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What is InpharmD™?

Literature searching is tedious. InpharmD™ is here to help.

Clinical pharmacists can ask any question, anytime, from anywhere, and we’ll perform a custom literature search.

(And a 32% chance it’s already been asked.)


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This is how InpharmD™ transforms LITERATURE.

What's Being Asked...

What is the current evidence for using doxycycline for urinary tract infections?
Please send us summary of studies/data comparing misoprostol vs Dinoprostone. Thanks!
Are there any clinical scenarios with literature to support using rocuronium over cisatracurium as a continuous infus...
Is there any evidence of motixafortide use in pediatric patients?
What ECMO dosing strategies exist for aztreonam, cefazolin, and cefepime? (assuming normal renal function)

What would you like to ask InpharmD™?

InpharmD's Answer GPT's Answer

Author:Naveed Aijaz, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Current evidence supporting the use of doxycycline for urinary tract infections (UTIs) is limited, and major guidelines generally recommend against its routine use. The Infectious Diseases Society of America (IDSA) Antimicrobial-Resistant Treatment Guidance does not recommend doxycycline for treatment of extended-spectrum beta-lactamase–producing Enterobacterales (ESBL-E) cystitis, pyelonephritis, or complicated UTIs due to limited urinary excretion and insufficient clinical efficacy data. Al...

According to the Infectious Diseases Society of America (IDSA) Antimicrobial-Resistant Treatment Guidance for gram-negative bacterial infections, doxycycline is not recommended for the treatment of extended-spectrum beta-lactamase Enterobacterales (ESBL-E) cystitis. Despite the fact that oral tetracyclines have demonstrated effectiveness for the treatment of urinary tract infections (UTIs) in two older clinical outcome studies, the rationale for this recommendation is that both studies primarily focused on the treatment of P. aeruginosa, an organism that is not susceptible to oral tetracyclines. Additionally, doxycycline is primarily eliminated through the intestinal tract and has limited urinary excretion. The panel recommends against the use of doxycycline for treatment of ESBL-E cystitis until more robust data are available demonstrating clinical effectiveness of oral doxycycline for this indication. The panel also recommends against using doxycycline for the treatment of ESBL-E ...

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A search of the published medical literature revealed 4 studies investigating the researchable question:

What is the current evidence for using doxycycline for urinary tract infections?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious Diseases Society of America 2024 Guidance on the Treatment of Antimicrobial-Resistant Gram-Negative Infections. Clin Infect Dis. Published online August 7, 2024. doi:10.1093/cid/ciae403
[2] Mukerji AC, Sharma MM, Taneja OP, Saxena SN, Bhatnagar RK, Ghosh-Ray B. A clinical trial of alpha-6-deoxyoxytetracycline (doxycycline) in the treatment of urinary tract infections. Chemotherapy. 1969;14(2):77-85. doi:10.1159/000220613
[3] Musher DM, Minuth JN, Thorsteinsson SB, Holmes T. Effectiveness of achievable urinary concentrations of tetracyclines against "tetracycline-resistant" pathogenic bacteria. J Infect Dis. 1975;131 Suppl:S40-S44. doi:10.1093/infdis/131.supplement.s40
[4] Agwuh KN, MacGowan A. Pharmacokinetics and pharmacodynamics of the tetracyclines including glycylcyclines. J Antimicrob Chemother. 2006;58(2):256-265. doi:10.1093/jac/dkl224
[5] Jodlowski T, Ashby CR, Nath SG. Doxycycline for ESBL-E Cystitis. Clin Infect Dis. 2021;73(1):e274-e275. doi:10.1093/cid/ciaa1898
[6] White CR, Jodlowski TZ, Atkins DT, Holland NG. Successful Doxycycline Therapy in a Patient With Escherichia coli and Multidrug-Resistant Klebsiella pneumoniae Urinary Tract Infection. J Pharm Pract. 2017;30(4):464-467. doi:10.1177/0897190016642362
[7] Cunha BA. An infectious disease and pharmacokinetic perspective on oral antibiotic treatment of uncomplicated urinary tract infections due to multidrug-resistant Gram-negative uropathogens: the importance of urinary antibiotic concentrations and urinary pH. Eur J Clin Microbiol Infect Dis. 2016;35(4):521-526. doi:10.1007/s10096-016-2577-0
[8] Lockey JE, Williams DN, Raij L, Sabath LD. Comparison of 4 and 10 days of doxycycline treatment for urinary tract infection. J Urol. 1980;124(5):643-645. doi:10.1016/s0022-5347(17)55594-9
[9] Holloway WJ, Furlong JH, Scott EG. Doxycycline in the treatment of infections of the urinary tract. J Urol. 1969;102(2):249-252. doi:10.1016/s0022-5347(17)62124-4
[10] Cunha, B.A. Oral doxycycline for non-systemic urinary tract infections (UTIs) due to P. aeruginosa and other Gram negative uropathogens. Eur J Clin Microbiol Infect Dis 31, 2865–2868 (2012). https://doi.org/10.1007/s10096-012-1680-0
[11] Lai CC, Chen CC, Huang HL, Chuang YC, Tang HJ. The role of doxycycline in the therapy of multidrug-resistant E. coli - an in vitro study. Sci Rep. 2016;6:31964. Published 2016 Aug 18. doi:10.1038/srep31964
[12] Onduru OG, Aboud S, Nyirenda TS, Rumisha SF, Mkakosya RS. Antimicrobial susceptibility testing profiles of ESBL-producing Enterobacterales isolated from hospital and community adult patients in Blantyre, Malawi. IJID Reg. 2021;1:47-52. Published 2021 Sep 6. doi:10.1016/j.ijregi.2021.08.002

InpharmD's Answer GPT's Answer

Author:zophia@inpharmd.com, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Current guideline recommendations and pooled comparative evidence support both misoprostol and dinoprostone as effective options for cervical ripening and labor induction in term, singleton pregnancies with intact membranes, with misoprostol administered orally or vaginally and dinoprostone available as a vaginal gel or sustained-release vaginal insert. Across multiple analyses, rates of vaginal delivery, cesarean delivery, and key neonatal outcomes such as low Apgar scores and neonatal inten...

A 2025 Clinical Practice Guideline from the American College of Obstetricians and Gynecologists (ACOG) extensively evaluates contemporary methods for cervical ripening in term, singleton, vertex pregnancies with intact membranes. The panel highlighted that commonly used pharmacologic agents for cervical ripening include misoprostol, a prostaglandin E1 analogue, and dinoprostone, a prostaglandin E2 preparation. Both are recommended options, with oral or vaginal misoprostol supported by strong recommendations and high quality evidence, and vaginal dinoprostone supported by strong recommendations with moderate quality evidence. Misoprostol may be administered orally or vaginally in a range of dosing regimens, whereas dinoprostone is available as a vaginal gel or a 10 mg vaginal insert. Misoprostol is contraindicated in patients with a history of uterine surgery, including cesarean delivery, because of the risk of uterine rupture, and selection of any agent should consider patient chara...

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A search of the published medical literature revealed 11 studies investigating the researchable question:

Please send us summary of studies/data comparing misoprostol vs Dinoprostone.

Level of evidence
B - One high-quality study or multiple studies with limitations  

READ MORE→

[1] Cervical Ripening in Pregnancy: ACOG Clinical Practice Guideline No. 9. Obstet Gynecol. 2025;146(1):148-160. doi:10.1097/AOG.000000000000595
[2] World Health Organization. WHO Recommendations for Induction of Labour. Geneva: World Health Organization; 2011.
[3] World Health Organization. WHO Recommendations for Induction of Labour, At or Beyond Term. Geneva: World Health Organization; 2022.
[4] Yount SM, Lassiter N. The pharmacology of prostaglandins for induction of labor. J Midwifery Womens Health. 2013;58(2):133-44.
[5] Liu A, Lv J, Hu Y, Lang J, Ma L, Chen W. Efficacy and safety of intravaginal misoprostol versus intracervical dinoprostone for labor induction at term: a systematic review and meta-analysis. J Obstet Gynaecol Res. 2014;40(4):897-906.
[6]Tan SY, Au N, Peel MD, et al. Oral misoprostol (PGE1) vs vaginal dinoprostone (PGE2) for labor induction: individual participant data meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol. Published online November 8, 2025. doi:10.1002/uog.70100
[7] Lakho N, Hyder M, Ashraf T, et al. Efficacy and safety of misoprostol compared with dinoprostone for labor induction at term: an updated systematic review and meta-analysis of randomized controlled trials. Front Med (Lausanne). 2024;11:1459793. Published 2024 Dec 9. doi:10.3389/fmed.2024.1459793
[8] Ramadan M, Bashour G, Eldokmery E, et al. The efficacy and safety of oral and vaginal misoprostol versus dinoprostone on women experiencing labor: A systematic review and updated meta-analysis of 53 randomized controlled trials. Medicine (Baltimore). 2024;103(40):e39861. doi:10.1097/MD.0000000000039861
[9] Patabendige M, Chan F, Vayssiere C, et al. Vaginal misoprostol versus vaginal dinoprostone for cervical ripening and induction of labour: An individual participant data meta-analysis of randomised controlled trials. BJOG. 2024;131(9):1167-1180. doi:10.1111/1471-0528.17794
[10] Taliento C, Manservigi M, Tormen M, et al. Safety of misoprostol vs dinoprostone for induction of labor: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2023;289:108-128. doi:10.1016/j.ejogrb.2023.08.382
[11] Wang L, Zheng J, Wang W, Fu J, Hou L. Efficacy and safety of misoprostol compared with the dinoprostone for labor induction at term: a meta-analysis. J Matern Fetal Neonatal Med. 2016;29(8):1297-1307. doi:10.3109/14767058.2015.1046828
[12] Austin SC, Sanchez-Ramos L, Adair CD. Labor induction with intravaginal misoprostol compared with the dinoprostone vaginal insert: a systematic review and metaanalysis. Am J Obstet Gynecol. 2010;202(6):624.e1-624.e6249. doi:10.1016/j.ajog.2010.03.014
[13] Facchinetti F, Fontanesi F, Del Giovane C. Pre-induction of labour: comparing dinoprostone vaginal insert to repeated prostaglandin administration: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2012;25(10):1965-1969. doi:10.3109/14767058.2012.668584

InpharmD's Answer GPT's Answer

Author:Muna Said, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Current evidence comparing continuous infusions of rocuronium and cisatracurium is limited. Available pharmacokinetic and observational data suggest that cisatracurium may provide more consistent recovery and lower inter-patient variability, likely due to its organ-independent Hofmann elimination, whereas rocuronium may have prolonged effects in patients with hepatic or renal impairment. While guidelines do not favor a specific agent, experts note that cisatracurium is the only neuromuscular ...

According to the 2016 Society of Critical Care Medicine (SCCM) clinical practice guideline on sustained neuromuscular blockade, a continuous intravenous infusion of a neuromuscular blocking agent (NMBA) may be considered early in the course of acute respiratory distress syndrome (ARDS) in adults with a PaO₂/FiO₂ ratio < 150 (weak recommendation, moderate-quality evidence). The recommendation is informed by randomized trials of cisatracurium infusions in ARDS patients but does not compare different agents or recommend one neuromuscular blocking agent (NMBA) over another. Specifically, three multicenter randomized trials (n= 431) evaluated early 48-hour cisatracurium infusions in mechanically ventilated ARDS patients, showing improved oxygenation, reduced 28-day and hospital mortality, and decreased risk of barotrauma without increasing intensive care unit (ICU)-acquired weakness. Mechanistically, NMBA therapy may provide benefit by preventing ventilator asynchrony and reducing lung s...

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A search of the published medical literature revealed 5 studies investigating the researchable question:

Are there any clinical scenarios with literature to support using rocuronium over cisatracurium as a continuous infusion for continuous neuromuscular blockade?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Murray MJ, DeBlock H, Erstad B, et al. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016;44(11):2079-2103. doi:10.1097/CCM.0000000000002027
[2] Alhazzani W, Belley-Cote E, Møller MH, et al. Neuromuscular blockade in patients with ARDS: a rapid practice guideline. Intensive Care Med. 2020;46(11):1977-1986. doi:10.1007/s00134-020-06227-8
[3] Iavarone IG, Al-Husinat L, Vélez-Páez JL, et al. Management of Neuromuscular Blocking Agents in Critically Ill Patients with Lung Diseases. J Clin Med. 2024;13(4):1182. Published 2024 Feb 19. doi:10.3390/jcm13041182
[4] Smetana KS, Roe NA, Doepker BA, Jones GM. Review of Continuous Infusion Neuromuscular Blocking Agents in the Adult Intensive Care Unit. Crit Care Nurs Q. 2017;40(4):323-343. doi:10.1097/CNQ.0000000000000171

InpharmD's Answer GPT's Answer

Author:Naveed Aijaz, PharmD, BCPS + InpharmD™ AI LEARN MORE 

At the present time, we were unable to identify any published clinical trials, case studies/series, or pharmacokinetic studies evaluating motixafortide in pediatric patients. However, limited unpublished data derived from company press releases describe real-world use of motixafortide, with the overall patient cohorts including individuals as young as 14 years; caution is warranted, as the data are not peer-reviewed, and specific outcomes for pediatric and adolescent patients remain unknown.

According to recent press releases from Ayrmid, a biopharmaceutical company that holds the licensed rights to motixafortide, the drug has been used in real‑world practice to mobilize hematopoietic stem cells (HSCs) in patients with sickle cell disease. The reported patient cohorts ranged from 14 to 50 years of age. These observations are from an unpublished, non-peer-reviewed context, and no detailed efficacy or safety outcomes were provided specifically for the adolescent or pediatric patients. Furthermore, the reports do not delineate the specific number of patients aged 14-18 years. [1,2]

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A search of the published medical literature revealed 0 studies investigating the researchable question:

Is there any evidence of motixafortide use in pediatric patients?

Level of evidence
X - No data  

READ MORE→

[1] Ayrmid Reports Additional New Real‑World Data on Motixafortide for Stem Cell Mobilization in Sickle Cell Disease and Beta‑Thalassemia. BioSpace. February 4, 2026. Accessed February 27, 2026. https://www.biospace.com/press-releases/ayrmid-reports-additional-new-real-world-data-on-motixafortide-for-stem-cell-mobilization-in-sickle-cell-disease-and-beta-thalassemia
[2] Ayrmid Ltd. Ayrmid reports promising new real‑world data on motixafortide for stem cell mobilization in sickle cell disease. Press release. Dec 6, 2025. Accessed February 27, 2026. http://gamida-cell.com/press_release/ayrmid-reports-promising-new-real-world-data-on-motixafortide-for-stem-cell-mobilization-in-sickle-cell-disease/

InpharmD's Answer GPT's Answer

Author:azkaa@inpharmd.com, PharmD, BCPS + InpharmD™ AI LEARN MORE 

Extracorporeal membrane oxygenation (ECMO) dosing strategies for aztreonam, cefazolin, and cefepime are not well defined, and the available literature consists primarily of case reports, case series, and pharmacokinetic (PK) studies without corresponding clinical outcomes. Antibiotic PK and pharmacodynamics (PD) may be significantly altered during ECMO due to increased volume of distribution, altered clearance, and drug adsorption to circuit components. Data describing aztreonam dosing in ECM...

A 2020 review aimed to examine how the use of extracorporeal membrane oxygenation (ECMO) impacts antibiotic pharmacokinetics and consequently influences dosing requirements in critically ill adult ECMO patients. The use of ECMO is associated with a high frequency of antibiotic use due to its complications, such as the risk of infection due to invasive cannulation and immunosuppression from critical illness and mechanical support devices. Antibiotic pharmacokinetics and pharmacodynamics are significantly altered in ECMO due to factors like increased volume of distribution, altered clearance, and adsorption into circuit components. These changes complicate the selection, management, and dosing of antibiotics. While literature on this topic is limited, recent research has shed light on antibiotic pharmacokinetics during ECMO support. Key findings include the influence of antibiotic properties on drug loss in the ECMO circuit, the need for separate dosing considerations for adults compa...

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A search of the published medical literature revealed 7 studies investigating the researchable question:

What ECMO dosing strategies exist for aztreonam, cefazolin, and cefepime? (assuming normal renal function)?

Level of evidence
C - Multiple studies with limitations or conflicting results  

READ MORE→

[1] Abdul-Aziz MH, Roberts JA. Antibiotic dosing during extracorporeal membrane oxygenation: does the system matter?. Curr Opin Anaesthesiol. 2020;33(1):71-82. doi:10.1097/ACO.0000000000000810
[2] Gomez F, Veita J, Laudanski K. Antibiotics and ECMO in the Adult Population-Persistent Challenges and Practical Guides. Antibiotics (Basel). 2022;11(3):338. Published 2022 Mar 4. doi:10.3390/antibiotics11030338
[3] Pina-Sánchez M, Rua M, López-Causapé C, et al. Ceftazidime-avibactam plus aztreonam cocktail for the treatment of VIM-producing Pseudomonas aeruginosa infections: good enough to have another?. J Antimicrob Chemother. 2025;80(5):1371-1376. doi:10.1093/jac/dkaf083
[4] Pau-Parra A, Núñez-Núñez M, Sadyrbaeva-Dolgova S, et al. [Translated article] National survey and consensus document on dosing strategies for beta-lactam antibiotics against multidrug-resistant gram-negative bacilli (MDR-GNB) in critically ill patients undergoing extracorporeal life-support techniques: The DOSEBL study protocol. Farm Hosp. 2025;49(3):T179-T183. doi:10.1016/j.farma.2024.11.005
[5] Northwestern Medicine. Northwestern Medicine Antimicrobial ECMO Dosing Guidance.; 2024. https://adsp.nm.org/uploads/1/4/3/0/143064172/nm_antimicrobial_ecmo_dosing.pdf. Accessed February 26, 2026.

Why choose InpharmD™?

Find answers, not documents.

Before InpharmD™


BeforeTime
Your team spends hours per week cobbling together literature from different studies, many behind paywalls, leaving little time for action.
BeforeTime
TI opportunities are discovered (or presented by third parties) months after the fact, resulting in costly missed savings.
BeforeTime
Decisions may be made without a complete picture, or pushed out while gathering consensus.

After InpharmD™


BeforeTime
InpharmD™ delivers customized, actionable drug information in real time, so you can focus on execution.
BeforeTime
Your team stays informed immediately when new data emerges or prices change, and you’ll always be the first to know when any changes impact your formulary.
BeforeTime
With InpharmD™, your team can make faster, more informed decisions and move forward with confidence.

What Clinical Pharmacists Are Saying...


     

Assists in our research and is a great way or us to get an answer to a medical question without spending an average of 2 hours researching UptoDate or PubMed ourselves.


—   Jordan C., PharmD, New Jersey

     

Huge time saver with thorough responses.


—   Jane D., PharmD, Georgia

     

I’d never heard of a DI pharmacist before, now I have one. In. My. Pocket. Amazing!


     

Holy Shhh. Cow! Holy Cow! These summaries are beautiful.


—   Jane D., PharmD, Georgia

     

I just want to say: This is such a brilliant idea! You people are genius.


     

OH MY GOD WHERE HAVE YOU BEEN ALL MY LIFE!


     

I can’t tell you how much time I spend literature searching. And how I CANNOT STAND PAYWALLS. THIS IS UNBELIEVABLE!! (covers face for sec) thank you, thank you, thank you!


     

So they’re basically connecting academic researchers with front line providers and then automating everything. It’s simply brilliant.


     

The clinical pharmacist was our secret weapon anyway. (Smiles wryly) This pharmacist AI seems superhuman. I’m just blown away, honestly. (Looks at camera somberly.)


     

It’s an ENTIRE DI DEPARTMENT, that lives in Epic. Give me a second. I’m just having a hard time wrapping my head around that.


     

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