A B S T R A C TThe emergence of the novel coronavirus disease (COVID-19) pandemic presents an unprecedented health communications challenge. Healthcare providers should reinforce behaviors that limit the spread of the pandemic, including social distancing and remaining in the home whenever possible. Formal communications toolkits may not be prepared in a timely fashion. Community pharmacists can reinforce mitigation behaviors by applying the health belief model (HBM). This commentary provides an overview of the HBM and offers suggestions on how community pharmacists can use it as a guide to patient communication in these uncertain contexts.

general surgery residency program director at Brigham and Women's Hospital, for their role in badge design and implementation. No compensation was received.

Background: Overlapping opioid and benzodiazepine use is associated with increased risk of overdose. Veterans receiving medications concurrently from VA and Medicare may be at higher risk of such overlap. Objective: To assess the association between dual use of VA and Medicare drug benefits and receipt of overlapping opioid and benzodiazepine prescriptions. Design: Cross-sectional Setting: VA and Medicare Participants: All Veterans enrolled in VA and Part D filling >2 opioid prescriptions in 2013 (n=368,891). Measurements: Two outcome measures: the proportion of patients with (1) a Pharmacy Quality Alliance (PQA) measure of opioid/benzodiazepine overlap (i.e., ≥2 fills for benzodiazepines with ≥30days overlap with opioids); or (2) high-dose opioid/benzodiazepine overlap (i.e., ≥30days overlap with daily opioid dosage >120 MME). We used augmented inverse probability weighting regression to compare these measures by source of prescription drugs: VA-only, Part D-only, or VA and Part D (Dual use). Results: Of the 368,891 eligible Veterans, 18.3% received all their prescriptions from VA only, 30.3% from Medicare only, and 51.4% from both VA and Medicare. The proportion with PQA opioid/benzodiazepine overlap was larger for the dual use group versus the VA only (23.1% vs. 17.3%, adjusted risk ratio (aRR) = 1.27, 95%CI 1.24–1.30) and Medicare only (23.1% vs. 16.5%, aRR 1.12, 95%CI 1.10–1.14) groups. The proportion with high-dose overlap was also larger for the dual use group versus the VA only (4.7% vs. 2.3%, aRR = 2.23, 95%CI 2.10–2.36) and Medicare only (4.7% vs. 2.9%, aRR=1.06, 95%CI 1.02–1.11) groups. Limitations: Data are from 2013 Conclusions: Among a national cohort of Veterans dually enrolled in VA and Medicare, receiving prescriptions from both sources was associated with a greater risk of receiving potentially unsafe overlapping opioid and benzodiazepine prescriptions.

Objective To review the place in therapy of isavuconazole, the active metabolite of isavuconazonium sulfate, via a review of the available literature on drug chemistry, spectrum of activity, pharmacokinetic/pharmacodynamic profile and trials assessing clinical efficacy and safety. Methods Relevant data, original research articles and reviews, were gathered primarily through the use of a PubMed database search. The search was conducted without date restrictions in order to collect both historical and recent data regarding isavuconazole. Key findings Isavuconazole is a triazole currently approved not only for use in invasive aspergillosis and mucormycosis but also has demonstrable activity against Candida species and other common fungal pathogens. This drug has features which make it more clinically appealing compared to other azoles with similar indications. In specific, isavuconazole does not require a cyclodextrin vehicle due to its water solubility, and at present, does not require therapeutic drug monitoring. Moreover, isavuconazole has displayed improved safety and tolerability compared to voriconazole. Available data from Phase III clinical trials shows isavuconazole to be a possible therapeutic option to currently available therapies for which it is approved; however, clinical conclusions should be reserved until results have been published and more data from clinical use is reported. Conclusions Isavuconazole is a new triazole with broad-spectrum antifungal activity including invasive aspergillosis and mucormycosis.

Background Skin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics. Methods A retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5–10 days of antibiotics. Data were analyzed and reported using descriptive statistics. Results Of the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) in 906 patients (70%) with a nonpurulent SSTI. Additionally, 819 patients (45%) received broad-spectrum Gram-negative coverage, and 860 patients (48%) received an antibiotic duration >10 days. Conclusions We identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.