Background and Objectives: Remdesivir (RDV) is the first antiviral agent approved in Japan for the treatment of coronavirus disease 2019 (COVID-19). The aim of our study was to assess the efficacy and safety of RDV treatment in mildly to moderately ill patients with COVID-19. Materials and Methods: A single-center, retrospective study was performed in Fukuoka University Chikushi Hospital. Patients admitted to our hospital from June to October 2021 for RDV treatment against COVID-19 were enrolled. The primary end point was clinical status on days 10 and 14, using a 6-point ordinal scale ranging from death (category 6) to discharge (category 1). Adverse events were assessed and graded using the Japanese version of Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results: In total, 47 COVID-19 patients receiving RDV treatment were assessed during the study period. Thirty-four (72.3%) out of 47 patients required oxygen therapy. Out of these 34 patients, 30 (88.2%) showed a 2-point clinical improvement on day 14 after RDV was initiated. Serum alanine aminotransferase levels were elevated in three patients (6.4%) (CTCAE Grade 3) and neutropenia was detected in one patient (2.1%) out of the 47 patients. Conclusions: RDV may be highly effective, with good safety profiles, in patients with COVID-19 requiring oxygen therapy.

A nucleic acid amplification test (NAAT) is recommended to determine whether or not patients have a Clostridioides difficile infection (CDI) when the glutamate dehydrogenase activity assay is positive and the rapid membrane enzyme immunoassays for toxins is negative. In our hospital, a NAAT was introduced to diagnose CDI precisely in April 2020. This study aimed to investigate the impact of a NAAT on the clinical outcomes in patients with CDI at our hospital. Seventy-one patients diagnosed with CDI between April 2017 and March 2022 were included in our study. Patients with CDI were divided into two groups: before (pre-NAAT) and after (post-NAAT) the introduction of NAAT. The clinical outcome was compared between the two groups. Of the 71 patients with CDI, 41 were sorted into the pre-NAAT group and 30 into the post-NAAT group. The clinical cure rate was significantly higher in the post-NAAT group compared to the pre-NAAT group (76.7% vs. 48.8%, p = 0.018). In the multivariable analysis, the clinical cure was significantly associated with the introduction of NAAT (p = 0.022). Our findings suggest that the introduction of NAAT can improve the clinical outcomes in CDI patients.

Antimicrobial stewardship (AS) Guidelines by the Infectious Diseases Society of America recommend employing prospective audit and feedback (PAF) as an effective intervention in AS programs. Since July 2022, our hospital has implemented PAF for all patients with positive blood cultures, including those with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC) bacteremia. Our study examined the effect of PAF on clinical outcomes in patients with ESBL-EC bacteremia. We enrolled 62 patients diagnosed with ESBL-EC via blood culture who were undergoing antibiotic treatment. The patients were divided into the pre-PAF and post-PAF implementation groups. The rate of antibiotic de-escalation from broad-spectrum antibiotics to narrow-spectrum cefmetazole was significantly higher in the post-PAF group than in the pre-PAF group (80.7% vs. 32.4%, p = 0.0003). The treatment failure rate in the pre-PAF group was higher than that in the post-PAF group (38.7% vs. 12.9%, p = 0.04). The results of this study indicate that the implementation of PAF is advantageous not only in terms of process indicators but also in improved clinical outcomes, including reduced treatment failure rates. We hope that this study will encourage the implementation of PAF in more facilities to instigate a collective effort to reduce the incidence of antimicrobial resistance.

Cetuximab infusion reactions (IRs) can disrupt the continuity of effective treatment. However, there is a lack of standardized practical ward-level strategies to prevent IR recurrence. Herein, we report a single-case observation of a pharmacist-led approach combining H2-receptor antagonist premedication with infusion-time extension in a high-risk patient. A 69-year-old woman with metastatic colorectal cancer (RAS wild-type, microsatellite instability-high, BRAF V600E mutation) receiving encorafenib/binimetinib plus cetuximab developed Grade 2 IR during her first cetuximab infusion (approximately 98 min after initiation). She also exhibited hypoxemia and throat tightness. After discontinuing the infusion, she was treated with oxygen, d-chlorpheniramine, and famotidine, allowing completion at a reduced rate. For rechallenge, the interprofessional team implemented the following pharmacist-proposed optimization: routine H1 antihistamine plus 20 mg of intravenous famotidine and extension of cetuximab infusion to approximately 2 h, alongside standardized nursing surveillance. On the subsequent cycle, 465 mg of cetuximab (250 mg/m²) was administered without recurrence. No airway symptoms occurred. This pragmatic bundle targeted histamine-mediated pathways while tempering mediator release via the slower infusion, aligning with regulatory labeling that prioritizes H1 premedication and rate control yet enabling individualized risk mitigation after previous IRs. A pharmacist-driven checklist that adds H2 blockade and prolongs infusion may enhance safety and preserve treatment intensity in general ward settings where desensitization resources are limited. The generalizability of the findings is limited due to the single-patient design. Prospective validation comparing H1 alone versus combined H1 + H2 premedication, using predefined infusion-rate algorithms, is warranted.

Background: Molnupiravir (MOV) is recommended for the treatment of patients with coronavirus disease 2019 (COVID-19) who are ineligible for remdesivir treatment. However, data regarding laboratory-based adverse events (AEs) associated with MOV use in hospitalized patients are limited. In this study, we evaluated MOV-associated laboratory abnormalities, including increased creatine phosphokinase (CPK) and decreased hemoglobin (Hb) levels (e.g., anemia), and evaluated related risk factors in hospitalized COVID-19 patients. Methods: We reviewed retrospective data for 78 adult inpatients with COVID-19 who received MOV upon admission at Fukuoka University Chikushi Hospital. Individuals with MOV treatment history, early discontinuation, or premature discharge were excluded. Data were collected on demographics, Charlson Comorbidity Index, bacterial coinfection, concomitant medications, COVID-19 severity, oxygen therapy, and length of hospital stay. The AEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Japanese Clinical Oncology Group. Multivariate analyses were conducted to identify risk factors for elevated CPK levels and anemia. Results: The median age of the study population was 82 years (interquartile range: 74 - 89 years; men: 56.4%), and 17.9% had bacterial coinfection. Twenty-seven patients (34.6%) experienced ≥ 1 AE, and MOV was discontinued in two patients because of a mild rash and CPK elevation. Elevated CPK levels and anemia each occurred in 11 patients (14.1%). Severe AEs (grade ≥ 3) were observed in one patient with grade 4 CPK elevation and in another with grade 3 anemia. Multivariate analysis showed that bacterial coinfection tended to increase CPK levels (adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): 0.75 - 13.32, P = 0.10) and was significantly associated with anemia (aOR: 5.40, 95% CI: 1.27 - 23.69, P = 0.022). Conclusions: MOV exhibits a generally favorable safety profile in hospitalized COVID-19 patients, with low treatment discontinuation rates and mild laboratory abnormalities. Elevated CPK levels and anemia may reflect the complications of bacterial coinfection rather than direct MOV toxicity; however, these results should be interpreted with caution because of the small sample size and single-center, non-controlled study design. Further multicenter prospective studies are warranted to determine the relationship between CPK elevation, anemia, and MOV treatment in COVID-19 patients.