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If the above diagnoses are inconclusive or if a treatment regimen has already been started, a biopsy of the affected skin (i.e. Spray tub and bathroom floor with disinfectant after each use to help prevent reinfection and infection of other household members. Wash feet, particularly between the toes, with soap and dry thoroughly after bathing or showering.
If you have experienced an infection previously, you may want to treat your feet and shoes with over-the-counter drugs. Dry feet well after showering, paying particular attention to the web space between the toes. Try to limit the amount that your feet sweat by wearing open-toed shoes or well-ventilated shoes, such as lightweight mesh running shoes. After any physical activity shower with a soap that has both an antibacterial and anti-fungal agent in it. Drugs with similar names are a threat to patient safety, and pharmacists must be on high alert when filling and dispensing these medications.


Errors have involved physicians prescribing the wrong drug, as well as nurses and pharmacists who confused the drugs while transcribing and dispensing them or misinterpreted the drug name due to poor handwriting. Strongly consider using both the brand and generic names when referring to these drugs, and determining their purpose when processing the orders. A pharmacist notified ISMP about a colleague who noticed that a heart transplant patient received valACYclovir in error for 10 days. Using tall man letters when listing the drugs in computerized inventories may help reduce the risk of medication errors (consider using valACYclovir and valGANciclovir.) You might also be able to configure a computer alert to warn of the risk of mix-ups during order entry.
A pharmacy student recently reported a mix-up that occurred between the seasonal allergy drug cetirizine and the antidepressant sertraline.
The Table lists the confused drug names reported to the ISMP MERP from July through September 2010. Both have uses associated with cytomegalovirus (CMV) and may be used in immunosuppressed patients with HIV or transplant patients. A nurse left a telephone prescription on the pharmacy’s voice mail system for cetirizine 10 mg.


Valtrex is used in the treatment of shingles (herpes zoster), cold sores (herpes labialis), and genital herpes (herpes genitalis), and as prophylaxis for prevention of CMV in patients with advanced HIV or after transplantation. The pharmacist interpreted the order as sertraline, however, due to the way the nurse pronounced the drug name. Valcyte is used in the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome and also for prevention of CMV in kidney, heart, and kidney–pancreas transplant patients. The patient caught the error when she read the antidepressant medication guide in the bag with her prescription bottle.
Just as for handwritten prescriptions, prescribers and their agents should include the purpose of the drug with all telephone prescriptions, including those left on a voicemail system.



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