Journal of Pharmacy Technology

Background/Objectives: Eravacycline is a fluorocycline with activity against multidrug-resistant (MDR) and difficult-to-treat (DTR) pathogens, but real-world outcome data are lacking for the treatment of infections caused by these organisms. The objective of this study was to evaluate the efficacy and safety of eravacycline for infections caused by MDR and/or DTR organisms. Methods: This was a retrospective, observational study of adult patients receiving eravacycline for at least 72 hours for MDR or DTR organisms. The primary outcome was 30-day mortality. Secondary outcomes included 60-day relapse, 30-day readmission, and adverse drug events (ADEs). Results: A total of 17 patients were included in the analysis. The cohort had a high baseline mortality risk (median Charlson Comorbidity Index of 5). Osteoarticular infections were the most common indication (52.9%). The most frequently isolated pathogens were Enterococcus spp. and Enterobacterales spp. (58.9% each). Most infections were polymicrobial. Eravacycline minimum inhibitory concentrations (MIC) were available in only 47% of cases, and the median time to treatment initiation was 6 days after culture collection. Thirty-day all-cause mortality occurred in 17.6% of patients. Among survivors, 60-day relapse and 30-day readmission were low (6% each). The ADEs occurred in 35% of patients but led to no discontinuations. Conclusions: In this cohort of severely ill patients with complex, predominantly polymicrobial MDR and DTR infections, eravacycline demonstrated favorable safety and efficacy results despite delays from index culture to initiation of targeted therapy. These data suggest eravacycline may be a viable treatment option for infections caused by MDR and DTR organisms.

Treatment of extensively drug-resistant (XDR) organisms is complicated by pharmacodynamic and pharmacokinetic (PK) limitations of current antimicrobial agents. Prostatitis is an infection that is historically difficult to treat with beta-lactams given poor tissue penetration as compared to fluoroquinolones and sulfamethoxazole-trimethoprim. Cefiderocol is a novel cephalosporin that is often used to treat a wide variety of gram-negative bacteria that have extensive resistance to other antibiotics. Cefiderocol remains stable against many β-lactamases and shows enhanced bacterial cell entry as a result of siderophore uptake. However, its penetration into prostatic tissue has not been studied. This review presents the use of cefiderocol in a patient with complicated urinary tract infection and prostatitis caused by XDR Klebsiella pneumoniae resistant to almost all tested antibiotics, including novel beta-lactam/beta-lactamase combinations. Although PK data suggest that cefiderocol may achieve therapeutic concentrations in prostatic tissue, further studies are needed to confirm its efficacy in treating prostatitis, particularly in cases of chronic or complicated infection. This case highlights cefiderocol as a potential therapeutic option for XDR Enterobacterales prostatitis, though additional research is required to fully understand its prostate penetration and clinical outcomes.

Background: Asthma is a common chronic respiratory disease, reducing the quality of life and increasing the mortality risk of patients. Medication adherence and proper inhaler technique play an important role in asthma control. Objective: To investigate medication adherence, inhaler use, asthma control level, and its related factors among asthma outpatients treated at a specialized tertiary respiratory hospital. Methods: A descriptive cross-sectional study was conducted on asthma outpatients treated at the specialized respiratory hospital (April 1, 2022-June 30, 2022). Medication adherence, inhaler use, and asthma control were assessed using the General Medication Adherence Scale, content-validated checklists, and the asthma control test. Data were analyzed using SPSS software, P value of < 0.05 was considered statistically significant.Results: There were 184 patients included (mean age 48.86 ± 13.28, females 53.8%). More than half of the patients had at least one comorbidity (mainly allergic rhinitis). All patients were prescribed inhaled corticosteroid (ICS) and long-acting beta agonist (LABA) as controller medications, and the most prescribed combination was ICS-LABA + leukotriene receptor antagonist (66.8%). The rates of patients with high medication adherence, proper inhaler technique, and good asthma control were 89.6%, 67.4%, and 75.0%, respectively. The higher medication adherence was associated with better asthma control (odds ratio = 4.584, 95% confidence interval 1.633-12.870, P = 0.004). Small sample size and single-center study may limit the generalizability of the results. Conclusions: Medication adherence was generally high, whereas inhaler technique errors remained common. Despite overall favorable asthma control, ongoing inhaler technique counseling and sustained medication adherence remain essential.

Background: Obesity is a prevalent condition associated with numerous comorbidities. Weight loss medications reduce comorbidity burden, but barriers hinder access and titration. Clinical pharmacists play a key role in chronic disease management, but limited research exists on pharmacists managing weight loss. Objective: Evaluate the impact of a clinical pharmacist on weight loss medication management for adults without diabetes in an outpatient Internal Medicine primary care resident clinic. Methods: This matched case-control study included adults without diabetes with at least 1 weight management visit with a clinical pharmacist between July 2023 and May 2024. Controls were matched on insurance and baseline body mass index, and included patients prescribed weight loss medications by clinicians and those without pharmacotherapy. Data were collected over 6 months. The primary outcome was percent weight loss. Rate of weight loss was explored as a secondary outcome. Results: 94 patients were included: 35 pharmacist-managed, 24 clinician-managed, and 35 without pharmacotherapy. At 6 months, mean weight change was −11.8%, −8.3%, and +1.3% in the pharmacist, clinician, and nonmedication groups, respectively. Absolute weight loss was greater in the pharmacist group, but not statistically significant compared with the clinician-managed group (P = 0.12). The weekly rate of weight loss was significantly higher in the pharmacist group (−0.29 kg/week; P = 0.04 and P < 0.001 vs controls). Conclusion: Patients prescribed obesity medications experienced significant weight loss, regardless of whether the patients were managed by pharmacists or primary care clinicians. These findings support a collaborative care model in obesity management.

Background: Pain is prevalent among critically ill patients and is frequently underrecognized due to sedation and mechanical ventilation. Opioids remain the primary analgesic therapy in the intensive care unit (ICU); however, opioid-related adverse effects have prompted increased adoption of multimodal analgesia strategies. Centrally acting skeletal muscle relaxants, including cyclobenzaprine and methocarbamol, are commonly used as adjuncts, yet data evaluating their anticholinergic adverse effects in critically ill populations are limited. Methods: The primary objective of this study is to determine the prevalence of anticholinergic adverse drug events (ADEs) associated with cyclobenzaprine and methocarbamol among ICU patients. Purpose: This retrospective cohort study evaluated adult patients (≥18 years) admitted to any ICU at a single academic medical center between January 1, 2023 and January 31, 2025, who received at least 1 dose of cyclobenzaprine or methocarbamol during ICU admission. The primary outcome was the prevalence of anticholinergic ADEs, identified through provider documentation and International Classification of Diseases, Tenth Revision (ICD-10) codes. Secondary outcomes included types of ADEs, dosing of the study drugs, and medication discontinuation rates. Results: Of 367 eligible patients, 260 were included in the final analysis. Cyclobenzaprine was administered to 112 patients (43%) and methocarbamol to 148 patients (57%). Potential anticholinergic ADEs were identified in 29 patients (14.4%) receiving cyclobenzaprine and 17 patients (10.8%) receiving methocarbamol. Among the 69 total ADEs, 55 (79%) prompted an intervention, most commonly pharmacologic therapy adjustments. Medication discontinuation due to ADEs was infrequent. Conclusions: Cyclobenzaprine and methocarbamol were associated with anticholinergic adverse effects in critically ill ICU patients, though this did not translate to medication discontinuation. These findings support the cautious use of centrally acting muscle relaxants as part of multimodal analgesia strategies. Pharmacists are uniquely positioned to evaluate and mitigate adverse drug effects in the critically ill.

Background: The (1,3)-β-D-glucan (BDG) test can be used as a stewardship approach to decrease antifungal overutilization, development of resistance, and excess costs. Objective: This study assessed the impact that a BDG algorithm has on micafungin duration of therapy (DOT) compared to standard of care (SOC). Methods: This retrospective, multisite, pre-post cohort study at a tertiary health system included nonneutropenic critically ill adults on empiric micafungin with risk factors for invasive candidiasis (IC). A BDG algorithm was utilized and compared to SOC for micafungin DOT. Secondary outcomes included length of stay (LOS), mortality, 30-day readmissions, cost, and BDG performance. Results: A total of 110 patients were included, with 55 patients per group. Overall, micafungin DOT was not different (94.7 [45.0-146.3] vs 95.4 [49.2-206.4] hours; P = .84) but was significantly shorter when BDG resulted within 48 hours (53.0 [46.1-98.1] vs 140.7 [72.8-226.6] hours; P = .014) or with algorithm compliance following negative results (47.6 [35.6-68.8] vs 94.7 [45.0-146.3] hours; P = .005). The test had negative and positive predictive values of 96.6% and 11.5%, respectively, with dialysis patients most likely to correlate with false positives (phi = 0.40, 95% CI: 0.15-0.60, P = .002). Patients who were immunocompromised or underwent surgery had prolonged DOT. Conclusion: A pharmacy-driven BDG algorithm did not significantly decrease micafungin DOT except with BDG results within 48 hours or with algorithm compliance following negative results. The BDG test may have less impact in immunocompromised, surgery, and dialysis patients. This highlights the need for research in antifungal stewardship to optimize patient outcomes.

Objective: To review the emerging evidence supporting the use of nerandomilast (Jascayd), a selective phosphodiesterase-4B (PDE4B) inhibitor, for the treatment of idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF). The review aims to summarize its mechanism of action, efficacy, safety, and potential role as monotherapy or in combination with existing antifibrotic therapies. Data Sources: A literature search was conducted using PubMed, Embase, ClinicalTrials.gov, and relevant conference proceedings from January 2018 through December 2025. Search terms included nerandomilast, BI 1015550, Jascayd, phosphodiesterase-4B inhibitor, idiopathic pulmonary fibrosis, progressive pulmonary fibrosis, interstitial lung disease, FIBRONEER-IPF, and FIBRONEER-ILD. Human studies published in English were included. Study Selection and Data Extraction: Original clinical studies, phase II and phase III trials, subgroup analyses, and regulatory publications evaluating nerandomilast in patients with IPF or PPF were reviewed. Studies were selected based on relevance to efficacy, safety, mechanism of action, and clinical outcomes. Data regarding study design, patient population, forced vital capacity (FVC) outcomes, adverse events, and concomitant antifibrotic use were extracted and qualitatively synthesized. Data Synthesis: Nerandomilast was approved in October 2025 for the treatment of IPF and PPF, representing the first PDE4B inhibitor approved for fibrotic lung disease. By inhibiting PDE4B, nerandomilast increases intracellular cyclic adenosine monophosphate (cAMP) levels, resulting in reduced inflammatory cytokine production and decreased fibroblast activation. Clinical trials, including the phase III FIBRONEER-IPF study, demonstrated a significant reduction in the rate of FVC decline compared with placebo, indicating attenuation of disease progression. Benefits were observed both in patients receiving nerandomilast alone and in those receiving background antifibrotic therapy with pirfenidone or nintedanib. Overall, nerandomilast demonstrated a favorable benefit-risk profile and offers a mechanistically distinct approach compared with currently available antifibrotic agents. Conclusions: Nerandomilast provides a novel anti-inflammatory and antifibrotic treatment option for patients with IPF and PPF. Available evidence suggests meaningful reductions in lung function decline with acceptable tolerability, including use alongside established antifibrotic therapies. As longer-term and real-world data emerge, nerandomilast may become an important component of the therapeutic strategy for progressive fibrotic lung diseases.

Background: Ischemic stroke is the leading cause of long-term disability in the United States. To reduce the likelihood of debilitating outcomes, early treatment with fibrinolytics is necessary; however, many struggle to identify strategies that limit time to treatment. The purpose of this study is to identify if implementing a process for obtaining laboratory blood draws by emergency medical services (EMS) prior to patient arrival at the hospital will reduce the door-to-needle time for patients arriving with acute ischemic stroke. Objectives: To compare the door-to-needle time for patients with acute ischemic stroke who had blood drawn via EMS versus in hospital. Methods: This single-center, retrospective cohort study was conducted from 2015 to 2017 at a 433-bed designated Level II Trauma Center and Comprehensive Stroke Center community hospital. A comprehensive chart review was done via stroke coordinator binders and electronic medical record. Adult patients ≥18 years of age with an acute ischemic stroke diagnosis who met criteria for and received alteplase were included in the study. Patients were excluded if they did not arrive via EMS. The primary end point assessed time to fibrinolytic treatment via door-to-needle times. Results: A total of 66 patients were included with 28 in the EMS laboratory drawn group and 38 in the usual group. Median door-to-needle time was 57.5 ± 19.0 minutes in the EMS group and 55.0 ± 31.9 minutes in the usual care group (p = 0.818). Conclusions: Collection of blood for laboratories by EMS personnel did not significantly shorten door-to-needle time.

Background: Among the many clinical decision support (CDS) mechanisms available in electronic health record (EHR) systems, dose range checking (DRC) is one of the most impactful safeguard tools integrated within most computerized provider order entry (CPOE) workflows. Unfortunately, improper configurations and lack of resources to maintain and monitor CDS systems can hinder and even disrupt daily clinical operations. Objective: This article seeks to highlight the impact that informatics pharmacists can make by implementing different strategies to decrease nuisance alerts and create clinically meaningful DRC alerts that guide clinicians in their practice. Methods: Following the activation of the DRC application for 3623 medication groupers (ie, generic drugs and all their dosage form variations), informatics pharmacists implemented strategies to monitor DRC alert output and decrease the number of inappropriate alerts. Such strategies included weekly monitoring of alerts, modification of order sentences (including dose, route, and age/weight filters), update to the rule triggering the alerts, and modifications of the preference settings. Results: From July to September 2018, an average of 70 DRC tables were reviewed by informatics pharmacists, reducing the number of overridden DRC alerts to 4796 in the first week of September—a 63% decrease in a 3-month period. Conclusions: By reducing the number of DRC nuisance alerts and improving the clinical content of DRC alerts, informatics pharmacists can contribute to lowering alert fatigue and improving providers’ trust in CDS alerts.