4- Thursday Pharmacotherapy News – 1st July

1 – The Immunomodulatory Effects of Opioids and Implications for Intensive Care Unit Populations

• Analgesia within the intensive care unit (ICU) is often achieved via the utilization of opioids in alignment with current guidelines.
• Recent evidence has not only demonstrated the potential impact of opioids in suppression of immune function, but also the potential harm of immunosuppression of patients within the ICU.
• Despite the potential immunosuppression seen with opioids in this at-risk population, their use remains frequent.
• In this review, they highlight the potential immunomodulatory impact of opioids within the critically ill and considerations for their use.

Source: ACCP

2 – Optimizing Rapid Diagnostics and Diagnostic Stewardship in Gram-Negative Bacteremia

• Antimicrobial resistance remains a high global concern, as it is associated with prolonged hospitalizations, increased morbidity and mortality, and escalating health care-related costs.
• Rapid diagnostic technology (RDT) has become the cornerstone in achieving prompt blood culture results providing a quicker initiation of optimal therapy, decreased mortality, and decreased spread of resistance.
• To maximize the benefits of RDTs, antimicrobial stewardship programs must implement a diagnostic stewardship (DS) subgroup to optimize communication, education, and interpretation of RDT results within the health care system.
• The DS subgroup is necessary to evaluate the technologies available, better integrate the selected technologies into the health care system, and develop innovative and appropriate use to improve patient outcomes.

Source: ACCP

3 – Direct Oral Anticoagulants Versus Warfarin in the Treatment of Left Ventricular Thrombus

• Use of direct oral anticoagulants (DOACs) for the treatment of left ventricular (LV) thrombus has gained considerable interest.
• This study aimed to evaluate if DOACs are effective in the treatment of LV thrombus compared with warfarin.
• The data suggest that DOACs may be reasonable alternatives for treatment of LV thrombus.
• When added to the totality of available studies, this study demonstrates that the effectiveness of DOACs in LV thrombus remains uncertain. Randomized clinical trials are needed.

Source: SAGE Journal

4- Safety of Single-Dose Oral Cefixime, Intramuscular Ceftriaxone, or Intramuscular Gentamicin for the Treatment of Gonorrhea: A Systematic Review and Meta-analysis

• This study compare the incidence and types of adverse effects between 3 recommended treatment options for gonorrhea and to compare the incidence of injection site pain between single-dose intramuscular ceftriaxone and gentamicin.
• The use of single-dose cefixime, ceftriaxone, and gentamicin-based regimens for treatment of gonorrhea appears to be safe and acceptable for use in practice.

Source: SAGE Journal

5 – Association between Patients’ Knowledge and Adherence to Anticoagulants, and Its Effect on Coagulation Control

• Warfarin requires strict monitoring by measuring prothrombin time (PT), international normalized ratio (INR), and time in therapeutic range (TTR).
• Several factors can lead to poor PT/INR control including vitamin K status, medication adherence, knowledge, and quality of life.
• The present study aims to assess patient adherence to warfarin treatment and its correlation with INR control.

Source: Karger

6 – Treatment of Essential Thrombocythemia with Anagrelide Is Associated with an Increased Risk of Worsened Kidney Function

• When choosing a cytoreduction method for patients suffering from essential thrombocythemia (ET), it is important to know the safety profile of the medicine used.
• Few articles have been published about the effects of hydroxycarbamide (hydroxyurea, HU) and anagrelide (ANA) on renal function in ET patients.
• This study is the largest analysis of nephrotoxicity of cytoreductive drugs used in ET therapy so far, which additionally includes risk factors for the progression of kidney disease and coexisting genetic mutation.
• The observations indicate that ANA should be used in patients with ET with great caution and taking into account the risk of worsened kidney function.

Source: Karger

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