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The article discusses a report on nonpharmaceutical fentanyl (NPF)-related deaths across the U.S. from April 2005 to March 2007. An increase in fentanyl overdoses reported to the U.S. Centers for Disease Control & Prevention (CDC) Epidemic Information Exchange (Epi-X) prompted the CDC to implement an ad hoc case-finding and surveillance system, later managed by the Drug Enforcement Administration (DEA). Statistics on NPF- related deaths in several states from the CDC/DEA surveillance system are presented.

Background: Fungal infections are rare complications of injections for treatment of chronic pain. In September 2012, we initiated an investigation into fungal infections associated with injections of preservative-free methylprednisolone acetate that was purchased from a single compounding pharmacy., Methods: Three lots of methylprednisolone acetate were recalled by the pharmacy; examination of unopened vials later revealed fungus. Notification of all persons potentially exposed to implicated methylprednisolone acetate was conducted by federal, state, and local public health officials and by staff at clinical facilities that administered the drug. We collected clinical data on standardized case-report forms, and we tested for the presence of fungi in isolates and specimens by examining cultures and performing polymerase-chain-reaction assays and histopathological and immunohistochemical testing., Results: By October 19, 2012, more than 99% of 13,534 potentially exposed persons had been contacted. As of July 1, 2013, there were 749 reported cases of infection in 20 states, with 61 deaths (8%). Laboratory evidence of Exserohilum rostratum was present in specimens from 153 case patients (20%). Additional data were available for 728 case patients (97%); 229 of these patients (31%) had meningitis with no other documented infection. Case patients had received a median of 1 injection (range, 1 to 6) of implicated methylprednisolone acetate. The median age of the patients was 64 years (range, 15 to 97), and the median incubation period (the number of days from the last injection to the date of the first diagnosis) was 47 days (range, 0 to 249); 40 patients (5%) had a stroke., Conclusions: Analysis of data from a large, multistate outbreak of fungal infections showed substantial morbidity and mortality. The infections were associated with injection of a contaminated glucocorticoid medication from a single compounding pharmacy. Rapid public health actions included prompt recall of the implicated product, notification of exposed persons, and early outreach to clinicians.

This study assessed the effects of switching to ciprofloxacin hydrochloride in patients initially treated with parenteral antibiotics for respiratory tract (RTI), skin or skin structure (SSS), bone or joint (BJI), or urinary tract infection (UTI). A total of 766 patients from 54 institutions were concurrently monitored and the projected effect of ciprofloxacin on duration of hospitalization and parenteral therapy was assessed based on previous experiences with each type of patient. The median duration of parenteral antibiotic therapy prior to oral ciprofloxacin was 4, 6, 6, and 7.5 days; the median duration of oral ciprofloxacin prior to discharge was 2, 2, 2, and 4 days for UTI, RTI, SSS, and BJI, respectively. It was estimated that more than 70 percent of patients would have continued parenteral antibiotics on an inpatient basis and only 10 percent would have received an alternative oral agent if ciprofloxacin were not available. Use of oral ciprofloxacin significantly affected both duration of parenteral therapy and duration of hospitalization. It was estimated that 16,732 doses of parenteral antibiotics were avoided and, after subtracting the cost of oral ciprofloxacin, resulted in a likely net savings of $187 146.50. An estimated total of 2266 hospital days were saved in 418 patients, resulting in estimated savings of $739 100. Total drug plus hospitalization cost savings were projected to be $980 246.50. Further research is required to determine if, and where, more aggressive intervention will achieve additional cost savings.