Dr. Wilcke's Contact Information

• jwilcke@vt.edu
• 231-4819 (Office)

1880 Pratt Drive, Room 1126 (0493) Building XV - Corporate Research Center Blacksburg, VA 24061

Corporate Research Center Map

Directions to Dr. Wilcke's Office

Notes

In an effort to stay current, I revise my class notes whenever I find something that needs editing. Once each year I'm asked to provide a printed copy for distribution in the form of handouts. Differences may include:

1. The web notes are interactive. There are spreadsheets imbedded as well as links to additional information that you may find helpful.
2. The web notes are the most recent "version". While most of the changes made are "stylistic", there may be some content differences. I will try to point out MAJOR differences in class.
3. The web notes are the OFFICIAL version of the notes. You must be able to access the web notes in order to access the syllabus, the calendar, etc.

As always, if you have any questions about the course content, in either substance or procedure, feel free to contact me by email or by phone. Email is the most certain way to contact me.

Method of Evaluation

1. Laboratories

4 x 25pts Total Points=100

Laboratories are entirely internet based. (http://cpharm.vetmed.vt.edu/VM8784/lab/index.htm) For each lab you will be asked to submit a relatively brief laboratory report.

2. Examinations

4 x 25 pt. exams Total points = 100

Exams are open book. Any (inanimate) source of information is fair game. We will use ½ hour of class time to complete each of them. Material presented after previous exams will be emphasized but there will likely be a cumulative flavor to some of them. Pharmacologic, patho-physiologic, and regulatory topics pertinent to clinical pharmacology will be fair game.

3. Paper

Total points = 200

In lieu of a final examination, an analytical paper on antimicrobial therapy will be due on the last day of final week. The paper will consist of no fewer than 4 and no more than 10 double spaced typed pages (I will NOT accept any paper in excess of 10 pages). Detailed outlines are also an acceptable format but will be valued at 95% of good prose. (Bad prose may be devalued even further. Poetry is a shot in the dark. Judicious use of humor is appreciated - don't get carried away!)

Appropriate case topics include but are not limited to those listed below. Be cautious if you use a real case. I'm not interested in a presentation of how a case WAS treated by someone else. I'm interested in how YOU will choose to treat a case and why. You need not seek my approval for a topic that does not appear on the list below. I will be glad to listen of course, if you're concerned that your idea might not work.

Assignment (simple version). C Papers will include these major items.

1. (10%) Invent case scenario wherein an animal or group of animals requires antimicrobial therapy.
2. (30%)Develop specific therapeutic objective(s) for antimicrobial portion of the therapy. Specific therapeutic objective(s) for antimicrobial therapy include description(s) of one or more bacteria suspected (no culture) or confirmed (via culture) for the case, the tissue target (infection location - e.g. intracellular in lungs), and whether there is a reason to assert that bacteriocidal therapy is REQUIRED for success.
3. (10%)List all antimicrobials that could be effective against the bacteria involved. Discuss the susceptibility of your list of bacteria to specific antimicrobials.
4. (30%) Reduce the list to one or more antimicrobials that you will actually use. Explain how you eliminated each drug you will not use.
5. (20%) Describe the actual therapy that will be administered to the patient. The description should include dose, route, interval, duration, cost, etc.

Assignment (detailed version with hints). B papers will include 'sufficient' details at this level and be factually correct. Logical explanations will be favorably reviewed, illogical explanations will not.

1. (10%)Invent case scenario wherein an animal or group of animals requires antimicrobial therapy. Provide the type and level of details one might expect for a clinical rounds presentation (Pertinent abnormalities only for: physical examination, pathology lab values, cytologic examinations, radiographic findings, ultrasound findings, etc.). It is appropriate to indicate that samples will be submitted for culture and susceptibility testing, but reserve the results for the next section. Conclude with a diagnosis (even if tentative). Discussions of diagnostic costs encouraged.
2. (30%) Develop specific therapeutic objective(s) for antimicrobial portion of the therapy AND develop a detailed description of one or more bacteria suspected (no culture) or confirmed (via culture) for the case. Don't oversimplify this unless your scenario supports it. Don't make this overly complicated (even if 5 different isolates from a single infection are possible, 1, 2, or 3 are probably plenty).
1. Include the following information in your discussion (this should not be viewed as an all inclusive list):
   1. What is the tissue "target" of your therapy? Where is the infection: urine? extracellular lung tissue? intracellular in macrophages?
   2. What characteristics should the drug possess in order to adequately reach the infection? (e.g., Distribution to ECF sufficient; High lipid solubility required (etc.)
   3. How important is bacteriocidal activity?
   4. Based on the scenario, is the patient likely to be able to distribute and eliminate drugs (in general) in a normal manner? If not, what specific alterations might you expect (e.g., increased or decreased Volume of distribution)


2. You may decide to base your therapy on culture and sensitivity results:
   1. If you decide to culture justify the cost.
   2. Present an isolation (1 or more organisms) and susceptibility profile that is logical for the clinical scenario.

OR

3. You may decide to forgo culture and sensitivity, or decide that therapy must begin before culture and sensitivity results are available:
   1. If you decide NOT to culture before starting therapy, justify the omission.
   2. List the bacteria that are probable causes of the infection described in the first section.
   3. Describe the most likely aggregate susceptibility pattern for this list of bacteria.
3. (10%)List all antimicrobials that could be effective against the bacteria involved. Discuss the susceptibility of your list of bacteria to specific antimicrobials.
4. (30%)Reduce the list to one or more antimicrobials that you will actually use. Explain how you eliminated each drug you will not use.
1. Appropriateness of the available dose form(s) Can you eliminate any drugs from your list based on dose form being unsuitable for the scenario?
2. Ability to reach the infection.
3. Do any existing pharmacokinetic alterations affect the drug? (compare patient to normal adult)? Is the alteration likely to cause a problem (toxicity or inefficacy) or benefit the patient (raise concentrations within safe limits)? Can you accommodate the alterations by altering drug administration (dose and/or interval)?
4. What potential toxicities should you be aware of?
5. What would be the total cost of each drug (not necessary to include costs for drugs that are not being considered for other reasons)? This is particularly important for the food animal cases. It may be necessary to describe the relative cost of the disease process or the value of the animal versus the proposed (or possible) therapies.
5. (20%)Describe, in detail, the actual therapy that will be administered to the patient. The description should include dose, route, interval, duration, cost, etc. Provide additional details to the description of this therapy in your patient. This description should include:
   1. The dose regimen for each antimicrobial (route, dose, frequency)
   2. What (possible) barriers to success (owner compliance, dose form preparation, etc.) exist?
   3. What adverse reactions can be anticipated?
   4. What is the duration of therapy, and how will you know that you have succeeded or failed?
   5. How long will it take for the patient to respond adequately?
   6. What steps you will take to validate the success or failure of the therapy (Rechecks, re-visits, etc.)? When and how do you judge success?.
   7. For food animals, state the withdrawal time and briefly describe the interaction with the owner concerning withdrawal time (its milk, its meat, it's forbidden to go into the food chain, it's on the label, etc. etc. etc.)

Papers receiving an 'A' will include the above and, they will be logical, to the point, factually correct and include "in line" citations for factual material or expert opinion used to support discussion points.

Suggested topics:

(There are many other good topics possible. If you do not believe that a topic you are interested in fits the format for the paper described above, please negotiate with the course leader.)