link-Pharmacy Newsletter 052011 - St. Mary's Hospital

Pharmacy
Editor: Kate Rotzenberg, PharmD
Drug Information Pharmacist
Katherine_Rotzenberg@ssmhc.com
700 S. Park St.
Madison, WI 53715
Phone: 608-258-6551
Fax: 608-258-5626
Ceftaroline (Teflaro ® ) in Cellulitis Treatment
Geri Naymick, PharmD, Antibiotic Stewardship Pharmacist
Ceftaroline is an “advanced generation” cephalosporin recently
approved by the FDA for skin and skin structure infections . It is
similar to the first and second generation cephalosporins with
activity toward gram positive (S. pneumoniae, MSSA, macrolide-resistant
S. pyogenes, and S. agalactiae) and gram
negative organisms (H. influenzae, E. coli, K. pneumoniae, K.
oxytoca). Unlike other generation cephalosporins, ceftaroline
has activity against MRSA, making it unique to the cephalosporin
family. Its activity includes MSSA, CA-MRSA, vancomycin-intermediate
(VISA) and vancomycin-resistant (VRSA) S.
aureus. The MIC 90 for community or hospital acquired MRSA
ranges from 0.25-1 mcg/ml. It does not cover pseudomonas,
Enterococcus or ESBL producers.
Ceftaroline appears to be an attractive antibiotic for cellulitis
treatment. Besides its broad antibacterial spectrum for uncomplicated
skin infections, there is a lack of drug interactions with
a low side effect profile. However, it requires dosing every 12
hours, a hindrance if outpatient treatment is considered. As an
alternative, providing ceftaroline on an in-patient basis for initial
therapy with transition to once-daily daptomycin in the outpatient
ID Infusion Clinic would be a cost-effective measure.
Daptomycin 500 mg vial costs approximately $230 compared to
$84 for twice daily ceftaroline vials. Patient cost reflects a
greater economic difference as daptomycin is dosed by weight
and can average about $500-1,000.
Status of Drug Shortages
Kate Rotzenberg, PharmD
To gain clinical experience with ceftaroline, the Infectious Disease
department would like ceftaroline to be ordered in patients
with cellulitis with a suspicion of MRSA. Infectious Disease
department must be consulted for facilitation of discharge to the
infusion clinic. Ceftaroline is dosed 600 mg every 12 hours;
pharmacy will adjust for decreased renal function. Crossreactivity
with other beta-lactams (penicillins, cephalosporins,
carbapenems) is established.
Reference: Medical Letter Jan 2011
Page 4
Adult amino acids (Clinisol®)
shortage is resolved.
Clevidipine (Cleviprex®) became
available in mid-April on a limited
basis (50mL only) .
Diltiazem injection shortage is resolved.
Erythromycin injection is currently
on back order, none is available for
use at this time.
Hyaluronidase injection continues to
be unavailable. For medications that
extravasate, continue to use the Extravasation
Policy on the intranet and
follow all steps without hyaluronidase.
Ibuprofen lysine (Neoprofen®) is
on back order. Indomethacin injection
is being used as an alternative
for PDA closure in neonates.
Lorazepam (Ativan®) bulk vial for
injection is now available for compounding
infusions, shortage is resolved.
Norepinephrine (Levophed®) injection
shortage has been resolved.
Propofol (Diprivan®) continues to
be in nationwide shortage. Manufacturers
continue to work with the FDA,
but cannot confirm a date when the
shortage will be resolved. At this
time, the pharmacy has been able to
maintain a supply of propofol.
Vitamin A injection remains on back
order.
Please consult with your pharmacist if you
have any questions related to drug shortages.
Pharmacy Newsletter