Drug Topics- August 11, 2008

57 Table 4 Recommended empirical antibiotics for outpatient community-acquired pneumonia Situation Previously healthy & no antibiotic use within the prior three months Treatment Azithromycin Clarithromycin Erythromycin (# Doxycycline-secondary agent) Moxifloxacin 400mg daily Gemifloxacin 320mg daily Levofloxacin 750mg daily Or Beta-lactam PLUS macrolide High-dose amoxicillin 1g TID Or amoxicillin/clavulanate 2g BID are preferred beta-lactams (alternatives: ceftriaxone, cefpodoxime, cefuroxime) Follow recommendations for co-morbidities or antibiotic resistance as above Comorbidities (diabetes, asplenia, etc.) or use of antibiotics in the prior three months High rates (>25%) of macrolide drug resistant S. pneumoniae in the community years, beta-lactam therapy within the previous three months, alcoholism, medical co-morbidities, immunosuppressive illness or therapy, and exposure to a child in a daycare setting. Consideration should also be given to risk factors or symptoms of CA-MRSA. Although rare, CA-MRSA is often seen following influenza and results in cavitary infiltrates in patients who are not at risk for aspiration pneumonia. Empiric treatment for patients who lack any previously mentioned risk factors for drug resistance includes a macrolide antibiotic or doxycycline, although the latter is less favorable. In patients with comorbidities, those who have risk factors for drug resistance, or in regions where there is a high rate (>25%) of high-level macrolide resistance, the use of a respiratory fluoroquinolone or a beta-lactam plus a macrolide is recommended. Drug selections may be found in Table 4. Measures of pneumonia prevention include vaccination as well as hand and respiratory hygiene procedures. The inactivated Influenza vaccine is recommended for all patients 50 years and greater, household contacts, and healthcare workers. The intranasally administered influenza vaccine may be offered as an alternative to patients two to 49 years of age with no underlying medical conditions. The pneumococcal polysaccharide vaccine should be administered to all patients 65 years of age, smokers, as well as those patients with preexisting medical conditions to prevent the bacterial complications of bacteremia and meningitis associated with Streptococcus pneumonia. A repeat vaccination is also recommended after five years. If the patient received the first dose prior to age 65, give a single revaccination at age 65 (or older) if at least five years have elapsed since the previous dose. Respiratory hygiene should include masks or tissues to cover the mouths of patients with illness. Finally as mentioned in prior prevention discussions, smoking increases a patient’s risk of acquisition of respiratory infections and their complications in addition to increasing cancer rates. A smoking cessation program should be discussed with this patient population. TEST QUESTIONS Write your answers on the answer form appearing on page 55 (photocopies of the answer form are acceptable) or on a separate sheet of paper. Mark the most appropriate answer. 1. Which of the following does NOT increase a person’s 2. Which of the following alternative therapies is effec- risk of acquiring a “cold?” a. Working with children b. Colder seasons c. Crowded environments d. Smoking tive in reducing “cold” symptoms? a. Vitamin C b. Echinacea c. Zinc d. Humidified air

Table of Contents Feed for the Digital Edition of Drug Topics- August 11, 2008

Drug Topics- August 11, 2008 Contents Latebreakers Letters DEA Proposes Rule To Allow Electronic Prescriptions for Controlled Substances Merger, Medicare Reform Could Mean Broader E-Prescribing Adoption New Combination Pill Approved for Type 2 Diabetes New Eczema Guildlines Promote Use of Emollients, Then Topical Corticosteroids Agencies Flush Original Strategies in Favor of Promoting Drug Take-Back Programs JP at Large: You Laughing at Me? Pharmacists Find Themselves at Mercy of Prior Authorization State Law Requiring PBM Transparency See Some Gains, Some Losses Global Counterfeiting Still Growing, Says U.S. Commerce Official FDA Saftey Page: Prophylthiouracil Still Confused with Purinethol (mercaptopurine) New Products Bring Lice Treatment to a Head NACDS Marketplace Showcases New Product that Fill Unmet Needs Update on Respiratory Tract Infections Execs Share War Stories About Adopting Technology in their Stores New Products Advertisters Index Classified Viewpoint: Medicare Part D Revisions sorely needed

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