Sara Grossman, PharmD

Diarrhea is a common adverse effect of antibiotics, affecting 11% to 40% of children treated with broad-spectrum antibiotics.

 Antibiotic-associated diarrhea (AAD) may occur when anti biotics disrupt the normal balance of the gut flora, causing harmful bacteria to multiply and destroy the gut microflora.

 Probiotics restore the natural balance of gut flora through the introduction of nonpathogenic bacterial or yeast microbiota and have been used in clinical trials and in practice to manage AAD in children.

Probiotics are generally well tolerated in healthy children, with minor adverse effects being dyspepsia, abdominal pain, nausea, and bloating.

 Probiotics should be avoided in children who are immunocompromised or severely debilitated.

 Likewise, probiotics must be used with caution in specific populations such as premature infants, critically ill patients, and patients with a central venous catheter, cardiac valvular disease, and short-gut syndrome.

 Although evidence supporting a clinically meaningful interaction between probiotics and antibiotics is lacking, the use of antibiotics could theoretically eradicate the microorganisms contained in the probiotics. Therefore, it has been suggested to space the administration of probiotics from antibiotics by 2 hours.

Because antibiotics are commonly used in the pediatric population, we sought to examine the evidence concerning the use of probiotics for the prevention of pediatric AAD. After applying search criteria, 7 relevant articles were identified, which are summarized below.

Shan et al described an open label, randomized, controlled trial involving 333 hospitalized children who were being treated with intravenous antibiotics.

 The study’s objective included an assessment of the efficacy of 

, dosed at 500 mg per day, for the prevention of AAD. Patients were followed during and 2 weeks after antibiotic therapy. The primary outcomes related to the prevention of AAD were the frequency and duration of AAD. In this study, the use of 

 resulted in statistically significant fewer occurrences of AAD. The investigators concluded that using 

 was effective for the prevention of AAD in children.

Georgieva et al described a randomized, controlled study that examined the efficacy of 

 In this study, 100 hospitalized children aged 3 to 12 years were randomly assigned to receive a probiotic tablet containing 1 × 10

 or placebo once daily during the antibiotic treatment period and for an additional 7 days. The primary study end point was the incidence of diarrhea during and up to 21 days post antibiotic treatment. The investigators found no statistically significant difference between the 2 groups but noted that because of the low incidence of AAD in both groups, no conclusion can be made about the efficacy of 

Fox et al described a randomized, double-blind, placebo-controlled study that examined the efficacy of a yogurt containing probiotics (

) for the prevention of AAD.9 In this study, 72 outpatients aged 1 to 12 years were randomly assigned to receive active yogurt or pasteurized yogurt (placebo) for the duration of their antibiotic treatment. The primary outcome was stool frequency and consistency. There were significantly fewer occurrences of diarrhea in the children who were given the probiotic-rich yogurt as compared with those receiving placebo. Also, more adverse events, including abdominal pain, loss of appetite, and nausea, were reported in the placebo group compared with the active group. The investigators concluded that the specific probiotic-rich yogurt used in the trial was an effective intervention for reducing the incidence of antibiotic-associated gastrointestinal disturbance in children.

Olek et al described a randomized, double-blind, placebo-controlled study that examined the efficacy of probiotics for the prevention of AAD in 438 outpatient children aged 1 to 11 years.

 Patients were assigned to receive a probiotic capsule containing 1 × 10

 or placebo once daily for the duration of antibiotic therapy and for 1 week after completion of treatment. The primary outcome was the incidence of antibiotic-associated loose/watery stools; the investigators found no statistically significant differences between the groups regarding this outcome. Furthermore, the incidence of children with at least 1 adverse event was significantly higher in the placebo group compared with the probiotic group. The investigators concluded that there was no beneficial effect of 

Kołodziej and Szajewska assessed the efficacy of 

 for the prevention of diarrhea and AAD in hospitalized children.

 The investigators randomly assigned 250 children younger than 18 years to receive 

 CFU or placebo twice daily for the duration of antibiotic treatment. Primary outcome measures were the occurrences of diarrhea and AAD. The investigators found no statistically significant differences between the 2 groups in the primary outcome measures. Additionally, there were no statistically significant differences in adverse effects. The investigators concluded that the study provided no evidence to support the use of 

Wronowski et al described a prospective, randomized, double-blind, placebo-controlled study in a pediatric hospital.12 In this study, 156 children aged 1 to 18 years were randomly assigned to receive 100-mg bovine lactoferrin or placebo twice daily for the duration of antibiotic therapy. The primary outcome was the occurrence of AAD during treatment and up to 2 weeks after antibiotic therapy. The investigators found no statistically significant benefit for the probiotic and concluded that bovine lactoferrin was not effective for the prevention of AAD.

Esposito et al described a placebo-controlled study designed to evaluate the effectiveness of 

 for the prevention of AAD in children receiving antibiotic therapy postoperatively.13 The study consisted of 3 groups (probiotic, no treatment, and placebo), with 30 boys in each group. The overall incidence of AAD was statistically significantly lower in the probiotic group compared with the other groups. Also, the duration of AAD was statistically significantly longer in the control groups than the probiotic group. The investigators concluded that the use of 

 significantly reduced the incidence and duration of AAD in children.

Clinical trials evaluating the use of probiotics for the prevention of AAD in children yielded varying results. A systematic review that assessed the results of 33 randomized, controlled studies concluded that probiotics produced

a moderate reduction in the incidence of pediatric AAD, with a larger effect noted with high-dose probiotics (≥ 5 billion CFUs/day).1 Furthermore, probiotics reduced the duration of diarrhea by almost 1 day. Among the various probiotics evaluated, 

 (eg, Florastor) at 5 to 40 billion CFUs per day appeared to be most appropriate for preventing AAD in children. The authors of the systematic review also stated that it is pre- mature to draw firm conclusions about other probiotic agents.

Notably, there does not seem to be a consensus concerning the use of probiotics to prevent AAD in children as a standard of care. When making recommendations concerning the use of probiotics, pharmacists should follow evidence-based practices.

Guo Q, Goldenberg JZ, Humphrey C, El Dib R, Johnston BC. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. 

. 2019;4(4):CD004827. doi:10.1002/14651858.CD004827.pub5

Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics—approaching a definition. 

. 2001;73(suppl 2):361S-364S. doi:10.1093/ajcn/73.2.361s

Probiotics. Natural Medicines. Updated March 10, 2022. Accessed May 31, 2022. 

Salminen MK, Rautelin H, Tynkkynen S, et al. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic 

Hojsak I, Fabiano V, Pop TL, et al. Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups. 

. 2018;107(6):927-937. doi:10.1111/apa.14270

. 2010;67(6):449-458. doi:10.2146/ajhp090168

​​Shan LS, Hou P, Wang ZJ, et al. Prevention and treatment of diarrhoea with 

 in children with acute lower respiratory tract infections. 

. 2013;4(4):329-334. doi:10.3920/BM2013.0008

Georgieva M, Pancheva R, Rasheva N, Usheva N, Ivanova L, Koleva K. Use of the probiotic 

 DSM 17938 in the prevention of antibiotic-associated infections in hospitalized Bulgarian children: a randomized, controlled trial. 

. 2015;21(4):895-900. doi:10.5272/jimab.2015214.895

Fox MJ, Ahuja KD, Robertson IK, Ball MJ, Eri RD. Can probiotic yogurt prevent diarrhoea in children on antibiotics? A double-blind, randomised, placebo-controlled study. 

. 2015;5(1):e006474. doi:10.1136/bmjopen-2014-006474

Olek A, Woynarowski M, Ahrén IL, et al. Efficacy and safety of 

 DSM 9843 (LP299V) in the prevention of antibiotic-associated gastrointestinal symptoms in children-randomized: double-blind, placebo-controlled study. 

. 2017;186:82-86. doi:10.1016/j.jpeds.2017.03.047

DSM 17938 in the prevention of antibiotic-associated diarrhoea in children: a randomized clinical trial. 

. 2019;25(6):699-704. doi:10.1016/j.cmi.2018.08.017

Wronowski MF, Kotowska M, Banasiuk M, Kotowski A, Kuzmicka W, Albrecht P. Bovine lactoferrin in the prevention of antibiotic-associated diarrhea in children: a randomized clinical trial. 

. 2021;9:675606. doi:10.3389/fped.2021.675606

Esposito C, Roberti A, Turrà F, et al. Frequency of antibiotic-associated diarrhea and related complications in pediatric patients who underwent hypospadias repair: a comparative study using probiotics vs placebo. 

. 2018;10(2):323-328. doi:10.1007/s12602-017-9324-4

Articles

Evidence of the relationship between probiotics and antibiotics is lacking.

Probiotics for the Prevention of Pediatric Antibiotic-Associated Diarrhea

Vaccines are a critical means of preventing disease-related morbidity and mortality,

 providing individual and herd immunity, and decreasing the burden of certain diseases.

 While vaccination is important at every age, it is especially important for older adults: As people age, their immune system weakens, making them more vulnerable to infections. Likewise, age-related comorbidities may increase the risk of complications from illnesses.


Preventive medicine is the most effective strategy to protect the health of older adults, and vaccination is one of the most feasible approaches.

 Read on for an overview of current vaccination recommendations for adults 65 years and older and strategies to ensure the effective vaccination of this population.

The CDC provides recommendations for immunization practices, which are available on the CDC website.

 Specific recommendations are made based on age group as well as on medical condition and other indications. A summary of the CDC recommendations for those 65 years and older is presented in the 

Table. Routine Vaccinations for Individuals 65 Years and Older

The COVID-19 vaccine reduces the risk of contracting and spreading SARS-CoV-2 and decreases the risk of serious illness. The dosing regimen differs based on the specific product that is used. The CDC updated its recommendations in late December 2021 to include a clinical preference for the Pfizer-BioNTech or Moderna mRNA vaccines over the Johnson & Johnson vaccine.

 The CDC also recommends a single booster dose of the COVID-19 vaccine.

At press time, individuals who received the Pfizer-BioNTech vaccine are eligible to receive a booster dose 5 months after their completed series,9 and those who received the Moderna vaccine, after 6 months. Individuals who received the Johnson & Johnson vaccine are eligible to receive a booster dose beginning 2 months after their initial vaccination.

Because of the uncertainty about the duration of protection and the emergence of new variants of the virus, recommendations for booster doses of the COVID-19 vaccine may change.


All individuals 65 years and older should receive an annual influenza vaccine, ideally by the end of October but no earlier than September because of concerns of waning immunity.

 During the 2017-2018 flu season, nearly 80% of influenza-related deaths were in individuals 65 years or older.12 The CDC recommends the influenza inactivated vaccine (IIV) or the influenza recombinant vaccine (RIV4) in adults over 50 years; the influenza live attenuated vaccine (LAIV4) is not recommended in this population.

A tetanus and diphtheria (Td) booster, with or without pertussis, is recommended every 10 years. Individuals who have not been previously vaccinated with tetanus, diphtheria, and pertussis (Tdap) at or after the age of 11 should receive 1 dose of Tdap followed by Td or Tdap boosters every 10 years.

The risk for developing herpes zoster increases with age.13 As such, it is recommended that adults 50 years and older receive a 2-dose series of the recombinant zoster vaccine (Shingrix) spaced 2 to 6 months apart, regardless of previous herpes zoster infection or previous administration of a live zoster vaccine (Zostavax, ZVL).

The overall case-fatality rate for pneumococcal bacteremia is about 20% among adults; this rate may be as high as 60% among older patients.14 The CDC currently recommends 1 dose of the pneumococcal polysaccharide vaccine (PPSV23) for all adults 65 and older. If PPSV23 was administered prior to age 65, the dose of PPSV23 should be administered at least 5 years after the previous dose. A dose of PCV13 may also be considered in addition to PPSV23 in those who did not receive PCV13 previously; a determination concerning its administration should be based on shared clinical decision-making. In patients requiring both vaccines, PCV13 should be administered first, at least 1 year before the PPSV23 vaccine.

In addition to the aforementioned vaccines recommended for most adults 65 years and older, the CDC recommends other vaccines—including varicella, hepatitis A, hepatitis B, MenACWY (meningococcal A, C, W, Y), MenB (meningococcal B), and 

 type b5—for those with certain risk factors or other indications.


There are several reasons elderly adults may not be vaccinated according to CDC recommendations. Patient-related factors include lack of awareness of declining immunity or the importance of vaccines in this age group, lack of familiarity with vaccine recommendations, the belief that a healthy lifestyle can take the place of vaccines, worries about vaccine safety, underestimation of the impact of vaccine-preventable diseases on health, concerns about cost, and mobility issues preventing the individual from getting to a vaccination site.

Provider-related issues and other systematic issues include lack of familiarity with vaccine recommendations, lack of promotion of vaccination to patients, limited access to immunization records, and availability of a vaccine at the provider’s practice site.

Overcoming barriers to vaccination among older individuals means addressing patient-level, provider-level, and systematic issues. Key to the success of vaccination efforts is buy-in from the patient; effective patient education and encouragement can help facilitate this. Health care professionals should identify knowledge gaps and patient concerns, achieved via motivational interviewing that alleviates concerns. Inform patients that Medicare Part B covers influenza and pneumococcal vaccines, as well as other vaccines for those who are at increased risk. Vaccines may also be covered by Medicare Part D, Medicaid, or private insurers.

At the provider level, attaining the proper education and training necessary to effectively address vaccination needs in the community can help. Keeping current with the CDC’s recommendations is essential. Providers must maintain complete and up-to-date patient records, ensure sufficient supply of properly stored vaccines. Providers must also be proactive in examining patient history and screening for immunization needs. Although this should be an ongoing process, it may be instrumental to designate a particular visit to ensure that an overall assessment of patient immunization status is performed.

armacists are uniquely positioned to play a significant role in vaccination efforts. Community pharmacies are convenient vaccination sites, staffed with trusted professionals who are knowledgeable and trained.

On a systemic level, government and social agencies and the health care community should work to facilitate successful vaccination programs. Those who live in community-based group homes or who receive home health care should be included in vaccination outreach programs. Involving caregivers is also important. Vaccines should be offered at convenient locations: senior centers, community centers, or independent living facilities for older adults. Pay special attention to those who are homebound, and to people living in rural or remote areas. Lastly, create effective communication material specifically geared for this population; this is likely to be instrumental in maximizing the impact of these efforts.

Older adults are among the most vulnerable populations. By leveraging expertise to advocate for and facilitate vaccine administration, pharmacists are poised to ensure widespread vaccination in this cohort.


View the rest of our February 2022 issue here

Weinberger B. Vaccines for the elderly: current use and future challenges. 

. 2018;15:3. doi:10.1186/s12979-017-0107-2

Why vaccinate? The history of vaccines. The College of Physicians of Philadelphia. Updated January 25, 2018. Accessed January 3, 2022. 

https://www.historyofvaccines.org/content/articles/why-vaccinate

Adults age 65 and older. US Department of Health & Human Services. Updated April 29, 2021. Accessed January 3, 2022. 

https://www.hhs.gov/immunization/who-and-when/adults/seniors/index.html

Ciabattini A, Nardini C, Santoro F, Garagnani P, Franceschi C, Medaglini D. Vaccination in the elderly: the challenge of immune changes with aging. 

. 2018;40:83-94. doi:10.1016/j.smim.2018.10.010

Adult immunization schedule. CDC. Updated February 12, 2021. January 3, 2022. 

https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html

Types of vaccines available. CDC. Updated December 29, 2021. Accessed January 3, 2022. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html

CDC endorses ACIP’s updated COVID-19 vaccine recommendations. News release. CDC. December 16, 2021. Accessed January 3, 2022. https://www.cdc.gov/media/releases/2021/s1216-covid-19-vaccines.html

CDC expands eligibility for COVID-19 booster shots. News release. CDC. October 21, 2021. Accessed January 3, 2022. 

https://www.cdc.gov/media/releases/2021/p1021-covid-booster.html

CDC recommends Pfizer booster at 5 months, additional primary dose for certain immunocompromised children. CDC. News release. January 4, 2022. Accessed January 4, 2022. https://www.cdc.gov/media/releases/2022/s0104-Pfizer-Booster.html

COVID-19 vaccine booster shots. CDC. Updated December 28, 2021. Accessed January 3, 2022. 

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html

Key facts about flu vaccines. CDC. Updated November 18, 2021. Accessed January 3, 2022. 

https://www.cdc.gov/flu/prevent/keyfacts.htm

Frank T. Flu deaths rising for Americans over 65. AARP. October 2, 2018. Accessed January 3, 2022. 

https://www.aarp.org/health/conditions-treatments/info-2018/older-flu-deaths-rising.html

Shingles. Mayo Clinic. September 17, 2021. Accessed January 3, 2022. 

https://www.mayoclinic.org/diseases-conditions/shingles/symptoms-causes/syc-20353054

Pneumococcal vaccines (PCV13 and PPSV23). Immunization Action Coalition. Updated October 22, 2020. Accessed January 3, 2022. 

https://www.immunize.org/askexperts/experts_pneumococcal_vaccines.asp

Aging and immunity: the important role of vaccines. American College of Physicians. Accessed January 3, 2022. 

https://www.acponline.org/system/files/documents/clinical_information/resources/adult_immunization/aging_and_immunity_guide.pdf

Ventola CL. Immunization in the United States: recommendations, barriers, and measures to improve compliance: part 2: adult vaccinations. 

Tak CR, Marciniak MW, Savage A, Ozawa S. The essential role of pharmacists facilitating vaccination in older adults: the case of herpes zoster. 

. 2020;16(1):70-75. doi:10.1080/21645515.2019.1637218

Jurisdictions: Vaccinating older adults and people with disabilities. CDC. Reviewed August 26, 2021. Accessed January 3, 2022. 

https://www.cdc.gov/vaccines/covid-19/clinical-considerations/older-adults-and-disability/access.html

Vaccines are important for everyone, but they’re critical for adults older than 65 years. 

Review: Vaccine Guidelines for Older Adults

Since the onset of the COVID-19 pandemic, emphasis has been placed on monitoring health status, screening for disease states, and ensuring that the general public is not exposed to the virus and/or exhibiting signs and symptoms of COVID-19. One of the methods used to detect illness and prevent the spread of the disease is monitoring for fever with the use of thermometers. According to IRI, a Chicago-based market research firm, the sale of personal thermometers increased by 297% during the 4-week period ending March 22, 2020, compared to the same time period 1 year earlier.

 Since COVID-19 remains a public concern, it is important for pharmacists to be familiar with the various types of thermometers available on the market and to provide proper guidance on their use.

The body maintains a state of homeostasis regulated by the hypothalamic thermoregulatory center. The center balances excess heat production from metabolic activity in the muscle and liver by allowing heat to be released from the skin and lungs to maintain a mean oral temperature of 36.8

 0.7o F). Fluctuations in body temperature occur throughout the day, with temperature being lower in the morning and higher in the evening.

 Furthermore, the temperature considered to be fever differs based on the measurement site (

Body Temperature per Site of Measurement

Considerations When Selecting a Thermometer

Various thermometers are available on the US market. When selecting a thermometer, identifying one that will provide an accurate reading is most important. Since the FDA regulates thermometers as medical devices, all approved thermometers are considered accurate and reliable, when used appropriately.

 To do so, considerations must be given to the ease of use, which may be a function of the site of temperature measurement. Thus, consideration should be given to the versatility afforded by certain thermometers, allowing for measurements to be obtained in more than one body site. The following is a discussion of various types of thermometers. 

Rectal thermometers have been generally accepted as the “gold standard” for measuring temperature in very young children; however, some caregivers refrain from using them due to their intrusive nature and associated risks. These risks may include the development of peritonitis, rectal or intestinal perforation, and retaining of the thermometer inside the rectum.

 Rectal temperature measurements should not be taken in patients with obstructive hemorrhoids or diarrhea, as well as in patients with neutropenia due to their increased susceptibility to infection. Other considerations when measuring rectal temperature are that it is cumbersome and time consuming and that rapid changes in body temperature may not be detected due to the large muscle mass and poor blood flow to the rectal area.

 Notably, rectal temperatures tend to run higher than oral temperatures.

Oral thermometers are commonly used in medical offices and within households. However, to obtain accurate readings, certain factors must be kept in mind. For instance, oral temperature readings should be obtained at least 20 to 30 minutes after drinking and/or eating and should not be taken in patients who have a difficult time keeping the thermometer under their tongue and/or difficulty creating a tight seal around the thermometer.

 For younger patients who may struggle with these issues, pacifier thermometers are an alternative option to measure temperature. To obtain a proper reading with a pacifier thermometer, patients should wait 30 minutes after eating or drinking and should hold the pacifier in their mouth without moving it for 2 to 6 minutes.

 Lastly, oral temperatures should not be obtained in patients who are hyperventilating, uncooperative, lethargic, confused, and/or those who have had recent oral surgery.

Tympanic thermometers are usually used in pediatric offices to take the temperature via the ear. These provide a relatively quick and accurate measurement because the ear is close to the hypothalamus which allows for an accurate reading of core body temperature.

 However, proper positioning of the thermometer is extremely important to ensure an accurate reading. Other factors such as inflammation of the ear canal, age (children younger than 6 months do not have fully developed ear canals), and earwax buildup may also affect temperature readings.

 Additionally, cold or hot weather can affect temperature readings so it is recommended to wait at least 15 minutes after being exposed to extreme temperatures before using the thermometer.

Proper technique requires the user to pull the ear backward to help straighten the ear canal and to aim the tip of the probe towards the patient's eye on the opposite side of his or her head.

Temporal touch thermometers use an infrared scanner to scan the temporal artery in the forehead. This task is completed by placing the thermometer on 1 side of the forehead and then moving it across the forehead; the process usually takes a few seconds. This method of measuring temperature can be very sensitive in detecting fever but the scanner needs to be in contact with the skin at all times. Overall, this method provides an easy and accurate temperature reading in most patients.

 Yet, one must keep in mind that direct sunlight, cold temperature, sweaty forehead, and poor technique can impact the accuracy of the reading.

Noncontact temporal thermometers also use infrared technology but these do not require direct contact with the skin. Thermometers are generally held between 1.2 and 6 inches from the skin.

 Using a forehead noncontact infrared thermometer is quick, convenient, noninvasive, and carries a low risk of disease transmission. Studies suggest that taking temperature immediately after coming in from the cold underestimates body temperatures and as such, infrared temporal thermometers are not ideal for screening for diseases during cold weather.

 To ensure accuracy, measurements should be taken at least 10 minutes after coming in from the cold.

 These thermometers should also be used in environments free from secondary infrared sources, such as direct sunlight and incandescent lamps.

Axillary temperatures usually run lower than oral temperatures. Compared with the rectal and oral methods of measuring temperature, axillary thermometers are less reliable at detecting fevers.

 Although they may be favored because of their ease of use and noninvasive nature, their use should be discouraged because of concerns with accuracy.

 When used, temperatures should not be taken directly after vigorous activity or bathing since these can alter body temperature.

Basal thermometers are used to monitor basal body temperature for the purpose of tracking ovulation in women who are trying to conceive or prevent pregnancy.

 The digital basal thermometers have smaller gradations than regular thermometers (0.1 degree vs 0.2 degree), enabling them to detect small changes in body temperatures. This is important since the temperature increase that follows ovulation is small (approximately 0.4 to 1.0

Temperature can be taken orally, rectally, or vaginally; however, the same site must be used each day. Temperature must also be taken at approximately the same time each morning before rising, after at least 3 hours of sleep.

Color change thermometers usually involve placing a strip on the forehead, which changes color according to the heat radiating from the body. These thermometers are easy to use, provide a quick reading, and are sometimes reusable. However, they can be inaccurate as they do not reliably detect changes in the core temperature but only changes in skin temperature.

Glass Thermometers vs Digital Thermometers

Two types of glass thermometers are available, one with mercury and the other without it. Mercury-containing thermometers are no longer recommended due to toxic effects and may be banned in some states.

 Notably, though, individuals may still have access to these thermometers at home. Before taking measurements, it is important to ensure that the thermometer’s mercury is at the bottom of the measurement column. If this is not the case, the thermometer should be flicked to bring down the mercury in the column. Mercury-free glass thermometers use a gallium-indium-tin alloy, as a substitute for mercury.

 Glass thermometers differ in their tips. Those that utilize a long, thin tip are indicated for oral and axillary use whereas those with a short, round tip are for rectal use.

Digital thermometers are commonly used as an alternative to glass thermometers since they are faster, easier to read, and remove the environmental concern of mercury.

 Furthermore, there are no clinically significant differences between the accuracy of glass thermometers and digital thermometers.

 Digital thermometers are portable and can be used to measure oral, axillary, and rectal temperatures.

Several factors should be considered when selecting a thermometer. Thermometers vary in their mechanisms of measuring temperatures and in their intended uses. Pharmacists must be familiar with the different thermometers so they can ensure proper use by the consumer.

1. COVID-19 and the Economy: Tacking the Dramatic Pivot of U.S. Consumer and Shopper Behavior. IRI Worldwide. Published April 3, 2020. Accessed May 12, 2021. https://www.iriworldwide.com/iri/media/library/covid-19-thought-leadership-4-3-2020.pdf

2. Dinarello CA, Porat R. Fever. In: Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, eds. 

Harrison’s Principles of Internal Medicine

, 20th ed. McGraw Hill: 2020. Accessed March 16, 2021.

3. Lemay V, Feret BM. Fever. In: Krinsky DL, ed. 

Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care.

 19th ed. APhA Publications; 2018:97-110. 

4. Temperature: Digital and Glass Thermometers. Nationwide Children’s. Updated February 2017. Accessed March 24, 2021. https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/helping-hands/temperature-digital-and-glass-thermometers

5. Thermometers: Understanding the Options. Mayo Clinic. Updated November 17, 2020. Accessed March 25, 2021. https://www.mayoclinic.org/diseases-conditions/fever/in-depth/thermometers/art-20046737

6. Non-Contact Temperature Measurement Devices: Considerations for use in Port of Entry Screening Activities. Centers for Disease Control and Prevention. Published August 22, 2014. Accessed March 19, 2021. https://stacks.cdc.gov/view/cdc/24857/cdc_24857_DS1.pdf

7. Dzien C, Halder W, Winner H, Lechleitner M. COVID-19 screening: are forehead temperature measurements during cold outdoor temperatures really helpful? 

. 2021;133(7-8):331-335. doi: 10.1007/s00508-020-01754-2.

8. Erenberk U, Torun E, Ozkaya E, Uzuner S, Demir AD, Dundaroz R. Skin temperature measurement using an infrared thermometer on patients who have been exposed to cold. 

 2013;55(6):767-770. doi: 10.1111/ped.12188

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 19th ed. APhA Publications; 2018:899-922. 

10. Basal Body Temperature for Natural Family Planning. Mayo Clinic. Updated March 3, 2021 Accessed May 26, 2021. https://www.mayoclinic.org/tests-procedures/basal-body-temperature/about/pac-20393026

11. Mercury Thermometers. US Environmental Protection Agency. Updated March 30, 2021. Accessed June 9, 2021. 

https://www.epa.gov/mercury/mercury-thermometers

12. Baura G. Thermometers. In: Baura G, ed. 

Medical Device Technologies: A System Based Overview Using Engineering Standards.

 2nd ed. Academic Press; 2020; doi: 10.1016/B978-0-12-811984-6.00012-X

13. Hardu G, Murugan R. Is there a significant difference between digital and glass mercury thermometers? 

Pharmacists must be familiar with the different thermometers so they can ensure proper use by the consumer. 

Thermometers: A Review

Back in December 2020, the FDA issued an emergency use authorization for Pfizer-BioNTech’s COVID-19 vaccine, followed by authorization for the Moderna and Janssen (Johnson & Johnson) vaccines. Many Americans have yet to be vac- cinated, with the most common reasons for refusing being fear of potential adverse effects (AEs) and concerns about the rapid vaccine development process.

Pharmacists must be familiar with the safety profiles of the vaccines to assure the public of their safety.

COVID-19 Vaccines Available in the United States

Three vaccines are currently available on the US market. The Pfizer and Moderna vaccines are both messenger RNA (mRNA) vaccines, whereas the Janssen is a viral-vector vaccine.

 All 3 result in the production of SARS-CoV-2 spike proteins, which trigger the development of antibodies. The development of immunity and memory cells typically takes a few weeks and, when complete, these protect the body against COVID-19 infections.

 Although the vaccines stimulate an immune response, they do not cause a full COVID-19 infection.

Before a vaccine receives FDA approval, it undergoes a series of trials during which its efficacy and safety profiles are established. Trials begin in animal models and continue with 3 phases of clinical trials. A vaccine gains FDA approval only if the efficacy and safety data prove that its benefits outweigh the risks. Once a vaccine has been approved and launched, postmarketing surveillance begins. Such surveillance allows for the collection of safety data in a larger and more diverse population.

Postmarketing safety information for COVID-19 vaccines has been gathered in several ways. For all vaccines, the FDA’s Center for Biologics Evaluation and Research monitors vaccine safety through passive and active surveillance.

 Passive surveillance consists of adverse event reports received from the public and health care professionals, which are entered into the Vaccine Adverse Event Reporting System. Active surveillance involves proactively obtaining and analyzing information from large health care data systems to verify safety signals identified through passive surveillance or to detect additional safety signals. If a possible link between a vaccine and an AE is identified, public health officials assess the benefits and risks and determine whether the vaccine can continue to be administered and whether administration guidelines require adjustment.

Reported Adverse Effects Associated With COVID-19 Vaccines

The AEs reported with the COVID-19 vaccines are generally mild and resolve within a few days.

Ease patients’ concerns by being well versed in the safety profiles of each vaccine.