Fluoroquinolone Patents?

I think Levaquin goes in 2010 and Avelox in 2014

Arixtra is up to go..

So is Primaxin...

Well, you know Cipro went generic... both tabs and IVs

njac said:

I knew Primaxin was coming up soon. Arixtra, really? Before any of the LMWHs?

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FDA is about to approve generic enoxaparin too...

StaviZFingerZ said:

FDA is about to approve generic enoxaparin too...

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What makes you think they are "about to"??

When is telavancin up?

I have levofloxacin in June 2011 and moxifloxacin March 2014

Priapism321 said:

What makes you think they are "about to"??

When is telavancin up?

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Because I said so...

StaviZFingerZ said:

Because I said so...

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You are the man....

Priapism321 said:

You are the man....

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ehhh... actually I got in on Momenta stock in 2007 when the FDA denied approval...it crashed below $5.. sometime last year, it hit almost $20..so I got out. Then I went back in at $13...and have been sitting on it. Once the approval and the run up, I'm getting out.

This will be the biggest generic news of the decade..

when linezolid loses exclusivity, will you put it in every hcap, vap and hap protocol in the building?

StewardshipDude said:

when linezolid loses exclusivity, will you put it in every hcap, vap and hap protocol in the building?

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will you?

njac said:

how do you feel about the Linezolid having better lung penetration for MRSA pnas?

I need to actually read up on it myself, but some people I work with immediately swap to Linezolid when they get a MRSA positive sputum.

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That depends on your facility's MRSA and the MIC. How often are you seeing Vancomycin interemediately sensitive MRSA at MIC > 1? We strive for trough at 10X the MIC... though no definitive studies have shown it, many ID practitioners will bump the trough.

Now there are studies showing Vanco resistance is correlated to Linezolid and Dapto resistance..

njac said:

how do you feel about the Linezolid having better lung penetration for MRSA pnas?

I need to actually read up on it myself, but some people I work with immediately swap to Linezolid when they get a MRSA positive sputum.

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How long do they treat for? That seems like a lot of expense and risk of toxicity for not a lot of data. I don't think you can completely abandon vancomycin for pulmonary indications just yet.

What we need is that surfactant-stable formulation of daptomycin that's in the works...

njac said:

Our MRSA Vanco sensitivities are still pretty good, I haven't seen actual MIC numbers though.

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Why not?

njac said:

how do you feel about the Linezolid having better lung penetration for MRSA pnas?

I need to actually read up on it myself, but some people I work with immediately swap to Linezolid when they get a MRSA positive sputum.

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Linezolid has activity against PVL toxin in cases of necrotizing pneumonia that vanco does not.

I wouldn't give pts linezolid just because of MRSA PNA unless we had a problem with higher MICs.

Let's give Tygacil!!! It covers MRSA!!! heh!!!!




Don't shoot me.. I'm just imitating some physicians who think this is a good idea..

njac said:

the PVL toxin is more common in CA-MRSA, right?

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Clinda should work for that... not that I would recommend it.

I'm just an Ops guy... can't hang with you clinical kids..

Just failed my first ID midterm. I at least now know some of the alphabet, but still have very little clue on coverage. Half the test was on the genetics of resistance as opposed to concentrating on coverage and what to switch to when resistance was encountered. Do I really need to know MSLB's mechanism of resistance?

Farmercyst said:

Just failed my first ID midterm. I at least now know some of the alphabet, but still have very little clue on coverage. Half the test was on the genetics of resistance as opposed to concentrating on coverage and what to switch to when resistance was encountered. Do I really need to know MSLB's mechanism of resistance?

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can't hurt to know.

Farmercyst said:

Just failed my first ID midterm. I at least now know some of the alphabet, but still have very little clue on coverage. Half the test was on the genetics of resistance as opposed to concentrating on coverage and what to switch to when resistance was encountered. Do I really need to know MSLB's mechanism of resistance?

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Did you fail because the teacher didn't make it clear what the exam was going to stress? There are two parts of school:

• Learning the stuff you need to pass the exam.
• Learning the stuff you need to be a practicing pharmacist.

When you have a good teacher they are identical. As to your question. The more knowledge you have at the lowest levels the less you need to memorize at the upper levels. So the answer is yes. When you see a new drug 10 years from now, your knowledge of what goes on at the cellular level will be helpful in sorting out the wheat from the chaff.....

njac said:

we had to hide Tygacil because Podiatry, of all services, was going nuts with it.

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Thank god we rarely use this drug. I think I've seen it once here.

Old Timer said:

Did you fail because the teacher didn't make it clear what the exam was going to stress? There are two parts of school:

• Learning the stuff you need to pass the exam.
• Learning the stuff you need to be a practicing pharmacist.

When you have a good teacher they are identical. As to your question. The more knowledge you have at the lowest levels the less you need to memorize at the upper levels. So the answer is yes. When you see a new drug 10 years from now, your knowledge of what goes on at the cellular level will be helpful in sorting out the wheat from the chaff.....

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Dayum old mang.. you're so serious..

KARM12 said:

Thank god we rarely use this drug. I think I've seen it once here.

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You mean.... y'all aint got no resistant Acinetobacters?

StaviZFingerZ said:

Dayum old mang.. you're so serious..

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I didn't flunk the exam either....

We have tigecycline restricted at our institution and use it as a carbapenem sparing agents when we have ESBLs as part of a mixed infection. It is also our drug of choice for KPCs (although I'm sure Stavi recommends Colistin for everyone) which we are seeing more off. Overall though, we use very little and are happy to keep it saved.

StewardshipDude said:

(although I'm sure Stavi recommends Colistin for everyone)

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You ain a little bitter about being wrong on Zosyn generic.. are you. Suck it up dood..and eat your well deserved crow. I hear soaking it in some italian dressing makes it taste better.

Happy Thankgiving Grasshopper.

StaviZFingerZ said:

You mean.... y'all aint got no resistant Acinetobacters?

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That was the one time I've seen it. Surprisingly, we don't see too many. Most are still susceptible to high dose unasyn.

Old Timer said:

Did you fail because the teacher didn't make it clear what the exam was going to stress? There are two parts of school:

• Learning the stuff you need to pass the exam.
• Learning the stuff you need to be a practicing pharmacist.

When you have a good teacher they are identical. As to your question. The more knowledge you have at the lowest levels the less you need to memorize at the upper levels. So the answer is yes. When you see a new drug 10 years from now, your knowledge of what goes on at the cellular level will be helpful in sorting out the wheat from the chaff.....

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It's totally a time management issue on my part and I readily admit that. We have 2 course coordinators. One stresses molecular genetics and chemical structures, the other stresses abx coverage, dosage forms, and MOA. As a result I had to choose what to spend the most time on. I did fairly well on coverage, dosage forms and MOA, but rather poorly on molecular genetics and mechanisms of abx resistance on the cellular level. Admittedly to some degree they're all important, but time management and the number of irons in my fire dictated my overall performance. In the end I know my grades are my own and no one else's.

Farmercyst said:

It's totally a time management issue on my part and I readily admit that. We have 2 course coordinators. One stresses molecular genetics and chemical structures, the other stresses abx coverage, dosage forms, and MOA. As a result I had to choose what to spend the most time on. I did fairly well on coverage, dosage forms and MOA, but rather poorly on molecular genetics and mechanisms of abx resistance on the cellular level. Admittedly to some degree they're all important, but time management and the number of irons in my fire dictated my overall performance. In the end I know my grades are my own and no one else's.

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The only important thing about screwing up is figuring out what went wrong and how to make sure it doesn't happen again....

I spoke to some guys from Ortho in 2007 or 2008 and they said Levofloxacin would be off patent in about two years...

njac said:

During discussion at work today we were wondering when the patents on Levofloxacin and Moxifloxacin will be up. I saw something that said June 23, 2009 on Levo, but obviously there's no generic on the market yet.

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On a related note, have any of you guys run across any of the newer anti-MRSA fluoroquinolones?

StaviZFingerZ said:

You mean.... y'all aint got no resistant Acinetobacters?

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I haven't seen as much of it lately, but we had an outbreak about 2006 during the summer.

njac said:

speaking of, I saw one today, still intermediate to Unasyn. Can you overcome the intermediate with high-dose or do you give in to the Tygacil?

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Everyone, put the tigecycline back on the shelf....I would look to a carbapenem or colistin before using tigecycline for a resistant Acinetobacter, which in my mind is an unproven drug that gets more play then it deserves because it is rather easy to use.

The following represents why I worry about treating potentially deadly infections with tigecycline unless there is nothing left:

http://www.atypon-link.com/doi/abs/10.1592/phco.27.8.1198

http://www.theannals.com/cgi/content/abstract/42/9/1188

njac said:

holy crap! Was there anywhere left on that 1st lady that wasn't growing acinetobacter?

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Urinary tract, spine, respiratory tract, no big deal!!

agreed, tigecycline should not be used 1st line for Acin.B.

what about KPCs? Do you really advocate using colistin and all it's toxicities for KPCs before tigecycline? please, please tell me you don't.

StewardshipDude said:

agreed, tigecycline should not be used 1st line for Acin.B.

what about KPCs? Do you really advocate using colistin and all it's toxicities for KPCs before tigecycline? please, please tell me you don't.

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don't be so transparent. just because ur pissed off at ur admin for pressuring to cut antibiotic cost. you throwing a trap question for some of us to admit 'cutting cost despite risking patient safety' is laughable.

just know that patient care is the foremost concern in my practice. and quit it with ur elementary questions.

StaviZFingerZ said:

don't be so transparent. just because ur pissed off at ur admin for pressuring to cut antibiotic cost. you throwing a trap question for some of us to admit 'cutting cost despite risking patient safety' is laughable.

just know that patient care is the foremost concern in my practice. and quit it with ur elementary questions.

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Wow you are an angry, bitter person. Just answer the question. In fact, re-read this thread or any thread and you never answer the question but instead offer ridicule and sarcasm. You seldom ever contribute with anything but deflecting questions of you own.

WOULD YOU AGREE THAT TIGECYCLINE IS A SAFER, MORE EFFECTIVE OPTION THAN COLISTIN IN CONFIRMED KPC INFECTIONS FOR MOST PATIENTS? Simple enough.

You and I have been through this before, I am not pissed at administration. They get it. I am pissed at my pharmacy breathern who have been taught that generics (even when more expensive and more toxic) are by default better than brand name products simply because they are generic. If you had a family member who was febrile 7 days into VAP not responsive to ABXs and the ID says he suspects a yeast or a mold - would you really risk "shake and bake" when the IDSA offers 2 branded primary options?

I get it, you'd have them on vanc and AmphoB. Shake, Bake and Red Man all to keep the generic manufacturer in Zinzhang happy.

hey... I hear crickets! do you hear crickets? cricket infestation!

StewardshipDude said:

Wow you are an angry, bitter person. Just answer the question. In fact, re-read this thread or any thread and you never answer the question but instead offer ridicule and sarcasm. You seldom ever contribute with anything but deflecting questions of you own.

WOULD YOU AGREE THAT TIGECYCLINE IS A SAFER, MORE EFFECTIVE OPTION THAN COLISTIN IN CONFIRMED KPC INFECTIONS FOR MOST PATIENTS? Simple enough.

You and I have been through this before, I am not pissed at administration. They get it. I am pissed at my pharmacy breathern who have been taught that generics (even when more expensive and more toxic) are by default better than brand name products simply because they are generic. If you had a family member who was febrile 7 days into VAP not responsive to ABXs and the ID says he suspects a yeast or a mold - would you really risk "shake and bake" when the IDSA offers 2 branded primary options?

I get it, you'd have them on vanc and AmphoB. Shake, Bake and Red Man all to keep the generic manufacturer in Zinzhang happy.

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StewardshipDude said:

Wow you are an angry, bitter person. Just answer the question. In fact, re-read this thread or any thread and you never answer the question but instead offer ridicule and sarcasm. You seldom ever contribute with anything but deflecting questions of you own.

WOULD YOU AGREE THAT TIGECYCLINE IS A SAFER, MORE EFFECTIVE OPTION THAN COLISTIN IN CONFIRMED KPC INFECTIONS FOR MOST PATIENTS? Simple enough.

You and I have been through this before, I am not pissed at administration. They get it. I am pissed at my pharmacy breathern who have been taught that generics (even when more expensive and more toxic) are by default better than brand name products simply because they are generic. If you had a family member who was febrile 7 days into VAP not responsive to ABXs and the ID says he suspects a yeast or a mold - would you really risk "shake and bake" when the IDSA offers 2 branded primary options?

I get it, you'd have them on vanc and AmphoB. Shake, Bake and Red Man all to keep the generic manufacturer in Zinzhang happy.

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If I (or a family member) had pneumonia caused by carbapenemase producing bacteria, I would want to be placed on colistin.