Back to the Future: Penicillin-Susceptible Staphylococcus Aureus

All health professionals know and fear antibiotic resistance. A penicillin resistance has been present in Staphylococcus aureus for years due to its widespread usage for bacterial infections. However, penicillin may be making its come back! New data suggests that penicillin may becoming out of a period of antibiotic resistance. A study published by the American Journal of Medicine examined penicillin resistance in methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.

At the McGill University Health Centre in Montreal, Canada, all adult MSSA bacteremia from April 2010 to April 2015 were reviewed for susceptibility to penicillin, erythromycin, clindamycin, and trimethoprim-sulfamethoxazole.  Out of 324 samples of MSSA bacteremia, 90 were susceptible to penicillin. This means that more than one quarter of patients with MSSA bacterium could use parenteral penicillin for treatment. This returning treatment may possibly have pharmacokinetic advantages over other beta-lactam, such as amoxicillin. Such pharmacokinetic advantages could potentially lead to better outcomes in the treatment of bacterial infections.

While working at a community pharmacy, I often fill prescriptions for amoxicillin, but I have never seen a prescription for penicillin. This new discovery regarding penicillin resistance could lead to a change in prescribing patterns from physicians in the future. I think that this discovery is also valuable at this time because other antibiotic resistances are emerging in our population. Bringing back an old antibiotic would be very useful to combat bacterial infections that are not responding to current top antibiotics. Although it is great to see the renaissance of an old antibiotic, antibiotic resistance is a serious problem and will continue to be a serious problem unless pharmacists step in to provide effective patient counseling and form beneficial interprofessional relationships with prescribers.

Am J Med. Published online February 25, 2016.

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A Mind-Body Program for Older Adults With Chronic Low Back Pain

Approximately 100 million individuals in the United States suffer from chronic pain. Pain is prevalent in 52.9% of the older adult population ages 65 and older. Of the 52.9% experiencing pain, 30.3% were experiencing chronic back pain. Analgesics commonly cause severe adverse effects in older adults. Because of this prevalent drug therapy problem, nonpharmacologic treatments must often be utilized for effective management of chronic low back pain.

An experimental study was conducted among 282 patients with low chronic back pain 65 years or older. The goal of this study was to assess the effectiveness of a mind-body program at increasing function and reducing pain. The patients received an 8-week group program followed by 6 monthly sessions. The program was modeled on the Mindfulness-Based Stress Reduction program. This program took regular activities such as sitting, walking, and lying down and transformed then into meditation through breathing exercises and mindful awareness of thoughts and sensations. Compared with the control group, those receiving this mind-body treatment improved short-term function and long-term current and most severe pain.

The trial did not yield sustained results in treatment of lower chronic back pain, suggesting that future development of this intervention should focus on durability. This article was particularly of interest to me because it combined two of my interest in medicine with my interest in meditation. I often use meditation as a form of stress relief, and it is intriguing to see that meditation could also be used in pain management. Prescription pain medication is not the answer  for every patient and it is very often over-prescribed. I believe that is important for pharmacists to be aware of other pain management methods and share these methods with their patients. Although I do not believe that meditation alone is the answer, I think that a combination of medication therapy and meditation could be a very effective treatment for a lot of patients suffering from chronic pain.

JAMA Intern Med. Published online February 22, 2016.

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Pharmacist Education and Inpatient Influenza and Pneumococcal Vaccination Acceptance Rates

The United States is vastly affected by pneumococcus pneumonia, invasive pneumococcal infections, and seasonal influenza each and every year. Although there are vaccines that prevent these diseases, approximately 70 million high-risk adults are vulnerable to pneumococcus by by remaining unvaccinated. The number of deaths related to influenza has been steadily increasing in the United States since 1990. If patients qualify, patients can receive both the influenza and pneumonia vaccinations to protect themselves from these disease, however, less than half of adults 18 years of older were vaccinated during the 2012 to 2013 flu season. It is apparent that pharmacists, as immunizers in the community setting, are increasing the current vaccination rates in the population today.

A study was conducted to determine just how effective pharmacist-driven education programs were at increasing vaccination rates. Patients in a small community hospital who initially rejected vaccinations upon admission were educated by pharmacists and pharmacy interns and reoccurred the vaccination. As a result, 39.2% of patients changed there minds and decided to receive the influence and pneumococcal pneumonia vaccines.

This study proves the importance of patient education. Pharmacists need to provide patients with all the available information in order for patients to make the right decisions in regards to their health care. I am proud to be going in to a profession that has such a big influence on its patient population.

Journal of Pharmacy Practice (2016): n. pag. Web.

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Prescription Drugs and Dental Students

The act of prescribing is a complex clinical process. Many factors go in to consideration when writing a prescription. A study was conducted to evaluate the knowledge of drug prescriptions in third year and final year dental students at a dental school in India.

The study was conducted among 170 male and female dental students and consisted of 10 open-ended questions. According to the results of these studies, pain was found to be the dental students’ most important reason for prescribing medication. The most commonly prescribed NSAID was diclofenac, and the most commonly prescribed antibiotic was amoxicillin. The dental students’ number one reason for error was due to the lack of knowledge about drug dosing. Most of the students stated that they got their information regarding professors from their professors and were not familiar with the WHO Guide to Good Prescribing.

Journal of Basic and Clinical Pharmacy. 2015;7(1):12-16.

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This article made me think of inter professionalism. It is important to spread knowledge of prescribing drugs across all health professionals. Educational programs should be in place to teach prescribers of the resources they can use to determine proper prescribing methods. A pharmacist has more education on prescription drugs than any other health professional, therefore, a pharmacist should help other health professionals make smarter medication-related decisions.

Barriers to Effective Management of Hypertension in Older Populations

The leading cause of preventible death, not only in our own country, but worldwide, is hypertension. There is substantial evidence from robust trials for management of hypertension in older adults. The prevalence of hypertension seems to  increase with age, and therefore management of hypertension among older individuals through pharmacotherapy is essential to reach optimal health care for older populations. I study was conducted through the Journal of Pharmaceutical Policy and Practice to determine how exactly the prevalence of hypertension changes with age. The study also explored evidence regarding current pharmacological management in older adults for hypertension. The evidence from this study was then used to identify barriers that prevent older adults from receiving the best quality of care in the management of their hypertension.

The study found that the number of individuals struggling with hypertension increases significantly with age. At the age of 65 years or younger, 30% of the population has hypertension. But the age of 80 and over, this percentage of individuals with hypertension increased to 70% of the population. With the increase of the prevalence of hypertension with age, there is good evidence for the use of a number of medications to control blood pressures in older population.  However, despite good evidence for pharmacological management of hypertension in older adults, the quality of care available for treatment of hypertension in older adults is suboptimal. System, physician, and patient related barriers prevented older adults from reaching optimal blood pressure control.

J of Pharm Policy and Pract Journal of Pharmaceutical Policy and Practice 8.1 (2015): n. pag. Web.

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This study showed me the importance of open dialogue between patients and pharmacists. A pharmacist could easily prevent the patient-related barrier to the optimal treatment of hypertension in older adults. A pharmacist must make sure that each of his or her patients knows exactly how to adhere to his or her medication regimen. A pharmacist must also be able to advocate for his or her patients by expressing any concerns that they may have to the physician. Communication and a strong patient-pharmacist relationship are key to fixing the under treatment of hypertension in the older population.

Hypertension and Precision Medication

Hypertension is one of the most common disease states amongst US adults today. About 80 million US adults are currently dealing with high blood pressure, and amongst these 80 million patients, 48% are taking more than one medication and 40% are still seeing no response to their drug therapy. In order to combat this issue, precision medicine and epigenetics have the potential to yield more effective drug treatment for hypertension control by identifying personalized targets for prevention and treatment.

The Precision Medicine Initiative that was introduced in 2011 by the US National Research Council is intended to produce new approaches for detecting, measuring, and analyzing biomedical information. Current work in precision medicine focuses mainly on genome sequences, however, this alone does not account for environmental and lifestyle factors that contribute to complex diseases like hypertension. Epigenomics, on the other hand, does pick up on environmental and lifestyle factors it is therefore important to include this study when assessing for more complex pathologies.

The mechanism behind hypertension and responses in blood pressure to different antihypertensives varies between different groups of patients. Blood pressure is not an easily identifiable phenotype because of specific environmental exposures. It is predicted that in the future, precision medicine that also incorporates epigenomics will lead to the development  of new drug targets for the treatment of hypertension. Translating these findings into a clinical setting will require a cooperated and coordinated effort.

JAMA. 2016;315(4):343-344.

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Precision medicine and epigenomics, in my opinion, is leading to a more  efficient community of medicine. This increase in efficiency is going to lead to an overall more positive medication experience for all patients. Despite some of the negative perceptions of genetic sequencing, I believe that is important for the future of medicine to lead more and more individuals towards personalized medication. This will result in less drug therapy problems and faster responses to drug therapy. It is exciting to see personalized medication make its way to more common disease states.


Substantial Decline in Hydrocodone Prescribing

Opioid abuse is a major concern to be addressed today in the United States. In 2011, there were about 100,000 drug abuse-related emergency department visits due to hydrocodone combination analgesic products. In response to this growing problem, the United States Drug Enforcement Administration rescheduled hydrocodone from schedule III to a more stringent schedule II. This action provided stricter prescribing laws for hydrocodone, including prohibition of prescription refills.

As a result of this rescheduling, the year of 2015 had 26.3 million less prescriptions for hydrocodone. Data from the IMS Health National Prescription Audit concluded that hydrocodone combination product prescriptions fell 22% within the first 12 months after rescheduling, predominantly due to the restriction of refills. With the decline of hydrocodone prescriptions, there was a 5% rise in prescriptions for nonhydrocodone combination product analgesics in the first year after rescheduling. Most health care professional specialities dispensed less hydrocodone combination products, most specifically in primary care physicians and surgeons.

JAMA Intern Med. Published online January 25, 2016.

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The United States Drug Administration has made great efforts to reduce the amount of drug abuse that is currently occurring in our community. It is important for pharmacists to join their effort in the reduction of overall drug abuse. Other than refusing to fill, what what else do you think pharmacists can do to contribute?

Mailing Nicotine Patches to Aid in Smoking Cessation

This past July, a randomized clinical trial just concluded after nearly three years of study which evaluated whether or not mailing nicotine patches to adult smokers without behavioral support would help increase quit success rates. The trial included 2,093 individuals who smoked more than 10 cigarettes daily. Individuals who were interested and eligible to participate were designated to either an experimental group that received a 5-week supply of nicotine patches by mail or a control group that offered any other form of intervention. The individuals were followed-up with by the investigators at 8 weeks and at 6 months.

After the study, self-reported assistance rates were significantly higher for those in the experimental group who received nicotine replacement therapy via mail compared to those in the control group. Overall, the trial provided evidence that mailed nicotine patches were effective to promote successful tobacco cessation. However, because of the lack of biochemical validation for all the individuals in the study, the strength of these findings is somewhat tempered.

JAMA Intern Med. Published online January 25, 2016.

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This article came of interest to me because it brought to my attention how increased access to healthcare can lead to an overall healthier lifestyle. Like with available mailing services, more and more patients will be able to obtain the healthcare that they need as pharmacists move to provider status. I personally am looking forward to the future of healthcare that leads to a better well-being amongst the community.