Problems associated with reconstitution, administration, and storage of antibiotic suspensions for pediatrics: a cross-sectional study in Nablus city, Palestine.

BACKGROUND: The objective of this study was to evaluate the appropriateness of antibiotic suspensions use for pediatrics among Palestinian mothers' including their reconstitution, dose administration, duration, and storage conditions. METHODS: This study was a questionnaire based cross sectional descriptive study. It was conducted at a governmental primary healthcare center and a pediatric private clinic in Nablus city between January and March 2013. A sample of 400 mothers were met and asked to answer a face to face questionnaire. RESULTS: The results showed that 347 (86.8 %) of mothers told that they read instructions, 311 (77.8 %) could understand manufacturers' instructions, and 176 (44.0 %) of mothers asked pharmacists for advice when instructions were not well understood. In order to prepare antibiotic suspension, 302 (75.5 %) used boiled then cooled water, 192 (48.4 %) of mothers used a syringe to measure the needed amount of water, and 304 (76.6 %) added water in two steps, 392 (98.0 %) of mothers claimed that they shook the suspension bottle before use. Regarding dose administration, 313 (78.2 %) considered syringe as the most accurate tool for dose administration, most of mothers told that they gave drug dose with major meals when direction were to give three times daily, about use duration only 6 (1.5 %) mothers said that they used antibiotic suspension after 2 weeks, and 53 (6.5 %) gave left over antibiotic suspension to another child. One hundred seventy seven (44.2 %) mothers told they stored dry powder antibiotic in medicinal cabinet, while 226 (56.5 %) of them stored suspension in refrigerator. CONCLUSION: The results reflect a good level of correct practice. However, there is a room for improvement. The pharmacists are recommended to explain the correct directions, to supply a syringe with suitable calibration for dose administration, and to counsel parents about suitable storage condition, frequency of dosing and duration of use.

Weight and content uniformity of lorazepam half-tablets: A study of correlation of a low drug content product.

The aim of this study was to investigate the degree of correlation between the weight and the content of spilt-halves of lorazepam 2.5 mg tablets. Weight variation and drug content of lorazepam half-tablets were evaluated according to the European Pharmacopoeia tests. Only one individual mass of the 30 half tablets was outside the limits of 85-115% of the average mass, but since it was within 75-125% of the average mass, the product passed the test. Each individual content was between 85% and 115% of the average content (99.8% expressed as a percent to label claim) and within the limits of 75-125%, so the product passed the uniformity of content test. The correlation coefficient (r) between the weight and the content of split halves was found to be 0.994. The weights of split tablet halves appear to be directly correlated with their drug content even for a medication with a low drug content, thus it is recommended that pharmacists who split tablets into two halves, assure the weight uniformity of the resultant halves. Manufacturers should develop formulation and manufacturing procedures that ensure high degree of correlation between weight and content not only among the whole tablet but also among the obtained tablet halves.

Impact of a renal drug dosing service on dose adjustment in hospitalized patients with chronic kidney disease.

BACKGROUND: Appropriate drug selection and dosing for patients with chronic kidney disease (CKD) is important to avoid unwanted drug effects and ensure optimal patient outcomes. OBJECTIVE: To assess the rate of inappropriate dosing in patients with CKD in a nephrology unit and to evaluate the impact on dose adjustment, adverse drug events (ADEs), and drug cost of having a pharmacist accompany a team of physicians on their rounds. METHODS: This was a comparative study with a preintervention and postintervention design. The preintervention phase served as the control; it was prospective and observational only and was conducted from the beginning of February to the end of May 2007. The second phase (intervention phase) was conducted from the beginning of March to the end of June 2008. Two random samples of 300 patients with an estimated creatinine clearance less than or equal to 50 mL/min were included. During the intervention phase, a clinical pharmacist made rounds with the nephrology unit team and gave dosing adjustment recommendations when needed. A collection of reliable and up-to-date drug information references that are commonly used globally were used during the intervention. RESULTS: In the preintervention group, drug dosage adjustment or avoidance, based on renal function, was necessary in 607 of 2814 (21.6%) prescriptions. Of these, 322 (53.0%) did not comply with guidelines. In the intervention group, adjustment was necessary for 640 of 2981 (21.5%) prescriptions. The pharmacist made 388 recommendations related to dosing adjustment, 212 (54.6%) of which were accepted by physicians. Clinicians' noncompliance with dosing guidelines decreased to 176 (27.5%) (p < 0.001). In the preintervention group, 64 (21.3%) patients had a suspected ADE, with a total of 73 events. In the intervention group, this number was significantly lower with 49 events in 48 (16.0%) patients (p < 0.05). The intervention resulted in drug cost savings of $2250 US. CONCLUSIONS: A renal drug dosing service for patients hospitalized with CKD can increase the proportion of drug dosing that is adjusted to take into account renal function. This can save drug costs and may prevent ADEs.

Drug use and dosing in chronic kidney disease.

One of the most important drug-related problems in patients with chronic kidney disease (CKD) is medication dosing errors. Many medications and their metabolites are eliminated through the kidney. Thus, adequate renal function is important to avoid toxicity. Patients with renal impairment often have alterations in their pharmacokinetic and pharmacodynamic parameters. The clearance of drugs eliminated primarily by renal filtration is decreased by renal disease. Therefore, special consideration should be taken when these drugs are prescribed to patients with impaired renal function. Despite the importance of dosage adjustment in patients with CKD, such adjustments are sometimes ignored. Physicians and pharmacists can work together to accomplish safe drug prescribing. This task can be complex and require a stepwise approach to ensure effectiveness, minimise further damage and prevent drug nephrotoxicity.