A 2020 review article provided relevant pharmacokinetic and follow-up studies regarding the interaction between carbapenems and valproic acid. One cited pharmacokinetic study of 36 patients reported a continual decrease in valproic acid concentrations for up to 7 days after discontinuing meropenem, which then gradually increased to baseline concentrations after 8 to 14 days. In general, the effects seem to last for 7 days, followed by a 7- to 14-day recovery period after stopping carbapenem, suggesting an interaction via enzyme inhibition. [1,2] A 2018 review notes that the majority of data describing drug interactions of valproic acid and carbapenems are based primarily on case reports and retrospective studies. The mechanism responsible for the interaction between valproic acid and carbapenems is largely unknown, but it is thought that carbapenems act by inhibiting the activity of the acylpeptide hydrolase enzyme that converts valproic acid-glucuronide to valproic acid. This le...

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A 2023 study abstract describes the effectiveness of intravenous push (IVP) versus extended infusion (EI) cefepime in hematopoietic stem cell transplant (HSCT) recipients with neutropenic fever. The retrospective analysis included 120 patients, with 40 receiving IVP cefepime and 80 receiving EI cefepime for at least 48 hours. The primary outcome, defervescence at 72 hours, occurred in 70% of IVP patients and 63.8% of EI patients, which was not statistically significant. Secondary outcomes, including 30-day in-hospital mortality, ICU transfer within 72 hours, ICU length of stay, hospital length of stay, breakthrough infection, and escalation of gram-negative therapy within 72 hours, were also similar between the two groups. The study concluded that no significant differences in clinical outcomes were observed when administering cefepime as IVP or EI for the treatment of neutropenic fever in HSCT recipients. [1]

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The 2022 International Society for Peritoneal Dialysis (ISPD) guideline provides recommendations on prevention and treatment of peritonitis. It was emphasized that the stability and compatibility of antibiotics in peritoneal dialysis (PD), as described in a 2022 review article, is one of the factors influencing treatment success. The panel states that cefepime remains stable for 14 days in dextrose-based PD solutions when refrigerated, while vancomycin is stable for 28 days at room temperature, though higher ambient temperatures reduce its stability. Additionally, vancomycin’s stability in icodextrin-based PD solutions has been confirmed for 14 days at both 4°C and 25°C. [1-5] According to a 2022 review article on stability and compatibility of antibiotics in PD solutions, cefepime is less commonly used for PD-related peritonitis compared to other cephalosporins, and stability data for intraperitoneal (IP) administration is limited. Cefepime 312.5 mg in a 1.25 L bicarbonate compa...

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The recommendation for a 30 mL/kg crystalloid fluid bolus in a septic patient was established by the Surviving Sepsis Campaign (SSC), with the current guidelines published in 2018 still recommending the bolus regimen (strong recommendation, low quality of evidence). Since its publication, reviews and commentaries from real world settings note the minimal supporting clinical data and reliance on expert opinion for this recommendation. These reviews suggest that the 30 mL/kg fluid challenge can needlessly expose patients to large volumes of fluid, and could actually be harmful by overloading organ function and paradoxically worsening shock. Other guidelines like American College of Emergency Physicians (ACEP) recommend individualizing fluid resuscitation needs for each patient. [1-3] A 2020 review discussing the lack of supporting evidence for fluid resuscitation in septic shock recommends a flat initial bolus of 500 mL of balanced crystalloid solutions, followed by monitoring of p...

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The American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) developed the 2022 practice parameter update on drug allergies, which addresses the topic of beta-lactam cross-reactivity. It was highlighted that guidance on administering carbapenems to patients with penicillin allergy has changed since the previous drug allergy practice parameter update. Though not specific to ampicillin, the panel suggests that in patients with a history of penicillin or cephalosporin allergy, carbapenems may be administered without testing or additional precautions, even in cases where the previous reaction was anaphylactic (conditional recommendation, moderate certainty of evidence). [1] The reported incidence of carbapenem allergy ranges from 0.3% to 3.7%. Clinical cross-reactivity between carbapenems and other beta-lactams is low, with multiple review articles reporting a cross-sensitivity risk of less than 1% between penicil...

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