Prescribing practice for smokers

There are concerns that Vancouver's supervised injection facility (SIF) for injection drug users (IDU) is an amplifier of drug-related crime. Therefore, we sought to evaluate the possible association between SIF use and recent incarceration among IDU. We examined incarceration experiences among participants in the Scientific Evaluation of Supervised Injecting (SEOSI) prospective cohort. The relationship between recent incarceration and frequent SIF use was assessed using generalised estimating equations (GEE). Nine-hundred two individuals were included in this analysis, of whom 255 (28.27%) were female. The rate of incarceration remained stable throughout follow-up with between one-quarter and one-third reported incarceration in the previous 6 months at each study visit. In a multivariate GEE analysis, frequent SIF use was not associated with recent incarceration (AOR: 0.99, p = 0.916). Although incarceration is a common experience among local IDU, our analysis does not provide evidence to support claims that, use of the SIF is increasing involvement in drug-related crime in the community. Our findings also indicate that incarceration continues to be associated with high-risk behaviours.     

Prescribing antibiotics for impetigo

Impetigo, a contagious superficial pyogenic infection of the skin, can be treated orally or topically. Nowadays oral erythromycin is the treatment of choice, although flucloxacillin is preferred in areas where the causative micro-organisms are resistant to erythromycin. Topical mupirocin ointment has shown itself to be as effective as oral therapy in many cases and is less likely to be associated with unwanted effects. The availability of 2 forms of therapy-oral and topical-means that treatment can be tailored according to the preferences of the patient. Consequently, drug therapy is more likely to be used appropriately. Arguments for and against the prescribing of each form of therapy are presented.     

A Computer-based Module for Prescribing Error Instruction

Objective

To evaluate an instructional module''s effectiveness at changing third-year doctor of pharmacy (PharmD) students'' ability to identify and correct prescribing errors.

Design

Students were randomized into 2 groups. Using a computer-based module, group 1 completed worksheet A, watched a presentation on medication errors, and then completed worksheets B and C. Group 2 completed worksheets A and B, watched the presentation, and then completed worksheet C.

Assessment

Both groups scored a median 50% on worksheet A and 66.7% on worksheet C (p < 0.001). Median scores on worksheet B differed between groups (p = 0.0014). Group 1 viewed the presentation before completing worksheet B and scored 62.5%, while group 2 viewed the presentation after scoring 50% on worksheet B.

Conclusion

The module effectively taught pharmacy students to identify and correct prescribing errors.     

Rapid colorimetric assay for gentamicin injection

A rapid colorimetric method for determining gentamicin concentration in commercial preparations of gentamicin sulfate injection was developed. Methods currently available for measuring gentamicin concentration via its colored complex with cupric ions in alkaline solution were modified to reduce the time required for a single analysis. The alkaline copper tartrate (ACT) reagent solution was prepared such that each milliliter contained 100 mumol cupric sulfate, 210 mumol potassium sodium tartrate, and 1.25 mmol sodium hydroxide. The assay involves mixing 0.3 mL gentamicin sulfate injection 40 mg/mL (of gentamicin), 1.0 mL ACT reagent, and 0.7 mL water; the absorbance of the resulting solution at 560 nm was used to calculate the gentamicin concentration in the sample. For injections containing 10 mg/mL of gentamicin, the amount of the injection was increased to 0.5 mL and water decreased to 0.5 mL. The concentration of gentamicin in samples representing 11 lots of gentamicin sulfate injection 40 mg/mL and 8 lots of gentamicin sulfate injection 10 mg/mL was determined. The specificity, reproducibility, and accuracy of the assay were assessed. The colored complex was stable for at least two hours. Gentamicin concentration ranged from 93.7 to 108% and from 95 to 109% of the stated label value of the 40 mg/mL and the 10 mg/mL injections, respectively. No components of the preservative system present in the injections interfered with the assay. Since other aminoglycosides produced a colored complex, the assay is not specific for gentamicin. The assay was accurate and reproducible over the range of 4-20 mg of gentamicin. This rapid and accurate assay can be easily applied in the hospital pharmacy setting.     

Patient selection for serum gentamicin levels

This article describes a set of criteria that can be used to select appropriate patients for serum gentamicin level (SGL) determinations. The set was generated through a critical review of the literature relevant to gentamicin pharmacokinetics and specific patient factors that can influence gentamicin elimination. Gentamicin was chosen because it has been widely used, and a large portion of the body of knowledge concerning aminoglycosides involves gentamicin. Using these criteria, we prospectively evaluated 73 Medical University Hospital patients for appropriateness of sampling. Forty-nine patients (67.2%) were appropriately selected for SGL measurement. This included patients who conformed to at least one criterion and received SGL determination(s), as well as patients who did not conform to any criterion and did not receive a SGL determination. Forty patients (54.8%) conformed to at least one criterion. Although the majority of patients were appropriately selected, only 40% of patients who met at least one criterion received SGL measurement(s). These data suggest the need for greater awareness by the clinician of factors that predispose patients to toxic or subtherapeutic gentamicin therapy.