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Pharmacology Pearls - Cellulitis and Outpatient Vancomycin

Rob Orman, MD and Bryan Hayes, PharmD, DABAT
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06:21
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Nurses Edition Commentary

Lisa Chavez, RN and Kathy Garvin, RN
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00:26

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EM:RAP 2017 June Written Summary 647 KB - PDF

In patients with soft tissue infection, the practice of using outpatient IV antibiotics is becoming more commonplace. Vancomycin is one of the most frequently selected agents, but is it being used correctly? Is once a day enough? Bryan Hayes says… no. Most people will clear vancomycin before the 24 hour mark and need to be dosed at least twice daily. But this brings up the larger question- is IV vancomycin the best choice in the first place?

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Xander Merboo -

I'm wondering why we're talking about starting with IV formulations of subsequent PO regimens that have equivalent bioavailability. Seems like there has been a big push lately to NOT start IV abx if the regimen is able to be given PO due to lack of difference in effect

Bryan H. -

Great point. Apologies if that was not clear in the podcast. In practice, the decision to start IV antibiotics and 'observe' the patient overnight for improvement is routinely done. Most patients can receive oral antibiotics right from the start without the need for IV. In fact, even one-time dose of IV antibiotics portends higher likelihood of c. diff and antibiotic-associated diarrhea (https://www.ncbi.nlm.nih.gov/pubmed/25149599). One helpful article that might guide who should get IV (vs. PO) outlines risk factors for failing outpatient therapy. Here is a quick summary: https://em.umaryland.edu/educational_pearls/2429/.

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Don’t Fear The Stink! Full episode audio for MD edition 245:23 min - 342 MB - M4AEM:RAP 2017 June Canadian Edition Canadian 24:49 min - 34 MB - MP3EM:RAP 2017 June German Edition Deutsche 68:28 min - 94 MB - MP3EM:RAP 2017 June French Français 29:35 min - 41 MB - MP3EMRAP 2017 June Resumen Español Español 94:49 min - 130 MB - MP3EM:RAP 2017 June Board Review Answers 187 KB - PDFEM:RAP 2017 June Board Review Questions 170 KB - PDFEM:RAP 2017 June MP3 328 MB - ZIPEM:RAP 2017 June Written Summary 647 KB - PDF

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