What would you do in this situation?

[GreyFox2002]

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Someone drops off a script for Bactrim and Levaquin early in the day (Friday), says they'll return later. Tech takes in the Rx, we go to bill it later, PA needed for Levaquin. Call the DR, line is disconnected. Try a secondary number, line is disconnected. Call the patient, he gives me a third number, only get an answering machine. Leaves a message. Calls later in the day, no answer.

Patient comes by after 5 to see whats the scoop. Gives them his Bactrim and explains the doctor hasn't called back (and its going to be hard, considering its Friday after 5, to hear from him till Monday). I ask the patient what infection he was treating, he says he just got released s/p Necrotizing Fasciitis on his leg!!!!!!! WTF would you do? I call the insurance company and beg for an override, they say sorry no, need an MD's PA.

I tried to find an answering service for the MD but it was to no avail. He said he would check back tomorrow. My plan is for him to go back to the hospital and get a script for Levaquin from a different MD, but I'm not sure if that would fly.

I wanted to loan him a weekend supply, but you can't just give out $100 in medication like that. Of course the patient couldn't our cash price even at cost (Medicaid).

What would you do in this very tricky situation?

 

[Praziquantel86]

Call the hospital and see if was even a patient there. Doctor's lines are very rarely disconnected, let alone two. Sounds like he's treating a UTI more than anything, maybe with a pad he found.

If you think the patient is completely legit, loan him a day or two of levo.

 

[GreyFox2002]

Call the hospital and see if was even a patient there. Doctor's lines are very rarely disconnected, let alone two. Sounds like he's treating a UTI more than anything, maybe with a pad he found.

If you think the patient is completely legit, loan him a day or two of levo.

40 something year old male with a UTI? Stealing a script pad to write an abx script? No offense but I'm not buying it.

I'll loan him some.

 

[Praziquantel86]

40 something year old male with a UTI? Stealing a script pad to write an abx script? No offense but I'm not buying it.

I'll loan him some.

I wouldn't either, but given the multiple disconnected numbers, it adds a shady element to where there would be none. Besides, the meds might not be for him (uninsured girlfriend?)

And like I said, once you're sure he's legit (which he most likely is) loan him the meds. You don't have much of a choice otherwise. Just wondering, did he have a prescription for any pain meds? True necrotizing fasciitis almost always requires extensive surgical debridement.

 

[WVUPharm2007]

Bactrim and Levaquin...? I'd have thought they'd use something else....but wtf do I know...

 

[KARM12]

Bactrim and Levaquin...? I'd have thought they'd use something else....but wtf do I know...

Allow me to be Z....

What is nec fasc?

What are the common pathogens associated with nec fasc?

What empiric antibiotic regimens are recommended for initial coverage?

What adjucn non pharm therapy is necessary for treatment of nec fasc?

 

[StaviZFingerZ]

 

[GreyFox2002]

Allow me to be Z....

What is nec fasc?

What are the common pathogens associated with nec fasc?

What empiric antibiotic regimens are recommended for initial coverage?

What adjucn non pharm therapy is necessary for treatment of nec fasc?

I'll take a stab.

"Flesh-eating disease" Aka a widespread, rapid onset, and quickly moving infection of the subcutaneous layers of the skin.

Typical organisms are Group A Strep Pneumo or staph, many times of the MRSA type.

Need to cover for resistance so Vanco + Clinda.

Non-pharm therapy would be surgical debridement, possible amputation, typical ICU management.

I would imagine if it wasnt MRSA after culture and the patient's condition was stabilized early and controlled, a discharge regimen of Bactrim and Levaquin would be very adequate.

 

[WVUPharm2007]

Allow me to be Z....

What is nec fasc?

What are the common pathogens associated with nec fasc?

What empiric antibiotic regimens are recommended for initial coverage?

I ain't one of your students, dammit...Cellulitis and all that wonderful soft tissue **** is just about the only thing we get in the summer, it seems. Lots of obese people with weird fat-on-fat infections...

What adjucn non pharm therapy is necessary for treatment of nec fasc?

Who cares. That's outside my pay scale.

 

[GreyFox2002]

I ain't one of your students, dammit...




Who cares. That's outside my pay scale.

👍

 

[StaviZFingerZ]

 

[StaviZFingerZ]

I'm just happy to see someone else posesses the ability to lead a teaching session... in a style I love..

 

[StaviZFingerZ]

I'll take a stab.

"Flesh-eating disease" Aka a widespread, rapid onset, and quickly moving infection of the subcutaneous layers of the skin.

Typical organisms are Group A Strep Pneumo or staph, many times of the MRSA type.

Need to cover for resistance so Vanco + Clinda.

Non-pharm therapy would be surgical debridement, possible amputation, typical ICU management.

I would imagine if it wasnt MRSA after culture and the patient's condition was stabilized early and controlled, a discharge regimen of Bactrim and Levaquin would be very adequate.

If this was a response in a Therapeutics exam verbal or written....I'd give you 50 out of 100. Good try though... and at least you ask some interesting questions..

 

[StaviZFingerZ]

I ain't one of your students, dammit...Cellulitis and all that wonderful soft tissue **** is just about the only thing we get in the summer, it seems. Lots of obese people with weird fat-on-fat infections...




Who cares. That's outside my pay scale.

You better know how this is treated.

 

[GreyFox2002]

If this was a response in a Therapeutics exam verbal or written....I'd give you 50 out of 100. Good try though... and at least you ask some interesting questions..

Well expert, tell us what you would do.

 

[StaviZFingerZ]

Well expert, tell us what you would do.

1. I'm not the expert.
2. No, I'm not giving you the answer.
3. Trust me. I know the appropriate treatment options.

 

[WVUPharm2007]

You better know how this is treated.

Jesus H...man, I can read a god damn guideline article...I'm prolly looking the same one you are...I got a notebook I bring to work with me...has all of those id guidelines in them...but just the abx treatment charts (really, who needs the rest of that ****...)...plus IV administration guidelines...what drug needs to go into what solution...infusion times...it's all organized and useful...

 

[StaviZFingerZ]

Jesus H...man, I can read a god damn guideline article...I'm prolly looking the same one you are...I got a notebook I bring to work with me...has all of those id guidelines in them...but just the abx treatment charts (really, who needs the rest of that ****...)...plus IV administration guidelines...what drug needs to go into what solution...infusion times...it's all organized and useful...

What a dork...you carry a notebook? Chit...I haven't read the SSI guidelines in a while...I'm assuming it hasn't been updated since 2005 or 6...

 

[rphello]

Read the Sanford guide and call it a day.

S/P necrotizing fasciitis? Give the guy his ****ing meds!

 

[StaviZFingerZ]

Read the Sanford guide and call it a day.

S/P necrotizing fasciitis? Give the guy his ****ing meds!

Sanford? shame on you..

 

[rphello]

Sanford? shame on you..

I knew you would say that.

 

[WVUPharm2007]

What a dork...you carry a notebook? Chit...I haven't read the SSI guidelines in a while...I'm assuming it hasn't been updated since 2005 or 6...

**** you old man. Until I memorize all of this random ****, yes. The new guideline for Skin/Soft Tissue is suppossed to be out come next fall. Then they can tell me how uselessly expensive Tigacil is. Maybe that dalbavancin **** will be out, too.

 

[WVUPharm2007]

I knew you would say that.

Still the funniest school promo picture ever:

OMG! Sanford is so clinical looking. It's got Kanji on it!

 

[StaviZFingerZ]

**** you old man. Until I memorize all of this random ****, yes. The new guideline for Skin/Soft Tissue is suppossed to be out come next fall. Then they can tell me how uselessly expensive Tigacil is. Maybe that dalbavancin **** will be out, too.

I beg to differ. Tygacil has a place..

 

[rphello]

Still the funniest school promo picture ever:

Ain't that the truth. What the hell is wrong with those people, and why does this picture make me want to hulk out and destroy something?

 

[WVUPharm2007]

I beg to differ. Tygacil has a place..

Fine, then differ.

 

[WVUPharm2007]

Ain't that the truth. What the hell is wrong with those people, and why does this picture make me want to hulk out and destroy something?

I like the token white boy in the background.

 

[StaviZFingerZ]

Ain't that the truth. What the hell is wrong with those people, and why does this picture make me want to hulk out and destroy something?

I would love to join that table and start quizzing that mustache professor dude...

 

[rphello]

I like the token white boy in the background.

Like he can read that micro print from 5 feet away. He's an ass kisser.

 

[rphello]

I would love to join that table and start quizzing that mustache professor dude...

I bet his stache would catch on fire.

 

[StaviZFingerZ]

I bet his stache would catch on fire.

Heh..we should all look him up at ASHP this Dec...I should find him and have him autograph the pic... 👍

 

[rphello]

Heh..we should all look him up at ASHP this Dec...I should find him and have him autograph the pic... 👍

That dude is a rockstar. I bet he has a fan club. He probably has those damn kanji tattooed on his ass.

Come my children, gather around the Guide, and together we'll treat infectious diseases and sing kumbaya.

 

[StaviZFingerZ]

That dude is a rockstar. I bet he has a fan club. He probably has those damn kanji tattooed on his ass.

Come my children, gather around the Guide, and together we'll treat infectious diseases and sing kumbaya.

lol... this is post is worthy as a sig..

 

[StaviZFingerZ]

students scared to respond? have I put that mmuch fear into the minds of sdn rx students?

 

[PharmDstudent]

students scared to respond? have I put that mmuch fear into the minds of sdn rx students?

😴

 

[Vitamin K]

Would somebody please fill me in? I haven't spent much time in hospitals, and do understand that infections aren't exactly "by the book"....but what about Sanford's makes it so ridiculous that it's laughable? I've been under the impression that it was a reasonably good guide?

 

[Praziquantel86]

Would somebody please fill me in? I haven't spent much time in hospitals, and do understand that infections aren't exactly "by the book"....but what about Sanford's makes it so ridiculous that it's laughable? I've been under the impression that it was a reasonably good guide?

It's just not the kind of book a group of people would huddle around and learn from. Picture the pocket pharmacopeia with lots of antibiotics/bugs.

 

[Smilescali]

Would somebody please fill me in? I haven't spent much time in hospitals, and do understand that infections aren't exactly "by the book"....but what about Sanford's makes it so ridiculous that it's laughable? I've been under the impression that it was a reasonably good guide?

During my ID rotation I was expected to use IDSA or Medical Letter mainly for treatment options. If I used Sanford the ID pharmacist would have a tissy. However, the docs didn't mind in fact they often had a copy near by....

 

[metrarx]

....

 

[WVUPharm2007]

IDSA > Sanford....

...but keep in mind that those are all written by people that usually do not take pharmacoeconomics into account. In the real world you need to keep the whole picture in mind...efficacy and cost...

 

[metrarx]

....

 

[KARM12]

I want to talk about nec fasc dammit!

 

[StaviZFingerZ]

I want to talk about nec fasc dammit!

I've been waiting for some answers all day..

 

[WVUPharm2007]

I want to talk about nec fasc dammit!

Then talk. I'll listen.

 

[StaviZFingerZ]

Aight...I'll start.

BTW..not Strep Pneumo.. rather Pyogenes.

Start with Surgery Consult...then

I'd start with Pip/Tazo, Clinda, and Vanc.

Why not just PCN and Clinda? You tell me why not PCN...and tell me why I'd add Clinda?

 

[ForcedEntry]

PCN+Clinda is a little targeted to start with (group A), and I would want to continue broad coverage throughout treatment (pip/tazo, clinda, vanc), just in case one of those nasty buggers decided to glob on to an easy route of entry.

Clinda has less resistance issues than PCN, and you can avoid any unknown allergies.

 

[StaviZFingerZ]

PCN+Clinda is a little targeted to start with (group A), and I would want to continue broad coverage throughout treatment (pip/tazo, clinda, vanc), just in case one of those nasty buggers decided to glob on to an easy route of entry.

Clinda has less resistance issues than PCN, and you can avoid any unknown allergies.

Clinda has other properties.

 

[Smilescali]

Aight...I'll start.

BTW..not Strep Pneumo.. rather Pyogenes.

Start with Surgery Consult...then

I'd start with Pip/Tazo, Clinda, and Vanc.

Why not just PCN and Clinda? You tell me why not PCN...and tell me why I'd add Clinda?

One of the few indications where I could recommend Clinda at my hospital. For this characteristic of Clinda...otherwise I was to seek it out on the Antibiotic Report and research exactly why it was being used...mainly it was being used as double coverage for divertic with Zosyn (just to be sure)...... or Zosyn with Flagyl... (with no C Diff)

We kindly would request the docs to D/C Clinda or for that matter the Flagyl and 50% of the time they would listen. Or based on our antibiogram and the AST the preferred treatment would be Ancef + Flagyl for divertic, but the docs would never use this as Ancef in their opinion is a "Staph" drug. Even though it has better coverage against E coli in our hospital than Zosyn...

Sorry continue the lesson on Strep Group A Nec Fas....

 

[StaviZFingerZ]

One of the few indications where I could recommend Clinda at my hospital. For this characteristic of Clinda...otherwise I was to seek it out on the Antibiotic Report and research exactly why it was being used...mainly it was being used as double coverage for divertic with Zosyn (just to be sure)...... or Zosyn with Flagyl... (with no C Diff)

We kindly would request the docs to D/C Clinda or for that matter the Flagyl and 50% of the time they would listen. Or based on our antibiogram and the AST the preferred treatment would be Ancef + Flagyl for divertic, but the docs would never use this as Ancef in their opinion is a "Staph" drug. Even though it has better coverage against E coli in our hospital than Zosyn...

Sorry continue the lesson on Strep Group A Nec Fas....

why not go with Rocephin flagyl combo. Cheaper than ancef route. Then again, for complicated intra-ab... I'd feel a little uneasy with Ancef.. even with e coli.

 

[njac]

Eagle effect!