Knowledge, attitude and practice of travel medicine among primary care physicians in Oman: the need for intervention

Background: Oman is witnessing an increase in outbound and inbound travelers.

Aims: This study was undertaken to assess the current knowledge, attitude, and practice of travel medicine among primary care physicians (PCPs) working in the Muscat Governorate.

Methods: We conducted a cross-sectional survey of 108 primary healthcare physicians in primary healthcare institutions in the Muscat Governorate in December 2014 using a self-administered questionnaire.

Results: We had a response rate of 81%, 78% (n = 84) were females, 56.5% (n= 61) were Omani nationals. More than 50% (n= 54) of study participants had been in practice for more than 8 years. Sixty-eight (58.3%) reported having pre-travel consultations during the previous 1-month period and 86 (79.6%) had post-travel consultations. Most of the PCPs were aware of the issues that needed to be addressed in pre-travel consultation.

Conclusions: This study showed that travel health is in an early stage of development in Oman and supports the need for the establishment of travel medicine services

Surveillance of adverse events following immunization in Oman, 2006-2015

Background: In 1996, Oman launched its surveillance programme for adverse events following immunization [AEFI] to address vaccine safety concerns. In 2010, an analysis of surveillance activities for AEFI was done for 10 years [1996-2005]. Objectives: The main objective of the study was to describe the trend of AEFI over the 10-year period, 2006-2015, and compare the findings with a previous report in Oman and reports from other countries. Methods: A descriptive record-based review of AEFI was carried out using the national AEFI surveillance database for the study period, 2006-2015. Results: A total of 890 adverse event reports were received, giving an annual rate during the review period of 21.4 per 100 000 population or 8.3 per 100 000 doses administered. The most frequently reported AEFI were BCG adenitis and local reactions - 31.1 and 4.1 per 100 000 doses respectively. There were no reported deaths. Pentavalent vaccine was responsible for the greatest proportion of adverse events [30%]. Local reaction was the most common adverse event among all vaccines administered. The Hexa vaccine caused fewer adverse events compared with the pentavalent vaccine, probably due to the acellular pertussis component – 0.8 versus 1.5 per 100 000 doses administered respectively. Conclusion: The overall rate of AEFI [8.3 per 100 000 doses administered] is comparable to the rate [10.8/100 000 doses] in the previous decade [1996-2005] in Oman. The reported rates for individual vaccines are similar to or below international rates

Patterns of antimicrobial prescribing in a tertiary care hospital in Oman

Objectives: Antimicrobial stewardship programs have been designed to measure and improve the use of antimicrobials to achieve optimal clinical outcomes and reduce bacterial resistance. The aim of this study was to review patterns of antimicrobial prescribing for hospitalized patients in the acute care setting and assess the appropriateness of antimicrobial use among prescribers in a tertiary care hospital in Oman

Methods: We conducted a retrospective audit of the appropriateness of antimicrobial prescribing in patients admitted to acute care settings in a tertiary care hospital in Oman over a four week period [1 November to 28 November 2012]. The data of all discharged patients were retrieved from the department databases. Patient records and prescriptions were reviewed by an infectious disease consultant. The rationality of antimicrobial use was evaluated, analyzed, and judged based on local standard guidelines and the experience of the evaluating consultant

Results: There were 178 patients discharged from acute medical teams over the study period. Sixty-four percent of the patients received a total of 287 antimicrobial agents during admission. The average number of antimicrobials prescribed per patient in those prescribed antimicrobials was 2.5 +/- 1.1. The most commonly prescribed antimicrobial agent was piperacillin/tazobactam. Most patients had infections from gram-negative organisms, and high rates of extended spectrum beta-lactamase producing organisms were observed. Cultures were obtained before antimicrobial initiation in 25% of patients. Variability in antimicrobial selection for common infections was observed

Conclusions:National guidelines for the management of common infections are needed to minimize the overuse and misuse of antimicrobial agents in tertiary care hospitals. A large surveillance study on antimicrobial prescribing appropriateness in different hospital settings is warranted

Native valve endocarditis caused by coagulase negative staphylococci; an appeal to start outpatient antimicrobial therapy: an unusual case report

Coagulase negative staphylococci [CNS] were a rare cause of native valve endocarditis. However, they are emerging as an important cause of native valve endocarditis [NVE] in both community and healthcare settings. We describe a 64 yrs. old male who developed mitral valve endocarditis caused by coagulase negative staphylococci. There were no predisposing conditions or underlying cardiac disease that could have been the risk factor for the development of native valve infection. The patient had good recovery after six weeks of treatment with anti-staphylococcal antibiotics

Dengue haemorrhagic fever presenting as acute abdomen

We describe a case of a 38 year-old Sri Lankan female who was referred to the surgeon on call with a picture of acute abdomen. She presented with a three-day history of fever, headache, abdominal pain and diarrhea; however, the physical examination was not consistent with acute abdomen. Her platelet count was 22 x 10[9]/L. A diagnosis of dengue haemorrhagic fever [DHF] was made and dengue serology was positive. Dengue epidemics have been associated with a variety of gastrointestinal symptoms and signs, including acute abdomen. Acute abdomen in patients with DHF makes the diagnosis and management challenging

Tricuspid valve endocarditis in an intravenous drug abuser masquerading as pulmonary tuberculosis

Intravenous drug abuse contributes to considerable illness burden in developed and developing countries. Tricuspid valve endocarditis [TVE] is rare in Middle East countries, though many reports of it in intravenous drug abusers are found in other countries. We describe a case of TVE mimicking pulmonary tuberculosis in a 33-year-old man with a history of intravenous heroin use

prospective randomized clinical trial of ceftazidime versus ceftazidime plus gentamicin versus meropenem versus piperacillin/ tazobactam plus gentamicin in the treatment of febrile neutropenia [FN] in Oman

A prospective randomised clinical trial was designed to evaluate the efficacy and safety of 4 frontline intravenous [IV] antibiotic regimens in treatment of FN in adults receiving chemotherapy. During a 3 year enrolment period 120 episodes of FN in 96 patients were randomly allocated to receive one of die 4 IV antibiotic arms: [ceftazidime [F] Vs [F] plus gentamicin [FG] Vs meropenum [M] Vs piperacilin/tazobactam plus gentamicin [TG]]. Main end points were: clinical outcome, number of days to become afebrile and cost of treatment. 117 episodes in 96 patients [52 males and 44 females - median age of 44.9 years, 42% lymphomas and 58% solid tumours] were evaluable for response. F= 30, FG=29, M=28 and TG= 30 episodes. Bacteraemia was reported in 19% [12% gram-negative and 7% gram-positive], clinically confirmed infection in 36%, and fever of unknown reason in 45% of studied cases. No statistical significance was found between the 4 arms in terms of response rate [RR] [80%, 83%, 85% and 87% respectively]. The mean time to fever defervescence was significantly shorter in the TG arm [F=3.3, FG=3.1, M=2.8 and TG=2.1 days P=0.014]. Overall episode treatment cost was significantly lower for TG arm [p=0.005]. The 4 arms showed equal RR. However, time to clinical response, and total cost was in favour of TG combination