This retrospective analysis sought to determine the comparative incidence of cross-reactivity associated with carbapenem antibiotic treatment among patients with versus those without penicillin allergy. We sought to determine whether the incidence of cross-reactivity is different between imipenem-cilastatin and meropenem. A total of 211 patients were treated with a carbapenem antibiotic. Included were 100 patients with and 111 patients without a documented or reported penicillin allergy. Within each group, subgroups of penicillin-allergic and penicillin-nonallergic patients were balanced equally between imipenem-cilastatin and meropenem. The incidence of patients with a reported or documented penicillin allergy experiencing an allergic-type reaction to a carbapenem was 11%, which is 5.2 times greater than the risk in patients who were reportedly not allergic to penicillin (P=.024). No difference in the occurrence of allergic-type reactions was observed between the 2 carbapenems.

Extended-interval once-daily dosing with the aminoglycoside tobramycin has been proven to be equally efficacious as traditional thrice-daily dosing for treatment of the pulmonary exacerbations of cystic fibrosis in adults and children older than 5 years. The frequencies of acute ototoxicity and nephrotoxicity do not appear to be significantly different between patients treated with once- versus thrice-daily dosing, and the risk of acute nephrotoxicity may actually be lower in pediatric patients when once-daily dosing is used. Long-term studies are needed to fully assess the impact that cumulative treatments with once-daily dosing have on renal and auditory function. An increase in antimicrobial resistance has been suggested with once-daily dosing in the cystic fibrosis population. The extended-interval aminoglycoside dose should be determined based on previous therapeutic drug monitoring. If the patient is aminoglycoside (tobramycin) naïve, a dose of 10 mg/kg once/day is suggested, with the dose adjusted by using therapeutic drug monitoring to individualize therapy.

Educational programs in pharmacy must focus on educating pharmacists of the future who are prepared to serve as competent and confident health care ''providers'' whose ''practice'' can occur in any number of current and future settings; and whose expertise is essential to an interprofessional health care team. Graduates must be able to incorporate a scholarly approach to their practice in identifying patient care problems; practicing in an evidence-based manner; and ensuring safe, effective, and appropriate use of medications. It is time for colleges and schools of pharmacy to implement contemporary teaching and assessment strategies that facilitate effective and efficient student learning that is focused at the graduate professional level, to evolve the content around which the curriculum is organized, and clearly articulate the abilities graduates must have to function effectively in the myriad professional roles in which they may find themselves.

No abstract