The next big drug

[Epic]

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Ceftobiprole, the fifth generation cephalosporin which covers MRSA and Pseudomonas. Good candidate for monotherapy...but will also break the hospital antibiotic budget if not controlled.

Basilea Pharmaceutical, a swiss company's stock has tripled in the past 3 or so years... the drug will be comarketed with Johnson and Johnson..which means your favorite Levaquin reps are salivating today...

J&J will probably assasinate me.. because I'll make sure this drug is not added to any formulary..anwhere...while getting Levaquin off the formulary.

 

[MountainPharmD]

Ceftobiprole, the fifth generation cephalosporin which covers MRSA and Pseudomonas. Good candidate for monotherapy...but will also break the hospital antibiotic budget if not controlled.

Basilea Pharmaceutical, a swiss company's stock has tripled in the past 3 or so years... the drug will be comarketed with Johnson and Johnson..which means your favorite Levaquin reps are salivating today...

J&J will probably assasinate me.. because I'll make sure this drug is not added to any formulary..anwhere...while getting Levaquin off the formulary.

Does that by any chance treat pharmacitis?

 

[Epic]

Does that by any chance treat pharmacitis?

No drug treats Pharmcitis. Only Lobectomy..

 

[MountainPharmD]

No drug treats Pharmcitis. Only Lobectomy..

Sweet!

 

[Old Timer]

No drug treats Pharmcitis. Only Lobectomy..

Don't you mean Lobotomy......

 

[Epic]

If he is going to call ua pharmicitis, heck I too can make up words.

 

[WVUPharm2007]

But, but, it's novel!

 

[Farmercyst]

yeah, and novel=fiction right.😀

 

[KARM12]

MRSA and Psuedomonas?! And a free pen?!

 

[Epic]

And a lot of money...friends have been flown in for market research for $2,000 for a day of participation.

 

[genesis09]

Another cephalosporin?! Tears in eyes, I just memorized them. It was a difficult task because they all sound alike, but it was done.

 

[Priapism321]

This drug will also be the first cephalosporin to cover Enterococcus. I spend at least 10 minutes a week explaining to medical residents/pharmacy students that I do not care if the patient is on cefepime, it will not work. One actually pulled out our hospital antibiogram to prove me wrong and showed me the numbers. She points out cefepime and sure enough, 97% of the isolates in the hospital were sensitive. Unfortunately, I had to break it to her that she was showing me the information regarding Enterobacter, not Enterococcus. She immediately said we must need linezolid. Another 5 minutes explaining that high dose ampicillin would be the drug of choice for an ampicillin resistant Enterococcus in the urine in a patient making urine.

 

[Epic]

Another cephalosporin?! Tears in eyes, I just memorized them. It was a difficult task because they all sound alike, but it was done.

you only need to know cefazolin, cefotaxime, cefoxitin, cefotetan, ceftazidime, cefepime, cephalexin, cefuroxime...and suprax.. oh.. and ceftriaxone.

 

[Priapism321]

you only need to know cefazolin, cefotaxime, cefoxitin, cefotetan, ceftazidime, cefepime, cephalexin, cefuroxime...and suprax.. oh.. and ceftriaxone.

We just added cefixime; only to be used in the ED for gonococcal infections, presumably when it is not feasible to give ceftriaxone.

 

[Epic]

This drug will also be the first cephalosporin to cover Enterococcus. I spend at least 10 minutes a week explaining to medical residents/pharmacy students that I do not care if the patient is on cefepime, it will not work. One actually pulled out our hospital antibiogram to prove me wrong and showed me the numbers. She points out cefepime and sure enough, 97% of the isolates in the hospital were sensitive. Unfortunately, I had to break it to her that she was showing me the information regarding Enterobacter, not Enterococcus. She immediately said we must need linezolid. Another 5 minutes explaining that high dose ampicillin would be the drug of choice for an ampicillin resistant Enterococcus in the urine in a patient making urine.

You aint spending enough time then...were you the one arguing with me about Linezolid resistant VRE...??

That Enterobacter story is funny chit...

I don't know why so many people have hard time with ID....

 

[Epic]

We just added cefixime; only to be used in the ED for gonococcal infections, presumably when it is not feasible to give ceftriaxone.

when is it ever not feasible to give IM ceftriaxone without lidocaine for STD??

 

[Epic]

btw..have you been getting detailed on the drug or are you just reading it on your own... on ceftobiprole that is

 

[Priapism321]

You aint spending enough time then...were you the one arguing with me about Linezolid resistant VRE...??

Yeah, I tend to handle it on a case per case basis, either with my team or when I am staffing; it tends to come up about once per week (that is why I estimated 10 minutes).

January to June 2007 Antibiotic Suscebtibility Report:

Enterococcus faecium: 8% resistant to linezolid. Yikes.

 

[Priapism321]

when is it ever not feasible to give IM ceftriaxone without lidocaine for STD??

That was my question. We keep a very limited supply and plan to reassess the hospital's need in six months.

 

[Epic]

Yeah, I tend to handle it on a case per case basis, either with my team or when I am staffing; it tends to come up about once per week (that is why I estimated 10 minutes).

January to June 2007 Antibiotic Suscebtibility Report:

Enterococcus faecium: 8% resistant to linezolid. Yikes.

Love it!!!!!!

What you gonna do now.... Bad Bug Bad Bug..

Breakout the Synercid!! Insert that central line!

 

[Priapism321]

btw..have you been getting detailed on the drug or are you just reading it on your own... on ceftobiprole that is

Haven't been detailed yet; can't speak for our ID Pharmacists though. I actually did a presentation on the drug last year, as it created a pretty big buzz at ICAAC in 2005.

The ID Pharmacist I work with told me last week he does not think it is going to be a drug that lives up to its hype, and we may try to keep it off our formulary as well. However, we have a highly restricted anti-infective formulary, and two stewardship pharmacists; so even if it was added, use would be controlled. If we can just stop Surgery from stealth dosing us all the time.....

 

[Epic]

Well, theoretically speaking, b-lactam coverage against MRSA should be better than Vanc, Tygacil, Linezolid...etc. But it doesn't look like the studies are showing it to be more effective.

But at the end of the day, we're not puzzled because we can't treat MRSA and Pseudomonas.... I bet it will come out with price higher than Linezolid..

 

[WVUPharm2007]

Yeah, I tend to handle it on a case per case basis, either with my team or when I am staffing; it tends to come up about once per week (that is why I estimated 10 minutes).

January to June 2007 Antibiotic Suscebtibility Report:

Enterococcus faecium: 8% resistant to linezolid. Yikes.

We've been getting that, too. We had one E. faecium that was resistant to the whole damn motley assortment of **** except for one drug.....chloramphenicol.....of all things. That's Darwin's UTI right there...

 

[Epic]

We've been getting that, too. We had one E. faecium that was resistant to the whole damn motley assortment of **** except for one drug.....chloramphenicol.....of all things. That's Darwin's UTI right there...

what did y'all end up doing?

 

[npage148]

was it sensitive to nitrofurantoin?

 

[Epic]

was it sensitive to nitrofurantoin?

ahhhh...good question!!

 

[WVUPharm2007]

what did y'all end up doing?

I actually have no idea, the ID team came in and told everyone else to **** off and eat some cookies....so she wasn't on my round list anymore....and after that happens, they take your access to that patient away in the computer.

 

[WVUPharm2007]

was it sensitive to nitrofurantoin?

No....and I think it was actually pyelo, anyway.....

The sensitivity was like:

R: linezolid, levofloxacin, ampicillin, amox/clav, nitrofurantoin, trim/sulf, amikacin, a few cephalosporins, maybe some other stuff...

I: One drug....I forget which...

S: chloramphenicol

I'm glad that rotation is over as of Friday and I'm now out of that town. I got a viral lung infection there that lasted a week and a half. Hell, I'm still coughing up mucus. It's like Taiwan in America....maybe I got the SARS.

 

[Epic]

I actually have no idea, the ID team came in and told everyone else to **** off and eat some cookies....so she wasn't on my round list anymore....and after that happens, they take your access to that patient away in the computer.

That aint good enough. The clinical pharmacist has to be on the team to see it resolved. I bet the bug was susceptible to Synercid.

 

[WVUPharm2007]

That aint good enough. The clinical pharmacist has to be on the team to see it resolved. I bet the bug was susceptible to Synercid.

I actually think the ID team had a pharmacist...and I would assume he looked at it. I was on medicine....so I did other stuff....though you probably are right...it was likely succeptable to synercid and cubicin....being that neither were likely used in that entire community....ever. I just know that neither were on the formulary...nor on the hospital's stock sensitivity report.

 

[Epic]

I actually think the ID team had a pharmacist...and I would assume he looked at it. I was on medicine....so I did other stuff....though you probably are right...it was likely succeptable to synercid and cubicin....being that neither were likely used in that entire community....ever. I just know that neither were on the formulary...nor on the hospital's stock sensitivity report.

Dapto and Synercid data were probably there but suppressed in the C/S report.

 

[CaliCPhT]

Ceftobiprole, the fifth generation cephalosporin which covers MRSA and Pseudomonas. Good candidate for monotherapy...but will also break the hospital antibiotic budget if not controlled.

Basilea Pharmaceutical, a swiss company's stock has tripled in the past 3 or so years... the drug will be comarketed with Johnson and Johnson..which means your favorite Levaquin reps are salivating today...

J&J will probably assasinate me.. because I'll make sure this drug is not added to any formulary..anwhere...while getting Levaquin off the formulary.

Curious... will this be oral or IV? Does it have a trade name? When are we expecting it be become commerically available?

Eek! bugs are becoming resistant to Zyvox? That didn't take long!!!

 

[WVUPharm2007]

Dapto and Synercid data were probably there but suppressed in the C/S report.

Could the drug company refuse access to those pathology tester stick thingies if the hospital doesn't have their product on formulary? I'd think that would be a good way to strong arm hospitals into adding your new MRSA drug onto formulary. Sure...you've got linezolid....but what if? You could make the product dropship only from manufacturer. If all of the MRSA drug manufacturers got together, they could totally pull that off.

 

[Epic]

Curious... will this be oral or IV? Does it have a trade name? When are we expecting it be become commerically available?

Eek! bugs are becoming resistant to Zyvox? That didn't take long!!!

IV for now. Not sure of brand name. I suspect next 6 months we'll see it released. Yes, Zyvox resistant enterococcus are popping up.

Good questions..

 

[Epic]

Could the drug company refuse access to those pathology tester stick thingies if the hospital doesn't have their product on formulary? I'd think that would be a good way to strong arm hospitals into adding your new MRSA drug onto formulary. Sure...you've got linezolid....but what if? You could make the product dropship only from manufacturer. If all of the MRSA drug manufacturers got together, they could totally pull that off.

You mean C/S Panel? Why would they... if we don't have the panel, guess what, your drug doesn't get added to the formulary. And no way in hell drug companies will work together to price gouge...that would be illegal anyways for one...and unless Pfizer buys them all out, it will never ever happen.

And because Vanco is generic... if we don't have Zyvox, Dapto, Synercid, Tygacil... boo freakin hoo... I couldn't careless.

 

[WVUPharm2007]

You mean C/S Panel? Why would they... if we don't have the panel, guess what, your drug doesn't get added to the formulary. And no way in hell drug companies will work together to price gouge...that would be illegal anyways for one...and unless Pfizer buys them all out, it will never ever happen.

And because Vanco is generic... if we don't have Zyvox, Dapto, Synercid, Tygacil... boo freakin hoo... I couldn't careless.

It wouldn't be price gouging if they just restricted access uniformly...and if they were all in on it....hmmm. I should work for a drug company's marketing dept. I think I am conniving enough to figure out a way to force people to buy ****....

 

[Epic]

It wouldn't be price gouging if they just restricted access uniformly. I should work for a drug company's marketing dept. I think I am conniving enough to figure out a way to force people to buy ****....

Cubicin is already a dropship.

And treating MRSA is no big deal.. no way you can force anyone to buy any antibiotic. Rather, pharm companies are begging hospitals to get their drugs on the formulary.

 

[WVUPharm2007]

MRSA isn't a big deal. Bactrim and Vanc are two cheap options...but the way things are headed, multiple drug resistant VRSA will be here in droves next decade....and if the manufacturers of the 4 "after Vanc" drugs got together, they could oligopolize that ****s. Think about the future of antimicrobial resistance...

 

[Epic]

can you see Dodge, Ford, Chevy, Toyota, and Nissan (makers of full size trucks) getting together to price jack trucks? Those are the only options us consumers have for full size trucks.. But it'll never happen... just like Pharma companies..unless one company buys everyone else out. What makes it more difficult is that unlike trucks..drugs go generic and other smaller generic companies will go haywire with the drugs.

Your idea gets a D-.. Not an F because you put a little thought into it.

 

[WVUPharm2007]

Those drugs won't go generic until the 2020s...

 

[Old Timer]

We've been getting that, too. We had one E. faecium that was resistant to the whole damn motley assortment of **** except for one drug.....chloramphenicol.....of all things. That's Darwin's UTI right there...

Rocky Mountain Spotted UTI..... Is this stuff still made???????? Talk about old time drugs....wow. I haven't seen an order for Chloramphenicol in ages...😱

 

[WVUPharm2007]

I s'pose.

 

[steveysmith54]

Next big drug will be male birth control IMO. 😉 I personally wouldn't take it though. 😀

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