Kazuko Higuchi

Problems associated with prophylactic use of erythromycin in 1566 staff to prevent hospital infection during the outbreak of pertussis.

Background and objective:  Pertussis developed in Kagawa University Medical School and University Hospital in May 2007. To control the outbreak and prevent the infection of hospital inpatients, the Infection Control Team (ICT) carried out the prophylactic administration of erythromycin (EM) to hospital staff (1566 staff) who might be exposed to Bordetella pertussis.

Peritoneal pharmacokinetics of cefepime in laparotomy patients with inflammatory bowel disease, and dosage considerations for surgical intra-abdominal infections based on pharmacodynamic assessment

This study aimed to examine the peritoneal pharmacokinetics of cefepime and to assess its pharmacodynamic exposure in peritoneal fluid (PF). Cefepime (1 g) was administered to eight patients with inflammatory bowel disease before abdominal surgery. Venous blood and PF samples were obtained at the end of the 0.5-h infusion and at 1, 2, 3, 4, 5, and 6 h thereafter. Drug concentrations in plasma and PF were determined, analyzed pharmacokinetically, and used for a Monte Carlo simulation with minimum inhibitory concentration (MIC) data. Cefepime penetrated well into PF, with a maximum drug concentration in a PF/plasma ratio of 0.59 ± 0.15 (mean ± SD, n = 8), and an area under the concentration-time curve ratio of 0.90 ± 0.10. The probabilities of attaining the bacteriostatic and bactericidal targets (40% and 70% of the time above the MIC, respectively) in PF were ≥85% against Escherichia coli, Klebsiella species, and Enterobacter cloacae with 0.5 g every 12 h, 1 g every 12 h, 1 g every 8 h, and 2 g every 12 h. However, 1 g every 8 h or 2 g every 12 h was required for bacteriostatic and bactericidal probabilities ≥85% against Pseudomonas aeruginosa. These conventional regimens did not achieve a high probability against Bacteroides species. These results should help to give us a better understanding of the peritoneal pharmacokinetics of cefepime while also helping to choose the appropriate dosage to prevent surgical intra-abdominal infections on the basis of the pharmacodynamic assessment.

Estimation of the Supporting Functions for Prescription Making in an Order Entry System.

In order to ensure that an order entry system for prescritions operates correctly and efficiently, we estimated the value of the supporting functions for prescription making. We examined the reports concerning the information supplied (e.g., drug name and directions), the functions of inspection prior to prescription making (e.g., usual dose and maximum dose), and the functions of inspection subsequent to prescription making (e.g., printing of the name of the diagnosis). In our hospital, rate of questions asked due to doubts about the prescription decreased from 4.2% to 0.6% since the order entry system was introduced. This decreasing factor of this asking rate was caused by “checking for an omission” (41%), “using information supplied” (37%), and conducting an “inspection prior to prescription making” (22%). The doctors and pharmacists concerned answered in the affirmative with regard to the supporting functions for the prescription making.We classified the prescription-making supporting functions into three levels on the basis of importance. In our classification, we concluded that the minimum required supporting functions (fundamental functions) for the preparing of a complete prescripton were “checking for an omission”, “information about the patient”, “drug name”, “selection of the drug”, “directions”, “ unit”, and “dose and times” . In addition, we summarized our standardization of the fundamental functions using the results of this examination.