Summary: This week, Dr. Bryan Hayes – Clinical Pharmacologist and expert in Toxicology gives an amazing talk highlighting 10 of his top tips for antimicrobial use in the emergency department & for the critically ill patient. This is probably one of the most clinically useful lectures I’ve listened to in a long time. Bryan has actually started his own campaign to make sure we are all using Vanc right in 2014 – he even made it a New Years Resolution of his own (Check out his post on <a href="http://academiclifeinem.com/new-years-resolution-properly-dose-vancomycin-ed/">Academic Life in EM</a>)<br> <br> Pearls<br> <br> * How to correctly give a dose of vancomycin<br> <br> * Dose: 15-20 mg/kg every 8-12 hours in patients with normal renal function, MAX: 2 grams<br> * Consider an even higher loading dose In seriously ill patients (e.g. sepsis, meningitis, infective endocarditis) with suspected MRSA infection: 25-30 mg/kg — again, MAX 2 grams (ISDA recommendation).<br> * Weight based dosing by using actual body weight<br> * In adults, we round to the nearest 250 mg increment (to help out your friendly pharmacist)<br> <br> <br> * In the critically ill obese patient, aminoglycosides should be dosed by adjusted body-weight<br> <br> * ABW = Ideal BW + 0.4*(Actual BW – Ideal BW)<br> <br> <br> * A Penicillin allergy is NOT a contraindication to cephalosporin use!<br> <br> * 3rd, 4th, & 5th Generation cephalosporins can be safely given to PCN allergic patients.<br> * Avoid keflex, cefaclor, cefadroxil, cefprozil as their beta lactam side chain is similar to PCN.<br> * Carbapenems are also safe in PCN allergic patients<br> <br> <br> * HCAP “double coverage” should include only 1 beta-lactam antimicrobial, the 2nd agent should have a different mechanism of action (i.e. fluoroquinolone, etc.)<br> * Don’t forget the atypical coverage in HCAP patients! Send the urine legionella antigen.<br> * CAP patients admitted to the ICU should not be treated with a fluoroquinolone alone. Add the beta-lactam.<br> <br> Thanks Bryan – we’ll make sure to get it right in 2014.<br> <br> References<br> <br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=19106348%5D">Ryback M, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm2009;66(1):82-98.</a><br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=23466019">Rosini JM, et al. Prescribing habits of vancomycin in the emergency department: are we dosing appropriately? J Emerg Med 2013;44(5):979-84.</a><br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=21208910">Liu C, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.Clin Infect Dis 2011;52(3):e18-55. </a><br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=23260465%5D">Fuller BM, et al. Emergency department vancomycin use: dosing practices and associated outcomes. J Emerg Med 2013;44(5):910-8.</a><a href="http://www.ncbi.nlm.nih.gov/pubmed/23260465"><br> </a><br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=24144562">Frankel KC, et al. Computerized provider order entry improves compliance of vancomycin dosing guidelines in the emergency department. Am J Emerg Med 2013;31(12):1715-6.</a><a href="http://www.ncbi.nlm.nih.gov/pubmed/24144562"><br> </a><br> * <a href="http://www.ncbi.nlm.nih.gov/pubmed/21742459">Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2012;42(5):612-20.</a><br> <br> <br>
