It is important to recognize that pharmacy practice models are changing quickly. Although the concepts of pharmaceutical care depict all pharmacists as clinical practitioners, there are still significant opportunities for individuals to develop advanced and refined skills and knowledge, and to seek recognition. Criteria for professional advancement need to be reevaluated and modified periodically. As departments become more effective in implementing pharmaceutical care, and practice skills advance, criteria for advancement must be updated. Recognition and advancement within newer models of practice such as patient focus units, clinical path teams, and quality improvement teams complicate assessment and evaluation strategies. In the future, pharmacy managers will need to look at reward and advancement systems that incorporate the recommendations of the team manager or members for these newer models of practice. Perhaps there will be a shift in responsibility for recognition to the team manager. Career ladders may need to provide for new roles, and reward practitioners for behaviors not currently represented in most departmental performance evaluations. Performance evaluation, standards of practice, and advancement criteria will need to be carefully reviewed and integrated with the patient focus team's objectives, structure, and processes to assure that appropriate recognition is given to pharmacists in this exciting new environment. Career ladders provide one form of reward and advancement for practitioners. Institutions can include many elements of career ladder process, function, and structure, as well as implement many other management tools for reward and recognition, without implementing a complete career ladder.

Cefepime is a potent, broad-spectrum, fourth-generation cephalosporin with enhanced activity against most gram-positive aerobic bacterial pathogens and many gram-negative aerobic bacteria that are resistant to other cephalosporins. The drug's zwitterionic structure contributes to more rapid penetration of gram-negative bacterial cell membranes, and its low affinity for most type I beta-lactamases leads to significantly reduced enzymatic degradation compared with other cephalosporins. Cefepime has a good toxicity profile, with minor gastrointestinal and central nervous system symptoms being most prevalent. At dosages ranging from 1-2 g every 8-12 hours, it is an alternative option for infections of the lower respiratory tract, urinary tract, and skin and skin structures, as well as febrile episodes in neutropenic patients with cancer, and bacteremia or septicemia in critically ill patients.

Bacterial infections, including those that cause infection in the healthy host as well as those that are more opportunistic, occur very commonly among persons infected with the human immunodeficiency virus (HIV). Bacterial infections are a direct result of the severe humoral and cellular immune defects found in these patients. Epidemiologic factors such as intravenous drug use and stage of HIV infection may also play important roles. Pulmonary, bloodstream, gastrointestinal, central nervous system, skin and soft tissue, and catheter-related infections are common, as are endocarditis, prostatitis, and others. Frequently reported pathogens are common organisms such as Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and enteric gram-negative pathogens, as well as less typical ones such as Listeria monocytogenes and Nocardia sp. The frequency of infection is specific to organ system and pathogen, often being many times higher than in immunocompetent hosts. Prompt recognition and aggressive therapy are required to reduce morbidity and mortality due to these infections.

Bacterial infections, including those that cause infection in the healthy host as well as those that are more opportunistic, occur very commonly among persons infected with the human immunodeficiency virus (HIV). Bacterial infections are a direct result of the severe humoral and cellular immune defects found in these patients. Epidemiologic factors such as intravenous drug use and stage of HIV infection may also play important roles. Pulmonary, bloodstream, gastrointestinal, central nervous system, skin and soft tissue, and catheter-related infections are common, as are endocarditis, prostatitis, and others. Frequently reported pathogens are common organisms such as Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, and enteric gram-negative pathogens, as well as less typical ones such as Listeria monocytogenes and Nocardia sp. The frequency of infection is specific to organ system and pathogen, often being many times higher than in immunocompetent hosts. Prompt recognition and aggressive therapy are required to reduce morbidity and mortality due to these infections.