Ronald A. Herman

Pharmacokinetics of morphine sulfate in patients with burns

Morphine sulfate (MS) pharmacokinetics was evaluated in seven patients with a mean body surface area burn of 21.5% to ascertain a rational basis for the management of pain in patients with burns. Treatments included a MS constant rate infusion followed by an oral MS solution (MS-OS) (5 to 15 mg administered every 3 hours) and then a 30 mg MS-controlled release tablet (MS-CR) every 8 hours. Each treatment was separated by a washout period when sampling of morphine was done. The apparent terminal half-life for MS-OS was 3 hours, which is similar to that of patients without burns, but the apparent terminal half-life for the MS-CR in patients with burns was substantially longer at 14.7 hours. The mean time to reach peak concentration for MS-CR was delayed relative to MS-OS 1.4 versus 0.5 hours, and the peak concentration was attenuated. The mean release time of the MS for the CR tablet is about 15 hours. The renal clearances of the MS-CR (114 ml/min) and MS-OS (147 ml/min) were less than the measured creatinine clearance (177 ml/min) but greater than the creatinine clearance (106 ml/min) predicted for a healthy individual. The prolonged release of MS-CR makes the MS-CR a good choice in the management of pain in patients with burns on an 8- to 12-hour dosing schedule, even though the patient might exhibit an increased clearance.

Etiology and treatment of community-associated methicillin-resistant Staphylococcus aureus

PURPOSE Risk factors and treatment recommendations for community-associated methicillin-resistant Staphylococcus aureus are reviewed. SUMMARY A new strain of methicillin-resistant Staphylococcus aureus (MRSA) has prompted researchers to examine the factors associated with infections acquired in outpatient settings as opposed to those that develop nosocomially. Infections of the skin, lungs, urinary tract, and bloodstream diagnosed within 24-72 hours of hospitalization and with no risk factors present were categorized as community-associated MRSA (CA-MRSA) and differentiated from health-care-associated methicillin-resistant S. aureus (HA-MRSA) on a molecular basis. Pulsed-field electrophoresis has been instrumental in genotyping the S. aureus organism to identify bacterial isolates. Molecular differences between community- and hospital-associated strains show that the organisms were genetically distinct and had not migrated to other settings. Some studies examining antibiotic resistance indicated a steady increase in the rate of MRSA infections. In addition, results of a 15-year longitudinal study indicated significant increases in CA-MRSA-positive isolates between 1991 and 2004. Race, age, sex, hygiene, living environment, and socioeconomic status have been shown to play a key role in the incidence of CA-MRSA. CONCLUSION Health care providers should recognize how CA-MRSA and HA-MRSA are differentiated and what factors are associated with infections caused by the organisms. This will enable health care providers to quickly identify and initiate appropriate treatment for these infections.

Emtricitabine: A Once-Daily Nucleoside Reverse Transcriptase Inhibitor

OBJECTIVE: To review the pharmacology, virology, pharmacokinetics, safety, and efficacy of the nucleoside reverse transcriptase inhibitor (NRTI) emtricitabine. DATA SOURCES: English-language reports were accessed using MEDLINE (1966-June 2003) and the Iowa Drug Information Service database (1966-June 2003) using emtricitabine and Coviracil as key words. (Coviracil was the proposed trade name for the product prior to approval.) The Internet was also searched using the terms HIV/AIDS conferences, then emtricitabine within the conference proceedings. STUDY SELECTION AND DATA EXTRACTION: Abstracts, posters, and oral presentations from scientific conferences, both published and unpublished, were included. Preference was given to published controlled trials. Studies providing a description of the pharmacology, virology, effectiveness, safety, or pharmacokinetics of emtricitabine were used in this review. DATA SYNTHESIS: Emtricitabine is an NRTI used to treat HIV-1 infection. Once-daily administration can decrease pill burden and potentially increase adherence to multidrug HIV therapy. Further, emtricitabine has shown equivalent or improved outcomes compared with lamivudine and stavudine. CONCLUSIONS: Emtricitabine is a safe and effective option for HIV-1 infection in adults as part of a multidrug regimen. It may be a better alternative than lamivudine for once-daily therapy because of its extended intracellular half-life and better than lamivudine and stavudine because of a possibly decreased potential for drug resistance.

A systematic review of validated methods for identifying transfusion-related sepsis using administrative and claims data

To systematically review algorithms to identify transfusion‐related sepsis or septicemia in administrative data, with a focus on studies that have examined the validity of the algorithms.

A systematic review of validated methods for identifying lymphoma using administrative data

To systematically review published studies for algorithms that identified lymphoma as a health outcome of interest in administrative or claims data and examined the validity of the algorithm to identify lymphoma cases.

Once-Daily Abacavir in Place of Twice-Daily Administration

OBJECTIVE To review the safety and efficacy of a once-daily dosage regimen for abacavir, a nucleoside reverse transcriptase inhibitor. DATA SOURCES English-language MEDLINE and Iowa Drug Information Service database reports were accessed from 1966 to March 2005. International Pharmaceutical Abstracts was searched from 1970 to March 2005. The key words used in all searches were abacavir and Ziagen. Article bibliographies were used to identify additional relevant articles. The Internet was searched to identify abstracts of poster and oral presentations that have not yet been published. The manufacturer was also contacted to obtain unpublished information. STUDY SELECTION AND DATA EXTRACTION Publications were included that provided information related to the safety and efficacy of abacavir when used once daily. Preference was given to randomized, double-blind, controlled trials comparing once-daily abacavir regimens with other antiretroviral regimens. Abstracts from professional meetings were included for unpublished studies, and conference coverage reviews were included if the abstracts were not available. DATA SYNTHESIS In trials directly comparing once- and twice-daily abacavir, little difference was shown in the efficacy of the 2 regimens. Despite similar adverse effect profiles, significantly more severe hypersensitivity reactions and severe diarrhea were seen with once-daily abacavir in one trial. CONCLUSIONS Once-daily administration of abacavir has not been shown to be inferior to twice-daily dosing, but it may put patients at increased risk for severe hypersensitivity reactions and diarrhea. More data are needed to confirm this risk.

Comparison of a neural network approach with five traditional methods for predicting creatinine clearance in patients with human immunodeficiency virus infection

Study Objective. To compare the results of an artificial neural network approach with those of five published creatinine clearance (Clcr) prediction equations and with the measured (true) Clcr in patients infected with the human immunodeficiency virus (HIV).

Book Review: Medline: A Guide to Effective Searching in PubMed and Other Interfaces, 2nd Edition

cal practiceguidelines for specifichematologic or oncologic diseases. Pertinent information is givento enhance the pharmacists role in managing thediseases. Limitations: The majorlimitation is that the book is not sufficiently comprehensive in discussing all of the common tumors (eg,breastcancer,lymphomas, coloncancer, adultchronic leukemias, werenot included in the text).The treatment of hematology and oncology is dynamic; therefore,any textbookcan quickly become outdated due to new research outcomes. Comparison with Previous Edition or Volume: The fiftheditionis comparable in its content and quality to previous editions. Noted changesare smallermodulesthat can be completedindependently for credit,footnote references, andanabbreviated annotated bibliography. Comparison with Other Related Booksor Products: The bookis a valuable resource; however, itsdiscussion of numerous hematologic diseases and tumors is incomplete. Otherhematology and oncology textbooks that wouldbe more comprehensive are Clinical Oncology!and Cancer: Principles and Practice ofOncologyi Reviewers Summary: Hematology/Oncology I and lJ-PSAP·V, Book 10 provides an overview of manyhematologic andoncologic disease topics,although its scope can not be consideredcomprehensive. The program also provides an excellent opportunity for pharmacists to complete continuing education credits or to prepare for theBCPS.