Ceftaroline Approved

[KARM12]

---

Members do not see this ad.

ampi-gent!!

# of strains that are amp resistant and amp-gent sensitive?

 

[Quiksilver]

No just discussing what you think is the best therapy. So if not linezolid, then?

Levaquin for prophy especially if we expect neutropenia. In most we otherwise prophy with acyclovir, fluc and SMX-TMP

Zosyn and vanco get a lot of work (and work for a lot of the patients)

Carbapenems are also quite popular choices as well.

Linezolid is reserved

Cubicin is used in maybe 1 patient a month?

 

[KARM12]

Levaquin for prophy especially if we expect neutropenia. In most we otherwise prophy with acyclovir, fluc and SMX-TMP

Zosyn and vanco get a lot of work (and work for a lot of the patients)

Carbapenems are also quite popular choices as well.

Linezolid is reserved

Cubicin is used in maybe 1 patient a month?

For MRSA?

 

[Charlottefromca]

does anyone know the price??

 

[Its Z]

does anyone know the price??

Charlottefromca, no one knows.

ZfromCharlotteA.

 

[StewardshipDude]

Is an oral in development? Priced right, they could take a bunch of the market. We are under intense pressure to move folks out as soon as possible and an oral helps. Of course, our profit minded IDs will continue to have a PICC line placed and send them to their own infusion suite for vanc or dapto but for folks like me, I would like an oral option. Price too will be critical as will how quickly they can get on microscan. Our lab fights us over any manual requests outside of qc.

 

[Its Z]

Jamaica?

Good to be back in the states.

View from the hospital.

Drive on the wrong side of the road.

The Universidad

The cove.

 

[Praziquantel86]

A donde?

 

[WVUPharm2007]

Is that y'alls Virgin Islands hospital?

 

[Its Z]

 

[KARM12]

Is an oral in development? Priced right, they could take a bunch of the market. We are under intense pressure to move folks out as soon as possible and an oral helps. Of course, our profit minded IDs will continue to have a PICC line placed and send them to their own infusion suite for vanc or dapto but for folks like me, I would like an oral option. Price too will be critical as will how quickly they can get on microscan. Our lab fights us over any manual requests outside of qc.

Dude this is IV...you call yourself an ID person?

 

[StewardshipDude]

Dude this is IV...you call yourself an ID person?

are you serious? of course I know it's an IV right now. I clearly asked, if an oral was under development. Many patients admitted to our hospital are started on IV antibiotics then switched to equivalent oral therapy after clinical success or defervescence . Advantages of early IV to oral switch include: reduced cost, early discharge, less need for home IV therapy, virtual elimination of line infection. We regularly do this with doxy, minocycline, clindamycin, metronidazole, chloramphenicol, amox, trimethehoprim-sulfa, quinolones, and linezolid. We would love to do it with more cephalosporins but bioavalabilty issues have limited us. The delivery technology so far cannot provide an oral option for dapto, pip/tazo, ceftaz.

Sad that you call yourself a pharmacist. Glad you ain't licking any of my labels.

 

[Its Z]

are you serious? of course I know it's an IV right now. I clearly asked, if an oral was under development. Many patients admitted to our hospital are started on IV antibiotics then switched to equivalent oral therapy after clinical success or defervescence . Advantages of early IV to oral switch include: reduced cost, early discharge, less need for home IV therapy, virtual elimination of line infection. We regularly do this with doxy, minocycline, clindamycin, metronidazole, chloramphenicol, amox, trimethehoprim-sulfa, quinolones, and linezolid. We would love to do it with more cephalosporins but bioavalabilty issues have limited us. The delivery technology so far cannot provide an oral option for dapto, pip/tazo, ceftaz.

Sad that you call yourself a pharmacist. Glad you ain't licking any of my labels.

Shouldn't you know if the PO form is in development? Aren't you the one bragging about talking it up with MSL??

 

[KARM12]

are you serious? of course I know it's an IV right now. I clearly asked, if an oral was under development. Many patients admitted to our hospital are started on IV antibiotics then switched to equivalent oral therapy after clinical success or defervescence . Advantages of early IV to oral switch include: reduced cost, early discharge, less need for home IV therapy, virtual elimination of line infection. We regularly do this with doxy, minocycline, clindamycin, metronidazole, chloramphenicol, amox, trimethehoprim-sulfa, quinolones, and linezolid. We would love to do it with more cephalosporins but bioavalabilty issues have limited us. The delivery technology so far cannot provide an oral option for dapto, pip/tazo, ceftaz.

Sad that you call yourself a pharmacist. Glad you ain't licking any of my labels.

IV to PO = ID 101. Obviously we know the benefits of PO in cases where it is possible. Give me a reliable abx that treats PSA. In some cases vanco home infusion is cheaper than linezolid and many insurance companies give you a hell of a time trying to get it approved.

You'll never emilinate line infections, unless you eliminate lines. You can reduce them with PO abx in some cases. Many people who get line infections are HD, Chemo, TPN... For those who get infections from short term lines, the majority of them are acquired during the insertion process due to poor technique or location.

We should have an ID bowl. I'd run circles around you.

 

[StewardshipDude]

any time. and getting lines out does eliminate chancing of acquiring lines infections. i can explain it in small words if need be.

carry on.

 

[WVUPharm2007]

Let me grab a tape measure so I can see who has the biggest internet ID specialist penis.

BRB.

 

[All4MyDaughter]

Please try to act like adults. Thanks. 🙂

 

[KARM12]

Let me grab a tape measure so I can see who has the biggest internet ID specialist penis.

BRB.

I am a girl.

 

[KARM12]

Stewardship dude is not an ID specialist....he just has a lot of friends who are MSLs.

 

[WVUPharm2007]

I am a girl.

It's a saying...internet peen...

 

[KARM12]

It's a saying...internet peen...

That makes me feel dirty. 😉

 

[Its Z]

He's just pissed off because crow tastes bad. Something about crickets and generic zosyn.

 

[StewardshipDude]

I am not mad Z. We stayed with brand pip/tazo as did most accounts in the U.S. because wyeth cut us a deal to pay $1 more than the average generic price on vials. We got to keep frozen and the buck per vial is worth it to us for all the reasons we hashed out last year. You might have better info, but my understanding from Premier is that wyeth or whoever now kept about 85% of the market. Granted, they are selling it for less, but the generic ain't selling in this country for executional risk reasons. It is selling in South America, Spain, and Eastern Europe.

Anyway, we had a cool case this morning and I have to get back to writing it up. Getting better with non-zoonotic therapy as a result.

 

[Its Z]

Hospira brand generic just received approval not long ago.

The reason Wyeth kept the marketshare has nothing to do with therapeutics. It's all about contracts. Broadlane ran with generic and the floodgate has opened. It won't be long before the pricing gets diluted out.

 

[DaveRX]

I would be interested in the gram negative spectrum. Right now we have approval for CAP, as it was compared to CTX in clinical trial. Does it have anti-pseudomonal activity, but not tested in trials? Obviously you worry about resistance with these super antbiotics, in if we are using it for just MRSA, are we inducing resistance to G-.... I think of tigecycline which was supposed to be the be all, end all antibiotic and did not live up to the hype.

5th generation...wow, I feel old.

Ceftaroline has very similar Gram-negative activity to ceftriaxone. It covers Enterobacteriaceae but has no activity against nonfermenters (e.g., Pseudomonas, Acinetobacter), so it's not going to be used empirically for nosocomial infections.

I am struggling to find a role for ceftaroline. At least tigecycline can be used for ESBLs and MDR Acinetobacter.