Background: Viral induced hemorrhagic cystitis (VIHC) is very common among patients who become immunocompromised following organ transplantation. However, there is neither consensus on the standard of care nor clear guidelines to aid in clinical decision making when treatment VIHC. This review discusses currently available pharmacologic agents, presents investigational drug therapies, and outlines alternative treatment options that could be effective against VIHC.Recent findings: Letermovir is a novel antiviral agent approved for CMV prophylaxis in patients post-hematopoietic stem cell transplantation (HSCT). Although no studies have yet been conducted in patients with VIHC, this new antiviral agent shows promise in preventing emergence of CMV in patients after HSCT. Additionally, newer studies addressing the efficacy of brincidofovir, an experimental drug derived from cidofovir, against CMV infection may provide preliminary evidence for brincidofovir’s role in therapy and therefore warrant further investigation.Conclusion: Polyoma BK virus (BKV), cytomegalovirus (CMV), and adenovirus (ADV) are the primary culprits for HC occurrence in patients undergoing renal transplantation or allogeneic HSCT. CMV-associated HC could be prevented or treated by ganciclovir and valganciclovir because these agents’ effectiveness has been clearly established in other non-HC infections related to CMV. ADV-associated HC could be mitigated by brincidofovir and ribavirin, however the high toxicity associated with these agents may be a limiting factor for their use. BKV-associated HC is best managed by cidofovir and leflunomide, but not by fluoroquinolones. Finally, intravesicular instillation should be preferred in patients who experience toxicities associated with systemic use of antivirals.
Purpose: Pharmacists play a key role in preventing medication errors during transitions of care and preventing hospital readmissions through medication reconciliation (MR) programs. This study retrospectively evaluated the implementation of a standardized pharmacy residentdriven MR program for patients at high risk for readmission as defined by the Hospital Readmissions Reduction Program (HRRP). Methods: This was a single-center, retrospective cross sectional study of a pharmacy resident-driven MR program including patients at high risk of readmission defined by HRRP. The primary objective was to determine the number of inpatient regimen interventions identified during the MR. Secondary objectives include severity of interventions, number of medication discrepancies identified, types of interventions and discrepancies identified, and all-cause hospital readmission rates within 30 days of discharge.. Results: Fifty-three high-risk patients were included in the study. Pharmacy intervention recommendations were accepted by prescribers for nine patients (9/53; 17.0%) with a total of 13 accepted inpatient regimen interventions. The two most commonly identified medication classes for interventions were anticonvulsants (3/13; 23.1%) and antidepressants (6/13; 46.2%). Discrepancies on the admission MR were identified for 46 (46/53; 86.8%) patients with a median of three discrepancies per patient (interquartile range 2-4). The most common type of discrepancy was an incorrect or unnecessary drug. The 30-day all-cause readmission rate was 35.8% (19/53) for the total patient Conclusion: A pharmacy-resident driven MR program provided value in clarifying prior to admission medications and may help prevent drugrelated adverse events.
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