Treatment of Candida Endocarditis

[Sparda29]

We have a couple of patients in here with Candida endocarditis. Doc has them both on Ambisome, which is stupid expensive, a pain in the ass to compound, and only stable for 6 hours after compounding, especially being that dosing was initiated in the middle of the night when there is only one pharmacist working.

Anyone hear of any other options?

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[rxlea]

If your organism isn't susceptible to fluconazole, probably not. I wouldn't want to mess around with that. Just compound it. The vials are good for 7 days reconstituted in the fridge. Then you just have to filter to make a dose (fast). Just reconstitute enough for the remaining doses....

It's not that hard. Quit being lazy.

 

[rxlea]

They can reconstitute them in the day. Bang them out fast, put a wrap on them,, stick them in the fridge. Then all you have to do is draw up/ inject using a filter. I use the filter to draw out of the vial. One filter for each vial. Shoot a little air quickly into the vial through the filter and the positive pressure makes it easy. Four vials into a 60 cc syringe then shoot with a 16 gauge into the bag.

 

[Lubeckd]

There was a research done with voriconazole and caspofungin....

http://www.biomedcentral.com/1471-2334/6/73

Also with Caspofungin alone + Caspofungin and fluconazole.

http://www.ncbi.nlm.nih.gov/pubmed/15825018
http://www.ncbi.nlm.nih.gov/pubmed/16274746

Both Caspofungin and Voriconazole had limited data. Caspofungin also costs a lot...

 

[Sparda29]

If your organism isn't susceptible to fluconazole, probably not. I wouldn't want to mess around with that. Just compound it. The vials are good for 7 days reconstituted in the fridge. Then you just have to filter to make a dose (fast). Just reconstitute enough for the remaining doses....

It's not that hard. Quit being lazy.

Where did you hear that it is good for 7 days reconstituted in the fridge? I've read its only good for 24 hours in the fridge reconstituted. Besides, we suggested this to the director but he doesn't wanna do this in case the patient dies/gets transferred/order discontinued, because then it comes a waste. Also, I'm not the overnight pharmacist. The overnight pharmacist has no time to do this, their job is to set up anesthesia kits, catch up on all the orders that we leave behind, stats from the ER, not spend 30 minutes in the IV room compounding one drug.

They can reconstitute them in the day. Bang them out fast, put a wrap on them,, stick them in the fridge. Then all you have to do is draw up/ inject using a filter. I use the filter to draw out of the vial. One filter for each vial. Shoot a little air quickly into the vial through the filter and the positive pressure makes it easy. Four vials into a 60 cc syringe then shoot with a 16 gauge into the bag.

Don't have 16 gauge needles here, 18 is the biggest.

 

[iFarm]

We provide Ambisome to patients at home. Check out extended stability. It's good for longer than 7 days (refrigerated & at the right concentration).

 

[rxlea]

We provide Ambisome to patients at home. Check out extended stability. It's good for longer than 7 days (refrigerated & at the right concentration).

Right. It's much longer but we only do 7 days in house and only in anticipation of scheduled doses.

 

[rxlea]

Where did you hear that it is good for 7 days reconstituted in the fridge? I've read its only good for 24 hours in the fridge reconstituted. Besides, we suggested this to the director but he doesn't wanna do this in case the patient dies/gets transferred/order discontinued, because then it comes a waste. Also, I'm not the overnight pharmacist. The overnight pharmacist has no time to do this, their job is to set up anesthesia kits, catch up on all the orders that we leave behind, stats from the ER, not spend 30 minutes in the IV room compounding one drug.



Don't have 16 gauge needles here, 18 is the biggest.

Sparda, it doesn't take 30 minutes. No way. And 18 is fine too. I just like the bigger one. When you shoot the 12 ml in, do it fast to wet everything (kinda like how you have to shoot it in fast with melphalan). Then shake the **** out of it for about 15 seconds and move on to next vial. Then shake both for 15 seconds and so on down the line. I shake up to four at the same time. Get a 60 cc syringe and put the filter on then the needle and push about 8ml of air into the vial starting with the one you reconstituted first (without drawing anything into the filter) then pull back into the 60cc through the filter. Change filter and needle for next vial etc. pull up four vials (50cc) into one syringe and shoot that in the bag. Then change your syringe and repeat.

It's really not that hard and shouldn't take you that long if you shake the **** out of it .

 

[Sparda29]

Sparda, it doesn't take 30 minutes. No way. And 18 is fine too. I just like the bigger one. When you shoot the 12 ml in, do it fast to wet everything (kinda like how you have to shoot it in fast with melphalan). Then shake the **** out of it for about 15 seconds and move on to next vial. Then shake both for 15 seconds and so on down the line. I shake up to four at the same time. Get a 60 cc syringe and put the filter on then the needle and push about 8ml of air into the vial starting with the one you reconstituted first (without drawing anything into the filter) then pull back into the 60cc through the filter. Change filter and needle for next vial etc. pull up four vials (50cc) into one syringe and shoot that in the bag. Then change your syringe and repeat.

It's really not that hard and shouldn't take you that long if you shake the **** out of it .

Tell that to the overnighter who has to compound it. According to them, they were in the IV room for an hour trying to figure out how to compound it and compounding it, meanwhile a mob was developing at the window and they had no idea since the IV room is all the way in the back. You cannot hear or see a thing that is happening in front. Nurses could be yelling as loud as they want, all the phones could be ringing and they still would have no idea what's going on.

 

[iFarm]

Tell that to the overnighter who has to compound it. According to them, they were in the IV room for an hour trying to figure out how to compound it and compounding it, meanwhile a mob was developing at the window and they had no idea since the IV room is all the way in the back. You cannot hear or see a thing that is happening in front. Nurses could be yelling as loud as they want, all the phones could be ringing and they still would have no idea what's going on.

Is there not a tech available to mix meds at night? How many beds is this hospital?

 

[Sparda29]

No techs after 11pm, about 350 beds.

 

[rxlea]

No techs after 11pm, about 350 beds.

Again, your joint has issues...

 

[Sparda29]

Again, your joint has issues...

It's weird, we don't have the money to hire 2-3 more techs. But we have the money to hire a 2nd clinical pharmacist.

 

[smercer]

Dude your joint totally sucks. Only having 1 pharmacist w/ 0 techs at night is just asking to get someone killed. Who is double checking those IVs?

 

[Sparda29]

Dude your joint totally sucks. Only having 1 pharmacist w/ 0 techs at night is just asking to get someone killed. Who is double checking those IVs?

Well the techs do batch add-vantage/minibags during the day and a pharmacist double checks that. But for stuff that needs to be compounded, only the pharmacist works on it and no one double checks.

 

[R xxx]

Oh geez. We have 2 techs at night and less beds than that.