Journal of Pharmacy Technology

To review the role of Chlamydia pneumoniae in the pathogenesis of coronary heart disease (CHD).

Articles indexed in MEDLINE from 1966 to April 1998 as well as references identified in these articles were searched.

Studies investigating seroepidemiologic and pathologic evidence for an association of C. pneumoniae with CHD and randomized clinical trials evaluating the effectiveness of antibiotic therapy on cardiovascular outcomes are presented.

Seroepidemiologic and pathologic studies provide circumstantial evidence of an association between C. pneumoniae and CHD. Results of initial small trials suggest a reduction in CHD events in patients treated with macrolide antibiotics.

Direct evidence implicating chlamydial infection in CHD is lacking. Formal recommendations for antimicrobial therapy should not be made until results of additional clinical trials are available.

To report a suspected case of subclinical neuroleptic malignant syndrome (NMS) that possibly responded to electroconvulsive therapy.

A 51-year-old white woman with a history of schizoaffective disorder, depressed type, was admitted to our inpatient unit after presenting with all features of NMS except fever. The patient's symptoms were markedly improved after eight courses of electroconvulsive therapy.

The “spectrum concept” of NMS is increasingly being recognized. More controlled studies are required to understand the components of this syndrome.

Trimethoprim/sulfamethoxazole (TMP/SMX) is an important antibiotic for the treatment and prevention of opportunistic infections in patients infected with HIV. However, the high rate of hypersensitivity reactions in this population of patients significantly limits the use of this drug.

To determine whether early initiation of Pneumocystis carinii pneumonia prophylaxis with TMP/SMX in patients with HIV whose CD4+ lymphocyte count is >200 cells/mm³ results in a decrease in the number of hypersensitivity reactions.

Retrospective cohort study. The main outcomes measured were the number of and the time to hypersensitivity reactions.

There were 134 patients who met the eligibility criteria (62 with a CD4+ cell count ≤200 cells/mm³ and 72 with a CD4+ cell count >200 cells/mm³). Overall, 47 (35.1%) patients had adverse reactions including 29 (21.6%) episodes of hypersensitivity. The mean time to a hypersensitivity reaction for the group with a CD4+ cell count ≤200 cells/mm³ was 155 days and for the group with a CD4+ cell count >200 cells/mm³ it was 261 days (mean difference = 106; p = 0.07; 95% CI 66 to 146 days). The number of episodes of hypersensitivity reactions was similar among the two groups: 15 (24.2%) and 14 (19.4%), respectively (p = 0.5; relative risk for CD4+ cell count ≤200 cells/mm³ = 1.14; 95% CI 0.7 to 1.7). Log-rank test did not reveal a significant difference in reaction-free survival among the groups (p = 0.3).

Our data suggest that initiation of P. carinii pneumonia prophylaxis with TMP/SMX at a CD4+ cell count >200 cells/mm³ would lead to prolongation of the mean time to a hypersensitivity reaction, but would not significantly decrease the risk of a reaction over time.

To determine whether losartan usage follows the hospital's guidelines in terms of indications and reasons for use and to assess the accuracy of physicians in completing the losartan usage monitoring forms.

Drug utilization survey.

A major government hospital in Hong Kong.

Inpatients or outpatients prescribed losartan for the first time.

Physicians were to complete a monitoring form with both indications and reasons for losartan use.

The appropriateness of losartan prescribing was evaluated in terms of indications (for hypertension with impaired left-ventricular function or hypertension in diabetic patients with persistent proteinuria) and reasons for preferred use (previous intolerance to adverse effects of angiotensin-converting enzyme inhibitors). The accuracy of completed monitoring forms was also assessed.

Forty-eight patients were prescribed losartan since its addition to the hospital formulary through the end of the study period (September 1997-May 1998). A review of medical records (regardless of the information provided by the physicians on the monitoring forms) revealed that 39 patients (81.3%) were prescribed losartan for appropriate indications and that 22 (45.8%) were given losartan rather than angiotensin-converting enzyme inhibitors for appropriate reasons according to the guidelines. Both appropriate indications and reasons were met in only 15 patients (31.3%). Of the 48 monitoring forms that were collected, three (6.3%) were not completed. The concordance rate of information provided by the doctors and information from case notes was 61.5% for indications and 34.8% for reasons of preferred use.

Adherence to the hospital's usage guidelines and accuracy of the monitoring forms were suboptimal. Considering the high cost of losartan and its potential for long-term use, more educational activities, better dissemination of information, and more frequent evaluation of the acceptability of recommended usage guidelines are warranted.

To provide an overview of pharmacy technician distance learning based on an established program.

Technical college pharmacy technician training program cooperating with similar institutions located in remote areas of South Carolina.

Midlands Technical College, Columbia, SC, developed a project to provide pharmacy technician training in underserved rural South Carolina. Didactic instruction is by live television broadcast that is received in the students' local technical college. Laboratory instruction is conducted in two auxiliary laboratories geographically located within reasonable driving distances of the students' local college; instruction is scheduled to require a minimum number of trips. Experiential training is received in the students' home community. Midlands faculty make monthly visits into distance communities to review student progress.

The performance of distance-learning students has thus far matched the performance of Columbia-based students. Student performance, both Columbia and distance-learning, was compared using earned grade points. A statistical analysis was not applied to this comparison. Results from the first two years of this project demonstrated a slightly higher grade-point performance for distance-learning students. Success of distance-learning students has shown that pharmacy technician instruction can be delivered successfully into remote sites in South Carolina.