| Archives
2002
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CDC
Needs You To Help Stop Antibiotic-Resistant Bugs
Notching up its efforts against the threat of drug-resistant
pathogens, the Centers for Disease Control and Prevention
(CDC) launched a major educational campaign aimed at clinicians.
Called “Prevent Antimicrobial Resistance,” the
campaign provides clinicians with concrete action steps
based on CDC guidelines and other research.
The
first set of 12 action steps focuses on hospitalized adults
and includes simple, memorizable directives such as “Get
the catheters out” and “Know when to say ‘No’
to vanco(mycin).” Similar 12-step programs will be
issued to guide the care of other subgroups of patients,
such as those in the ED and those on dialysis. In each
program, the steps will center around four common strategies—prevent
infection, diagnose and treat infection effectively, use
antimicrobial agents wisely, and prevent transmission
of resistant pathogens. CDC training materials include
slide programs, posters, and pocket reminder cards.
For
more information, visit www.cdc.gov/drugresistance/healthcare
or call (800) 311-3435. Centers for Disease Control and
Prevention. “CDC promotes campaign to prevent antimicrobial
resistance in healthcare settings.” 2002. www.cdc.gov/od/oc
/media/pressrel/r020326.htm (5 Apr. 2002).
[TOP]
Preventing
Febrile Neutropenia Can Be Done In Fewer Doses
A newly approved drug, pegfilgrastim (Neulasta), drastically
reduces the number of injections required to ward off
infections that often arise from chemotherapy-induced
febrile neutropenia in cancer patients. In clinical studies,
a single 6 mg injection of pegfilgrastim given SQ once
per chemotherapy cycle provided protection from infection
that was comparable to 11 daily injections of filgrastim
(Neupogen). It reduced both the duration of severe neutropenia
and the frequency of neutropenia with fever. Pegfilgrastim
is derived from filgrastim; both agents promote the growth
of neutrophils, which cytotoxic chemotherapy depletes.
Pegfilgrastim is approved only for patients receiving
myelosuppressive chemotherapy for nonmyeloid cancers.
It shouldn’t be given during the period 14 days before
to 24 hours after administration of chemotherapy. In studies,
the most common adverse effect (26%) was mostly mild to
moderate bone pain. Patients should be monitored for potential
risk of adult respiratory distress syndrome, splenic rupture,
and sickle-cell crisis.
Amgen.
“FDA approves Amgen’s Neulasta for serious and
frequent chemotherapy side effect.” 2002. www.neulasta.com/neulasta_press_release1.html
(13 Mar. 2002).
[TOP]
Not
Enough Cardiac Patients Are Put
On Aspirin Therapy
The use of aspirin as prophylaxis against cardiac events
and death in patients with coronary artery disease (CAD)
is still “disappointingly low,” according to
a large retrospective study funded by the federal Agency
for Healthcare Research and Quality. Not all the news
was bad, however. Analyzing follow-up data on 25,000 patients
who’d been referred to Duke University Medical Center
for coronary angiography, the researchers found that aspirin
use increased from 59% of patients in 1995 to 81% in 1999,
the most recent year for which data was available. Still,
these numbers meant that many patients were not taking
aspirin regularly, despite its known benefits and an absence
of contraindications to it. The researchers estimated,
roughly, that the risk of death among patients who never
took aspirin was 85% higher than among regular aspirin
users.
Califf,
R. M., DeLong, E. R., et al. (2002). Underuse of aspirin
in a referral population with documented coronary artery
disease. Am J Cardiol, 89(6), 653.
[TOP]
Form
Helps Patients Learn More
About Their Meds
Empowering patients is important not only for effective
care but also for medication safety. To support those
goals, the FDA offers a printer-friendly form with questions
patients should ask their healthcare providers about their
medications. Questions include: What’s this drug
for? How and when should I use it? When should I see a
difference? What other drugs, supplements, foods, or activities
should I avoid? What are possible side effects? What do
I do if one occurs? (Tip: With a little word-processing,
you can adapt the form so there’s room for patients
to write down the answers.) To print out the form for
patients, simply point your browser to www.fda.gov/cder/consumerinfo
/question_guide.htm.
U.S.
Food and Drug Administration. “Be an active member
of your health care team.” 2001. www.fda.gov/cder/consumerinfo/active_member.htm
(23 Jan. 2001).
[TOP]
Warnings
On Lactic Acidosis, Other Risks,
With HIV Drug
Bristol-Myers Squibb Company has issued a warning letter
alerting clinicians to the risk of rare but potentially
fatal lactic acidosis syndrome (LAS) or hyperlactatemia
in HIV patients taking nucleoside analogues, including
its drug stavudine (Zerit), in combination with other
antiretrovirals. The company had received reports of rapidly
worsening neuromuscular weakness resembling symptoms of
Guillain-Barré syndrome (including respiratory
failure) that, in some cases, resulted in death. According
to the manufacturer, patients on stavudine should be monitored
for—and taught to recognize and immediately report—early
signs of these disorders, which include nausea, vomiting,
abdominal pain, sudden unexplained weakness, tachypnea
and dyspnea, or neurologic symptoms. If a patient develops
these symptoms, particularly motor weakness, antiretroviral
therapy should be stopped and the patient given a full
evaluation immediately. Symptoms may continue or worsen
even after antiretroviral therapy has been halted. In
patients with confirmed LAS, permanent discontinuation
of the drug should be considered.
U.S.
Food and Drug Administration MedWatch. “Zerit (stavudine).”
2002. www.fda.gov/medwatch/SAFETY/2002/safety02.htm#zerit
(11 Apr. 2002).
[TOP]
FDA
Upgrades Steroid’s Rating For Pregnancy
The pregnancy rating for the inhaled corticosteroid budesonide
(Pulmicort Turbuhaler)—a maintenance therapy in asthma—has
been “upgraded” to Category B. In this case,
that designation means that although adverse effects on
the fetus were seen in animal studies, human studies haven’t
found a risk to the fetus in the first trimester, and
there’s no evidence of risk in later trimesters.
All other inhaled steroids are Pregnancy Category C. (Briefly
put, this classification means that animal studies either
have not been done or have shown a risk to the fetus,
and there are no adequate human studies during pregnancy.)
The change for budesonide is based on the FDA’s review
of data from three Swedish registries covering over 2,000
births. The rate of recorded congenital malformations
in infants born to mothers who used inhaled budesonide
during early pregnancy was similar to the rate seen in
the general population. The drug’s labeling, however,
cautions that the possibility of fetal harm can’t
be ruled out. The inhaler should be used during pregnancy
only if clearly needed, at the lowest effective dose,
and with monitoring.
Astra-Zeneca.
“FDA approves pregnancy rating label change for asthma
medication.” 2002. www.astrazeneca-us.com/news/article.asp?file=2002010301.htm
(23 Jan. 2002).
OTC
Talk
Acetaminophen And Kids: Handle With Care
Tylenol and Panadol, two brands of acetaminophen, can
be found in countless medicine cabinets across the country.
Parents, in particular, rely on it when their children
aren’t feeling well. But they may not always stop
to think that, like any other drug, it should be used
with caution. That’s especially true when you consider
that toxicity can occur not only as the result of an accidental
(or intentional) overdose, but from cumulative normal
doses in some patients. Early side effects include nausea,
vomiting, and malaise. Less commonly, toxicity may lead
to severe, even fatal, liver damage. Children and adults
with hepatic disease should avoid acetaminophen because
of their increased risk for these effects. Guidelines
from the American Academy of Pediatrics advise providers
to give parents specific written instructions on the exact
dose of acetaminophen required, based on the child’s
weight and the formulation used (infant drops, liquid,
“junior strength” tablets, suppositories, etc.).
Remind parents not to give their child additional cough/cold
products that may contain acetaminophen, as well. Finally,
parents, not the child, should administer the acetaminophen
dose, preferably with food.
Source:
American Academy of Pediatrics Committee on Drugs. (2001).
Acetaminophen toxicity in children. Pediatrics, 108(4),
1020.
THE
AUTHOR
JAMES
M. WOOTEN, a member of the RN editorial board, is an assistant
professor of medicine at the University of Missouri School
of Medicine, in Kansas City, Mo.
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