P H A R M A G R A M

OSF Saint Francis Medical Center, Peoria, Illinois

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

January, 2004

Parenteral to Oral Switch for Gatifloxacin (Tequin®) and Other Fluoroquinolines:                   

Several studies have shown equivalent therapeutic efficacy and outcomes when intravenous antibiotics are switched to an equipotent equivalent oral dosage form. In addition, these studies also demonstrated significant cost savings. Practice Guidelines for treating community-acquired pneumonia published by the Infectious Diseases Society of America promotes changing from IV to oral therapy and sites economic, health care, and social benefits.  A number of antibiotics, including the fluoroquinolones, metronidazole (Flagyl®), fluconazole (Diflucan® and azithromycin (Zithromax®) achieve similar serum drug levels when administered orally or intravenously. For these reasons and with the success of the IV to oral switch of famotidine (Pepcid®) and pantoprazole (Protonix®), the P&T Committee has approved guidelines for a pharmacist-implemented IV to oral gatifloxacin (and all other fluoroquinolones) conversion.  All pediatric, ICU and neutropenic patients are excluded from this protocol.  Pharmacists will ensure adult patients have a functioning GI tract, a resolution of abnormal vital signs, and a decreasing WBC before the conversion occurs.  Physicians will know a conversion occurred by the presence of a signed protocol order form in the medical record.  This program will begin in January.                                                                                                                   

Formulary Additions:                                                                                                                                                    

Two newer drugs used to treat attention deficit hyperactive disorder have been added to the Formulary.  Extended-release methylphenidate (Concerta®) can be initiated with 18mg daily in the morning. The other drug is an extended-release combination of amphetamine and dextroamphetamine (Adderall XR®) which may be initiated with 5mg daily.

Topical lidocaine 4% cream (LMX4®, Elamax®) was approved onto the Formulary and will replace lidocaine/prilocaine cream (Emla®). An autosubstitution was also approved by the P&T Committee which will allow pharmacists to switch to the Elamax® product whenever the Emla® is ordered.                                 

 

Drug Shortages and Re-supply:

Ø      Methylprednisolone injection (SoluMedrol®) continues to be in short supply until the middle of 2004. Parenteral dexamethasone and hydrocortisone are possible alternatives, as well as oral methylprednisolone.

Ø      A shortage of cartridges used in the preparation of hydromorphone (Dilaudid®) and fentanyl for PCA  pumps has been resolved. Both of these products may now be ordered for patient therapy.

Ø      Availability of parenteral erythromycin has improved and is available for prescribing.

Ø      The manufacturer of injectable betamethasone suspension has restricted distribution of this drug to hospitals with neonatal intensive care units. Based on the current supply and history of utilization, it was decided to make this drug available once again, but restricted to antepartum administration. 

Reminder: Include Dictation Numbers When Writing Orders:                                

Dictation numbers are more easily read, help identify prescribers and assist in quickly resolving questions about written orders.

Adverse Drug Events Hotline – 655-6805

Drug Information Service – 655-2382 (Mon-Fri; 8am – 4pm)