Objectives: In light of the ongoing global pandemic, this paper reviews data on a number of potential and approved agents for COVID-19 disease management, including corticosteroids, remdesivir, tocilizumab, and monoclonal antibody combinations. Dose considerations, potential drug–drug interactions, and access issues are discussed. Key findings: Remdesivir is the first antiviral agent approved for the treatment of COVID-19, based on results from large clinical trials showing reduction in recovery time, faster clinical improvement, and decrease in time to discharge with remdesivir. Dexamethasone and tocilizumab have demonstrated mortality benefits in large, randomized controlled trials. Consequently, the use of corticosteroids has become the standard of care for hospitalized patients with severe or critical COVID-19, while tocilizumab is recommended for use in combination with a corticosteroid in certain hospitalized patients. Recently, monoclonal antibody combinations bamlanivimab/etesevimab and casirivimab/imdevimab received emergency use authorizations for use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression. Summary: As data from large clinical trials emerge, the paradigm of COVID-19 treatments has shifted significantly. The use of corticosteroids, remdesivir, and tocilizumab depend on disease severity. Emerging data on monoclonal antibody combinations are promising, but further data are required. Pharmacists can play a role in ensuring appropriate access, correct administration, and safe use of COVID-19 treatments and are encouraged to stay abreast of new developments.

With an increasing obese population nationwide, there has been an increase in the number of laparoscopic surgeries performed. However, few studies have evaluated different methods to reduce pain in bariatric patients after laparoscopic surgery. Bupivacaine infusion pumps (On-Q® pumps) have shown efficacy in reducing postoperative pain in other surgical populations, such as orthopedic patients. Therefore, the purpose of this study was to investigate whether infusion pain pumps improve postoperative pain control and decrease length of hospital stay in bariatric patients. Between January 2015 and August 2016, 125 charts were retrospectively reviewed. Patients were divided into two groups: those who received infusion pain pumps and those who did not. The primary endpoints were hospital length of stay and the amount of postoperative narcotic use. Secondary endpoints included postoperative pain score, use of non-narcotics, and complications due to opioids or bupivacaine. There were 82 patients in the infusion pain pump group and 43 patients in the control group. Baseline characteristics were similar between both groups. There were no statistically significant differences in length of hospital stay (p = 0.39) or postoperative opioid use (p = 0.48) between the two groups. Although the median postoperative pain score was significantly reduced in the infusion pain pump group (3.5) compared to the control group (5) for the first 48 h (p = 0.002), this difference was not statistically significant for the first 24 h (p = 0.06). The use of infusion pain pumps did not significantly reduce the length of hospitalization and use of narcotics postoperatively.

Background: Inappropriate antibiotic use is a major public health concern. Excessive exposure to antibiotics results in the proliferation of multidrug-resistant bacteria, increase in potentially avoidable adverse drug reactions, healthcare utilization, and cost. Currently, systematic reviews and controlled trials assessing the effects of antimicrobial stewardship programs (ASP) on hospital length of stay (LOS), mortality, and cost-savings are conflicting. Some studies reported a significant cost-savings driven by shorter hospital LOS while the others found no effect and, in some cases, prolonged LOS. Shortening the time to appropriate therapy and reducing unnecessary days of therapy have been shown to reduce hospital LOS. Objective: The purpose of this study was to evaluate the effects of prescriber acceptance to ASP interventions on hospital LOS. Methods: Between January 2018 and December 2019, 764 charts were retrospectively reviewed for patients who received antimicrobial treatment and in whom an ASP intervention was performed. Patients were allocated into 2 groups: those whose ASP interventions were accepted and those whose were rejected. Provider responses were then documented within 24 hours of being communicated. The primary outcome was hospital LOS. Secondary outcomes included 30-day readmission rates and inpatient antimicrobial duration of therapy (DOT). Results: There were 384 patients with an accepted ASP intervention and 380 with a denied intervention. Baseline characteristics were similar between both groups, except for a difference in the types of intervention performed ( P < 0.001). The median hospital LOS for patients in the accepted intervention group was 6.5 days compared to 7 days in the rejected intervention group ( P = 0.009). Antimicrobial DOT was also shorter in the accepted intervention group (5 vs 7 days; P < 0.001). There was no difference in 30-day readmission rates ( P = 0.98). Conclusion: Prescriber acceptance to ASP interventions decreases hospital LOS and antimicrobial DOT without affecting 30-day readmission rates.