Point prevalence survey of antibiotics use among hospitalised neonates and children in Saudi Arabia: findings and implications.

Background: Neonates and children are more susceptible to a variety of infections, leading to frequent antibiotic prescriptions. However, the inappropriate use of antibiotics leads to antibiotic resistance and higher mortality rates. Therefore, this study aimed to determine the prevalence of antibiotic use, and current antibiotic prescribing practices among neonates and children admitted in the selected hospitals of Saudi Arabia. Methods: A cross-sectional study was conducted from September to November 2023 to assess the prevalence of antibiotic use, and the current antibiotic prescribing practices across six hospitals of Saudi Arabia. Results: The study included 499 children and neonates, with 94.6% receiving antibiotic prescriptions. The most frequently prescribed antibiotic class was third-generation cephalosporin (31.5%), with ceftriaxone being the most commonly prescribed antibiotic (15%). The majority of patients were prescribed one antibiotic (81.4%), and the intravenous route (96.4%) was the primary route for administration. The majority of patients were prescribed antibiotics empirically (69.7%), and community-acquired infections (64.2%) were the most common type of infection for antibiotic prescription. Similarly, sepsis (39.2%) was the most common indication for antibiotics, and the majority of prescribed antibiotics (61.7%) belonged to the 'Watch' category as per WHO AWaRe classification. Conclusion: Our study revealed excessive antibiotic consumption in neonates and children, therefore quality improvement programmes including antimicrobial stewardship programmes are urgently needed to address ongoing issues.

Pharmacist-led education curriculum for fourth-year medical students: a single-center experience

Background: Doctors are usually challenged by the transition between theoretical basic science knowledge and actual clinical practice. Thus, a critical educational intervention is the early incorporation of pharmacists into the pharmacotherapy courses for undergraduate medical students from their college years and moving to the practice setting. Objective: We sought to determine if a pharmacist-led education course would improve medical students’ knowledge of general pharmacotherapy topics. Methods: All fourth-year female medical students were invited to enroll in the pharmacy practice curriculum between January and March 2022. The program was divided into three main domains: formal lectures, a hands-on prescription writing skills session, and on-site pharmacy practice sessions. The pharmacy practice session was divided into three sections: first section pharmacy practice, second section pharmacy innovation, and the third section clinical pharmacy. Those who completed the curriculum were requested to complete preand post-session assessments and curriculum evaluations. Results: One hundred fourteen medical students enrolled in the pharmacy practice module. One hundred eleven (97.4%) completed the pre-and post-course assessment. After completing the module, the medical students’ knowledge scores improved from pre- to post-course. A significant difference in the overall knowledge was observed between the pre-course and post-course scores (9.51 versus 16.04; p<0.001). The difference between the pre-course and post-course scores was also significant when comparing the knowledge per each part of the assessment, showing an average score of 2.78 versus 4.05 (p<0.001) for the first section; 3.39 versus 5.49 (p<0.001) for the second section; 3.34 versus 6.48 (p<0.001) for the third section. The program received overall positive feedback; the experience was rated overall as “Excellent” by 73% of the participants. (AU)

Extended infusion versus intermittent infusion of Piperacillin/ tazobactam: altering current methods to optimize future outcome

Due to worldwide bacterial resistance, researchers and clinicians were required to optimize existing antimicrobials by influencing the pharmacokinetics and pharmacodynamics (PK/PD) features. Piperacillin/tazobactam (PIP/TZB) is one of the most frequently empirical antibiotics prescribed globally. The aim of the review was to evaluate the use of an extended infusion (EI) versus an intermittent infusion (II) of PIP/TZB in hospital settings in terms of patient safety and efficacy. Several PK/PD studies assessed the use of an extended infusion of PIP/TZB to reach different minimum inhibitory concentration (MIC) levels for many microorganisms including Pseudomonas aeruginosa. One of the main parameters to define the size of the effect of PIP/TZB to various microorganisms is the percentage of time the free drug concentration above MIC (%fT > MIC). Many studies have compared extended infusion (EI) versus intermittent infusion (II) in terms of mortality rate, clinical cure or efficacy, length of stay whether in an intensive care unit (ICU) or hospital, duration of therapy, and cost. The clinical data reviewed in this article include PK/PD studies, prospective trials, systematic reviews, and meta-analysis. The review emphasized the role of an extended infusion in a population with altered pharmacokinetics including patients on continuous renal replacement therapy (CRRT), critically ill patients with augmented renal clearance, and patients with cystic fibrosis. Our review reports a positive trend when using an extended infusion of PIP/TZB which encourages the adoption and implementation of the extended infusion to achieve positive patient outcomes. Nevertheless, more studies are required to attain generalizable and reliable data to determine whether an extended infusion improves patient outcomes. (AU)

Incidence and Risk Factors of Colistin-Induced Nephrotoxicity Associated with The International Consensus Guidelines for the Optimal Use of the Polymyxins: A Retrospective Study in a Tertiary Care Hospital, Saudi Arabia.

Background: Colistin is an effective therapy against multidrug-resistant gram-negative bacteria. However, nephrotoxicity is a major issue with its use. Objective: We aimed to evaluate the incidence and the potential risk factors of nephrotoxicity in colistin-treated patients. Methods: A retrospective cohort study was conducted. All adult patients aged 18 years and older who received colistin for ≥72 h were included in the study, while end-stage kidney disease patients requiring dialysis or had renal transplants were excluded. The incidence and severity of acute kidney injury (AKI) were assessed based on the Kidney Disease Improving Global Outcomes (KDIGO). Result: Out of 128 patients who received colistin, 51.56% of them have experienced AKI. The incidence was increased among oldest patients (above 80) and those who did not receive the appropriate dose (p-value = 0.0003). In addition, the median time until the AKI occurred was 10 days after receiving the colistin treatment. Rates of AKI in patients with previous AKI (71.7%) were three times higher than patients who did not previously experience AKI (HR = 2.97, 95% CI [1.8-4.8]). Conclusions: Nephrotoxicity is a significant issue among patients who receive colistin in the hospital, especially among older patients and those who did not receive the appropriate dose. As a result, healthcare providers should play a major role in colistin dosing, especially among the older adult population.

Incidence and risk factors of adverse drug reactions in patients with coronavirus disease 2019: A pharmacovigilance experience utilizing an ADR trigger tool.

BACKGROUND: Since the World Health Organization declared coronavirus disease (COVID-19) as a pandemic, most countries started treating their patients with various therapies. However, the data regarding their safety and effectiveness is still lacking. OBJECTIVES: We aimed to evaluate the adverse drug reactions (ADRs) incidence and their predisposing factors among COVID-19 patients. METHODS: A retrospective observational study that was conducted at a tertiary academic hospital from March - June 2020. Patients were included if they were ≥ 18 years old, inpatient, had a reverse transcriptase-polymerase chain reaction (PCR) positive for COVID-19, and were treated with; (lopinavir-ritonavir, hydroxychloroquine, chloroquine, favipiravir, ribavirin, or interferon-ß) either as monotherapy or combination therapy for three days or longer. The data of eligible patients were retrieved from the electronic medical records. A standardized data collection form was designed to collect patient demographics, COVID-19 severity based on the Saudi Ministry of Health management protocols, antiviral therapies, duration of therapy, and length of stay (LOS). The ADRs were identified via conducting a comprehensive review using predefined triggers and were evaluated using Naranjo Score. RESULTS: A total of 155 patients were included of which 123 (79.4%) were males. In our sample, the incidence proportion of ADRs per patient was 72.3%. A total of 287 ADRs were identified most of them were hepatic (n = 101, 35.2%), gastrointestinal (n = 59, 20.6%), hematological (n = 47, 16%), and endocrine (n = 45, 15%). Hydroxychloroquine was the most common drug associated with ADRs (n = 155). The length of stay (10 - 20 days) was the only statistically significant with the ADR incidence (p-value = 0.008; 95 %CI 1.216:3.568). CONCLUSIONS: The ADRs are prevalent among COVID-19 patients, which assure the importance of implementing active hospital-based pharmacovigilance systems.