Hospital Pharmacy - July/August 2018 - 275
275
Co et al
Appropriate
*
Acute infection requiring presentation to emergency department, urgent care, or hospital
*
Infection severe enough to require IV antibiotic therapy, in patients who are otherwise candidates for outpatient treatment
*
Failure or intolerance to oral antibiotics
*
No major comorbidities which require acute management and hospitalization (including sepsis)
*
Situations in which compliance or access to outpatient parenteral antibiotic therapy may be challenging
*
Treatment of a disease state for which oritavancin has FDA approval (skin and soft tissue infections)
Inappropriate
*
Inpatient treatment for situations in which other anti-infectives (i.e. vancomycin) are appropriate
*
Treatment of a disease state for which oritavancin does not have an FDA approval (including but not limited to: MRSA pneumonia,
bacteremia, septic arthritis, osteomyelitis, endocarditis, MRSA infection of CNS)
*
Contraindications or drug interactions exist which would interfere with either therapy
Figure 2. Sample Oritavancin Use Criteria.
Further analysis of the data revealed that 75% (13 patients)
of the total inappropriate cases were attributed to a single
provider from the private infectious disease group. Of note,
oritavancin orders prescribed by cardiologist were all appropriate, as the indication was for treatment of cellulitis around
pacemaker insertion sites.
Education to providers concerning appropriate prescribing
habits and compliance with criteria for use of oritavancin was
achieved by both one-on-one discussions of specific cases
with the provider from the private infectious disease group, as
well as educational in-services to various hospital committees
highlighting the results of this study and our oritavancin criteria for use. Based on our institutional criteria for use and the
results of this study, a sample of use criteria are listed in
Figure 2 which may be used for provider education and the
development of antibiotic policies at other institutions.
One data point included in the baseline characteristics
was the number of patients with prior antibiotic use. Prior
antibiotic use was recorded for any patient who had received
antibiotic therapy with the intent to treat the same infection
for which oritavancin was prescribed. Patients receiving
empiric broad-spectrum therapy or antibiotics intended to
treat another infection were not included in this data point.
The majority of prior antibiotic use was in treatment failure
of patients treated with outpatient oral antibiotics, including
clindamycin, sulfamethoxazole-trimethoprim, cephalexin,
amoxicillin-clavulanate, and doxycycline.
A secondary outcome in this study was to determine the
number of patients readmitted to our health system facilities within 14 days of oritavancin therapy. The 14-day window was chosen based on the time point for posttherapy
clinical evaluation (PTE) used in the SOLO I and SOLO II
trials.4,5 While no patients required readmission as inpatients after receiving oritavancin, a total of 8 patients
returned to the ED with complaints of worsening or persistence of the infection. Upon evaluation by ED providers,
none of these patients were found to have symptoms severe
enough to require hospitalization. The majority of these
patients were prescribed alternative oral therapy (including
clindamycin, amoxicillin-clavulanate, and doxycycline)
and allowed to return home. Other patients were instructed
to use warm compresses and acetaminophen as needed for
pain, and also allowed to return home. While the persistence of symptoms may suggest treatment failure, these
patients returned to the ED within 24 to 72 hours after their
initial discharge and were not found to have symptoms
severe enough to indicate treatment failure when evaluated
by emergency medicine providers. The cost of additional
therapy and visits to the ED was not addressed in this study,
but may be include as part of a more robust financial analysis. It is also important to note that due to the limitations of
the data collection method, only patients who returned to a
facility within our health system could be documented. The
true number of patients who required subsequent care may
be higher when accounting for patients treated at another
health care system, a primary care provider office, or an
urgent care clinic within 14 days of receiving oritavancin.
Based on this information, our study failed to show an association between indication and readmission for patients
treated with oritavancin.
The final outcome addressed in this study was the potential financial benefit of oritavancin use to the institution. In
this analysis, annual savings were estimated according to the
following assumptions: Oritavancin is used for an appropriate indication and administered to a patient before the patient
is ever required to be admitted; the average length of stay for
treatment of ABSSTIs (and therefore the potential number of
inpatient days saved) is 6.62 days; the annual number of
patients eligible for admission-sparing therapy with oritavancin is similar to the sample size (n = 67) of patients
included in this study. Because the goal of adding oritavancin
to hospital formulary was to reduce ABSSTI hospital admissions, patients who failed therapy with oritavancin and
required a subsequent admission would constitute a negative
financial impact to the institution. As there were no subjects
who required a full readmission after oritavancin therapy in
this study, readmission costs were not included as part of the
financial analysis.
Using a national average6 ABSSTI cost-per-day of $1,999
and AWP pricing for cost of drug, the estimated annual savings was greater than $650,000. This estimated annual savings
may be applied to other institutions by substituting institutionspecific figures for average length of stay, cost-per-day, drug
acquisition cost, and anticipated number of eligible patients.
Table of Contents for the Digital Edition of Hospital Pharmacy - July/August 2018
Ed Board
TOC
Antibiotic Stewardship: The Health of the World Depends on It
ISMP Medication Error Report Analysis: CycloSPORINE Dispensing Errors
ISMP Adverse Drug Reactions
Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights January-March 2018
Restructuring a Pharmacy Department: Leadership Strategies for Managing Organizational Change
Angiotensin II
RxLegal: A Rapid Review of Right-To-Try
New Medications in the Treatment of Hereditary Transthyretin Amyloidosis
Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience
Impact of a Clinical Decision Support Tool on Cancer Pain Management in Opioid-Tolerant Inpatients
Lyme Carditis: A Case Report and Review of Management
Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System
Evaluation of Oritavancin Use at a Community Hospital
Hospital Pharmacy - July/August 2018 - Cover1
Hospital Pharmacy - July/August 2018 - Cover2
Hospital Pharmacy - July/August 2018 - 201
Hospital Pharmacy - July/August 2018 - 202
Hospital Pharmacy - July/August 2018 - 203
Hospital Pharmacy - July/August 2018 - 204
Hospital Pharmacy - July/August 2018 - 205
Hospital Pharmacy - July/August 2018 - Ed Board
Hospital Pharmacy - July/August 2018 - 207
Hospital Pharmacy - July/August 2018 - TOC
Hospital Pharmacy - July/August 2018 - 209
Hospital Pharmacy - July/August 2018 - 210
Hospital Pharmacy - July/August 2018 - 211
Hospital Pharmacy - July/August 2018 - 212
Hospital Pharmacy - July/August 2018 - 213
Hospital Pharmacy - July/August 2018 - Antibiotic Stewardship: The Health of the World Depends on It
Hospital Pharmacy - July/August 2018 - 215
Hospital Pharmacy - July/August 2018 - 216
Hospital Pharmacy - July/August 2018 - ISMP Medication Error Report Analysis: CycloSPORINE Dispensing Errors
Hospital Pharmacy - July/August 2018 - 218
Hospital Pharmacy - July/August 2018 - 219
Hospital Pharmacy - July/August 2018 - ISMP Adverse Drug Reactions
Hospital Pharmacy - July/August 2018 - 221
Hospital Pharmacy - July/August 2018 - 222
Hospital Pharmacy - July/August 2018 - Summaries of Safety Labeling Changes Approved By FDA: Boxed Warnings Highlights January-March 2018
Hospital Pharmacy - July/August 2018 - 224
Hospital Pharmacy - July/August 2018 - Restructuring a Pharmacy Department: Leadership Strategies for Managing Organizational Change
Hospital Pharmacy - July/August 2018 - 226
Hospital Pharmacy - July/August 2018 - 227
Hospital Pharmacy - July/August 2018 - 228
Hospital Pharmacy - July/August 2018 - 229
Hospital Pharmacy - July/August 2018 - Angiotensin II
Hospital Pharmacy - July/August 2018 - 231
Hospital Pharmacy - July/August 2018 - 232
Hospital Pharmacy - July/August 2018 - 233
Hospital Pharmacy - July/August 2018 - RxLegal: A Rapid Review of Right-To-Try
Hospital Pharmacy - July/August 2018 - 235
Hospital Pharmacy - July/August 2018 - New Medications in the Treatment of Hereditary Transthyretin Amyloidosis
Hospital Pharmacy - July/August 2018 - 237
Hospital Pharmacy - July/August 2018 - 238
Hospital Pharmacy - July/August 2018 - Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Hospital Pharmacy - July/August 2018 - 240
Hospital Pharmacy - July/August 2018 - 241
Hospital Pharmacy - July/August 2018 - 242
Hospital Pharmacy - July/August 2018 - 243
Hospital Pharmacy - July/August 2018 - 244
Hospital Pharmacy - July/August 2018 - 245
Hospital Pharmacy - July/August 2018 - 246
Hospital Pharmacy - July/August 2018 - Utilization of Lean Techniques in Pharmacy Residency Training: Modifying the PGY1 Management and Leadership Experience
Hospital Pharmacy - July/August 2018 - 248
Hospital Pharmacy - July/August 2018 - 249
Hospital Pharmacy - July/August 2018 - 250
Hospital Pharmacy - July/August 2018 - 251
Hospital Pharmacy - July/August 2018 - 252
Hospital Pharmacy - July/August 2018 - 253
Hospital Pharmacy - July/August 2018 - 254
Hospital Pharmacy - July/August 2018 - 255
Hospital Pharmacy - July/August 2018 - Impact of a Clinical Decision Support Tool on Cancer Pain Management in Opioid-Tolerant Inpatients
Hospital Pharmacy - July/August 2018 - 257
Hospital Pharmacy - July/August 2018 - 258
Hospital Pharmacy - July/August 2018 - 259
Hospital Pharmacy - July/August 2018 - 260
Hospital Pharmacy - July/August 2018 - 261
Hospital Pharmacy - July/August 2018 - 262
Hospital Pharmacy - July/August 2018 - Lyme Carditis: A Case Report and Review of Management
Hospital Pharmacy - July/August 2018 - 264
Hospital Pharmacy - July/August 2018 - 265
Hospital Pharmacy - July/August 2018 - Impact of the Implementation of Project Re-Engineered Discharge for Heart Failure patients at a Veterans Affairs Hospital at the Central Arkansas Veterans Healthcare System
Hospital Pharmacy - July/August 2018 - 267
Hospital Pharmacy - July/August 2018 - 268
Hospital Pharmacy - July/August 2018 - 269
Hospital Pharmacy - July/August 2018 - 270
Hospital Pharmacy - July/August 2018 - 271
Hospital Pharmacy - July/August 2018 - Evaluation of Oritavancin Use at a Community Hospital
Hospital Pharmacy - July/August 2018 - 273
Hospital Pharmacy - July/August 2018 - 274
Hospital Pharmacy - July/August 2018 - 275
Hospital Pharmacy - July/August 2018 - 276
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