We evaluated the effectiveness of pharmacist-managed pharmacotherapy clinics in implementing and maximizing therapy with agents known to reduce the morbidity and mortality associated with cardiovascular disease. This was a retrospective chart review of 150 patients who were treated for coronary artery disease in primary care clinics. Appropriate treatment of hypercholesterolemia occurred in 96% of patients referred to a clinical pharmacy specialist, compared with 68% of those followed by primary care providers alone (p<0.0001). Eighty-five percent and 50%, respectively, achieved goal low-density lipoprotein (LDL) values below 105 mg/dl (p<0.0001). Appropriate therapy with aspirin or other antiplatelet or anticoagulant drugs was prescribed in 97% and 92%, respectively (p=0.146). As appropriate therapy with these agents was high in both groups, the ability to detect a difference between groups was limited. Among patients with an ejection fraction below 40%, appropriate therapy with an angiotensin-converting enzyme inhibitor or acceptable alternative was 89% and 69%, respectively (p<0.05). Twenty-seven cardiac events were documented in the clinical pharmacy group, versus 22 in the primary care group (p=0.475). Despite the relatively high percentage of patients reaching goal LDL in the primary care group, referral to clinical pharmacy specialists resulted in statistically significant increases in the number of patients appropriately treated for hypercholesterolemia and achieving goal LDL.

Objective: To review the use of antibiotic prophylaxis in acute necrotizing pancreatitis. Background: Acute necrotizing pancreatitis is a complication that occurs in a minority of patients with acute pancreatitis, but has a high incidence of morbidity and mortality. Surgery and supportive care are important in the management of this disease. However, the role of antibiotic prophylaxis has been debated for decades. Data Sources: English-language clinical studies and review articles involving human subjects and appropriate in vitro data were located through a literature search (MEDLINE, January 1966-July 1998). Study Selection and Data Extraction: Relevant studies describing the use of antibiotic prophylaxis in acute necrotizing pancreatitis were reviewed. Data Synthesis: Earlier studies of antibiotic prophylaxis in patients with acute necrotizing pancreatitis did not show any benefit compared with placebo. Newer studies have shown a decrease in mortality and morbidity when antibiotic prophylaxis is given to patients with severe necrotizing pancreatitis. Conflicting results leave many questions unanswered, such as the effect of antibiotic use in resistance patterns, which antibiotic to use, duration of therapy, and cost-effectiveness of this strategy. Conclusions: With the available data, it is adequate to recommend that patients with at least 30% necrosis of the pancreas receive antibiotics to prevent infectious complications and to decrease potential mortality. Use of imipenem/cilastatin is supported by the largest prospective trial to date; however, the drug was compared with no treatment. Cefuroxime is the only drug shown to decrease mortality and should be considered an alternative that may be more cost-effective than therapy with imipenem/cilastatin. A comparison trial is needed before further recommendations are given.