What would you do in this situation?

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StaviZFingerZ said:
Clinda has other properties.
Click to expand...

To the guidelines it is...

"The rationale for clindamycin is based on in vitro studies demonstrating both toxin suppression and modulation of cytokine (i.e., TNF) production, on animal studies demonstrating superior efficacy versus that of penicillin, and on 2 observational studies demonstrating greater efficacy for clindamycin than for b-lactam antibiotics"
 
ForcedEntry said:
To the guidelines it is...

"The rationale for clindamycin is based on in vitro studies demonstrating both toxin suppression and modulation of cytokine (i.e., TNF) production, on animal studies demonstrating superior efficacy versus that of penicillin, and on 2 observational studies demonstrating greater efficacy for clindamycin than for b-lactam antibiotics"
Click to expand...


A-ha!! 👍

When an infection involves protein systhesis... this could also occur with pneumonia..

So, in Nec Fac... What the heck is going on beyond the infection?? Tissue damage?
 
man..it's like pulling a healthy teeth with you kids..dang!
 
Anaerobes. Stinky!
 
StaviZFingerZ said:
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.
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I thought Ancef was a tad weak too. I was informed by the AST docs and pharmacists that the guidelines are great, but it is the local antibiogram that dictates treatment options and Ancef had the best E coli coverage of all the cephs. I tried to find the numbers to be exact, but I know the Ancef was above 90 and I believe ceftriaxone was in the 80s.... Levaquin was in the 60s...
 
Smilescali said:
I thought Ancef was a tad weak too. I was informed by the AST docs and pharmacists that the guidelines are great, but it is the local antibiogram that dictates treatment options and Ancef had the best E coli coverage of all the cephs. I tried to find the numbers to be exact, but I know the Ancef was above 90 and I believe ceftriaxone was in the 80s.... Levaquin was in the 60s...
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That is true.

Also, I tend to believe First Gen Ceph being the Gram Positive Abx is a misnomer. The reason I would shy away from Ancef here was due to ESBL..
 
but wait...I aint through.

3 days into it the culture comes back on this nondiabetic patient... and its not polymicrobic rather monomicrobic infection....

what now?
 
StaviZFingerZ said:
but wait...I aint through.

3 days into it the culture comes back on this nondiabetic patient... and its not polymicrobic rather monomicrobic infection....

what now?
Click to expand...

What is the bug?
What kind of culture was it...tissue versus swab versus deep tissue...

Man, this thread gets going when I was at work.
 
KARM12 said:
What is the bug?
What kind of culture was it...tissue versus swab versus deep tissue...

Man, this thread gets going when I was at work.
Click to expand...

you tell us. ur the expert....not me. im just an operations pharmacist not a clinitian..
 
Man, y'all getting too boring with this ID ****...let's talk about refeeding syndrome...metabolic pharmacology...that's where it's at, baby...any disease state that's entire mechanism involves irony, I'm a fan of...
 
WVUPharm2007 said:
Man, y'all getting too boring with this ID ****...let's talk about refeeding syndrome...metabolic pharmacology...that's where it's at, baby...any disease state that's entire mechanism involves irony, I'm a fan of...
Click to expand...

But ID has irony too!

For example: bacteria carrying the VanD resistance gene actually require vancomycin to grow. The patient isn't actually sick until you give them vancomycin, and then boom, they're bacteremic. Irony as Shakespeare intended it.
 
StaviZFingerZ said:
That is true.

Also, I tend to believe First Gen Ceph being the Gram Positive Abx is a misnomer. The reason I would shy away from Ancef here was due to ESBL..
Click to expand...

Point Taken. 👍
 
Praziquantel86 said:
But ID has irony too!

For example: bacteria carrying the VanD resistance gene actually require vancomycin to grow. The patient isn't actually sick until you give them vancomycin, and then boom, they're bacteremic. Irony as Shakespeare intended it.
Click to expand...


I did not know this.
 
Praziquantel86 said:
Evidently it evolved from the inducibly resistant strains. They lost the capability to make the cell wall normally, but didn't gain the constitutive ability to make the vancomycin-resistant version.
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hmmmmm....interesting.... is this found in VRE??
 
As manager of an independant where I'm responsible for the bottom line, the answer is easy. Don't loan it out and tell them to take it to Walgreens to see if they will loan it to them. There's plenty of pharmacies out there that customers have the option of going to and I really don't see any legal or moral necessity to be a free pharmacy onsidering the vast choices available to the customer in our area.
 
imperial frog said:
As manager of an independant where I'm responsible for the bottom line, the answer is easy. Don't loan it out and tell them to take it to Walgreens to see if they will loan it to them. There's plenty of pharmacies out there that customers have the option of going to and I really don't see any legal or moral necessity to be a free pharmacy onsidering the vast choices available to the customer in our area.
Click to expand...


👎 😡 😡

Threadjack!!
 
Praziquantel86 said:
As far as I know, it's only found in VRE. About a dozen or so case reports published.
Click to expand...


where are you learning this chit? Hmmm...so about a dozen cases of VanD genes? Interesting...I shall research this stuff..
 
WVUPharm2007 said:
There are still independent pharmacies? Wooooow.
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You know I owned an independent until 2 years ago... tho I never worked a day in it...

And just last week, buddy of mine asked if I'd be willing to open one nearby.. he sez it has potential..
 
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