The antibacterial activity of octenidine dihydrochloride (WIN 41464-2)

BackgroundPenicillin allergy is reported in 10% patients in the US Patients with penicillin allergies are treated with broader spectrum antibiotics, often leading to more antibiotic-resistant infections, including C. difficile, increased risk of surgical site infections, and increased healthcare costs.MethodsAfter informed consent, Medical-Surgical patients with documented allergies to penicillin (P) or cephalosporins (C) were given challenge doses through a standardized 2-step protocol from June 2015 to November 2017 at our community hospital. Patients with documented IgE-mediated hypersensitivity (HSR), rash or unknown reactions were eligible. Those with anaphylaxis or Type II-IV HSR were excluded. Treating clinicians selected the antibiotic for testing guided by the protocol: 323/336 patients (96%) were challenged with C. Based on results, allergies were updated in patients’ charts, noting that tolerance of cephalosporins does not preclude penicillin allergy. Charts were reviewed to determine adverse events and antibiotic narrowing, the latter adjudicated by ID specialists not directly involved in the patient’s care. A cost analysis used the acquisition cost of administered antibiotics before and after testing.Results336 patients (53 Medical, 283 Surgical) underwent the allergy test dose protocol: 267 with reported P allergy, 47 C allergy, 22 P+C allergy. None had a major adverse reaction. 7 patients (2%) experienced minor reactions: rash (4), throat irritation (1), urticaria (1), wheezing (1). Before testing, 321/336 were prescribed inappropriate or broad antibiotics. After challenge dose testing, the antibiotic spectrum was narrowed in 308/321 (96%). The total Pharmacy cost savings was $38,281.00 with the optimized antibiotic regimen, translating to $630 saved per patient. In Surgical patients there was a 50% cost savings.ConclusionDespite the frequency with which β-lactam allergies are reported, few patients had an allergy that interfered with optimal treatment when tested. This standardized protocol can be safely performed in a community hospital setting and lead to improved antibiotic choice and pharmacy cost savings.ReferenceIammateo M et al, J Allergy Clin Immunol Pract, November 2014; 2, 768–74.Disclosures All authors: No reported disclosures.

Background: Polypharmacy and inappropriate prescribing are risk factors for adverse drug reactions, which commonly cause complications in older people. The STOPP (Screening Tool of Older Persons’ Prescriptions)/START (Screening Tool to Alert Doctors to Right Treatment) criteria are screening tools, which aim to improve prescribing in the elderly. Objectives: The aim was to improve prescribing, using the STOPP/START criteria, for patients aged 65 and above, who were admitted to the Clinical Decisions Unit at University Hospital Lewisham. We focused on the most common prescribing errors in clinical decision unit, an emergency medicine department. Methods: We reviewed all patients aged 65 and above admitted to the Clinical Decisions Unit in September. Data was collected from clinical documentation and archived drug charts. This pilot study of 114 patients revealed the most common prescribing errors, of which 8 were STOPP and 11 were START criteria. A plan–do–study–act methodology was implemented over 1 month, involving presentations, emails and posters. Prescribing patterns were then reviewed over 4 weeks in December in 111 patients. Results: Focusing on the 8 STOPP and 11 START criteria, there was a significant reduction in the proportion of patients with at least one STOPP error (17.5% to 9%, p = 0.04). However, the decrease in the percentage of patients with at least one START error was insignificant (24.6% to 20.7%, p = 0.24). Conclusion: By identifying problematic areas of prescribing and using targeted interventions, the proportion of STOPP errors made in clinical decision unit reduced significantly. This study highlights the prevalence of prescription errors in the clinical decision unit and the impact of using screening tools to reduce incorrect prescribing.

A series of bispyridines were examined for their bactericidal activities against in vitro, preformed, pure-culture plaques of selected oral plaque-forming bacteria. The antimicrobial activities of these agents were examined in relation to their molecular configurations. These studies demonstrated that the length of the interpyridine polymethylene group bridge and the length of the alkyl side chain were important determinants of antiplaque and antimicrobial efficacy. The most potent compounds of the bispyridine series were studied to determine the minimal conditions (concentration, duration, and frequency) of treatment required for likely clinical efficacy.

A new polycrystalline form of hydroxylapatite, CHA, has been shown to closely mimic dental enamel, in vitro, in regard to rate and degree of plaque formation and effectiveness of antiplaque drugs. The material has successfully been exploited as a standardized hydroxylapatite plaque growth substrate in conjuntion with a mass antidental plaque drug screening program.