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Urinary tract infections (UTIs) are among the most commonly treated bacterial infections. Over the past decade, antimicrobial resistance has become an increasingly common factor in the management of outpatient UTIs. As treatment options for multidrug-resistant (MDR) uropathogens are limited, clinicians need to be aware of specific clinical and epidemiological risk factors for these infections. Based on available literature, the activity of fosfomycin and nitrofurantoin remain high for most cases of MDR Escherichia coli UTIs. Trimethoprim-sulfamethoxazole retains clinical efficacy, but resistance rates are increasing internationally. Beta-lactam agents have the highest rates of resistance and lowest rates of clinical success. Fluoroquinolones have high resistance rates among MDR uropathogens and are being strongly discouraged as first-line agents for UTIs. In addition to accounting for local resistance rates, consideration of patient risk factors for resistance and pharmacological principles will help guide optimal empiric treatment of outpatient UTIs.

Approximately 25% of Veterans have diabetes. Both the American Diabetes Association (ADA) and Department of Veterans Affairs/Department of Defense (VA/DoD) guidelines recommend treatment with glucagon-like peptide-1 (GLP-1) agonists, such as liraglutide, as second line options after metformin. In May 2016, the Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives updated criteria for use of GLP-1 agonists, increasing prescribing of this drug class. This coincided with recent data demonstrating cardiovascular benefit of liraglutide and led to increased usage at the Louis Stokes Cleveland Veterans Affairs Medical Center (LSCVAMC). A medication use evaluation was conducted to assess adherence to the criteria for use and to describe the characteristics of liraglutide usage at LSCVAMC. Sixty-two patients with T2DM and a prescription for liraglutide initiated between July 1, 2016 and January 30, 2017 were included. Patients were predominantly male (97%), had a baseline hemoglobin A1c (HgbA1c) of 9.2% and were prescribed metformin (82%). Adherence to the criteria for use was 90%. Follow-up HgbA1c after three to six months was obtained in 87% of patients. Average HgbA1c reduction of 0.76% was achieved in 72% of patients, while 28% were without improvement. Given the less than expected reduction in HgbA1c seen with liraglutide and the pharmacoeconomic impact of this medication, facility changes were implemented to ensure more appropriate prescribing of liraglutide at the LSCVAMC. Disclosure R.L. Rychel: None. M. Low: None. S.A. Watts: None. C. Falck-Ytter: None. K.M. Pascuzzi: None. A. Lyman: None.