Royal Columbian Hospital and Eagle Ridge Hospital
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Pharmacy Updates

Oseltamivir (Tamiflu) inventory for H1N1 - RCH process for out patients presenting to Emergency Department

General Summary

Start within 48h of first onset of symptoms.

1. Inpatients ordered Oseltamivir: provided by RCH Pharmacy

2. ER Encounter patients (seen and discharged with prescription for Oseltamivir)
- three pharmacies near RCH will fill oseltamivir Rx 75mg BID x 5 days (community Rx cost: ~ $50.00)
- "Fair Pharmacare" drug benefits may cover some of Rx cost
- some pharmacies are open 0800 - midnight
- OK if first dose cannot be started until morning after.

Antibiotic Updates December 2009

Major Changes:

1. Addition of Cefazolin + oral Cephalexin Option - a Third Option
- for patients requiring more intense antibiotic therapy than cefazolin 2g daily but do not required Cefazolin BID or cannot undertake visits. A 2 week survey found approximately half of patients received cefazolin 2g BID. Cephalexin 1g is approximately 50% absorbed and comparable to cefazolin 500mg IV. Offering an option of twice daily antibiotic (1 IV dose and 1 oral dose) should provide comparable outcomes and decrease ER encounters compared to BID cefazolin IV.
** Pharmacy Services is not able to provide oral cephalexin therapy
** Physician will issue community pharmacy prescription to patient. The community Rx will be used
Suggested Rx: Cephalexin 1000mg orally daily (in addition to IV dose) until step-down to 500mg QID
Sig: cephalexin 500mg x 36 tabs
This Rx will accommodate 4 days of combination IV/PO therapy and 7 days of oral stepdown therapy.