iForumRx.org header image 1

Cut It Out! Removing EHR Allergy Warnings to Improve Antimicrobial Stewardship

WARNING: Patient has a penicillin allergy! Do you want to continue with this cephalexin order?

Although these warnings are commonplace, immunologic cross-reactivity between penicillins and cephalosporins is uncommon. When B-lactams are indicated as first-line therapy for therapy, cephalosporins are often avoided if the patient has a penicillin allergy listed. Would the removal of EHR warnings about potential penicillin allergies when cephalosporins are ordered be helpful or harmful? 

Guest Authors:  Brian Wenger, PharmD and Nora Sharaya, PharmD, BCPS, BCACP, BC-ADM

Music by Good Talk

Should Penicillin Allergy Skin Testing be a Thing of the PAST?

Many, many, many patients report they have penicillin (PCN) allergy. But while nearly 10% report being allergic to PCN, fewer than 1% have a true allergy. And this hampers antimicrobial stewardship efforts because clinicians are often forced to turn to agents with a broader spectrum, that are more expensive, and more likely to cause adverse effects including the development of resistance. However, determining whether a patient has a true PCN allergy is time-consuming and expensive. Historically, patients were sent to an allergist for PCN allergy skin testing (PAST) followed by oral provocation challenge (OPC). What if patients could skip past the skin test and receive a direct OPC instead? Direct OPC may not only increase patient willingness to be tested but also the feasibility of offering testing in primary care (and perhaps community pharmacy) settings.

Guest Authors:  Frank A Fanizza, PharmD, BCACP and Emily S Prohaska, PharmD, BCACP, BCGCP

Music by Good Talk

Using CRP in COPD to Guide Treatment Decisions During Exacerbations

Patients frequently present to outpatient clinics and community pharmacies with acute exacerbations of chronic obstructive pulmonary disease and clinicians have an important decision to make. Should they prescribe antibiotics? Patients may seek antibiotics as a quick fix to their symptoms, but many AECOPD are not caused by bacterial infection. Prescribing unnecessary antibiotics exposes patients to adverse effects and can increase antimicrobial resistance.  But not prescribing antibiotics could delay recovery if the exacerbation is of bacterial origin … or worse, result in an avoidable hospitalization and death. Could a simple, bedside test empower patients and prescribers to use antimicrobials more selectively?

Guest Author:  Brittany Schmidt, PharmD, BCACP

Music by Good Talk

Don’t Kid Yourself: Broad- versus Narrow-Spectrum Antibiotics in Children

Overuse of broad-spectrum antibiotics can lead to antimicrobial resistance, increased cost, and higher prevalence of adverse drug reactions. Nearly 2 million infections and 23,000 deaths are caused by bacteria that are antibiotic-resistant each year in the United States costing the healthcare system an estimated 20 billion dollars. Moreover, adverse reactions to antibiotics are the most common reason for pediatric patients to visit the emergency department.  Narrow-spectrum antimicrobials are generally preferred, but there are instances where broader coverage is recommended.  A recent study attempts to “clean up” the debate by examining the benefits and risks of using narrow- versus broad-spectrum antibiotics in children with acute respiratory tract infections.

Guest Authors:  Amber Giles, PharmD, MPH, BCPS, AAHIVP  and Paige Hughes, PharmD

Music by Good Talk

Azithromycin to Prevent Asthma Exacerbations: What AMAZES Us and What Doesn’t

Despite good adherence to high-dose inhaled corticosteroids (ICS) and concomitant long-acting beta agonists (LABA), millions of people with asthma continue to experience exacerbations.  What more can patients and clinicians do to reduce the risk of exacerbations?  Does the routine use of antibiotics reduce the frequency of exacerbations?  This is the question the recently published AMAZES study attempted to answer.

Guest Authors: Michael Nagy, Pharm.D. and Ashley Crowl, Pharm.D.

Music by Good Talk

Podbean App

Play this podcast on Podbean App