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TimestampWhat is your level of training or primary profession? Rater: What is your field of expertise, if applicable Rater: Where are you? Comments?
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1/23/2013 6:45:48NPemergencyArizona, USAGreat article. Good back up for current practice.
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1/23/2013 11:20:29PharmacistEmergency medicineVA USAGreat post. I see this frequently with patients who receive very broad spectrum antibiotics (pip/tazo and vancomycin) and are then discharged on a different PO anitbiotic. The reasoning is to "see the patient improve in the department before discharge". But the problem with that is while they may see improvement in the department, the patient cannot be discharged on those medications so it instills false confidence.

When it comes to intravenous antibiotics in the department, I have a different view with intravenous clindamycin or ampicillin/sulbactam. Higher doses can be given intravenously, so an intravenous dose in the department truly does give a load.
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1/23/2013 15:24:46PhysicianEMCosta Rica
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1/23/2013 20:38:39physicianemergency medcanadagreat post. relevant to Emergency Med not just for vancomycin but for principles of IV vs oral bioavailability pertaining to ABx in general. would be interested to see the data on quinolone IV vs oral use in patients tolerating po intake - bioavailability basically equal, way more expensive in IV form.
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1/29/2013 21:39:24residentEMCA
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1/31/2013 22:12:59physicianEMSC
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5/16/2013 15:39:41Pharm.D.Emergency MedicineCAThank you for succinctly summarizing a point we routinely emphasize in the ED.
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5/27/2013 15:04:01Pharm.dEmergency MedicineColoradoThis post is fantastic and exactly what I am investigating in an ED. I see many situations of single dose vancomycin as well as single dose ceftaroline and daptomycin in patients that are discharged on PO SMX/TMP or doxy. Some patients may receive up to 3 x IV doses with repeat visits to the ED while they are taking SMX/TMP or doxy. The question I have asked the providers is "how do you know which antibiotic is working". The providers in my ED seem to think that the single antibiotic dose will cover the patient for the time frame of the dosing interval (i.e 12 hours) I am working on changing this practice which will be tough with a private ED group who has been working together a long time and only with me for a short time. We are level 1 non-academic with an ED pharmacy service (one year old) at a hospital with no abx stewardship program in place but coming soon. The patients in consideration are the "grey zone patients".

Also, some of the failures I have seen with SMX/TMP were possibly under dosed. IDSA recommends 8-12mg/kg TMP per day in divided doses, so the 100kg patient probably need more than 1DS tab bid (assuming normal renal fx).

P.S. Fantastic Blog! I am a pharmacist that restarted ED services at my hospital and just found this blog. Keep up the good work!
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