Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

2 days ago
A recent study suggests that discontinuation of dexamethasone premedication after two uneventful infusions or reduction in the dose of dexamethasone paclitaxel premedication are both safe alternatives to high-dose steroid premedications recommended in product labelling.
01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute. 

Vancomycin with beta-lactam reduces SSI, ups AKI risk after cardiac surgery

30 Jul 2017

Combination prophylaxis with vancomycin and beta-lactam reduces surgical site infections (SSIs) in cardiac surgery patients better than either antimicrobial alone, a new retrospective cohort study shows. However, combination prophylaxis also increases the risk of postoperative acute kidney injury (AKI).

Participants who underwent hysterectomy (n=1,724), colorectal (n=7,337), vascular (n=7,405), orthopaedic joint replacement (n=33,848) and cardiac (n=19,787) procedures were recruited and further stratified according to prophylaxis received: vancomycin alone, beta-lactam alone or combination.

SSI, 7-day incidence of postoperative AKI and 90-day incidence of Clostridium difficile infection (CDI) were compared among the three groups.

SSI was detected in 0.95 percent (n=66) of cardiac surgery patients who received combination prophylaxis. In comparison, 1.48 percent (n=190) of patients receiving single-agent prophylaxis developed SSI.

The risk of postoperative SSI in cardiac surgery was lower after receiving combination prophylaxis (adjusted risk ratio [aRR], 0.61; 95 percent CI, 0.46 to 0.83). SSI risk was also lower with combination prophylaxis than with beta-lactam (aRR, 0.61; 0.45 to 0.83) or vancomycin (aRR, 0.65; 0.43 to 0.99) alone.

On the other hand, combination prophylaxis was not associated with significantly reduced SSI in the other types of surgeries.

Of the 12,508 participants who received combination prophylaxis, 0.72 percent (n=90) developed CDI. In comparison, 0.81 percent (n=486) of participants who received a single agent developed CDI. There was no association between CDI and combination prophylaxis (aRR, 1.01; 0.78 to 1.31).

Combination prophylaxis was associated with elevated risks of AKI 7 days after orthopaedic joint replacement (aRR, 1.12; 1.02 to 1.23) and vascular surgery (aRR, 1.25 1.04 to 1.50) compared with either beta-lactam or vancomycin alone.

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Most Read Articles
01 Oct 2013

Heart disease is still New Zealand’s biggest killer, with one Kiwi dying from coronary heart disease every 90 minutes. Pharmacy Today New Zealand looks at how pharmacists can help

Dr. James Salisi, 01 Jul 2014

The recent spike in the number of new cases of human immunodeficiency virus (HIV) infection in the Philippines means that clinicians and pharmacists alike may need to increase their awareness and competency in prescribing and monitoring HIV treatment. Although taught in medical and pharmacy schools, the scarcity in exposure to clinical cases before highlights the need to for physicians and pharmacist to review HIV pharmacotherapy in order to cater to the increasing HIV patient population.

2 days ago
A recent study suggests that discontinuation of dexamethasone premedication after two uneventful infusions or reduction in the dose of dexamethasone paclitaxel premedication are both safe alternatives to high-dose steroid premedications recommended in product labelling.
01 Sep 2017
Complementary medicines can play an important part in maintaining wellness, preventing deficiencies and optimizing health outcomes, says Dr Lesley Braun PhD, Director of the Blackmores Institute.