RESUMO
Introduction: One of the most common reasons for pediatric outpatient visits is acute pharyngitis, an upper respiratory tract infection. Bacterial pharyngitis is caused by Group A beta-hemolytic Streptococcus (GABHS), also known as Streptococcus pyogenes. This research aimed to assess physicians' adherence to clinical guidelines for diagnosis, management, and selecting appropriate treatment for children suspected of bacterial pharyngitis. Methods: A retrospective, observational study was conducted by reviewing patient charts for childred aged 3 to 13 years old diagnosed with pharyngitis from June 2019 until December 2019 at the Emergency Department of Palestine Medical Complex (PMC). The Modified Centor score, throat swab collections, and assessment of antimicrobial selection were used to assess the extent of physicians' adherence to clinical guidelines for appropriate diagnosis and management of pharyngitis. SPSS was used for data analysis. Results: Out of 290 cases diagnosed with acute pharyngitis, 217 patients (74.8%) had a Modified Centor score of ≥2; 126 received antibiotics, and eight had their throat swabbed to confirm the diagnosis; furthermore, 73 patients (25.2%) had a Modified Centor score of <2; 34 of them received antibiotics. Azithromycin was the most commonly prescribed antibiotic (41.3%), followed by amoxicillin-clavulanic acid (38.1%). The frequency of empirical antibiotics prescribing was significantly higher among children with a Centor score >2, older children, and those presenting with fever. Conclusions: Most cases were not appropriately tested to confirm the diagnosis of bacterial pharyngitis and were mostly treated with inappropriate antimicrobial agents such as azithromycin. Nonadherence to clinical guidelines is very evident in this study.
RESUMO
Objective: To measure the prevalence and identify risk factors associated with drug-drug interactions among patients admitted to internal medicine departments in Palestinian hospitals. Methods: A retrospective cross-sectional observational study was conducted. Data were obtained from patient files from the internal medicine departments in Palestinian hospitals from 1 September 2017, to 31 March 2018. The data collected included patient gender, age, length of hospitalization, medications prescribed, and the number of medications. The digital clinical decision support system IBM Micromedex® was used to assess potential drug-drug interactions. Results: The number of patients included in this study is 513. The total number of potential drug-drug interactions detected in study participants is 1558. The average number of potential drug-drug interactions per patient was found to be 3 ± 3.9. Among study participants, 66.1% (n = 339) were found to have potential drug-drug interactions in their current medications. The most commonly encountered drug-drug interactions type was "major" drug-drug interaction, which was encountered in 43.6% (n = 681) of total detected drug-drug interactions. Other types of drug-drug interactions were encountered in 42% (n = 647), 14% (n = 224), and 0.4% (n = 6) which were moderate, minor, and contraindicated drug-drug interactions, respectively. Patients' age, number of medications, and length of hospitalization were associated with the increased risk of potential drug-drug interactions. Conclusion: The results indicated a high prevalence of potential drug-drug interactions in Palestinian hospitals, associated with polypharmacy, increased age, and increased length of hospitalization. Therefore, managing patient medication by a drug expert such as a clinical pharmacist to identify and resolve potential drug-drug interactions will possibly decrease the high prevalence of drug-drug interactions, prevent patient harm, and decrease the cost of hospitalization.
RESUMO
BACKGROUND: Drug design and development to overcome antimicrobial resistance continues to be an area of research due to the evolution of microbial resistance mechanisms and the necessity for new treatments. Natural products have been used since the dawn of medicine to heal skin infections. The antimicrobial properties of fusidic acid, zinc sulfate, and copper sulfate have been studied and are well known. Furthermore, these compounds have different mechanisms of action in targeting microorganisms, either by inhibiting protein synthesis or bacterial cell walls. Therefore, their combination is expected to have synergistic activity in killing bacteria. However, the synergistic antimicrobial activity has not been evaluated in a cream formulation. Therefore, the objectives of this in vitro study were to develop and evaluate the synergistic efficacy of fusidic acid in combinations with natural products, including oleuropein, thyme oil, zinc sulfate, and copper sulfate, as a cream to eradicate fusidic-acid-resistant microorganisms in skin infections. METHODS: Three different cream formulations were developed, compared, and labeled F1, F2, and F3. The compounds were studied for their antibacterial activity. In addition, the stability of the cream was investigated at 25 °C and 40 °C in plastic jars over three months. RESULTS: The F2 formula has adequate physicochemical properties. Furthermore, it displays stable and better results than the marketed trade product and has potential inhibition zones (ZOI). Interestingly, considerable numbers (9.5%) of fusidic-acid-resistant Staphylococcus aureus (FRSA) isolates possessed a high resistance pattern with MIC ≥ 128 µg/mL. In contrast, most tested FRSA isolates (90.5%) had a low resistance pattern with MIC ≤ 8 µg/mL. CONCLUSION: In conclusion, the F2 cream made with fusidic acid, oleuropein, thyme oil, zinc sulfate, and copper sulfate in the right amounts has stable physical and chemical properties and has potential against FRSA as an antimicrobial agent.
RESUMO
Background: Diagnosis of co-infections with multiple pathogens among hospitalized coronavirus disease 2019 (COVID-19) patients can be jointly challenging and essential for appropriate treatment, shortening hospital stays and preventing antimicrobial resistance. This study proposes to investigate the burden of bacterial and fungal co-infections outcomes on COVID-19 patients. It is a single center cross-sectional study of hospitalized COVID-19 patients at Beit-Jala hospital in Palestine. Methods: The study included 321 hospitalized patients admitted to the ICU between June 2020 and March 2021 aged ≥20 years, with a confirmed diagnosis of COVID-19 via reverse transcriptase-polymerase chain reaction assay conducted on a nasopharyngeal swab. The patient's information was gathered using graded data forms from electronic medical reports. Results: The diagnosis of bacterial and fungal infection was proved through the patient's clinical presentation and positive blood or sputum culture results. All cases had received empirical antimicrobial therapy before the intensive care unit (ICU) admission, and different regimens during the ICU stay. The rate of bacterial co-infection was 51.1%, mainly from gram-negative isolates ( Enterobacter species and K.pneumoniae). The rate of fungal co-infection caused by A.fumigatus was 48.9%, and the mortality rate was 8.1%. However, it is unclear if it had been attributed to SARS-CoV-2 or coincidental. Conclusions: Bacterial and fungal co-infection is common among COVID-19 patients at the ICU in Palestine, but it is not obvious if these cases are attributed to SARS-CoV-2 or coincidental, because little data is available to compare it with the rates of secondary infection in local ICU departments before the pandemic. Comprehensively, those conclusions present data supporting a conservative antibiotic administration for severely unwell COVID-19 infected patients. Our examination regarding the impacts of employing antifungals to manage COVID-19 patients can work as a successful reference for future COVID-19 therapy.
