likes, dislikes and suggestions to big pharma sales reps

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Epic said:
The rate of Linezolid resistant VRE is increasing in the US also.
Click to expand...

This is an interesting way to classify a bacterial strain: linezolid resistant vancomycin resistant Enterococcus. Never heard that before.
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The Infectious Diseases Society of America is currently formulating distinct guidelines on the treatment of oxacillin resistant Staphylococcal aureus. My guess is they are going to recommend E-testing every strain and using linezolid (or another active agent) if the minimum inhibitory concentration is greater than 2 mcg/mL. This strategy may be particularly useful against pulmonary infections, although I know one infectious diseases physician who does not believe ORSA pneumonia ever truly occurs. I'm not sure I am on board with that, although I have MUCH less experience.
 
Epic said:
What's tygacil good for except for those rare resistant acinetobacter? Zyvox is over priced.
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Apparently, there are already problems associated with tigecycline and Acinetobacter.....It is extremely concerning that case reports such as this are being published regarding a drug that is (hopefully) used so infrequently.

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

I have read this entire report, however, some may not have access to Pharmacotherapy, so I posted the abstract.
 
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Priapism321 said:
This is an interesting way to classify a bacterial strain: linezolid resistant vancomycin resistant Enterococcus. Never heard that before.
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You never heard of it because you're a new resident practicing in one hospital. There are many cases of Linezolid resistant VRE and Synercid resistant VRE.

Read.

Clinical-Use-Associated Decrease in Susceptibility of
Vancomycin-Resistant Enterococcus faecium to Linezolid: a
Comparison with Quinupristin-Dalfopristin
Issam I. Raad,1* Hend A. Hanna,1 Ray Y. Hachem,1 Tanya Dvorak,1
Rebecca B. Arbuckle,2 Gassan Chaiban,1
and Louis B. Rice3
Departments of Infectious Diseases, Infection Control, and Employee Health1 and Division of Pharmacy,2
The University of Texas M. D. Anderson Cancer Center, Houston, Texas, and Medical
Service, Louis Stokes Cleveland VA, Cleveland, Ohio3
Received 1
 
Epic said:
You never heard of it because you're a new resident practicing in one hospital. There are many cases of Linezolid resistant VRE and Synercid resistant VRE.

Read.

Clinical-Use-Associated Decrease in Susceptibility of
Vancomycin-Resistant Enterococcus faecium to Linezolid: a
Comparison with Quinupristin-Dalfopristin
Issam I. Raad,1* Hend A. Hanna,1 Ray Y. Hachem,1 Tanya Dvorak,1
Rebecca B. Arbuckle,2 Gassan Chaiban,1
and Louis B. Rice3
Departments of Infectious Diseases, Infection Control, and Employee Health1 and Division of Pharmacy,2
The University of Texas M. D. Anderson Cancer Center, Houston, Texas, and Medical
Service, Louis Stokes Cleveland VA, Cleveland, Ohio3
Received 1
Click to expand...

Just never heard anyone report microbiology as "We have a LRVRE on our hands, what do we do?"

Then again, I have never seen a linezolid resistant strain of Enterococcus. Maybe I am just too young, but my age shouldn't factor in all that much, linezolid hasn't been around too long.

To me, that's kind of like saying "We're looking at a levofloxacin resistant cefepime resistant piperacillin/tazobactam resistant Pseudomonas (LRCRZRP)" or something like that. Just sounds kind of stupid.
 
Priapism321 said:
Just never heard anyone report microbiology as "We have a LRVRE on our hands, what do we do?"

Then again, I have never seen a linezolid resistant strain of Enterococcus. Maybe I am just too young, but my age shouldn't factor in all that much, linezolid hasn't been around too long.

To me, that's kind of like saying "We're looking at a levofloxacin resistant cefepime resistant piperacillin/tazobactam resistant Pseudomonas (LRCRZRP)" or something like that. Just sounds kind of stupid.
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Stupid as it may, LRVRE is for real. We use that term all the time. Perhaps you can start a trend at your hospital...and be the cool guy.
 
well...linezolid hasn't been around that long.... you're right.

So LRVRE hasn't been around that long either.
 
Epic said:
Stupid as it may, LRVRE is for real. We use that term all the time. Perhaps you can start a trend at your hospital...and be the cool guy.
Click to expand...

If it was common enough for an abbreviation, I would probably just call it LRE. However, perhaps we have a superior antimicrobial management program at my one hospital, because we haven't had to incorporate this into our "lingo" yet. If you are using it "all the time", your hospital may need to reevaluate some things regarding appropriateness of use and antibiotic consumption.
 
Priapism321 said:
If it was common enough for an abbreviation, I would probably just call it LRE. However, perhaps we have a superior antimicrobial management program at my one hospital, because we haven't had to incorporate this into our "lingo" yet. If you are using it "all the time", your hospital may need to reevaluate some things regarding appropriateness of use and antibiotic consumption.
Click to expand...

We use the term often doesn't mean we have the bugs.... "all the time"

Then again...that's why we're brought into hospitals..to evaluate and fix broken system. We didn't cause it. We fix it.
 
So...if your hospital's antibiotic stewardship is so superior... how many dollars per patient days are you running on antibiotics?
 
Epic said:
So...if your hospital's antibiotic stewardship is so superior... how many dollars per patient days are you running on antibiotics?
Click to expand...

I was making a point that if a hospital is truly concerned with linezolid resistant Enterococcus, there may be some issues. We do not use linezolid very often at all (700 bed academic medical center). Since our stewardship program started, I believe we have reduced the hospital's cost of imipenem/cilastatin by 50%. Over the last year, consumption of imipenem/cilastatin has been reduced by 41% and fluoroquinolones by 26%. Resistance secondary to nosocomial gram negative infections is trending down, which is encouraging.
 
Epic said:
So...if your hospital's antibiotic stewardship is so superior... how many dollars per patient days are you running on antibiotics?
Click to expand...

Lots of ways to measure the economic benefits of a particular pharmaceutical therapy- preventing surgeries, ADR risk, preventing extended hospital stays, nosocomial infections, etc...

If you break it down to the pharmacy level, itself- you're probably right. But on a wholistic, non-compartmentalized hospital economic level, this poster (Priapism) may still be a steward and may still be saving the hospital money. It doesn't look that way on a standard cost-minimization analysis, but remember, you could dispense the lower-priced drug, but it may not have the same effect as the higher priced regimen (and those effects may translate into better overall outcomes that actually save money).

The hospital always loses when dispensing meds on the pharmacy side- but as a whole, it gains from good pharmaceutical care. Now the question is just defining that and doing cost-benefit analysis to go beyond just cost-cutting at the pharmacy.
 
Priapism321 said:
I was making a point that if a hospital is truly concerned with linezolid resistant Enterococcus, there may be some issues. We do not use linezolid very often at all (700 bed academic medical center). Since our stewardship program started, I believe we have reduced the hospital's cost of imipenem/cilastatin by 50%. Over the last year, consumption of imipenem/cilastatin has been reduced by 41% and fluoroquinolones by 26%. Resistance secondary to nosocomial gram negative infections is trending down, which is encouraging.
Click to expand...

Well...our 1,000 bed teaching institution is out of control...that's why we were brought in.
Reduction in use of antibiotic when appropriate is a good thing..but that's one of the things we do. Then again, becareful when you say you reduced the use of Primaxin... we see that happen all the time when Primaxin use goes down...but Merrem use goes up.

You can reduce use of a class of abx...but what is it doing to the abx usage globally? Is it increasing the use of cephalosporins? How is it affecting the use of antifungals?

That's why one of the most effective way to measure and trend abx is cost per adjusted patient days. Ask your advisor about the abx cost per apd trend for the past 3 years..and tell me where you were and where you are today. Then I will tell you if your stewardship is successful...or mediocre.
 
no-see-um said:
Lots of ways to measure the economic benefits of a particular pharmaceutical therapy- preventing surgeries, ADR risk, preventing extended hospital stays, nosocomial infections, etc...

If you break it down to the pharmacy level, itself- you're probably right. But on a wholistic, non-compartmentalized hospital economic level, this poster (Priapism) may still be a steward and may still be saving the hospital money. It doesn't look that way on a standard cost-minimization analysis, but remember, you could dispense the lower-priced drug, but it may not have the same effect as the higher priced regimen (and those effects may translate into better overall outcomes that actually save money).

The hospital always loses when dispensing meds on the pharmacy side- but as a whole, it gains from good pharmaceutical care. Now the question is just defining that and doing cost-benefit analysis to go beyond just cost-cutting at the pharmacy.
Click to expand...

Prevention of ADR, LOS, and future infections are called "opportunity cost" or "soft dollar" saved. That figure is hard to quantify and measure. Many times it's not scientific.

The reduction of antibiotic utilization (cost not purchase) is called the "hard dollar" saved.

We can measure it both ways....but the actually dollar saved is better represented with the latter method.
 
Epic said:
Well...our 1,000 bed teaching institution is out of control...that's why we were brought in.
Reduction in use of antibiotic when appropriate is a good thing..but that's one of the things we do. Then again, becareful when you say you reduced the use of Primaxin... we see that happen all the time when Primaxin use goes down...but Merrem use goes up.

You can reduce use of a class of abx...but what is it doing to the abx usage globally? Is it increasing the use of cephalosporins? How is it affecting the use of antifungals?

That's why one of the most effective way to measure and trend abx is cost per adjusted patient days. Ask your advisor about the abx cost per apd trend for the past 3 years..and tell me where you were and where you are today. Then I will tell you if your stewardship is successful...or mediocre.
Click to expand...

Good questions. I'm reading on a lot of these types of analyses just now. Textbook stuff, and studies seem to be getting at that these days.
 
Epic said:
Well...our 1,000 bed teaching institution is out of control...that's why we were brought in.
Reduction in use of antibiotic when appropriate is a good thing..but that's one of the things we do. Then again, becareful when you say you reduced the use of Primaxin... we see that happen all the time when Primaxin use goes down...but Merrem use goes up.

You can reduce use of a class of abx...but what is it doing to the abx usage globally? Is it increasing the use of cephalosporins? How is it affecting the use of antifungals?

That's why one of the most effective way to measure and trend abx is cost per adjusted patient days. Ask your advisor about the abx cost per apd trend for the past 3 years..and tell me where you were and where you are today. Then I will tell you if your stewardship is successful...or mediocre.
Click to expand...

Very good points. Clearly you have been doing this stuff far too long for a PGY-1 resident to stage a full blown argument (with anything substantial to stand on). I agree with almost everything you say, I just like to keep it interesting as a young punk, so to speak.

One other point I just came across regarding the institution I work at: caspofungin use down 53% over the last year (mostly due to prudent use of fluconazole). We are also very strict on meropenem use, although I don't have the numbers on this particular agent.
 
no-see-um said:
Good questions. I'm reading on a lot of these types of analyses just now. Textbook stuff, and studies seem to be getting at that these days.
Click to expand...

You won't find it in any textbook... but one of the latest ASHP journal had a nice case study of drugs cost per APD program instituted by U of Michigan... and how proud they were... except..we've been doing it for over 20 years...
 
Priapism321 said:
Very good points. Clearly you have been doing this stuff far too long for a PGY-1 resident to stage a full blown argument (with anything substantial to stand on). I agree with almost everything you say, I just like to keep it interesting as a young punk, so to speak.
Click to expand...

I know...this is not the first time you've done this..you did it to Zpack a few years ago when you were a student.

I know you're a young punk...but you'll be ok. I was a young punk once....I'm still a punk.
 
Epic said:
You won't find it in any textbook... but one of the latest ASHP journal had a nice case study of drugs cost per APD program instituted by U of Michigan... and how proud they were... except..we've been doing it for over 20 years...
Click to expand...

Thanks, I'll take a look at that. I'm still learning because I'd like to be an asset to a hospital when it comes to economic/benefit analyses. It seems like the a good way to justify good pharmaceutical care and one's job.
 
no-see-um said:
Thanks, I'll take a look at that. I'm still learning because I'd like to be an asset to a hospital when it comes to economic/benefit analyses. It seems like the a good way to justify good pharmaceutical care and one's job.
Click to expand...

consider Pharmacy Managment Companies...like Cardinal, McKesson, etc... they'll teach you.
 
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