In avian medicine, the use of antibiotic dosing regimens based on species-specific pharmacological studies is ideal. However, due to a lack of such studies, dose extrapolation, which may cause inefficacy and toxicity, is common practice. Multiple searches were performed using the PubMed and Web of Science databases to extract relevant pharmacological studies performed in exotic avian species. The pharmacokinetics (PK), pharmacodynamics (PD), and safety data of the selected antibiotics (enrofloxacin, marbofloxacin, gentamicin, amikacin, ceftiofur, doxycycline, and amoxicillin/clavulanate) from these studies were reviewed. This review aimed to identify trends amenable for safe inter-species dose extrapolation and provide updated findings on dosing regimens that are safe and efficacious for various exotic avian species. We observed that the half-life of antibiotics appears to be shorter in the common ostrich and that amikacin may be amenable to inter-species dose extrapolation as it is safe and shows little inter-species PK and PD variation. Species-specific enrofloxacin dosing regimens that were not listed in the Exotic Animal Formulary (5th ed.) were found for Caribbean flamingos, African penguins, southern crested caracaras, common ostriches, and greater rheas. Specific dosing regimens recommended for psittacine birds (doxycycline 130 mg/kg medicated water) and ratites (PO doxycycline 2–3.5 mg/kg q12 h, PO enrofloxacin 1.5–2.5 mg/kg q12 h and IM enrofloxacin 5 mg/kg q12 h) in the formulary may not be effective in budgerigars and common ostriches, respectively. Apart from the lack of species-specific pharmacological studies, a lack of multiple dose studies was also noted.

Background: Conventionally, vancomycin trough levels have been used for therapeutic drug monitoring (TDM). Owing to the increasing evidence of trough levels being poor surrogates of area under the curve (AUC) and the advent of advanced pharmacokinetics software, a paradigm shift has been made toward AUC-guided dosing. This study aims to evaluate the impact of AUC-guided versus trough-guided TDM on vancomycin-associated nephrotoxicity.Methods: A systematic review was conducted using PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Google scholar, and Cochrane library databases; articles published from January 01, 2009, to January 01, 2021, were retrieved and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Studies that evaluated trough-guided or AUC-guided vancomycin TDM and vancomycin-associated nephrotoxicity were included. Randomeffects models were used to compare the differences in nephrotoxicity.Results: Of the 1191 retrieved studies, 57 were included. Most studies included adults and older adults (n = 47, 82.45%). The pooled prevalence of nephrotoxicity was lower in AUC-guided TDM [6.2%; 95% confidence interval (CI): 2.9%-9.5%] than in trough-guided TDM (17.0%; 95% CI: 14.7%-19.2%). Compared with the trough-guided approach, the AUC-guided approach had a lower risk of nephrotoxicity (odds ratio: 0.53; 95% CI: 0.32-0.89). The risk of nephrotoxicity was unaffected by the AUC derivation method. AUC thresholds correlated with nephrotoxicity only within the first 96 hours of therapy. Conclusions:The AUC-guided approach had a lower risk of nephrotoxicity, supporting the updated American Society of Health-System Pharmacists guidelines. Further studies are needed to evaluate the optimal AUC-derivation methods and clinical utility of repeated measurements of the AUC and trough levels of vancomycin.

Background Medication use typically involves physicians prescribing, pharmacists reviewing, and nurses administering medications to patients. Drug information (DI) is often required during the process, with the various health care professionals (HCPs) seeking information differently according to their needs and familiarity with various resources. Objective This systematic literature review aims to evaluate studies on drug information‐seeking behaviour (ISB) of physicians, nurses and pharmacists to ascertain their DI needs, DI sources used, facilitators and barriers to DI‐seeking. Methods A systematic search was conducted on PubMed, http://embase.com, Scopus, PsycINFO, CINAHL and Cochrane Library to identify eligible primary research articles published between January 2000 and May 2020. Results The reviewed studies (N = 48) revealed that HCPs have a wide range of DI needs, with the top needs being similar across the three HCPs. Information sources used most often by all three groups were tertiary, followed by human and primary sources. Factors relating to the source characteristics were the most reported facilitators and barriers to DI‐seeking. Some differences in drug ISB were also identified. Conclusion Our findings can also guide information providers and educators to optimize information provision. It may also facilitate effective communication amongst HCPs when obtaining DI from or providing DI to one another.

Background Trough levels have been used for Vancomycin (VAN) therapeutic drug monitoring (TDM) historically due to its practicality. A paradigm shift towards the use of area under curve (AUC)-guided dosing TDM has been made due to availability of advanced pharmacokinetics software, variability between trough levels and AUC values and the potential for reducing toxicity. This review aims to evaluate the impact of AUC-guided vs trough-guided vancomycin TDM on nephrotoxicity-related outcomes. Methods A systematic review was conducted using PubMed®, Embase®, Web of Science®, CINAHL®, Google scholar and Cochrane library® up till 1st January 2021 and was reported according to the PRISMA checklist. Studies which evaluated AUC-guided or trough-guided VAN TDM and vancomycin-associated nephrotoxicity were included. Random effects models were used to compare differences in nephrotoxicity between trough level or AUC based vancomycin TDM due to expected heterogeneity in study designs. PRISMA Flowchart PRISMA flow chart depicting the selection process of studies included in the meta-analysis Results Of 1191 records retrieved, 57 studies were included. Majority of studies included adult and elderly patients (n=47, 82.5%). The pooled prevalence of nephrotoxicity was lower using the AUC-guided TDM [6.2%, 95% confidence interval (CI): 2.9 – 9.5%] compared to trough-guided TDM [17.0%; 95% CI: 14.7 – 19.2%]. The risk of nephrotoxicity was lower with the AUC-guided approach as compared with the trough-guided approach [OR: 0.53, 95% CI: 0.32–0.89]. AUC thresholds correlated with risk of nephrotoxicity only for the first 96 hours of therapy. A frequency analysis of significant multivariable factors showed that concomitant use of nephrotoxins, VAN trough levels and duration of VAN therapy were most commonly associated with nephrotoxicity. Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided Forest plot comparing the risk of nephrotoxicity of AUC-guided vs trough-guided Pooled nephrotoxicity rates from AUC-guided monitoring Pooled nephrotoxicity rates from AUC-guided monitoring Pooled nephrotoxicity rates from trough-guided monitoring Pooled nephrotoxicity rates from trough-guided monitoring Conclusion The AUC-guided approach appeared to have lower risk of nephrotoxicity which supports the updated American Society of Health-System Pharmacists recommendations. More studies should be performed to evaluate the optimal derivation of AUC and clinical utility of repeated measurements of vancomycin AUC and trough levels. Disclosures All Authors: No reported disclosures

In order to fully appreciate the interdisciplinary nature of energy resources, there is a need to understand pertinent issues from other viewpoints besides a purely chemistry perspective. In this paper, the teaching of cost−benefit analysis (CBA) and business databases as part of