days of mechanical ventilation for tocilizumab (n=21) vs control (n=15) was 8 vs 7 days, p=0.139, and the mechanical ventilation mortality was 10 (48%) vs 9 (60%) patients, p=0.463. In the tocilizumab group, for those expired (n=10) vs alive (n=16), 10 (100%) vs 7 (50%) patients respectively had a peak ferritin > 600 ng/mL, and 6 (60%) vs 8 (50%) patients had a peak D-dimer > 2,000 ng/mL. The incidence of secondary bacterial or fungal infections within 7 days of tocilizumab administration occurred in 5 (19%) patients. Conclusion These findings suggest that tocilizumab may be a beneficial treatment modality for severe COVID-19 patients. Larger, prospective, placebo-controlled trials are needed to further validate results. Disclosures Christian Cheatham, PharmD, BCIDP, Antimicrobial Resistance Solutions (Shareholder)

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