Israel Medical Association Journal

Background: Bloodstream infections (BSI) are associated with high morbidity and mortality. Inappropriate empirical antimicrobial therapy leads to poor outcomes.

Objectives: To evaluate the impact of clinical pharmacist intervention on the appropriateness of antibiotic treatment in patients hospitalized with bacteremia.

Methods: A retrospective study was conducted at the Soroka Medical Center in Israel. The intervention was implemented starting in July 2018. We compared 170 patients who received pharmacist intervention (August 2018 to June 2019) to 173 control patients (January 2017 to July 2018). The primary outcome was a composite of appropriate antibiotic choice and dosage.

Results: Pharmacist intervention significantly improved appropriate antibiotic dosing (97.6% vs. 91.3%, P = 0.011) and selection based on pathogen sensitivity (100% vs. 95.4%, P = 0.007). The most significant effect was observed in patients with intermediate renal function (CrCl 30–60 ml/min). Multivariate analysis confirmed pharmacist intervention as a strong predictor of appropriate treatment (odds ratio 5.00, 95% confidence interval 1.64–15.25, P = 0.005). The intervention group had longer hospital stays (median 15 vs. 9 days, P < 0.001) and lower 7-day relapse rates (2.4% vs. 8.7%, P = 0.010).

Conclusions: Clinical pharmacist interventions significantly improved the appropriateness of antibiotic treatment in patients with bacteremia, particularly in those with intermediate renal function. Despite longer hospital stays, the intervention group had lower early relapse rates than the control group. These findings support the integration of clinical pharmacists into antimicrobial stewardship programs.

Background: The annual incidence of epilepsy increases with age, from nearly 28 per 100,000 by the age of 50 years to 139 per 100,000 by the age of 75 years. Late-onset epilepsy differs from epilepsy at a young age in the prevalence of structural-related epilepsy, types of seizures, duration of seizures, and presentation with status epilepticus.

Objectives: To check the response to treatment in patients with epilepsy with age of onset of 50 years and older.

Methods: We conducted a retrospective study. The cohort included all patients referred to the Rambam epilepsy clinic between 1 November 2016 and 31 January 2018 with epilepsy onset at age 50 years or older and at least one year of follow-up at the recruitment time point and epilepsy not caused by a rapidly progressive disease.

Results: At recruitment, most patients were being treated with a single antiseizure medication (ASM); 9 of 57 patients (15.7%) met the criteria for drug-resistant epilepsy (DRE). The mean duration of follow-up was 2.8 ± 1.3 years. In an intention-to-treat analysis, 7 of 57 patients (12.2%) had DRE at the last follow-up.

Conclusions: Late-onset epilepsy, which is defined as a first diagnosis in patients older than 50 years of age, is easy to control with monotherapy. The percentage of DRE in this group of patients is relatively low and stable over time.