Background: Multidrug-resistant Acinetobacter baumannii (MDR-Ab) has emerged as an increasingly problematic cause of hospital-acquired infections in the intensive care unit (ICU). MDR-Ab is resistant to most standard antimicrobials but often retains susceptibility to polymyxin B and doxycycline. Objective: To evaluate the efficacy and toxicity of polymyxin B and doxycycline in the treatment of MDR-Ab infections. Methods: A retrospective chart review was conducted between March 2002 and May 2005 in patients who received doxycycline or polymyxin B for treatment of MDR-Ab infections in ICUs within Grady Memorial Hospital, Atlanta, GA. Results: Thirty-seven patients with MDR-Ab infections were treated with polymyxin B or doxycycline. Median age was 41 years and median ICU length of stay was 18 days prior to acquisition of MDR-Ab. Clinical cure was observed in 22 of 29 (76%) evaluable patients treated with polymyxin B and 2 of 4 (50%) patients treated with doxycycline. In patients with follow-up cultures, microbiological cure was observed in 17 of 21 (81%) patients treated with polymyxin B and 2 of 3 (67%) patients treated with doxycycline. Nephrotoxicity developed in 21% (7 of 33) of patients who received polymyxin B. Neurotoxicity was observed in 2 (6%) patients who received polymyxin B. No adverse reactions were observed with doxycycline. Overall, crude mortality was 27% (9 of 33) and 75% (3 of 4) among those who received polymyxin B and doxycycline, respectively. Three (9%) deaths were attributed to polymyxin B treatment failure, and no deaths were attributed to doxycycline treatment failure. Conclusions: Polymyxin B was effectively used to treat a substantial proportion of critically ill patients with MDR-Ab infection and was associated with a similar rate of nephrotoxicity as previously reported. Doxycycline monotherapy was used in a limited number of patients for the treatment of MDR-Ab; further evaluation of its efficacy in larger numbers of patients is warranted.

Purpose Epoetin alpha is the standard of care for anemia treatment in stage 5 chronic kidney disease patients. A pharmacist-managed anemia program was developed to allow initiation and adjustment of epoetin and iron therapy. The goal of this study was to describe the pharmacist-managed anemia program in an outpatient hemodialysis clinic and evaluate the program by comparing the results to the US averages. Methods Dosing was completed by a clinical pharmacist using a psysician-approved protocol. Data were collected from May 2002 to June 2004. Results Two hundred seventy-eight patients and 1,379 patient monitoring-months were evaluated. The study population was 68.2% male, 86.3% African-American, and had an average age of 46 ± 13 years. The most common causes of renal disease were hypertension and diabetes mellitus. The average initial hemoglobin was 9.5 g/dL and was 11.8 gm/dL at 6 months. Iron parameters show an initial average ferritin of 280.9 ± 326.4 ng/mL with an iron saturation of 21 ± 7.9%. These parameters improved to a ferritin of 431 ± 232.1 ng/mL and iron saturation of 33 ± 8% at 6 months. Eighty percent of patients had a hemoglobin greater than 11 gm/dL compared to the US average of 75%. The average epoetin dose in this group was 121 units/kg/wk (9,300 units) compared to the US average of 229 units/kg/wk (16,000 units). The reduced epoetin doses used in this program resulted in an annual cost avoidance of $3,000 per patient. Conclusions Pharmacist management of anemia can provide cost-effective care in the chronic kidney disease population.

The literature supports the safety and mortality benefits of using beta-blockers in COPD. Patients with mild to moderate COPD should receive cardioselective beta-blocker therapy when a strong indication exists.