Emre Kara

Background: Penicillin allergy is the most frequently reported drug allergy, yet most labels are inaccurate or no longer clinically relevant. Mislabeling may lead to avoidance of beta-lactam antibiotics, suboptimal antimicrobial therapy, increased healthcare costs, and potential contribution to antimicrobial resistance. Pharmacists increasingly contribute to antimicrobial stewardship programs; however, their role in penicillin allergy evaluation and delabeling has not been comprehensively synthesized. Objective: To map pharmacist-led or pharmacist-involved interventions aimed at clarifying inappropriate penicillin allergy labels and to describe reported antimicrobial stewardship–related outcomes. Methods: This scoping review followed the PRISMA extension for scoping reviews (PRISMA-ScR). PubMed, Scopus, and Web of Science were searched for English-language studies evaluating pharmacist-led or pharmacist-involved penicillin allergy interventions among adults receiving systemic antibiotics. Results: Of 1,269 records screened, 15 studies met the inclusion criteria. Interventions most commonly included structured allergy history assessment and risk stratification, education of healthcare professionals, and facilitation of penicillin skin testing and oral drug provocation testing. Pharmacist involvement was frequently associated with increased beta-lactam prescribing and reduced use of broad-spectrum alternatives. Several studies also reported shorter hospital length of stay and lower healthcare costs compared with usual care. Conclusions: Pharmacist involvement in penicillin allergy evaluation may help optimize antimicrobial therapy and strengthen antimicrobial stewardship efforts. Integration of pharmacists into allergy assessment workflows may improve the accuracy of allergy documentation and facilitate appropriate beta-lactam use. Further research is needed to evaluate long-term clinical, economic, and implementation outcomes across diverse healthcare settings.

Background: The growing number of older people with HIV (PWH) presents challenges in comprehensive care and maintaining health-related quality of life (HRQoL). This study aimed to evaluate the effect of a multidisciplinary intervention focusing on medication optimization and person-centered support on the HRQoL of older PWH. Methods: This prospective study included 3 groups: PWH ≥ 50 years (older); PWH < 50 years (younger); and HIV-negative individuals ≥ 50 years. Older PWH underwent a comprehensive assessment at baseline and approximately 6 months later, with interventions provided by clinical pharmacists, infectious disease specialists, and geriatricians. Medication Regimen Complexity Index (MRCI), STOPP/START and TIME criteria, and 36-Item Short Form Health Survey (SF-36) were used. Results: A total of 285 participants were included in this study (50% older PWH, 25% younger PWH, and 25% HIV-negative individuals). The mental component summary score of SF-36 was significantly higher in older PWH compared to younger PWH at baseline (P = .001). Antiretroviral therapy regimens were simplified in 24.1%, and at least 1 medication was deprescribed in 48.9% of older PWH. Older PWH demonstrated significant reductions in potentially inappropriate prescribing with STOPP/START and TIME criteria (P < .001) at the second interview, but no significant changes were observed in MRCI scores (P > .05). Additionally, physical and mental component summary scores of SF-36 increased significantly (P = .012 and P < .001, respectively) after intervention. Conclusions: Multidisciplinary care was associated over time with reductions in inappropriate prescribing and improvements in HRQoL among older PWH. These findings underscore the need for integrated, person-centered, age-tailored HIV care models to support healthy aging.

Introduction: Antifungal stewardship programs are increasingly implemented to optimize antifungal use. Pharmacists are frequently involved in these programs; however, their specific contributions and impact have not been systematically characterized. Aim: The aim of this systematic review was to synthesize the available evidence regarding the role and impact of pharmacists in antifungal stewardship programs, specifically focusing on clinical, utilization, and economic outcomes, using a narrative synthesis approach. Method: A systematic review was conducted. PubMed/MEDLINE and Scopus databases were searched for studies published from database inception to January 2026. Two reviewers independently screened titles, abstracts, and full texts according to predefined eligibility criteria. Data extraction was performed independently using a standardized form. Due to heterogeneity in study designs and outcomes, a narrative synthesis approach was applied. The review was reported in accordance with the PRISMA reporting guidelines. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Results: Fifteen studies met the inclusion criteria, the majority of which were quasi-experimental pre–post intervention studies conducted in tertiary care hospitals. Key pharmacist-driven interventions included antifungal dose optimization, de-escalation or discontinuation of therapy, facilitation of early appropriate antifungal treatment, therapeutic drug monitoring, and education or protocol development. Across studies, pharmacist involvement was associated with improvements in antifungal prescribing quality and stewardship process outcomes, including potential improvements in duration of antifungal therapy, antifungal consumption (measured by defined-daily-doses or days-of-therapy), time to appropriate therapy, and antifungal-related costs. Effects on clinical outcomes such as mortality and length of hospital stay were variable and generally not statistically significant. The overall certainty of the evidence is low to very low by the observational nature and the moderate-to-serious risk of bias of the included studies. Conclusion: Pharmacist participation in multidisciplinary antifungal stewardship teams may be associated with improved antifungal utilization and adherence to guidelines in hospitalized adults. The findings support that pharmacists are important members of multidisciplinary teams in antifungal stewardship.

Purpose Posaconazole plasma levels can vary considerably among patients, underscoring the need for therapeutic drug monitoring (TDM). Nevertheless, access to TDM is limited in many clinical settings. This study aimed to investigate the impact of posaconazole TDM in daily practice at a tertiary care hospital. Methods We conducted a single-center retrospective study at a university hospital, reviewing patients who received posaconazole delayed-release tablets and underwent TDM between January 1, 2022, and December 18, 2023. Results A total of 35 patients with 74 posaconazole TDM were evaluated. Twenty-seven (77.1%) patients received posaconazole for prophylaxis. The median plasma concentration of posaconazole was 1.45 mg/L (interquartile range [IQR]: 1.74 mg/L). Overall, 74.3% of posaconazole concentrations were within the target range. Target attainment was achieved in 75.9% of prophylactic measurements (> 0.7 mg/L) and 68.7% of treatment measurements (> 1 mg/L). Subtherapeutic levels were identified in 19 samples from 12 patients. Among eight patients receiving prophylactic posaconazole with trough levels below 0.7 mg/L, two experienced breakthrough invasive fungal infections. Diarrhea, sampling before steady state, medication non-adherence, and poor oral intake were significantly more frequent in cases with subtherapeutic posaconazole levels (p = 0.022). Among six measurements with posaconazole concentrations exceeding 3.75 mg/L, an adverse effect attributable to posaconazole was observed in only one of the five patients with these elevated levels. Conclusion The findings of this real-world assessment suggest that posaconazole TDM may play a critical role in optimizing both prophylaxis and treatment, particularly among patients at risk for subtherapeutic exposure.

Purpose: Therapeutic drug monitoring of vancomycin targeting an AUC/MIC ratio of 400–650 mg*h/L is required to ensure optimal therapeutic efficacy and safety in patients treated with vancomycin. The objectives of this study were to monitor vancomycin plasma peak and trough concentrations to calculate the area under the curve (AUC) to assess target achievement in real-world settings and to evaluate the relationship between AUC and acute kidney injury (AKI). Methods: In this single-center cohort study, prospectively calculated vancomycin AUC and trough concentrations were extracted from the database and evaluated for achievement of therapeutic ranges for AUC and trough concentrations at a university hospital. Patients were evaluated for the development of AKI according to KDIGO guidelines. Results: A total of 114 patients were included in the study. Vancomycin loading doses were initiated in 83.3% of patients, and 82.1% of patients received the appropriate weight-based dose. 79.8% of maintenance doses were appropriate. The median (min-max) values for peak, trough, and AUC were 23.25 (3.3-131.8) mg/L, 10.35 (0.6–56.4) mg/L, and 403(49-1786) mg/L*hour, respectively. The majority of values were outside the therapeutic target for both trough (65.3%) and AUC (63.7%). AKI was observed in 15.8% of patients. In patients without AKI, the median (min-max) trough concentration was 9.65 (0.60–45.30) mg/L and the AUC was 370 (49-1390) mg/L*hour. Conclusions: In this study, only one-third of baseline concentrations were in the therapeutic range and were increased by up to two-thirds with dose adjustments. Therapeutic drug monitoring to achieve target concentrations is critical in patients treated with vancomycin.