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ITL: Physician Reviews of HM-Relevant Research
Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?
Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.
Study design: Systematic review of the literature.
Setting: Twenty-six controlled studies.
Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.
Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.
Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.
Read more of our physician reviews of recent, HM-relevant literature.
Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?
Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.
Study design: Systematic review of the literature.
Setting: Twenty-six controlled studies.
Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.
Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.
Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.
Read more of our physician reviews of recent, HM-relevant literature.
Clinical question: What medication reconciliation practices are the most effective and beneficial to patients?
Background: Medication reconciliation identifies the most accurate medications a patient is taking which can limit adverse drug events. A wide variety of practices have been reported.
Study design: Systematic review of the literature.
Setting: Twenty-six controlled studies.
Synopsis: Using both MEDLINE and manual search, 26 studies of medication reconciliation practices were identified that met inclusion criteria. Studies were divided into pharmacist-related interventions, information technology interventions, and other. Reported interventions were found to successfully reduce medication discrepancies but the effects on adverse drug event reduction were inconsistent. The scarcity of rigorously designed studies does limit the ability to compare medication reconciliation strategies. Only 6 of the reviewed studies were considered good quality. Future studies will require more standardized methods and rigorous outcome measurements.
Bottom line: Current data regarding medication reconciliation is limited, but supports use of pharmacy staff and focusing efforts on patients at high risk for adverse drug events.
Citation:Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057-1069.
Read more of our physician reviews of recent, HM-relevant literature.
ITL: Physician Reviews of HM-Relevant Research
Clinical question: What is the optimal duration of oral ciprofloxacin in women with acute community-acquired pyelonephritis?
Background: Despite being a commonly encountered infection, there are little data on the appropriate duration of therapy for acute pyelonephritis in women.
Study design: Prospective, randomized, open-labeled, double-blinded, noninferiority trial.
Setting: Twenty-one infectious diseases centers in Sweden.
Synopsis: Two hundred forty-eight women aged 18 or older with a presumed diagnosis of pyelonephritis were randomized to treatment with seven or 14 days of oral ciprofloxacin 500 mg twice daily. One hundred fifty-six per protocol patients were analyzed, and short-term clinical cure was shown to be noninferior, with cure of 97% in the seven-day group and 96% in the 14-day group (90% confidence interval -6.5-4.8, P=0.004). Results were also shown to be valid for older women and those with more severe infections. With growing concerns of antibiotic resistance and adverse drug events, using shorter courses of antibiotics has come into favor. The authors warn that these findings should not be extrapolated to other classes of antibiotics.
Bottom line: Treatment of community-acquired acute pyelonephritis in women with ciprofloxacin 500 mg twice daily for seven days is not inferior to 14 days.
Citation: Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012; Jun 20: [Epub ahead of print].
Read more of our physician reviews of recent, HM-relevant literature.
Clinical question: What is the optimal duration of oral ciprofloxacin in women with acute community-acquired pyelonephritis?
Background: Despite being a commonly encountered infection, there are little data on the appropriate duration of therapy for acute pyelonephritis in women.
Study design: Prospective, randomized, open-labeled, double-blinded, noninferiority trial.
Setting: Twenty-one infectious diseases centers in Sweden.
Synopsis: Two hundred forty-eight women aged 18 or older with a presumed diagnosis of pyelonephritis were randomized to treatment with seven or 14 days of oral ciprofloxacin 500 mg twice daily. One hundred fifty-six per protocol patients were analyzed, and short-term clinical cure was shown to be noninferior, with cure of 97% in the seven-day group and 96% in the 14-day group (90% confidence interval -6.5-4.8, P=0.004). Results were also shown to be valid for older women and those with more severe infections. With growing concerns of antibiotic resistance and adverse drug events, using shorter courses of antibiotics has come into favor. The authors warn that these findings should not be extrapolated to other classes of antibiotics.
Bottom line: Treatment of community-acquired acute pyelonephritis in women with ciprofloxacin 500 mg twice daily for seven days is not inferior to 14 days.
Citation: Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012; Jun 20: [Epub ahead of print].
Read more of our physician reviews of recent, HM-relevant literature.
Clinical question: What is the optimal duration of oral ciprofloxacin in women with acute community-acquired pyelonephritis?
Background: Despite being a commonly encountered infection, there are little data on the appropriate duration of therapy for acute pyelonephritis in women.
Study design: Prospective, randomized, open-labeled, double-blinded, noninferiority trial.
Setting: Twenty-one infectious diseases centers in Sweden.
Synopsis: Two hundred forty-eight women aged 18 or older with a presumed diagnosis of pyelonephritis were randomized to treatment with seven or 14 days of oral ciprofloxacin 500 mg twice daily. One hundred fifty-six per protocol patients were analyzed, and short-term clinical cure was shown to be noninferior, with cure of 97% in the seven-day group and 96% in the 14-day group (90% confidence interval -6.5-4.8, P=0.004). Results were also shown to be valid for older women and those with more severe infections. With growing concerns of antibiotic resistance and adverse drug events, using shorter courses of antibiotics has come into favor. The authors warn that these findings should not be extrapolated to other classes of antibiotics.
Bottom line: Treatment of community-acquired acute pyelonephritis in women with ciprofloxacin 500 mg twice daily for seven days is not inferior to 14 days.
Citation: Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012; Jun 20: [Epub ahead of print].
Read more of our physician reviews of recent, HM-relevant literature.