OSF Saint Francis Medical Center, Peoria, Illinois

...an educational memo from your Pharmacy and Therapeutics Committee

November, 2001

After an extensive review and discussions with various physician groups and based on significant cost savings, it was decided to add gatifloxacin (Tequin®) to the Formulary and replace ciprofloxacin (Cipro) and levofloxacin (Levaquin) as the preferred fluoroquinolone. The dose, which is 200-400 mg once a day, is the same for IV and oral use. The microbiologic coverage of gatifloxacin is the same as levofloxacin based on the literature and our own in-house testing of over 100 isolates. Because of certain regulatory requirements, the microbiologic sensitivity panel will still show levofloxacin. However, just as oxacillin represents the penicillinase resistant class of antibiotics, gatifloxacin should be considered interchangeable with levofloxacin.

Red Man Syndrome is usually caused by a rapid infusion of vancomycin, and it is not considered a true allergy to the drug. The red rash that develops, usually over the upper portion of the body, can be severe, with hives and itching. In more severe cases, it can affect breathing and cause hypotension. Over the past year we have had 29 documented reactions. To reduce the occurrence of this reaction, all vancomycin doses will be infused over 2 hours, instead of the usual 60-90 minute infusions.

Because of possible adverse drug effects, known and unknown drug interactions and the questionable product quality, many herbal medications can and do pose certain health risks. Because of this and a shortage of scientifically sound studies documenting effectiveness, the Pharmacy and Therapeutics Committee voted to suspend all prescribing for hospitalized patients of herbal supplements, including the use of the patient’s own supplies.

As a result of medication errors associated with abbreviations and an increasing number of insulin products, the P&T voted to require prescriptions for insulin products to use the following names:

Lispro Lente NPH Regular

Ultralente Humalog 70/30 Insulin 50/50 Insulin

Lantus Velosulin BR Humalog 75/25

Orders for ‘L’, ‘UL’, ‘R’, ‘N’ insulins or ‘Hum Ins’ will no longer be acceptable.

The Pharmacy and Therapeutics Committee voted to ban pharmaceutical sales representatives from patient care rounds based on ethical issues and patient confidentiality.

Nesiritide, a natriuretic peptide with vasodilator and diuretic properties, was approved to the OSF

Saint Francis Formulary. Administered by intravenous infusion, nesiritide is approved for use in acutely, decompensated patients with congestive heart failure. Use of this drug will be restricted to the intensive care and intermediate intensive care units.

Drugs currently in short supply include calcitriol (Rocaltrol®) capsules, oxymorphone (Numorphan®), heparin, chlorothiazide (Diuril®) injection, albumin, pneumococcal vaccine (Prevnar®), and sincalide (Kinevac®). Drugs supplies that have improved include kanamycin (Kantrex®), phenobarbital injection, norepinephrine (Levophed®), isoproterenol (Isuprel®), methylprednisolone (SoluMedrol®), and dexamethasone (Decadron®).