SCPA Posted April 13, 2018 Share Posted April 13, 2018 Thoughts on gent vs daptomycin in tx of VRE uti? Link to comment Share on other sites More sharing options...
charlottew Posted April 13, 2018 Share Posted April 13, 2018 May depend on your local antibiogram. Is it inpatient or out? Symptomatic? Gentamicin can kill the cilia of the ear, but I guess I have used it more often then dapto. Do you have a local pharmacist you can consult? There's always linezolid. I have seen bad side effects (terminal pulmonary fibrosis), but those are supposed to be rare... Link to comment Share on other sites More sharing options...
SCPA Posted April 14, 2018 Author Share Posted April 14, 2018 3 hours ago, charlottew said: May depend on your local antibiogram. Is it inpatient or out? Symptomatic? Gentamicin can kill the cilia of the ear, but I guess I have used it more often then dapto. Do you have a local pharmacist you can consult? There's always linezolid. I have seen bad side effects (terminal pulmonary fibrosis), but those are supposed to be rare... Yes this pt is symptomatic .. many comorbidities and hx of urosepsis. I called her urologist who said to treat it. Work out in the sticks in family medicine. Local retail pharmacists seem to be of little help whenever called to discuss a case which could use pharm input -- anyone else experience this? Today I was asked how to spell one of the antibiotics in question from the pharmacist.. Anyway, I spoke with one of our ID docs who informed me linezolid went generic like last week and can now be had at a reasonable price..Easy solution. I was seriously dreading the the logistics of ordering gentamycin outpatient and following drug trough levels, renal fxn etc.. . And apparently the once daily dosing is only recommended as IV. I've never ordered daptomycin. Link to comment Share on other sites More sharing options...
SCPA Posted April 14, 2018 Author Share Posted April 14, 2018 3 hours ago, charlottew said: Gentamicin can kill the cilia of the ear. Yes most certainly gent is nephro and oto toxic! CAn you hear me now!? Link to comment Share on other sites More sharing options...
charlottew Posted April 14, 2018 Share Posted April 14, 2018 50 minutes ago, SCPA said: Yes this pt is symptomatic .. many comorbidities and hx of urosepsis. I called her urologist who said to treat it. Work out in the sticks in family medicine. Local retail pharmacists seem to be of little help whenever called to discuss a case which could use pharm input -- anyone else experience this? Today I was asked how to spell one of the antibiotics in question from the pharmacist.. Anyway, I spoke with one of our ID docs who informed me linezolid went generic like last week and can now be had at a reasonable price..Easy solution. I was seriously dreading the the logistics of ordering gentamycin outpatient and following drug trough levels, renal fxn etc.. . And apparently the once daily dosing is only recommended as IV. I've never ordered daptomycin. Oh ID consult - well, there ya go. If they recommend linezolid, and if you are treating as an outpatient, then that is the way to go. I work only inpatient, so the idea of a PO antibiotic seems exotic and a bit quaint. But yeah, linezolid. Good luck! This person sounds fairly ill at baseline.. Link to comment Share on other sites More sharing options...
QCEMPA Posted April 14, 2018 Share Posted April 14, 2018 Why no love for fosfomycin? 3 g one time oral dosing with possible redosing in 3 days if no improvement. Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted April 15, 2018 Administrator Share Posted April 15, 2018 On 4/13/2018 at 10:40 PM, LA_EM_PA said: Why no love for fosfomycin? 3 g one time oral dosing with possible redosing in 3 days if no improvement. Just yesterday I ran into a patient whom I had treated with fosfomycin 4y ago at a previous practice. She had to pay $50 out of pocket for it, but she's developed allergies to pretty much everything else over a lifetime of chronic UTIs, and she still uses it to this day for her UTIs. She remembered me by sight and how much she loved that I'd found that for her. In truth, I was so new when I did that I was reading all the fine print in the Sanford Guide... Link to comment Share on other sites More sharing options...
sk732 Posted April 15, 2018 Share Posted April 15, 2018 On 2018-04-14 at 0:40 AM, LA_EM_PA said: Why no love for fosfomycin? 3 g one time oral dosing with possible redosing in 3 days if no improvement. What's old is new, what's new is old...learned about it in school, wrote nada for past 7.5 years, wrote three Rx for it in the past year because of multi-drug resistant pee bugs around here. Nice to see linezolid going generic - it ain't cheap...usually if I see people on I, it's because they have seen the exterminators. Around here, for stewardship and cost reasons, most people getting put on it or ertapenem or other nuke drugs like that need an ID consult first. SK Link to comment Share on other sites More sharing options...
cinntsp Posted April 16, 2018 Share Posted April 16, 2018 On 4/13/2018 at 10:39 AM, SCPA said: Thoughts on gent vs daptomycin in tx of VRE uti? Gent is not meant to be used as a single agent for treatment of pretty much anything and is not appropriate for the outpatient setting or arguably even inpatient without ID being involved. Dapto is a good drug but is IV only. 8mg/kg once daily and done. Linezolid or fosfomycin would be the better way to go in your case. Link to comment Share on other sites More sharing options...
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