Tobramycin and Beta-Lactam Antibiotic Use in Cystic Fibrosis Exacerbations: A Pharmacist Approach

OBJECTIVES: Survey suggests that recommended doses and dosage regimens for antipseudomonal antibiotics for the treatment of acute pulmonary exacerbations in cystic fibrosis (CF) patients are not used, and one way to address these disparities is the involvement of pharmacists who are dedicated to CF. This is the first survey specifically designed for pharmacists at Cystic Fibrosis Foundation (CFF)–accredited centers to identify how tobramycin and antipseudomonal beta-lactams are being used. The purpose of this survey is to quantify this information and to promote future study to allow for implementation of tobramycin and beta-lactam dosage and monitoring standardization. METHODS: An anonymous national cross-sectional survey of pharmacists that are affliated with CFF-accredited programs was performed using Qualtrics.com. RESULTS: The survey had a 48.5% response rate. Most pediatric pharmacists (78.6%) report using extended-interval tobramycin dosage. The most common reported starting dosage was 10 mg/kg every 24 hours; most centers aim for a maximum serum concentration (Cmax) between 20 and 40 mg/L (78.6%). A total of 26 adult pharmacists reported using extended-interval dosage (96%), using an initial dosage of 10 mg/kg/day. The most common parameters used to adjust dosage were Cmax and area under the curve (AUC; 31%); the Cmax goal was 20 to 40 mg/L (84.2%). Most respondents (79%) report using beta-lactams in combination with tobramycin. Extended-infusion and continuous-infusion beta-lactams were used more in adults than pediatric patients. CONCLUSIONS: Most CF pharmacists report using extended-interval tobramycin. With the information from this survey, the establishment of future consensus recommendations by pharmacists for optimal and consistent tobramycin and antipseudomonal beta-lactam dosage and monitoring strategies needs to be considered.

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Vancomycin Dosing and Monitoring in the Treatment of Cystic Fibrosis: Results of a National Practice Survey

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-22.6.406 ◽

2017 ◽

Vol 22 (6) ◽

pp. 406-411 ◽

Cited By ~ 1

Author(s):

Rebecca S. Pettit ◽

Stacy J. Peters ◽

Erin J. McDade ◽

Kaci Kreilein ◽

Radha Patel ◽

...

Keyword(s):

Cystic Fibrosis ◽

Trough Concentration ◽

Pediatric Population ◽

Area Under The Curve ◽

Monitoring Strategy ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Monitoring Strategies ◽

Cystic Fibrosis Foundation ◽

Initial Starting

OBJECTIVES Vancomycin is commonly used in patients with cystic fibrosis (CF) to treat acute pulmonary exacerbations, but few guidelines exist to help dose and monitor patients. The objective of this study was to assess vancomycin use and monitoring strategies at Cystic Fibrosis Foundation (CFF)–accredited centers in hopes of developing and implementing vancomycin dosing and monitoring standards. METHODS An anonymous national cross-sectional survey of pharmacists affiliated with CFF-accredited pediatric and/or adult centers was performed by using Surveymonkey.com. The survey consisted of 3 sections: (1) CF Center Demographic Information (10 questions); 2) vancomycin use in pediatric CF patients (31 questions); and 3) vancomycin use in adult CF patients (29 questions); it was administered from March 9, 2015, to April 13, 2015. RESULTS The survey was completed by 31/69 (45%) pharmacists and 28 (90.3%) reported using vancomycin in the pediatric population. The most common initial starting dose for pediatric patients was 15 mg/kg/dose (57.1%) and every 6 hours was the most common dosing frequency (67.9%). The most common monitoring strategy was collection of a trough concentration (92.9%) with 57.7% of pharmacist targeting a range of 15 to 20 mg/L. The most common initial starting vancomycin dose in adults with CF was 15 mg/kg/dose (61.5%), and initial frequency of every 8 hours (73.1%). The most common monitoring strategy was a trough concentration (96.2%) with 83.3% of pharmacists reporting a goal trough range of 15 to 20 mg/L. CONCLUSIONS The most common vancomycin dosing reported was 15 to 20 mg/kg/dose every 6 hours (pediatric) and 15 to 20 mg/kg/dose every 8 to 12 hours (adults). Serum concentrations measured to meet monitoring parameters of trough concentrations of 15 to 20 mg/L, or area under the curve to minimum inhibitory concentration ratio > 400, were the same in both pediatric and adult patients.

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Faculty Opinions recommendation of Effect of beta lactam antibiotic use in children on pneumococcal resistance to penicillin: prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1003975.43808 ◽

2002 ◽

Author(s):

Marilyn Roberts

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Antibiotic Use ◽

Beta Lactam ◽

Beta Lactam Antibiotic ◽

Lactam Antibiotic ◽

Resistance To Penicillin

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The Economic Cost of Diet and Its Association with Adherence to the Mediterranean Diet in a Cohort of Spanish Primary Schoolchildren

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18031282 ◽

2021 ◽

Vol 18 (3) ◽

pp. 1282

Author(s):

Rosario Pastor ◽

Noemi Pinilla ◽

Josep A. Tur

Keyword(s):

Mediterranean Diet ◽

Fast Food ◽

Area Under The Curve ◽

Economic Cost ◽

Food Prices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Old Spanish ◽

Total Economic Cost ◽

Data Frequency

Background: Adoption of a certain dietary pattern is determined by different factors such as taste, cost, convenience, and nutritional value of food. Objective: To assess the association between the daily cost of a diet and its overall quality in a cohort of 6–12-year-old Spanish schoolchildren. Methods: A cross-sectional survey was conducted on a cohort (n = 130; 47% female) of 6–12-year-old children schooled in primary education in the central region of Spain. Three-day 24 h records were administered, and the nutritional quality of the diet was also determined by means of Mediterranean Adequacy Index (MAI). A questionnaire on sociodemographic data, frequency of eating in fast-food restaurants, and supplement intake were also recorded. The person responsible for the child’s diet and the schooler himself completed the questionnaires, and homemade measures were used to estimate the size of the portions. Food prices were obtained from the Household Consumption Database of the Spanish Ministry of Agriculture, Fisheries and Food. The economic cost of the diet was calculated by multiplying the amount in grams of the food consumed by each child by the corresponding price in grams and adding up the total amount for each participant. The total economic cost of the diet was calculated in €/day and in €/1000 kcal/day. Results: The area under the curve (AUC) for €/day and €/1000 kcal/day represent 62.6% and 65.6%, respectively. According to AUC values, adherence to Mediterranean diet (MD) is a moderate predictor of the monetary cost of the diet. A direct relationship between the cost of the diet and the adherence to MD was observed [OR (€/1000 kcal/day) = 3.012; CI (95%): 1.291; 7.026; p = 0.011]. Conclusions: In a cohort of Spanish schoolchildren with low adherence to the MD, a higher cost of the diet standardized to 1000 kcal was associated with above-average MAI values.

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PvMSP8 as a Novel Plasmodium vivax Malaria Sero-Marker for the Peruvian Amazon

Pathogens ◽

10.3390/pathogens10030282 ◽

2021 ◽

Vol 10 (3) ◽

pp. 282

Author(s):

Elizabeth Villasis ◽

Katherine Garro ◽

Angel Rosas-Aguirre ◽

Pamela Rodriguez ◽

Jason Rosado ◽

...

Keyword(s):

Plasmodium Vivax ◽

Area Under The Curve ◽

Surface Protein ◽

Merozoite Surface Protein ◽

Population Based ◽

Peruvian Amazon ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Malaria Exposure ◽

Plasmodium Vivax Malaria

The measurement of recent malaria exposure can support malaria control efforts. This study evaluated serological responses to an in-house Plasmodium vivax Merozoite Surface Protein 8 (PvMSP8) expressed in a Baculovirus system as sero-marker of recent exposure to P. vivax (Pv) in the Peruvian Amazon. In a first evaluation, IgGs against PvMSP8 and PvMSP10 proteins were measured by Luminex in a cohort of 422 Amazonian individuals with known history of Pv exposure (monthly data of infection status by qPCR and/or microscopy over five months). Both serological responses were able to discriminate between exposed and non-exposed individuals in a good manner, with slightly higher performance of anti-PvMSP10 IgGs (area under the curve AUC = 0.78 [95% CI = 0.72–0.83]) than anti-PvMSP8 IgGs (AUC = 0.72 [95% CI = 0.67–0.78]) (p = 0.01). In a second evaluation, the analysis by ELISA of 1251 plasma samples, collected during a population-based cross-sectional survey, confirmed the good performance of anti-PvMSP8 IgGs for discriminating between individuals with Pv infection at the time of survey and/or with antecedent of Pv in the past month (AUC = 0.79 [95% CI = 0.74–0.83]). Anti-PvMSP8 IgG antibodies can be considered as a good biomarker of recent Pv exposure in low-moderate transmission settings of the Peruvian Amazon.

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Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study

Antibiotics ◽

10.3390/antibiotics10020154 ◽

2021 ◽

Vol 10 (2) ◽

pp. 154

Author(s):

Sisira Donsamak ◽

Marjorie C. Weiss ◽

Dai N. John

Keyword(s):

Respiratory Infections ◽

Acute Diarrhoea ◽

Community Pharmacists ◽

Antibiotic Use ◽

Educational Interventions ◽

Community Pharmacies ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Case Vignettes ◽

A Chain

In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use.

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Antibiotic use in goats: role of experience and education of Missouri veterinarians

Veterinary Record ◽

10.1136/vr.105455 ◽

2020 ◽

Vol 186 (11) ◽

pp. 349-349

Author(s):

Lauren Landfried ◽

Patrick Pithua ◽

Roger D Lewis ◽

Steven Rigdon ◽

Jonathan Jacoby ◽

...

Keyword(s):

Continuing Education ◽

Health Management ◽

Intestinal Parasites ◽

Antibiotic Use ◽

Herd Health ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

Prescription Practices

BackgroundIn a previous study, we found that rates of antibiotic residues in goat carcasses in Missouri were three times the published national average, warranting further research in this area.MethodsWe conducted a cross-sectional survey of goat veterinarians to determine attitudes and practices regarding antibiotics, recruiting 725 veterinarians listed on the American Association of Small Ruminant Practitioners (AASRP) website and 64 Missouri Veterinary Medical Association (MVMA) veterinarians.ResultsWe collected 189 responses (26.1%) from AASRP members (170 valid) and 8 (12.5%) from MVMA veterinarians totalling 178 responses. While the vast majority of all veterinarians indicated that they prescribed antibiotics less than half of the time, Missouri veterinarians indicated that they spent more time treating goats for overt disease like intestinal parasites and less time on proactive practices such as reproductive herd health management comparatively. While veterinarians agreed that antibiotic resistance was a growing concern, veterinarians outside of Missouri seemed more confident that their own prescription practices was not a contributor. Although nationally most veterinarians felt that attending continuing education classes was beneficial, 73.4% in other states attended classes on antibiotic use compared to only four of the nine Missouri veterinarians.ConclusionMissouri veterinarians had less veterinary experience than veterinarians in other states, and this, in conjunction with low continuing education requirements in Missouri relative to most other states, may hinder development of more proactive and effective client–veterinary relationships.

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Antibiotic Use: A Cross-Sectional Survey Assessing the Knowledge, Attitudes and Practices amongst Students of a School of Medicine in Italy

PLoS ONE ◽

10.1371/journal.pone.0122476 ◽

2015 ◽

Vol 10 (4) ◽

pp. e0122476 ◽

Cited By ~ 38

Author(s):

Giacomo Scaioli ◽

Maria R. Gualano ◽

Renata Gili ◽

Simona Masucci ◽

Fabrizio Bert ◽

...

Keyword(s):

Antibiotic Use ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

School Of Medicine ◽

Knowledge Attitudes And Practices

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Italian young doctors’ knowledge, attitudes and practices on antibiotic use and resistance: A national cross-sectional survey

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2020.08.022 ◽

2020 ◽

Vol 23 ◽

pp. 167-173

Author(s):

F. Di Gennaro ◽

C. Marotta ◽

M. Amicone ◽

D.F. Bavaro ◽

F. Bernaudo ◽

...

Keyword(s):

Antibiotic Use ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices

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Knowledge and Expectations on Antibiotic Use among Older Adults in Malaysia: A Cross-Sectional Survey

Geriatrics ◽

10.3390/geriatrics4040061 ◽

2019 ◽

Vol 4 (4) ◽

pp. 61 ◽

Cited By ~ 1

Author(s):

Lai San Kong ◽

Farida Islahudin ◽

Leelavathi Muthupalaniappen ◽

Wei Wen Chong

Keyword(s):

Older Adults ◽

Viral Infections ◽

Antibiotic Use ◽

The Body ◽

Limited Information ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Inappropriate Use ◽

Validated Questionnaire

Antibiotics are commonly prescribed among older adults, and inappropriate use of antibiotics has been noted. However, there is limited information about their knowledge and expectations for antibiotics. This study aimed to assess older adults’ knowledge of antibiotic use and resistance, their expectations for antibiotics and the relationship between knowledge, expectation and inappropriate practices related to antibiotic use. A cross-sectional survey involving respondents aged 60 years and above was conducted, using a validated questionnaire. A lack of knowledge about the role of antibiotics was observed, whereby more than half of the respondents incorrectly believed that antibiotics can treat viral infections (53.5%) and colds and coughs (53.7%). Also, 67.9% of respondents incorrectly believed that antibiotic resistance occurs when the body becomes resistant to antibiotics. Almost half of the respondents would expect antibiotics for symptoms of self-limiting viral infections. Respondents who answered correctly for the role of antibiotics in viral infections were more likely not to expect antibiotics for cold, flu and cough (p < 0.001). Respondents who answered correctly regarding the need to adhere to antibiotics were more likely to have completed their antibiotic course (p < 0.001). Future educational initiatives should provide key information on the role of antibiotics and the importance of complying with antibiotics in this population.

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