Oral erythromycin, CYP3A inhibitor combination risky

Patients who took the antibiotic erythromycin with medications that inhibit CYP3A drug enzymes, such as certain calcium-channel blockers, certain antifungal drugs, and some antidepressants, had a five times greater risk of sudden death from cardiac causes than patients who did not take the drugs at the same time, according to a study co-funded by the Agency for Healthcare Research and Quality (AHRQ), the U.S. Food and Drug Administration, and National Institutes of Health. The study was published in the Sept. 9 issue of the New England Journal of Medicine

In the study, researchers at AHRQ’s Center for Education and Research on Therapeutics (CERTs) at Vanderbilt University in Nashville, TN, did not find the same increased risk for patients who took CYP3A inhibitors with other antibiotics, such as amoxicillin, or for those who had taken erythromycin in the past. The CERTs program is a national initiative to increase the awareness of the benefits and risks of new, existing, or combined uses of therapeutics and devices.

The researchers reviewed medical records for the Tennessee Medicaid program and identified patients who had experienced sudden death from cardiac causes during the period Jan. 1, 1988, to Dec. 31, 1993. They reviewed prescriptions for erythromycin, amoxicillin, and other medications from computerized Medicaid pharmacy files that included the drug, dose, and total medication dispensed.

The researchers concluded that clinicians should avoid prescribing a combination of erythromycin and CYP3A inhibitors to patients at the same time because there are safer alternatives.

Many patients don’t tell docs about medication underuse

A recent study found that two-thirds of chronically ill patients who planned to underuse medication because of the cost did not tell a clinician in advance. Thirty-five percent never discussed it at all.

The researchers conducted a nationwide survey of 660 older adults with chronic illnesses who reported underusing medication in the prior year because of cost. The researchers assessed whether patients discussed cost-related medication underuse with clinicians, reasons that some patients did not talk with clinicians about this problem, how clinicians responded when this issue was raised, and how helpful patients perceived clinicians to be. The study was published in the Sept. 13 issue of the Archives of Internal Medicine.

Of those who did not tell a clinician, 66% reported that no one asked them about their ability to pay for prescriptions, and 58% reported that they did not think providers could help them. When patients talked with clinicians about medication costs, 72% found those conversations helpful. However, 31% reported that their medications never were changed to a generic or less expensive alternative, and few patients were given other forms of assistance such as information about programs that help pay drug costs (30%) or where to purchase less expensive medication (28%). Patients were most likely to find clinicians helpful if clinicians provided free samples, asked about problems paying for prescriptions, and offered advice about how to pay for patients’ current regimens.

Scientists find potential way to control drug-resistant bacteria

Researchers are reporting that they believe they have discovered a potential new way to control drug-resistant bacteria. The results of the study were published in the Sept. 23 issue of the journal Nature.

The new research, funded by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, found that bacteriophages contain genes that allow them to quickly change their proteins to bind to different cell receptors. Researchers at the University of California-Los Angeles made the discovery. They found that the genome of the phage that infects Bordetella bronchiseptica, a relative of the bacterium that causes whooping cough, contains a series of genes that change the part of the virus that binds to the bacterial cell.

These genes allow the phage to rapidly evolve new variants that can recognize and attack bacteria that may have become resistant to the previous phage. The researchers believe that this discovery could lead to the use of genetically engineered phages to treat bacterial infections that have become resistant to antibiotics.

Drug shortages negatively affect patient safety, costs of care

A new study finds that ongoing drug shortages are having far-ranging, negative effects on patient care and hospital costs.

The survey, published in the Oct. 1 issue of the American Journal of Health-System Pharmacy, polled almost 1,500 pharmacy directors in U.S. health systems. The study revealed that 95% of respondents believe shortages have created roadblocks and hurdles for treating patients with the best medication. Sixty-one percent believe the scarcity of certain drugs has compromised patient care. The American Society of Health-System Pharmacists and pharmacy residents at Johns Hopkins Hospital in Baltimore conducted the survey in March 2003.

Pharmacy directors reported that drug shortages have affected patients in a number of ways, including contributing to the delay or cancellation of certain medical procedures, prolonged patient stays in hospitals, and serious medication errors.

Shortages also have affected drug prices as pharmacists are forced to buy the same product at higher-than-contracted prices or more expensive alternative products in the same therapeutic class. Survey respondents reported that shortages force their hospitals to spend an annual average of $20,000 more in incremental drug purchasing costs.

According to the survey, pharmacists are spending more time managing shortages, including tracking product availability; identifying therapeutic alternatives; contracting with vendors, manufacturers, and group purchasing organizations to buy therapeutic alternatives; and preparing written communications and training other health care providers on using other medications.

Wyeth: Glass vial breakage of pantoprazole sodium

Wyeth is informing health care professionals about reports of glass vial breakage of pantoprazole sodium (Protonix IV 40 mg vials) for injection during attempts to connect vials to spiked intravenous (IV) system adaptors.

This may be a safety issue for pharmacists when preparing pantoprazole IV vials in combination with spiked IV system adaptors, both during manual assembly and while using mechanical assistance, Wyeth says.

It is recommended that each vial be reconstituted with 10 mL of 0.9% sodium chloride injection, USP. This solution can be administered over a period of at least two minutes or further diluted (admixed) with 100 mL of 5% dextrose injection, USP, 0.9% sodium chloride injection, USP, or lactated ringer’s injection, USP. The admixed solution should be administered intravenously over a period of approximately 15 minutes. For more information about the warning, see www.fda.gov/medwatch/SAFETY/2004/safety04.htm#protonix.