PREFERRED THERAPIES: (additional pediatric-specific formulations appear in blue)
Most Common Approx Cost Non-Formulary Approx Cost Drug Class Formulary Agent Per Month‡ Per Month‡ Penicillins Augmentin XR 2gm BID BPA, F3, $165/10daysAllergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives Allergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives
PREFERRED THERAPIES: (additional pediatric-specific formulations appear in blue)
Most Common Approx Cost Non-Formulary Approx Cost Drug Class Formulary Agent Per Month‡ Per Month‡ Macrolides
$11-$20/10 days Ketek 800mg daily B3, F3, H4, MPA
$37-$75/10 days Zmax 2gm dailyx1 BPA, F3, H4, MPA, T3 $70/1dTetracyclines Sulfa Drugs Cephalosporins cefaclor monohydrate CR (g) 500mg $53/10d
PREFERRED THERAPIES: (additional pediatric-specific formulations appear in blue)
Most Common Approx Cost Non-Formulary Approx Cost Drug Class Formulary Agent Per Month‡ Per Month‡ Cephalosporins 3rd Generation Cedax 400mg daily BPA, FPA, H4, T3(continued) Quinolones
$16-$26/10days Factive 320mg daily BPA, FPA, H4, soln: 75mg/5ml B3, T3, H4, MPA, F3
Tindamax 2gmx1 BPA, F3, H4, MPA, T3Allergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives Allergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives
PREFERRED THERAPIES: (additional pediatric-specific formulations appear in blue)
Most Common Approx Cost Non-Formulary Approx Cost Drug Class Formulary Agent Per Month‡ Per Month‡ Anti-HerpeticsVaricella Zoster
20mg/kg/dose (max 800mg/dose) QID X5 days
(≥2 yrs and ≤ 40kg) (Begin treatment within the
PREFERRED THERAPIES: (additional pediatric-specific formulations appear in blue)
Most Common Approx Cost Non-Formulary Approx Cost Drug Class Formulary Agent Per Month‡ Per Month‡ Anti-Herpetics (continued) labialis (fever blisters/cold sores)Influenza Antiviral For the 2011-2012 influenza season, the CDC website should be consulted for the latestrecommendations due to changing resistance patterns of the flu viruses.Allergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives Allergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives • First-Line Antibiotics:
-MedVentive routinely monitors the prescribing of 1st versus 2nd-line antibiotics across our network. The fol owing is a list of products considered 1st-line
therapy: penicillin, amoxicillin, dicloxacillin, erythromycin, cephalexin, tetracycline, doxycycline, TMP-SMX, metronidazole, clindamycin. • Avoid cefadroxil (Duricef) use: similar spectrum of activity, at least 5X the cost of cephalexin. • Most episodes of sinusitis and acute bronchitis are viral in nature and resolve spontaneously without antimicrobial intervention.
-Initial treatment should be targeted at symptomatic relief (e.g., adequate hydration, decongestants, expectorants, analgesics, etc.)
-Consider initiation of AB therapy in patients with ≥7 days of moderate persistent symptoms, or those with high fever and purulent discharge.
-Amoxicillin, TMP-SMX, doxycycline or erythromycin should be considered as 1st-line agents. • First-line treatment of Community-acquired pneumonia:
- Uncomplicated pneumonia and no significant co-morbidities: azithromycin, clarithromycin XL or doxycycline. Fluoroquinolones should only be used in
cases in which macrolide-resistant S. pneumoniae is suspected.
- Co-morbidities or recent antibiotic use: respiratory fluoroquinolone (levofloxacin 750mg daily, or moxifloxacin 400mg daily) for a minimum of five days or
combination of beta-lactam and a macrolide or doxycycline. • If community associated methicillin resistant staphylococcus aureus (MRSA) is suspected, please refer to the guidelines issued by the CDC (September
2010) located at www.cdc.gov/mrsa for treatment recommendations. • Quinolones:
-Should not be considered 1st-line treatment in the management of mild to moderate lower respiratory tract infections.
-Should be avoided in pregnant women or nursing mothers. • Uncomplicated UTIs:
-Utilize TMP/SMX x 3 days as the regimen of 1st-choice.
-For sulfa-allergic patients, use nitrofurantoin or trimethoprim x 7 days. • Influenza Antiviral Agents:
-All of the available antiviral agents decrease symptom duration by only 1-2 days when started within 48 hours of symptom onset.
-Head-to-head studies have not been conducted and evidence does not support superiority of one agent over another.
-Influenza vaccination, especially in patients at high-risk (e.g., patients with diabetes mellitus, airways disease, immunocompromised, etc.) for influenza
related complications, remains the 1st-line of defense against influenza infection. • General Antibiotic Prescribing Principles:
-Avoid antibiotic prescribing in infections deemed VIRAL in origin (e.g., colds, flu, acute bronchitis, etc.).
-Alert patients of the fact that unnecessary antibiotics can be harmful, exposing the patient to potential allergic reaction, adverse drug reactions/interactions
and by promoting the emergence of resistant organisms in the community.
-Be confident in recommending OTC treatment options as primary therapy for symptomatic viral illnesses (e.g., analgesics, decongestants, cough
-When prescribing antibiotics, select the narrowest-spectrum agents offering the required antimicrobial activity.
-Strive to employ simple laboratory/diagnostic techniques where practical in an effort to insure more targeted antimicrobial coverage. Allergy Drugs Analgesics Antidepressants Hyperlipidemics Hypertensives Infectives
FOOT & ANKLE INTERNATIONALCopyright 2010 by the American Orthopaedic Foot & Ankle SocietyDOI: 10.3113/FAI.2010.0090 Current Concept Review: Osteochondral Lesions of the Talus Patrick J. McGahan, MD and Stephen J. Pinney, MD, FRCS(C) INTRODUCTION source of ankle morbidity.19 Many OLTs can be treated non-operatively. For patients in whom surgery is indicated, aOsteochondral le