In this episode I’ll:
1. Review an article about using imatinib for bleomycin interstitial pneumonitis.
2. Answer the drug information question “Should daptomycin or linezolid be used for VRE bacteremia?”
3. Share a resource provided by another pharmacist in the Pharmacy Nation slack group.
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Article
Imatinib for bleomycin induced pulmonary toxicity: a case report and evidence‐base review
Lead author: Iouri Banakh
Published in the journal Clinical Case Reports May 2016
Background
Bleomycin is an antibiotic chemotherapy agent that is used for management of Hodgkin’s lymphoma and testicular cancer. Bleomycin is known to cause lung toxicity including bronchiolitis obliterans with organizing pneumonia (BOOP), eosinophilic hypersensitivity, and interstitial pneumonitis (referred to as Bleomycin interstitial pneumonitis or BIP). Imatinib (a tyrosine kinase inhibitor) has been associated with successful treatment of BIP in a few case reports.
Case Report
The authors report a case of a 69 year old male with multiple co-morbidities who developed suspected bleomycin interstitial pneumonitis after treatment with bleomycin for Hodgkin’s lymphoma. He was given high dose steroid therapy (1 gram methylprednisolone daily) and imatinib 100 mg tid for the suspected BIP.
On day 9 of his ICU admission, he developed thrombocytopenia and gastrointestinal hemorrhage requiring blood transfusions and a pantoprazole infusion. The authors considered imatinib a likely contributing factor since it is known to cause both thrombocytopenia and gastrointestinal hemorrhage. The imatinib was discontinued, and after 3 weeks the patient and family decided to transition to comfort care.
Conclusion
The authors concluded:
This case report adds to the limited literature on the use of imatinib in BIP and highlights the potentially life‐threatening complications that may be associated with this agent. While the evidence supporting the use of imatinib for BIP is equivocal, judicious use of this agent may be considered in patients with BIP. Further experience on the use of imatinib is required to clarify the role of imatinib in BIP management.
Drug information question
This question comes from “Pharmacy Jon” who emailed me to ask:
Q: Should daptomycin or linezolid be used for VRE bacteremia?
A: Both may be used, provided the daptomycin dose is high enough.
Linezolid is FDA approved for the treatment of VRE bacteremia. Linezolid is bacteriostatic. This breaks the general rule of thumb to only use bacteriocidal agents for bacteremia.
Some meta-analyses have associated daptomycin with higher mortality compared with linezolid for VRE bacteremia. However the studies have significant limitations and are not considered definitive.
Daptomycin is bacteriocidal against VRE, but a dose of 8 to 12 mg/kg is needed to treat VRE bacteremia. The more serious the infection, the higher the dose should be.
In summary either linezolid or daptomycin can be used for VRE bacteremia, but if you are not willing to push the daptomycin dose to 12 mg/kg then linezolid should be used instead.
Resource
This resource came to me from “Pharmacy Mohammed” in the UK via the Pharmacy Nation Slack group. It is a review article by the UK Clinical Pharmacy Association that covers drug dosing in extremes of body weight. The article discussed several critical care medications and their use at extremes of body weight in great detail. The article is available via free pdf download.
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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