ABSTRACT
Overuse or misuse of antibiotics is one reason for the emergence of antibiotic resistance. Here, we present four cases where antibiotics were started (or proposed) although they were not needed. The first case was asymptomatic bacteriuria where antibiotic therapy was initiated but then stopped after the case was referred to the infectious diseases (ID) service. The second case was a cholangiocarcinoma patient in whom four antibiotics were continued after completing the treatment for a remote infection. Hence, the ID team discontinued the unneeded therapy after considering that the inflammatory process was due to malignancy. The third case was a patient who was diagnosed with pneumonia in whom both antibiotics and an antiviral were initiated. However, antibiotic therapy was continued despite the lack of bacterial growth in the respiratory culture. Thus, it wasn't until the ID team evaluated the case and decided that the pneumonia was viral in nature that antibiotic therapy was discontinued. The last case was for a patient who presented with dry cough presumed to be a pneumonia and was about to be started on antibiotics. The ID team noticed the patient had a history of decompensated congestive heart failure causing the cough. Antibiotics were not initiated when lack of clinical findings suggestive of pneumonia was also confirmed. These cases represent an example of daily occurrences of antibiotics overuse. Healthcare providers are encouraged to augment their knowledge regarding the safe and judicious use of antibiotics, as well as consulting an ID expert if doubts concerning the necessity of antibiotics arise.
ABSTRACT
Gentamicin is a potent antibiotic with a nephrotoxicity drawback which limits its use. D-α-tocopherol polyethylene glycol succinate (α-tocopherol) is widely used as a surfactant and have potent antioxidant properties. This study aimed to assess the protective effect of α-tocopherol on gentamicin-induced nephrotoxicity by loading gentamicin on nanostructured lipid carriers (NLC). In vivo, the product was administered intravenously to three groups of rabbits (control, gentamicin and gentamicin/α-tocopherol NLC) for 10 consecutive days. Blood was collected on days 1, 5 and 10 to assess renal function. A significant difference in all plasma parameters related to kidney function were observed in the gentamicin group compared to the control by day 5 and 10, confirming the nephrotoxicity effect. On the other hand, the same parameter levels of the NLC group were significantly different compared to the gentamicin group, confirming the protective effect on kidney function. Gentamicin also caused significant decreases in plasma levels of glutathione sulfhydryl (GSH) and superoxide dismutase (SOD) activity. However, gentamicin-α-tocopherol NLC significantly elevates both plasma levels of GSH as well as SOD activity. The present work indicates that, loading of gentamicin on NLC by using α-tocopherol, is an innovative strategy to protect against aminoglycoside-induced nephrotoxicity due to its antioxidant activity.
ABSTRACT
Background Misuse of prescription medicines is a global issue potentially resulting in severe consequences including adverse drug reactions, dependence, tolerance, increased healthcare utility and mortality. Objective To assess the public's perspectives of issues relating to medicines misuse. Method A survey of members of the public ( ≥ 18 years) attending medication safety awareness campaigns in Jeddah, Saudi Arabia. The questionnaire comprised: issues relating to misuse of prescription medicines; medicines used without being prescribed by a physician; and suggestions to reduce misuse. Potential participants were approached opportunistically during the campaigns, with those agreeing to participate administered the questionnaire and responses recorded electronically. Results Of the 511 respondents, 59 (11.5%) did not always have their prescription medicines prescribed by a physician, and 196 (38.4%) were uncertain. Commonly cited medicines obtained from sources other than a physician were analgesics (n = 375, 73.2%), antibiotics (n = 57, 11.2%), antipyretics (n = 33, 6.5%) and narcotics (n = 4, 0.8%). More than half (n = 282, 55.2%) claimed to know someone who had misused medicines, some with serious consequences including hospitalization (n = 96, 34.0%) and death (n = 14, 5.0%). Conclusion This general public survey has identified that issues of misuses of medicines in Jeddah, Saudi Arabia persist and may compromise safety and effectiveness of care.
