when dealing with infections, so I dnt know why the bs talk about generics . The drug that reacts the best to an infection will be the drug prescribed regardless of costs unless the patient request a lower costs drug. But if the infection can kill I would want the best available.
absolutely, 100% out of touch and incorrect. Don't know if you've been in a hospital in the past 15 years but pharmacy calls the shots, not the MD. Only IDs and in a few cases critical/care pulmonary can write without clearing it with pharmacy. We are not talking about treating 1 patient. If that were the case, no vanc would be written. If it was MRSA blood it would be dapto - MRSA lung -linezolid, MRSA skin - whatever is cheapest (tigecycline, ceftaroline, whatever). Outpatient would be bactrim or $2 Wal Mart co-pay doxy.
But we are not talking about 1 patient. We are talking about totality for the hospital, so vanc is 1st line because it is cheap. This isn't 1980 when the MD rules. MDs lost their power a long time ago to accountants in the hospitals and pharmacists are their henchmen. Pharmacy gets a bonus from their masters and sells biased info to the MDs just like reps do on their side. Only the rep knows what he is doing and most clinical pharmacists are self righteous hypocrites when it comes to antibiotics. Just ask them, if their mom was in the ED with pneumonia from the nursing home, was treated with a quin last month for a UTI, has temp of 100, CrCl or GFR of say 10-30mL/min, a serum creatinine of 1.3 mg/dL, WBC of say 10.9 elevated with leukocytosis and PMNs or 71% what would they write? They would write linezolid every single time for their mom but their protocol for everyone else would be vanc first. The ED pyxis would only have vanc. The willing hospitalist, who just wants to clock out would admit them and 3 days later when they finally got levels right, if the patient was alive, they would get an ID consult and switch to Linezolid. Happens every single hour all over America because linezolid costs so much. $250 day vs. $8 day. Add that up over the course of the year for say 10,000 HCAP admissions through the ED.
the MD has no power
Hey doc knowitall...protocols are set by the hospital's Pharmacy and Therapeutics Committee, not the pharmacy. Check out the members at your institution, and you will actually find a few doctors on the committee. And you sir our apparently incorrect and out of touch when it comes to doxycycline pricing....back in early 2013 competition was removed from play and it now it costs nearly $2 for a single capsule.
I don't know how your theory holds any weight when Zyvox had over 610 million is US sales and with Ted being only half the dosage amount of Zyvox and may I add TED has a much much better tolerance. I know TED will sell and have more than the 1% mkt as you claim.
Sentiment: Strong Buy
If a dr wrote a specific script you would bet it would get filled. Last thing a hospital/nursing home wants is a lock down. Of course economics would play a role in low class areas but don't tell me TED only gets 1% of mkt. Say J&J bought TRIUS imagine their sales staff moving this product.
The Gov't has already signaled their concern over drug resistant strains with the GAIN Act, which encourages the development of new drugs. Can you foresee the Gov't going a step further and passing laws encouraging - or even requiring - the adoption of these new drugs, to overcome the kind of "resistance" that you're talking about?
well some doctors will prescribe the medicine that gives the best bribes, dinners and souvenirs....and then put off others in the antibiotic area so that bacteria don't gain immunity to them...lolz