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Thursday, August 10th 2006

Delicious Lunch! Now Where Is My Perscription Pad?

My pharmacology lecturer today told a story.

Now that I have your attention with that compelling opening line to this post…

He was chatting up one of our primary teaching hospital’s Merck reps, down on the ground floor with several guys carrying platters of food behind him. Okay, your typical free lunch. The rep was on his way up to the 8th floor and the trauma/crit care surgical division.

A few hours later he gets a call, from the in house Pharm.D. covering the orders from the SICU.

“You’re not going to believe this, but I just go three orders for entrapenem in like four hours.”

Entrapenem is the carbapenem that isn’t. Also known, according to my pharm lecturer as a cross dressing cephalosporin. My pharmacology professor claims that one of the orders was for an acinetobacter infection.

Well, what’s the problem here?

It is true that carbapenem as a class is a highly effective choice against resistant acinetobacter. It certainly varies by physician and hospital whether they’re the drug of first choice or last resort (you don’t want to overuse it) But entrapenem doesn’t function like a typical carbapenem. It doesn’t cover acinetobacter.

A Merck rep sold the virtues of entrapenem over lunch and my pharm lecturer sees an increase in use within the same day, some of it inappropriately. I’m not going to take a single second hand story as hard core evidence of the massive influence gifts have on physician decision making. Still, stories like this are a little disturbing.