Pharmacy/Pharmacology

New RCT – Remifentanil vs. Neuromuscular Blockers for RSI First-Pass Success

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This randomized, non-inferiority trial found that remifentanil plus hypnotics were inferior to neuromuscular blocking agents plus hypnotics for rapid sequence intubation of patients at risk of aspiration in the operating room setting.

Source
Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. JAMA. 2023 Jan 3;329(1):28-38. doi: 10.1001/jama.2022.23550.

Point-Counterpoint | IV Haloperidol is Safe for Emergency Department Use

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The next couple of reviews will look at different authors making their case for why intravenous (IV) haloperidol (Haldol) should or should not be used in the emergency department setting.

Source
Haloperidol May Be Safely Administered Intravenously in the Emergency Department. Annals of Emergency Medicine. 2023;81:95-96. doi: 10.1016/j.annemergmed.2022.07.004

VIZIR RCT – Zinc for COVID-19?

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Zinc supplementation for patients with COVID-19 decreased 30-day ICU admission rate and led to shorter symptom duration. Subgroup analysis showed these effects were especially pronounced for elderly patients and those with comorbid conditions.

Source
Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. Clin Infect Dis. 2023;76(2):185-191. doi:10.1093/cid/ciac807

New RCT – High-Dose or Standard-Dose Cephalexin for Cellulitis?

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In this trial, investigators compared high-dose cephalexin (1000 mg QID) to standard dose (500 mg QID) for the treatment of non-purulent cellulitis. They found that high-dose cephalexin was associated with fewer instances of treatment failure but a higher proportion of adverse events.

Source
High-dose cephalexin for cellulitis: a pilot randomized controlled trial. CJEM. 2023 Jan;25(1):22-30. doi: 10.1007/s43678-022-00433-7. Epub 2023 Jan 2.

Clindamycin or Linezolid for Toxic Shock?

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Current guidelines dictate that treatment of Group A Streptococcus pyogenes (GAS) necrotizing soft tissue infections (NSTI) and toxic shock syndrome (TSS) include clindamycin in conjunction to a beta lactam in order to inhibit exotoxin production; but might we consider co-treatment with linezolid instead?

Source
Should Linezolid Replace Clindamycin as the Adjunctive Antimicrobial of Choice in Group A Streptococcal Necrotizing Soft Tissue Infection and Toxic Shock Syndrome? A Focused Debate. Clin Infect Dis. 2023 Jan 13;76(2):346-350. doi: 10.1093/cid/ciac720.

High-Dose Nitroglycerin Infusion in Sympathetic Crashing Acute Pulmonary Edema (SCAPE)

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This study suggests that high-dose nitroglycerin infusion may be a safe alternative to intermittent bolus dosing for SCAPE, but prospective trials are needed to determine optimal initial rates and titration strategies, as well as the proper use of other adjunct therapies.

Source
High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: The HI-DOSE SCAPE study. Am J Emerg Med. 2022 Oct 18;63:74-78. doi: 10.1016/j.ajem.2022.10.018. Epub ahead of print.

Amiodarone vs Lidocaine for In-Hospital Cardiac Arrest

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For in-hospital ventricular fibrillation/ventricular tachycardia (VF/VT) arrest (IHCA), lidocaine may have more favorable outcomes compared to amiodarone.

Source
Comparative Effectiveness of Amiodarone and Lidocaine for Treatment of In-Hospital Cardiac Arrest (IHCA). Chest. 2022 Nov 1;S0012-3692(22)04039-9. doi: 10.1016/j.chest.2022.10.024. Online ahead of print.

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