The “Good Stuff In Infectious Diseases” column pulls content from the infectious diseases community on Twitter. Commentary, relevant links and tweets are provided. This is the summary for the first week of August 2017.
Authored By: John D’Arcangelis, Pharm.D. Candidate 2018, Melissa Campo, Pharm.D., Andre Tran, Pharm.D., and Jamie Kisgen, Pharm.D., BCPS-AQ ID
[Last updated: 8-8-2017]
Tweet #1
Article link here
Link to products: Amazon here / eBay here
Commentary: People are looking for options to avoid spending money on visits to the doctor and pharmacy to treat their illnesses. Somewhat strikingly, a new way people are getting around conventional systems is through purchasing antibiotics online – antibiotics meant for fish that is!
Although generic antibiotics are relatively inexpensive and can sometimes be free, the cost of getting a prescription (e.g., a doctor or emergency room visit) can be costly. This can be a particular problem for those without insurance. So while a bit shocking, it is not that surprising to see people looking online for antibiotics.
Users are leaving a variety of reviews on Amazon for bottles of antibiotics meant for pet fish. However, the hidden messages embedded in these reviews are fairly concerning. While the reviewer states how effective the medicine was for their “fish,” their lightly veiled code suggests a disturbing possible truth that these comments come from users’ personal experience ingesting antibiotics meant for fish.
Fin Mox (amoxicillin) has over 400 reviews at the time of this post and a 4.8 out of five-star rating. Here is an example:
The above user comments with drug facts from drugs.com, which is a website that can identify medications based on imprint, shape, or color. It shows that the capsules in the fish bottles are the same ones that humans take!
It is alarming to see the availability of antibiotics for purchase without a prescription. This phenomenon encourages self-medication and can put uninformed individuals at risk. Many initiatives to reduce inappropriate use of antibiotics focus on controlling prescribing by health care clinicians. By removing that step in the process, the consumer is bypassing a key safety measure.
One thing we can do to combat this problem is help others become informed about rational use of antibiotics and the problem of antibiotic resistance. On that note, Antibiotic Awareness Week is right around the corner. Learn more about this week in November here!
Tweet #2
Article link can be found here.
Commentary: A 54-year-old female arrives in Emergency Department (ED) for a potential fractured wrist bone. A urine culture is subsequently ordered for her in the ED by a anxious intern and the next day the culture comes back positive for E. coli. The patient is started on empiric ceftriaxone therapy for the positive culture. Meanwhile, the patient never expressed any symptoms of a urinary tract infection and never should have had a urine culture performed… Sound the antimicrobial stewardship alarm!
Diagnostic tests are undoubtedly a powerful instrument to help aid clinicians in assessing the presence of an infection. However, an issue arises when these diagnostic tests are ordered, yet their results will not be clinically meaningful or if the result will further confuse providers. This can happen for example if a patient’s culture represents contamination rather than infection (e.g., a positive urine culture in a patient who does not have a urinary tract infection). Consequently, if the provider does not perform their due diligence (as happens more than we would all like to admit), patients may then be treated for a condition that they ultimately do not have.
As the battle against antibiotic resistance continues, diagnostic stewardship provides a different approach in addressing the inappropriate use of antibiotics. Through evaluation of the ordering, collection, processing, and reporting of diagnostic tests, interventions can be made to improve patient care and in turn, improve antibiotic use. The article proposes several best practices strategies that can be implemented to improve diagnostic stewardship in each of these various stages.
Tweet #3
Article link can be found here.
Commentary: According to the FDA, approximately 2.7 to 3.9 million people in the United States have chronic hepatitis C virus (HCV) infection. Treatment of this viral disease can prevent potential complications such as bleeding, ascites, infections, liver cancer, and even death. On August 3, 2017, the FDA approved a new HCV medication: glecaprevir/ pibrentasvir (GLE/PIB, Mavyret). This new combination drug consists of two new direct-acting antivirals. The approval of GLE/PIB adds to the growing competition within the HCV drug market.
GLE/PIB is approved for the treatment of chronic HCV in genotypes 1-6 with a treatment duration as short as a 8 weeks (depending on patient-specific characteristics). GLE/PIB provides a treatment option for a subset of patients with genotype 1 infection who did not achieve treatment success with previous agents. It is important to note that genotype 1 is the most common HCV genotype in the United States, consisting of an estimated 75% of Americans with HCV.
The drug also offers one additional and enticing selling point – a comparatively low cost. GLE/PIB’s price is $13,200 per month. This is a significant cost reduction compared to other agents competing in this space.
It will be interesting to see how GLE/PIB will influence formulary decisions and clinician choices for those patients living with HCV not yet treated. Here are two suggested resources to learn more about GLE/PIB:
- IDstewardship study guide glecaprevir/pibrentasvir page
- Have We Reached the End of HCV Drug Development?
Tweet #4
Link to video is here.
Commentary: This is a short video from PBS that attempts to create awareness amongst the public about issues our society faces secondary to drug-resistant bacteria. The video portrays an excellent message.
Here are some key points:
- Each year, superbugs infect more than 2,250,000 Americans, killing at least 38,000
- There are a rising number of patients developing infections that cannot be treated with standard antibiotics
- Resistance in bacteria can occur through a variety of mechanisms
- We do not have many new antibiotic coming to the market, so we need to be smart with the ones we do have
- The longer bacteria are exposed to an antibiotic, the more likely they are to develop resistance
- Finding new microbes that help us identify new antibiotic molecules is becoming harder
If you are interested, PBS has another installment of this issue here looking at the problem from an economic perspective. It discusses some of the reasons why new antibiotics are not being readily produced.
Tweet #5
Link to article is here.
Commentary: Antimicrobial stewardship aims to improve antibiotic use practices to reduce the development of bacterial resistance (among other things). However, the use of vaccines to prevent infections from occurring in the first place is another great solution that antimicrobial stewards should note.
Preventing infections from occurring through the use of vaccinations can reduce antibiotic use, which may help slow the progression of antibiotic resistance. However, this may be a challenge, especially in developing nations where resources are limited and antibiotics are more readily available than vaccines.
BONUS TWEET!
Food “Critic” Reviews
- Not worth the money. The portion was so small it was practically microscopic
- Depends on how it is served, if it’s done right it is to die for!
- It’s always in season!
- Doesn’t taste great but >90% efficacy in prevention of recurrent C diff
…
Guest Contributors: John D’Arcangelis, Pharm.D. Candidate Class of 2018, is a pharmacy student from the University of Florida College of Pharmacy and advance pharmacy practice experience student at Sarasota Memorial Hospital in Sarasota, Florida. Melissa Campo, Pharm.D. (@melissascampo) and Andre Tran, Pharm.D. (@InfxnSlayerJr) are PGY1 Pharmacy Practice Residents at Sarasota Memorial. They are acknowledged as contributing authors for this article.
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