COVID-19: Guidelines for pharmacists in South Africa

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: • Epidemiology • The virus, its modes of transmission and incubation period • Symptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19 • Social media myths and misinformation • Treatment guidelines and medicines that may need to be kept in stock • Treatment and prevention options, including an update on vaccine development • The case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19 • Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: • World Health Organization (WHO): https://www.who.int/emergencies/diseases/novelcoronavirus-2019 • National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseasesa-z-index/covid-19/ • National Department of Health (NDoH): http://www.health.gov.za/index.php/ outbreaks/145-corona-virus-outbreak/465-corona-virus-outbreak; https://sacoronavirus. co.za/

An overview of the management of back pain

Back pain affects people across any socio-economic category and is a leading cause of absenteeism and decreased productivity in the workplace. This symptomatic condition is caused by multiple factors, making it difficult to manage. With a small proportion of people experiencing back pain due to pathological reasons, in the larger majority, back pain is due to a mechanical cause. Taking a complete history that includes identifying risk factors such as depression, poor posture, lack of exercise, older age and a physically demanding job is crucial to the effective management of the condition. Behavioural, psychological and social factors of the patient should form the backbone for treatment of back pain. Non-pharmacological management such as exercise, spinal manipulation and acupuncture should be the first-line treatment; however, if this provides poor results then pharmacological measures such as the use of non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen or muscle relaxants such as cyclobenzaprine should be considered

An Overview of Pharmacotherapy-Induced Ototoxicity

This article provides an overview of ototoxic medication; as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine; they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies; further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team

Amphotericin B in the Management of Fungal Infections in a Neonatal Intensive Care Unit (NICU): Experiences in a Teaching Hospital

Background:Hospital-acquired pathogens cause considerable morbidity and mortality in preterm infants. Neonatal candidaemia plagued the neonatal ICU at Dr. George Mukhari Hospital. The standard treatment of candidaemia at the time of the study was fluconazole 10 mg/kg/day. The use of amphotericin B was introduced after identifying a problem with fluconazole resistance.Method:The application of the amphotericin B treatment protocol was monitored in the first 20 patients. A test dose of 0.25 mg/kg was administered with 0.25 mg/kg/dose increments until a maintenance dose of 1 mg/kg/dose was reached. Patients were kept on amphotericin B for one week after the first culture came back negative and were discharged as soon as the second blood culture also came back negative and they were clinically doing well. The patients' responses to amphotericin B were evaluated according to the laboratory data and clinical response.Results:Seventeen patients remained and were treated with amphotericin B for an average of 18.5 days (median=11 days) until the first negative Candida culture could be obtained; with a cumulative dose of 20.8 mg (median=19.2 mg) on average. The period to response in this study was relatively short.Conclusion:The specific strain cultured in this NICU could be eradicated with continuous use of amphotericin B. Further clinical investigation and improved infection control practices will be needed to decrease the incidence of invasive Candida infections; the duration of hospital stay associated with these infections and the side-effects associated with amphotericin B

Antibiotic Prescribing Patterns in a Neonatal Intensive Care Unit

An outbreak of invasive candidiasis in the neonatal intensive care unit (NICU) of the Dr George Mukhari Academic Hospital in Ga-Rankuwa necessitated evaluation of the antibiotic prescribing practices in the unit. A selective randomised sample of 100 patients was followed up over a nine-month period to evaluate prescribing patterns. The existing antibiotic policy was used to compare the prescription practices and use of antibiotics. The frequency of use; number of antibiotics per patient and duration of use were documented. Of the 100 patients followed; 95 were prescribed intravenous antibiotics. All prescribed antibiotics for 77 patients are listed in the antibiotic policy. Nineteen different antibiotics were prescribed; and 11 of the 19 prescribed antibiotics appear in the antibiotic policy. Most patients received more than two antibiotics during their stay; as the average number of antibiotics used per patient during the study period was 3.4. The average duration of use for all antibiotics; except cefepime and ceftriaxone; was for longer than seven days. Although antibiotics were used according to the ward protocol in the majority of patients; deviations from the protocol were associated with patients' clinical condition and/or results from blood cultures. The duration of antibiotic use needs to be monitored to prevent unnecessary prolonged use; as in this investigation. An antibiotic policy may be useful to guide and measure rational antibiotic therapy in a NICU