In this episode I’ll:
1. Discuss an article about antibiotic de-escalation in septic patients.
2. Answer the drug information question “Is linezolid ever bacteriocidal?”
3. Share a resource about financial advice for pharmacists by a pharmacist.
The article for this episode recently appeared in a weekly literature digest for members of my Critical Care Pharmacy Academy. Every week I send Academy members a summary of the most important critical care pharmacy articles, including my analysis of where the article fits in practice. The literature summary is brief, relevant, and presented in audio and video format. You can find out more at pharmacyjoe.com/academy.
Article
Lead author: Antonio Gutiérrez-Pizarraya
Published in Expert Review of Clinical Pharmacology March 2017
Background
Antibiotic de-escalation is frequently considered for critically ill patients with sepsis.
Methods
This study was a meta-analysis of published studies that have compared antibiotic de-escalation in non-immunocompromised patients with sepsis admitted to the ICU.
Results
817 patients with severe sepsis or septic shock were included. De-escalation was applied in about one-third of patients (274 patients). The authors found no differences in hospital length of stay between the de-escalation group compared to those who did not receive de-escalation. The authors also found significant lower hospital mortality in the de-escalation group as compared with the no modification group (25.9% vs. 43.1%).
De-escalation was also found to be a good prognostic factor for mortality in both gram negative and gram positive infections.
Conclusion
The authors concluded:
In our study there was an independent association of de-escalation and decrease mortality rate.
Discussion
I think this meta-analysis is a big deal! Antibiotic de-escalation previously had a very low level of evidence to support it. In any guideline, de-escalation was listed as either a best practice statement or ‘expert opinion.’
Now we have a meta-analysis that shows an independent association of de-escalation and decreased mortality rate. This should make the case for stewardship in this area even stronger. It is critical to note when applying the results of this analysis that it is limited to non-immunosuppressed patients.
Drug information question
Q: Is linezolid ever bacteriocidal?
A: Yes.
I’ve filed linezolid away in my brain as a bacteriostatic drug. But it is not 100% true to say that linezolid is bacteriostatic. Linezolid has bacteriocidal activity against some strains of pneumococci, Bacteroides fragilis and Clostridium perfringens. Bacteriostatic drugs are generally not used for bacteremia, but linezolid breaks this mold as well; it can be used for VRE bacteremia.
Resource
The resource for this episode is the website yourfinancialpharmacist.com. This blog is written by pharmacist Tim Ulbrich, PharmD and focuses on educating pharmacists about financial topics such as eliminating debt, saving for retirement, building financial IQ and balancing financial priorities.
If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies.
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