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What is InpharmD™?


Literature searching is tedious. InpharmD™ is here to help.

Clinical pharmacists can ask any question, anytime, from anywhere, and we’ll perform a custom literature search.

(And a 32% chance it’s already been asked.)


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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

Should we still consider gentamicin for streptococcus and staphylococcus endocarditis? The data seems limited and out...
What do treatment guidelines for hypercalcemia or literature say about the use of denosumab in the inpatient setting ...
Can ampicillin be administered as 12 grams over 24h at room temperature?
Is there data supporting safety and efficacy of oral caffeine for pediatric migraine and at what dose
What is the clinical efficacy of metronidazole 500 mg IV q12 hours when compared to metronidazole 500 mg IV q8 hours?

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

Author:Rachel Deryck, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Gentamicin continues to be recommended in select cases of infective endocarditis, but its role has become increasingly limited due to concerns over nephrotoxicity and a lack of demonstrated mortality benefit in recent analyses. Current societal guidelines support short-term adjunctive gentamicin use for certain streptococcal infections and prosthetic valve endocarditis caused by Staphylococcus aureus, typically restricting the duration to two weeks. However, its omission is now common in nati...

The 2015 American Heart Association (AHA) scientific statement provided an updated evidence-based framework for the diagnosis, antimicrobial management, and surgical indications in adult patients with infective endocarditis (IE), incorporating data from studies published between 2005 and 2013. It was stated that gentamicin enhances the bactericidal activity of penicillin or ceftriaxone against viridans group streptococci (VGS) and Streptococcus gallolyticus (bovis), with evidence of synergy in both in vitro studies and animal models of IE. In patients with uncomplicated IE, preserved renal function, and a rapid clinical response, a 2-week regimen that includes gentamicin is reasonable. For IE caused by group B, C, or G streptococci, gentamicin may be added during the initial 2 weeks of a 4- to 6-week course with penicillin or ceftriaxone. However, its use is not advised for right-sided staphylococcal native valve endocarditis (NVE). In staphylococcal IE involving prosthetic valves o...

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A search of the published medical literature revealed 2 studies investigating the researchable question:

Should we still consider gentamicin for streptococcus and staphylococcus endocarditis? The data seems limited and outdated.

Level of evidence
A - Multiple high-quality studies with consistent results  

READ MORE→

[1] Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association [published correction appears in Circulation. 2015 Oct 27;132(17):e215. doi: 10.1161/CIR.0000000000000332.] [published correction appears in Circulation. 2016 Aug 23;134(8):e113. doi: 10.1161/CIR.0000000000000427.] [published correction appears in Circulation. 2018 Jul 31;138(5):e78-e79. doi: 10.1161/CIR.0000000000000594.]. Circulation. 2015;132(15):1435-1486. d...

InpharmD's Answer GPT's Answer

Author:Dena Homayounieh, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Although studies specific to inpatient settings are limited, current societal guidelines and available data support denosumab as a reasonable option for patients with creatinine clearance (CrCl) less than 30 mL/min, particularly when bisphosphonates are contraindicated. Denosumab is not renally cleared and does not require dose adjustment in renal impairment; however, the risk of severe hypocalcemia is elevated in this population, especially without adequate calcium and vitamin D supplementat...

The Endocrine Society clinical practice guidelines for the treatment of hypercalcemia of malignancy in adults, suggest a longer infusion over 30 to 60 minutes in patients with glomerular filtration rate (GFR) <60 mL/min and caution that zoledronic acid may cause kidney damage especially if the glomerular filtration rate is <30 to 35 mL/minute. The panel also recommends denosumab as an alternative to bisphosphonates in patients with severe renal impairment or those with bisphosphonate-refractory hypercalcemia. However, it is emphasized that patients with GFR<30 mL/min are at increased risk of hypocalcemia; therefore, close monitoring of serum calcium and consideration of dose reduction are recommended. [1] Available review articles highlight that denosumab is not cleared by the kidney and has no renal toxicity, making it useful in patients with impaired renal function who cannot take bisphosphonates. It was also mentioned that because intravenous (IV) bisphosphonates may worsen re...

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A search of the published medical literature revealed 9 studies investigating the researchable question:

What do treatment guidelines for hypercalcemia or literature say about the use of denosumab in the inpatient setting for patients with a crcl of less than 30 mL/min? what about the use of zoledronic acid in this same setting and crcl cut off?

Level of evidence
C - Multiple studies with limitations or conflicting results  

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[1] El-Hajj Fuleihan G, Clines GA, Hu MI, et al. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine - - Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2023;108(3):507-528. doi:10.1210/clinem/dgac621
[2] Guise TA, Wysolmerski JJ. Cancer-Associated Hypercalcemia [published correction appears in N Engl J Med. 2022 Jul 7;387(1):96. doi: 10.1056/NEJMx220006.]. N Engl J Med. 2022;386(15):1443-1451. doi:10.1056/NEJMcp2113128
[3] Block GA, Bone HG, Fang L, Lee E, Padhi D. A single-dose study of denosumab in patients with various degrees of renal impairment. J Bone Min...

InpharmD's Answer GPT's Answer

Author:Neil Patel, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Clinical literature on 24-hour infusions of ampicillin is primarily presented in case reports. Pharmacokinetic studies show that ampicillin, depending on the concentration, maintains just above 90% concentration after 24 hours at room temperature, suggesting a 24-hour infusion is viable. Buffered solutions may have better stability, and solutions that are refrigerated before infusion may be more stable during a 24-hour infusion period.

The Infectious Diseases Society of America (IDSA) published guidelines for the diagnosis and treatment of prosthetic joint infections and native vertebral osteomyelitis in 2013 and 2015, respectively. Both guidelines discuss pathogen-specific intravenous antimicrobial therapy. For the management of penicillin-susceptible Enterococcus species, the expert panel recommends penicillin G 20–24 million units IV every 24 hours continuously or in 6 divided doses or ampicillin sodium 12 g IV every 24 hours continuously or in 6 divided doses as preferred treatment options. These recommendations offer clear guidance for managing these challenging infections. [1-2] A 2023 stability assessment investigated ampicillin sodium at two concentrations (15 mg/mL and 50 mg/mL) in 250 mL polyisoprene elastomeric infusion pumps (EIPs), with the goal of informing their suitability for outpatient parenteral antimicrobial therapy (OPAT). Ampicillin diluted in 0.9% sodium chloride was analyzed under refrige...

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A search of the published medical literature revealed 5 studies investigating the researchable question:

Can ampicillin be administered as 12 grams over 24h at room temperature?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015;61(6):e26-e46. doi:10.1093/cid/civ482
[2] Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25. doi:10.1093/cid/cis803
[3] Rodríguez-Martínez L, Castro-Balado A, Hermelo-Vidal G, et al. Ampicillin Stability in a Port...

InpharmD's Answer GPT's Answer

Author:Neil Patel, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Data assessing the use of oral caffeine for pediatric migraine management is limited and primarily derived from a small pilot trial (see Table 1). In this trial, ibuprofen combined with caffeine (50-100 mg) provided faster and greater pain relief compared to ibuprofen alone, though findings were not statistically significant. While caffeine may enhance analgesic efficacy when utilized as an adjunct in migraine management, its optimal dosing, safety, and overall efficacy in pediatric patients ...

A 2016 review article discussing the treatment of pediatric migraine highlights that acetaminophen and ibuprofen are the most commonly used over-the-counter options for pain relief and fever reduction in children. Both are effective and well tolerated, though ibuprofen is considered a better option for pain relief. However, the authors note that, based on their clinical experience, a combination of acetaminophen and a caffeine compound given at the onset of a migraine can provide faster and more effective relief than either agent alone. Ergot-based therapies, such as dihydroergotamine and ergotamine combined with caffeine, may also be beneficial during a migraine attack but should be used cautiously due to their vasoconstrictive effects; an angio-MRI may be considered before prescribing a caffeine-containing medication. Despite being a viable therapeutic agent, the authors emphasize that caffeine can still act as a migraine trigger, highlighting the importance of identifying and avo...

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A search of the published medical literature revealed 1 study investigating the researchable question:

Is there data supporting safety and efficacy of oral caffeine for pediatric migraine and at what dose?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Teleanu RI, Vladacenco O, Teleanu DM, Epure DA. Treatment of Pediatric Migraine: a Review. Maedica (Bucur). 2016;11(2):136-143.
[2] Lipton RB, Diener HC, Robbins MS, Garas SY, Patel K. Caffeine in the management of patients with headache. J Headache Pain. 2017;18(1):107. Published 2017 Oct 24. doi:10.1186/s10194-017-0806-2

InpharmD's Answer GPT's Answer

Author:Younghee Kwon, PharmD, BCPS + InpharmD™ AI

INTRODUCTION BY INPHARMD™ RESEARCHER

Available data from both a meta-analysis and cohort studies consistently demonstrated no statistically significant differences in clinical outcomes between metronidazole 500 mg IV administered every 12 hours versus every 8 hours. Across varied infection types, including anaerobic bacteremia and post-surgical prophylaxis, 12-hour dosing showed comparable rates of clinical cure, hospital length of stay, and mortality. Overall, these findings suggest that Q12H dosing may be clinically non-inferi...

A 2016 poster abstract details a retrospective chart review (N= 81) comparing metronidazole 500 mg twice daily (BID) versus three times daily (TID) for appendicitis or diverticulitis. Clinical outcomes and readmission rates were assessed at 30 days follow-up. Patients were excluded if they had concomitant infection, fistula, or chronic appendicitis. The authors did not find a statistical difference in resolution rates (values unspecified). The 30-day readmission rates were similarly nonsignificant with only 1 or 0 patients in the appendicitis or diverticulitis BID and TID groups being readmitted (p= 1 when comparing appendicitis and p= 0.417 when comparing diverticulitis). Yet, due to the small sample size and retrospective nature of the study, stronger evidence is needed to confirm these findings. [1] Despite the limited clinical outcomes regarding Q12H vs Q8H metronidazole dosing, relatively dated pharmacokinetic (PK)/pharmacodynamic (PD) studies have observed efficient blood l...

READ MORE→

A search of the published medical literature revealed 3 studies investigating the researchable question:

What is the clinical efficacy of metronidazole 500 mg IV q12 hours when compared to metronidazole 500 mg IV q8 hours?

Level of evidence
B - One high-quality study or multiple studies with limitations  

READ MORE→

[1] Béïque L, Tsang C, Geertsema S, et al. Comparison of metronidazole q12h to q8h in combination with other antibiotics on the clinical outcome and readmission rate of patients with appendicitis and diverticulitis. Open Forum Infectious Diseases. 2016;3(suppl_1):1037.
[2] Lamp KC, Freeman CD, Klutman NE, Lacy MK. Pharmacokinetics and pharmacodynamics of the nitroimidazole antimicrobials. Clin Pharmacokinet. 1999;36(5):353-373. doi:10.2165/00003088-199936050-00004
[3] Sprandel KA, Drusano GL, Hecht DW, Rotschafer JC, Danziger LH, Rodvold KA. Population pharmacokinetic modeling and Monte C...

Find answers, not documents.

Before InpharmD™


BeforeTime
Your team spends hours per week cobbling together literature from different studies, many behind paywalls, leaving little time for action.
BeforeTime
TI opportunities are discovered (or presented by third parties) months after the fact, resulting in costly missed savings.
BeforeTime
Decisions may be made without a complete picture, or pushed out while gathering consensus.

After InpharmD™


BeforeTime
InpharmD™ delivers customized, actionable drug information in real time, so you can focus on execution.
BeforeTime
Your team stays informed immediately when new data emerges or prices change, and you’ll always be the first to know when any changes impact your formulary.
BeforeTime
With InpharmD™, your team can make faster, more informed decisions and move forward with confidence.

What Clinical Pharmacists Are Saying...


     

Assists in our research and is a great way or us to get an answer to a medical question without spending an average of 2 hours researching UptoDate or PubMed ourselves.


  Jordan C., PharmD, New Jersey

     

Huge time saver with thorough responses.


  Jane D., PharmD, Georgia

     

I’d never heard of a DI pharmacist before, now I have one. In. My. Pocket. Amazing!


     

Holy Shhh. Cow! Holy Cow! These summaries are beautiful.


  Jane D., PharmD, Georgia

     

I just want to say: This is such a brilliant idea! You people are genius.


     

OH MY GOD WHERE HAVE YOU BEEN ALL MY LIFE!


     

I can’t tell you how much time I spend literature searching. And how I CANNOT STAND PAYWALLS. THIS IS UNBELIEVABLE!! (covers face for sec) thank you, thank you, thank you!


     

So they’re basically connecting academic researchers with front line providers and then automating everything. It’s simply brilliant.


     

The clinical pharmacist was our secret weapon anyway. (Smiles wryly) This pharmacist AI seems superhuman. I’m just blown away, honestly. (Looks at camera somberly.)


     

It’s an ENTIRE DI DEPARTMENT, that lives in Epic. Give me a second. I’m just having a hard time wrapping my head around that.


     

Sorry just give me a second, my mind is blown.


     

Stop reading and just download the app already! I’ve tried all of them. This is by far the most advanced, best-in-class.


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