Revisions

To ensure that we are providing our clients with the industry’s best and most current clinical information, we complete a 'post-publication' process and receive feedback regarding opportunities to add additional information or, in rare cases, make revisions.

Below is information on revisions, corrections, or modifications to existing monographs that have been identified in the past 12 months.

Sulfamethoxazole/Trimethoprim Injection – April 2017

Revision in the Dosage: Renal function impairment field of the Sulfamethoxazole/Trimethoprim Injection monograph in the Drug Facts and Comparisons database, available online and in the print publication Drug Facts and Comparisons, 2015, 2016 and 2017; and the loose-leaf edition beginning with the September 2014 update through October 2016.

The monograph previously read:

Dosage: Renal function impairment (only the portion of field impacted is presented):

P. jiroveci pneumonia treatment

Adults

Creatinine clearance less than 10 mL/minute

Trimethoprim 5 mg/kg IV every 12 hours

It has been revised to read:

Dosage: Renal function impairment (only the portion of field impacted is presented):

P. jiroveci pneumonia treatment

Adults

Creatinine clearance less than 10 mL/minute

Trimethoprim 5 mg/kg IV every 24 hours

Penicillin G (Parenteral/Aqueous) – March 2017

Revision in the Dosing: Adult field of the Penicillin G (Parenteral/Aqueous) monograph in the Lexi-Drugs database, available online, in mobile apps and in the print publication Drug Information Handbook, 26th edition (in press).

The monograph previously read:

Dosing: Adult (only the portion of the field that is impacted is presented):

Endocarditis, treatment: IV:

Enterococcus, native or prosthetic valve (penicillin-susceptible/gentamicin-susceptible strains) (off-label dose): 18 to 30 million units/day as continuous infusion or in divided doses every 6 hours with concomitant gentamicin.

Enterococcus, native or prosthetic valve (penicillin-susceptible/streptomycin-susceptible/gentamicin-resistant strains) (off-label dose): 18 to 30 million units/day as continuous infusion or in divided doses every 6 hours with concomitant streptomycin.

It has been revised to read:

Dosing: Adult (only the portion of the field that is impacted is presented):

Endocarditis, treatment: IV:

Enterococcus, native or prosthetic valve (penicillin-susceptible/gentamicin-susceptible strains) (off-label dose): 18 to 30 million units/day as continuous infusion or in divided doses every 4 hours with concomitant gentamicin.

Enterococcus, native or prosthetic valve (penicillin-susceptible/streptomycin-susceptible/gentamicin-resistant strains) (off-label dose): 18 to 30 million units/day as continuous infusion or in divided doses every 4 hours with concomitant streptomycin.

These changes have been posted to online and mobile app databases. (Please update your Lexi-Drugs mobile application to get this updated dosing.)

Revision in the Dosing: Usual field (adult dosing) of the Penicillin G (Parenteral/Aqueous) monograph in the Pediatric and Neonatal Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Usual [adult dosing] (only the portion of the field that is impacted is presented)

Endocarditis, treatment (AHA [Baddour 2015): IV:

Enterococcus: IV: 18 to 30 million units/day as continuous infusion or in divided doses every 6 hours; use in combination with other antibiotics based on susceptibility.

It has been revised to read:

Dosing: Usual [adult dosing] (only the portion of the field that is impacted is presented)

Endocarditis, treatment (AHA [Baddour 2015): IV:

Enterococcus: IV: 18 to 30 million units/day as continuous infusion or in divided doses every 4 hours; use in combination with other antibiotics based on susceptibility.

These changes have been posted to online and mobile app databases. (Please update your Pediatric and Neonatal Lexi-Drugs mobile application to get this updated dosing.)

Penicillin G Sodium Injection and Penicillin G Potassium Injection – March 2017

Revision in the Dosing: Adult field of the Penicillin G Sodium and Penicillin G Potassium Injection monographs in the Facts & Comparisons eAnswers database.

The monograph previously read:

Dosing: Adult (only the portion of the field that is impacted is presented):

Enterococcus, native or prosthetic valve (penicillin-susceptible/gentamicin-susceptible strains)

18 to 30 million units/day IV as continuous infusion or in divided doses every 6 hours with concomitant gentamicin.

Enterococcus, native or prosthetic valve (penicillin-susceptible/streptomycin-susceptible/gentamicin-resistant strains)

18 to 30 million units/day IV as continuous infusion or in divided doses every 6 hours with concomitant streptomycin.

It has been revised to read:

Dosing: Adult (only the portion of the field that is impacted is presented):

Enterococcus, native or prosthetic valve (penicillin-susceptible/gentamicin-susceptible strains)

18 to 30 million units/day IV as continuous infusion or in divided doses every 4 hours with concomitant gentamicin.

Enterococcus, native or prosthetic valve (penicillin-susceptible/streptomycin-susceptible/gentamicin-resistant strains)

18 to 30 million units/day IV as continuous infusion or in divided doses every 4 hours with concomitant streptomycin.

These changes have been posted to the online database.

Tobramycin (Systemic) – September 2016

Revision in the Dosing: Usual field of the Tobramycin (Systemic) monograph in the Pediatric and Neonatal Lexi-Drugs database, available online and in mobile apps.

The monograph previously read:

Dosing: Usual (only portion of field impacted is presented):

General dosing, susceptible infection:

Conventional dosing: Infants, Children, and Adolescents: IM, IV: 6 to 7.5 mg/kg/dose every 6 to 8 hours; individualize dosing based on patient-specific clinical parameters

It has been revised to read:

Dosing: Usual (only portion of field impacted is presented):

General dosing, susceptible infection:

Conventional dosing: Infants, Children, and Adolescents: IM, IV: 6 to 7.5 mg/kg/day divided every 6 to 8 hours; individualize dosing based on patient-specific clinical parameters (Red Book [APP 2015)]

These changes have been automatically posted to online and mobile app databases. (Please update your Pediatric and Neonatal Lexi-Drugs mobile application to get this updated dosing.)

Penicillin G (Parenteral/Aqueous) – September 2016

Revision in the Dosing: Neonatal field of the Penicillin G (Parenteral/Aqueous) monograph in the Pediatric and Neonatal Lexi-Drugs database, available online and in mobile apps, as well as the following print publications: Pediatric & Neonatal Dosage Handbook, 20th, 21st, 22nd, and 23rd editions.

The monograph previously read:

Dosing: Neonatal (only portion of field impacted is presented):

Meningitis: IV:

Other susceptible organisms (IDSA [Tunkel 2004]):

PNA 0 to 7 days: 50,000 units/kg/day in divided doses every 8 to 12 hours

PNA 8 to 28 days: 200,000 units/kg/day in divided doses every 6 to 8 hours

It has been revised to read:

Dosing: Neonatal (only portion of field impacted is presented):

Meningitis: IV:

Other susceptible organisms (IDSA [Tunkel 2004]):

PNA 0 to 7 days: 150,000 units/kg/day in divided doses every 8 to 12 hours

PNA 8 to 28 days: 200,000 units/kg/day in divided doses every 6 to 8 hours

These changes have been automatically posted to online and mobile app databases.

Methylprednisolone Acetate Injection – August 2016

Deletion of content in Indications (off-label uses) and Administration & Dosing (off-label dosing) fields of the Methylprednisolone Acetate Injection monograph in the Drug Facts and Comparisons database, available online and in the print publication Drug Facts and Comparisons, 2015 and 2016.

The monograph previously read:

Indications

Off-label uses:

Chronic obstructive pulmonary disease (acute exacerbation) -

G

No cure currently exists for chronic obstructive pulmonary disease (COPD). Treatment strategies are aimed at minimizing the impact of current exacerbations and preventing development of subsequent exacerbations. Short-term treatment with oral corticosteroids has been shown to reduce recovery time, risk of early relapse, treatment failure, and length of hospital stay, as well as to improve lung function and arterial hypoxemia. However, long-term use is associated with significant adverse effects; recurrent courses should be avoided. (See Administration and Dosage.)29 ,30 ,31 ,32

Juvenile idiopathic arthritis (intra-articular) -

C

Data evaluating the safety and efficacy of methylprednisolone acetate intra-articular injections for the treatment of juvenile idiopathic arthritis (JIA) are limited and indicate that it is less effective than alternative agents. Intra-articular injections of corticosteroids are now generally considered to be a standard of care for JIA for select patient groups (uncomplicated monoarticular disease, oligoarticular disease), with data supporting triamcinolone hexacetonide as the preferred product because of its longer duration of effect. Currently, there are no national guidelines for the management of JIA. (See Administration and Dosage.)24 ,25 ,26 ,27 ,28

Administration & Dosage

Adult:

Off-label dosing:

Acute gout (off-label) -

0.5 to 2 mg/kg initially IM; may repeat as clinically indicated.15

Chronic obstructive pulmonary disease (acute exacerbation) (off-label) -

125 mg IV every 6 hours for 72 hours, then a tapered dose of oral prednisone on days 4 to 57.29 ,30 ,31 ,32

It has been revised to read:

Off-label uses:

Juvenile idiopathic arthritis (intra-articular) -

C

Data evaluating the safety and efficacy of methylprednisolone acetate intra-articular injections for the treatment of juvenile idiopathic arthritis (JIA) are limited and indicate that it is less effective than alternative agents. Intra-articular injections of corticosteroids are now generally considered to be a standard of care for JIA for select patient groups (uncomplicated monoarticular disease, oligoarticular disease), with data supporting triamcinolone hexacetonide as the preferred product because of its longer duration of effect. Currently, there are no national guidelines for the management of JIA. (See Administration and Dosage.)24 ,25 ,26 ,27 ,28

Administration & Dosage

Adult:

Off-label dosing:

Acute gout (off-label) -

0.5 to 2 mg/kg initially IM; may repeat as clinically indicated.15

These changes have been automatically posted to the online and mobile app databases.