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Purpose-Imatinib often causes gastric upset resulting in frequent co-administration of an antacid. Elevated gastric pH, delayed gastric emptying, or introduction of Mg 2+ /Al 3+ could potentially change imatinib absorption, thereby affecting the therapeutic effectiveness of imatinib. Indeed, antacid coadministration with dasatinib does result in a two-fold decrease in dasatinib absorption. We aimed to define the effect of antacid on the pharmacokinetics of imatinib.Methods-Twelve healthy subjects were enrolled in a 2-period, open-label, randomized cross-over, fixed-sequence study. In one period, each subject received 400 mg imatinib p.o., and in the other, the same dose of imatinib preceded by 20 mL antacid, containing 1.6 g Al(OH) 3 + 1.6 g Mg(OH) 2 , 15 min before imatinib. Plasma concentrations of imatinib and its active N-desmethyl metabolite CGP74588 were determined by LC-MS, and data were analyzed non-compartmentally.Results-Antacid administration did not significantly affect the area under the plasma imatinib concentration versus time curve (AUC) (31.7 μg/mL·h alone versus 32.6 μg/mL·h with antacid, P=0.37; 80% power).Conclusions-Our results indicate that the use of a Mg 2+ -Al 3+ -based antacid does not significantly affect imatinib absorption.

Military settings present a unique context that can affect the continuity of care for substance abuse and other issues. We examined the impact of military work-related factors (increased work tempo, deployment, and permanent change of station) on treatment disruption for substance abuse and family violence among Army soldiers from the perspective of substance abuse treatment providers and clinical social workers. Among the 264 respondents, nearly 90% of providers reported that work-related factors

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Background Inappropriate prescribing of antibiotics is an important modifiable risk factor for antibiotic resistance. The Joint Commission has identified the need for outpatient antimicrobial stewardship efforts. The purpose of this study was to assess the incidence of optimal empiric antibiotic therapy for urinary tract infections (UTIs) in outpatient clinics at VCU Health. Methods This was a retrospective study of patients seen in internal medicine (IM) and urology clinics between July 1, 2018 and June 30, 2019. Patients were included if they were ≥ 18 years old, had a diagnosis of UTI per ICD-10 code, and received a prescription to treat a UTI at the visit. Patients were excluded if they had a concurrent infection, currently prescribed antibiotics, or pregnant. The primary outcome was to evaluate the incidence of optimal empiric treatment for UTIs. Appropriateness of antibiotic therapy was assessed based on prior culture data along with our institutional UTI treatment guideline. Results Two hundred and twenty-six patients were included: 136 in IM clinics and 90 in urology clinics. Patients in the IM clinics were significantly older (mean age 64.8 vs. 60.5, p= 0.033) and more were female (88% vs. 38%, p< 0.001). More patients in the urology clinics had a history of a UTI within 24 months (72% vs. 57%, p= 0.016), history of fluoroquinolone-resistant Gram-Negative UTIs (35% vs. 13%, p= 0.007), and history of genitourinary cancer (28% vs. 1%, p< 0.001). Overall, 61% of patients were treated with optimal empiric antibiotics. Incidence of optimal prescribing in the IM clinics was significantly higher compared to urology clinics (69% vs 49%, p= 0.002). See table 1 for additional results. Table 1. Optimal UTI Treatment in Internal Medicine Clinics vs Urology Clinics Conclusion IM clinics more frequently prescribed optimal empiric antibiotics for UTIs compared to urology clinics. Resident prescribers were more likely to prescribe optimal empiric therapy. Presence of a beta-lactam allergy was not predictive of optimal prescribing. These data highlight opportunities for antibiotic therapy optimization for UTIs at our health system. Disclosures All Authors: No reported disclosures