RESUMEN
The development and implementation of guidelines for the use of thrombolytic therapy at a 1000-bed community hospital are described. A thrombolytic therapy committee composed of two physicians, a nurse, and a pharmacist was established to develop the guidelines. The committee outlined goals for the guidelines, developed a format, and defined individual responsibilities. Indications, absolute requirements for use, contraindications, administration procedures, necessary tests before and during infusion, and recommendations for the use of anticoagulant therapy following thrombolytic therapy were listed. All of the committee members participated in educating the hospital staff involved with thrombolytic therapy. The pharmacist served as a liaison with the laboratory and used a flow sheet to monitor all patients receiving thrombolytic therapy. Two years after the guidelines were implemented an evaluation of physician compliance and adverse effects secondary to thrombolytic therapy showed excellent compliance (97-100% on all criteria listed) and an incidence of bleeding comparable with the values reported in the literature for heparin. The guidelines are reviewed annually by the committee and revised when necessary. The use of thrombolytic guidelines has minimized adverse effects and the misuse of laboratory tests, assisted with proper patient selection, and united several disciplines in a collaborative fashion toward a common goal.
Asunto(s)
Fibrinolíticos/uso terapéutico , Servicio de Farmacia en Hospital/normas , Connecticut , Utilización de Medicamentos/normas , Fibrinolíticos/efectos adversos , Formularios de Hospitales como Asunto , Hospitales con más de 500 Camas , Humanos , Comité de Profesionales , Estados Unidos , United States Food and Drug AdministrationRESUMEN
Four methods of predicting serum gentamicin concentrations (SGCs) in adult patients with stable impaired renal function were compared. Serum samples obtained from 17 patients receiving intravenous gentamicin therapy were assayed for gentamicin using a radioimmunoassay. Kinetic variables derived using four different methods were used to predict peak and trough concentrations. The Sawchuk-Zaske method uses individualized apparent volume of distribution (Vapp) and half-life (t1/2) derived from at least three SGCs following a given dose. The fitted method assumes Vapp equals 0.28 liters/kg lean body weight (LBW) and a t1/2 derived by a fitting technique using only one SGC. Both the Tozer and Hull methods assume Vapp equals 0.28 liters/kg LBW, and t1/2 is estimated from equations that take into account the patient's renal function (creatinine clearance). The predicted and measured SGCs for each method were compared using linear regression analysis. The prediction errors, defined as the predicted minus the measured SGC, were compared for the four methods. The correlation coefficients between the measured and predicted SGCs were significant at p less than 0.05 only for the Sawchuk-Zaske and fitted methods. For the Sawchuk-Zaske method, peak and trough r values were 0.73 and 0.91, respectively. For the fitted method, peak and trough r values were 0.53 and 0.71, respectively. No significant differences in the mean prediction errors were observed, except for the Sawchuk-Zaske method, which had significantly less mean prediction error than the Hull method. The Sawchuk-Zaske method was the most reliable and accurate pharmacokinetic technique. However, because it is more costly and less convenient than the other three methods, both the accuracy and cost should be considered when selecting a method for determining serum gentamicin concentrations for a particular patient.
Asunto(s)
Gentamicinas/sangre , Enfermedades Renales/sangre , Anciano , Femenino , Gentamicinas/metabolismo , Semivida , Humanos , Enfermedades Renales/metabolismo , Masculino , Métodos , Persona de Mediana EdadRESUMEN
Tetracyclines continue to be used extensively on a world-wide basis because of their unusually broad antimicrobial spectrum and their relative safety. The first generation tetracyclines are used almost exclusively via the oral route; the second generation tetracyclines may be used orally or intravenously. Intramuscular administration is not recommended. Doxycycline is preferred in the treatment of upper respiratory tract infections, atypical pneumonias, intraabdominal/pelvic sepsis or trauma, venereal diseases, and in the treatment of prostatitis. Minocycline is preferred for meningococcal prophylaxis, central nervous system infections (due to susceptible organisms), and in staphylococcal infections (when tetracycline is indicated).