Archive for December 23, 2014

Carbapenem-Resistance in Gram-Negative Bacilli and Intravenous Minocycline: An Antimicrobial Stewardship Approach at the Detroit Medical Center

Clinical Infectious Diseases November 15, 2014 V.59 N.10 S388-S393

Jason M. Pogue1,2, Anupama Neelakanta2, Ryan P. Mynatt3, Sarit Sharma2, Paul Lephart2,4, and Keith S. Kaye2,5

1Department of Pharmacy, Sinai-Grace Hospital, Detroit Medical Center

2Wayne State University School of Medicine, Detroit

3Department of Pharmacy, Detroit Receiving Hospital, Detroit Medical Center

4Detroit Medical Center University Laboratories

5Department of Internal Medicine, Division of Infectious Diseases, Detroit Medical Center, Michigan

Correspondence: Jason M. Pogue, PharmD, BCPS-ID, Clinical Pharmacist, Infectious Diseases, Sinai-Grace Hospital; Detroit Medical Center, Clinical Assistant Professor of Medicine, Wayne State University School of Medicine, 6071 W Outer Dr, Detroit, MI 48235 (jpogue@dmc.org).

In the era of carbapenem-resistance in Acinobacter baumannii and Enterobacteriaceae, there are limited treatment options for these pathogens. It is essential that clinicians fully assess all available therapeutic alternatives for these multidrug-resistant organisms.

We herein describe the approach of the antimicrobial stewardship team at the Detroit Medical Center (DMC) for the evaluation and use of intravenous (IV) minocycline for the treatment of these resistant organisms, given potential advantages of IV minocycline over tigecycline and doxycycline.

In vitro analyses at the DMC demonstrated good activity against A. baumannii (78% susceptibility), including 74% of carbapenem-resistant strains, but limited activity against our carbapenem-resistant K.pneumoniae (12% susceptibility.) Based in part on these results, IV minocycline was added to the formulary, primarily for the treatment of carbapenem-resistant A. baumannii.

Early experience has been positive: 6/9 (67%) of patients who received IV minocycline had infections due to these organisms cured, including 6/7 (86%) who received doses of 200 mg twice daily.

PDF

http://cid.oxfordjournals.org/content/59/suppl_6/S388.full.pdf+html

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December 23, 2014 at 4:01 pm

Guidelines for the management of adult lower respiratory tract infections.

Clin Microbiol Infect. 2011 Nov;17 Suppl 6:E1-59.

Woodhead M1, Blasi F, Ewig S, Garau J, Huchon G, Ieven M, Ortqvist A, Schaberg T, Torres A, van der Heijden G, Read R, Verheij TJ; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases.

Author information

1Department of Respiratory Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, UK. mark.woodhead@cmft.nhs.uk

Abstract

This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010.

It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI.

Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention.

Background sections and graded evidence tables are also included.

The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.

FULL TEXT

http://www.sciencedirect.com/science/article/pii/S1198743X1461404X

PDF

http://ac.els-cdn.com/S1198743X1461404X/1-s2.0-S1198743X1461404X-main.pdf?_tid=ad8a9290-8ad4-11e4-b2b8-00000aacb35f&acdnat=1419360857_02381ba4527725534b4b9932bb543c24

December 23, 2014 at 3:54 pm


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