In this episode I’ll:
1. Discuss an article about using nebulized amikacin to treat hospital and ventilator associated pneumonia.
2. Answer the drug information question “Can sodium polystyrene sulfate cause intestinal necrosis?”
3. Share a resource for pharmacy calculations and other useful information.
Article
Lead author: Nehal Hassan
Published in Critical Care Medicine October 2017
Background
Nebulized antibiotics offer high efficacy due to significant local concentrations and safety with minimal blood levels. This study evaluates the efficacy and nephrotoxicity of nebulized versus IV amikacin in post-cardiothoracic surgical patients with nosocomial pneumonia caused by multidrug-resistant Gram-negative bacilli.
Methods
The study was a prospective, randomized, controlled study on post-cardiac surgery patients split into two groups. Patients were enrolled if they were diagnosed with either hospital-acquired pneumonia or ventilator-associated pneumonia.
The first group was administered IV amikacin 20 mg/kg once daily. The second group was prescribed amikacin nebulizer 400 mg twice daily. Both groups were co-administered IV piperacillin/tazobactam empirically.
Clinical cure on day 7 of treatment was the primary outcome. Secondary outcomes assessed were the length of hospital stay, ICU stay, days on amikacin, days on mechanical ventilator, mechanical ventilator-free days, days to reach clinical cure, and mortality rate.
Results
The group that received nebulized amikacin took fewer days to achieve clinical cure. The nebulized group also had lower nephrotoxicity rates, shorter ICU stay, fewer days on the ventilator, and fewer days on amikacin treatment.
Conclusion
The authors concluded:
Nebulized amikacin showed better clinical cure rates, less ICU stay, and fewer days to reach complete recovery compared to IV amikacin for surgical patients with nosocomial pneumonia. It is also a less nephrotoxic option associated with less deterioration in kidney function.
Discussion
The regimen used was 400 mg of amikacin via nebulizer combined with piperacillin-tazobactam. Although this is a single center study in a cardiac ICU, it is important data supporting the use of amikacin nebulizer therapy in combination with piperacillin-tazobactam with better surrogate outcomes plus less nephrotoxicity.
Drug information question
Q: Can sodium polystyrene sulfate cause intestinal necrosis?
A: Yes!
Sodium polystyrene sulfate (SPS) is a cation exchange resin, and trades a harmless sodium ion for a potassium ion in the lumen of the GI tract. The best evidence available suggests that this medication is no more effective than laxative use for lowering serum potassium levels. While not common, this medication can cause intestinal necrosis, a potentially fatal complication. Certain conditions lead to a higher incidence of intestinal necrosis from SPS and should be considered absolute contraindications to use:
-Post-operative patients
-Patients with an ileus or who are receiving opioids
-Patients with a bowel obstruction
Resource
The resource for this episode is GlobalRPh.com. I’ve been using this site for nearly my entire practice in hospital pharmacy for its relevant and reliable pharmacy calculators. The site also contains many other useful references such as IV dilution information and medical abbreviation listings. I recently wrote a guest article for GlobalRPh.com about The Mindset of a Clinical Pharmacist. You can read my article here.
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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