Kheirollah Gholami, Professor
Journal of Pharmaceutical Care is an open access journal officially published by the Research Center for Rational Use of Drugs (RCRUD) of the Tehran University of Medical Sciences, and Iranian Society of Clinical Pharmacists which is focused on experimental and clinical pharmaceutical practices to present researches, hot topics, requirements and regulations of the pharmaceutical practice area. Manuscript in Clinical Pharmaceutical Practice, Pharmaceutical Care Regulations, Pharmaceutical Care in hospitals and community pharmacies, Pharmacotherapy, Pharmacoepidemiology, Pharmacogenomics, Pharmacokinetics, Pharmacoeconomics, Clinical pharmacokinetics, Drug Utilization Evaluation review, Medication safety, Drug and Poison Information Services and Health services research are welcome.Content includes Original Articles, Systematic Review or Meta-Analysis, Review Articles, Case Reports and Letters to the Editor.
JPC is an open access, peer-reviewed, and quarterly journal that considers for publication articles in all fields and specialties ofpharmaceutical care in English language. This journal has both online and print versions and no charges are levied for publication.
Our understanding of Alzheimer's disease (AD) has drastically improved during the past decade as multiple large-scale studies have been implemented. These studies try to provide a large data set of markers and characteristics of patients with AD. The complexity of these factors and the disease itself have hindered the introduction of novel therapeutic strategies for patients with AD and the success rate of clinical trials in AD is significantly low.
We propose the idea of implementing future clinical trials in AD in a more specified population of AD patients based on the mechanism of action of the drug candidate, stage of the disease, and markers involved in the pathogenesis and severity of the disease. The derived results of such trials will not have the problems of doing a post hoc analysis, and although it may harm the generalizability of the results, we may find novel and effective treatment approaches for AD patients with similar characteristics.
High Prevalence of Potential Drug-Drug Interactions Among Patients Treated with Off-label Therapies for COVID-19
Background: During the first wave of the COVID-19 pandemic, severe patients were treated with the off-label drugs hydroxychloroquine and lopinavir/ritonavir. The aim of the study was to determine the prevalence of potential drug-drug interactions (DDIs) between hydroxychloroquine, lopinavir/ritonavir and concomitant medications used by hospitalized patients treated for COVID-19 in Costa Rica.Methods: We included all patients that received lopinavir/ritonavir or hydroxychloroquine as treatment for COVID-19. Clinical pharmacists reviewed the prescription profile of each patient and determined the probability and severity of any DDI through two databases (The Lexi-Interact program) and the Micromedex online interaction checker. A logistic regression model was used to identify variables associated with the occurrence of potential DDIs.Results: We identified a total of 108 potential DDIs in 34 inpatients (n=34). At least one of these DDIs occurred in 27 patients (79.4%; 95% CI: 65.8-92.9%). A total of 70 DDIs (64.8%) were classified as clinically relevant (grade D or X) by the clinical pharmacists. Only the number of concomitant drugs was associated with the occurrence of a probable DDI. The most common drugs associated with any DDI were fentanyl (n=12, 11.1%), midazolam (n=11, 10.2%), and insulin (n=10, 10.2%).Conclusion: A large proportion of patients treated with hydroxychloroquine and lopinavir/ritonavir for severe COVID-19 were at risk for clinical meaningful DDIs.
Evaluation of Piperacillin/Tazobactam Use and Resistance Pattern in a Teaching Hospital, Northwest Iran
Background: Inappropriate use of broad-spectrum antibiotics has contributed to the emergence of resistant microorganisms, increased treatment costs, morbidity and mortality, drug toxicity, and prolonged hospitalization period. Determining the epidemiology of antibiotic resistance in various hospital wards allows for more precise drug selection in the hospital setting. This study evaluated the use and resistance pattern of a broad-spectrum antibiotic, Piperacillin/tazobactam, in Imam Khomeini, a referral teaching hospital in Urmia, Iran. Methods: All hospitalized patients who were treated with Piperacillin\Tazobactam from January to August 2018 were included. Demographic (age, sex, weight, comorbidities) and clinical data (Indication, dosing, duration of the treatment, susceptibility test, creatinine clearance, need for dose adjustment, clinical outcome, and mortality) of the patients were collected, and the compliance of piperacillin\tazobactam administration and its resistance pattern was assessed according to Lexi-comp- 2019 recommendations. Results: Among 177 patients, 88.7% received piperacillin\tazobactam without any appropriate susceptibility tests. The piperacillin disk was used in only 33.3% of the culture-positive cases in our research, with 70% resistance. Acinetobacter was the most common bacteria found in our culture-positive samples. The average duration of piperacillin\tazobactam treatment was 8.52 ± 5.84 days. Indications in 8.5%, doses in 18.5%, prescription period in 19.7%, and dose intervals in 31.4% of the cases were inappropriate. Piperacillin\tazobactam was mainly administered for pneumonia (34.5%) Conclusion: This study showed an injudicious use of Piperacillin/tazobactam in our hospital, evidenced by the significant number of inappropriate doses, intervals, and treatment duration. Decision-making based on susceptibility tests using appropriate and accurate methods, close monitoring of the patients' clinical status, including creatinine clearance, and antimicrobial stewardship programs may optimize the rational administration of broad-spectrum antimicrobials and avoid the emergence of bacterial resistance.
Epidemiological and Clinical Factors Affecting the Response to Etanercept Among Patients with Rheumatoid Arthritis
Background: This study aimed to inspect the association between the response to etanercept among patients with rheumatoid arthritis and several epidemiological and clinical variables and medication adherence, as measured by medication possession ratio (MPR). Methods: A cohort study that enrolls 120 active rheumatoid arthritis patients. The baseline values of disease activity score for 28 joints (DAS28) score,erythrocyte sedimmintation rate (ESR), WBC, tender joints count (TJC), swelling joints counts (SJC), and medication adherence, as measured by medication possession ratio (MPR), were identified. All patients received etanercept treatment for three months, and then the clinical response to etanercept was assessed after the end of the three months duration. Factors affecting clinical response were evaluated by univariate and multivariate logistic regression analysis. The predictive performance of a single independent predictor was then assessed using a receiver operating characteristic (ROC) curve. Results: The results of the univariate logistic regression model showed that the smoking, disease duration, baseline DAS28, and MPR could predict the patients' proclivity for being non-responder. The multivariate logistic regression model showed that only baseline DAS28 (P< 0.0001, OR=32.239, 95%CI: 4.941–210.338) and MPR (P=0.002, OR=0.00063, 95%CI: 0.00001–0.032) were independent predictive factors for the tendency of patients to be non-responder. ROC curve analysis disclosed that baseline ESR and DAS28 have a good area under the curve (AUC) with the optimal cut-off for the baseline ESR threshold was 52 mm/hr., whereas the baseline DAS28 threshold was 5.79. Conclusion: Current smoking is the main epidemiological factor that can predict the tendency for being non-responder. The potential of baseline ESR and DAS28 values as biomarkers for clinical response to etanercept in RA patients was identified by Receiver operating characteristic(ROC) analysis.
Background: Nowadays, due to the irrational and excessive use of antibiotics, antimicrobial resistance has become one of the main concerns of the medical community. Patients with burns are more prone to infections due to the loss of the skin's defense barrier and a weakened immune system. Therefore, proper antibiotic treatment is essential in these patients. In the present study, the rational use of antibiotics in the burn hospital of Imam Mousa Kazem in Isfahan was evaluated. Methods: This prospective cross-sectional descriptive study was performed on 102 hospitalized patients over 9 months (from January to September 2020). Adult burn patients who received at least one antibiotic were included in the study. All required information, including demographic data, the prescribed antibiotic, basis of administration (empiric vs. culture-based), dose and duration of use, microbial culture test, and treatment outcome were recorded in the data collection form by referring to patients’ medical profile and the hospital computer system. Judgments about the accuracy of the indication, dose, and duration of treatment, as well as the need for dose adjustment in renal or hepatic impairment were made using related guidelines and references. Results: Among the 196 antibiotic prescriptions, cefepime (40.3%) was the most frequently used antibiotic, followed by vancomycin (17.9%) and meropenem (16.8%). Most prescriptions were empirical, while the antibiotics were administered based on the microbial culture results only in two cases (1.9%). The indication of use was correct in 52.6% of prescriptions (n = 103), of which 74.8% (n = 77) had correct dose. In addition, in 47 cases (45.6%), the duration of antibiotic therapy was correct. 6.8% of the patients died, 10.75 discharged with the patient's personal consent, and the rest of the them discharged in good condition. Conclusion: Prescribing antibiotics in Imam Moussa Kazem Hospital is associated with many errors in various aspects, including indication, dose, de-escalation, and duration of treatment.
Evaluation of Medication Errors in Preparation and Administration of Intravenous Medicines in Intensive Care Units in Imam Reza and Shohada Hospitals in Tabriz
Background: Studies have shown that medication errors and adverse drug reactions are among the main causes of adverse events in hospitals leading to disability and death. Errors occur in the process of drug prescribing, dispensing, and administration. errors are most often made on the patient care units with various risk factors. The aim of the study was to evaluate medication errors in preparation and administration of intravenous medications in two Intensive Care Units of two university hospitals in Tabriz.Methods: An observational and single-blinded study was carried out in the pulmonary ICU of Imam Reza hospital and the ICU of Shohada hospital using general and mono-drug checklists of error-prone situations. 14 different error categories were studied.Results: Total of 367 administrations for 26 different drugs were observed. among 4558 opportunities for errors, 640 errors were identified. Error rate of 15.99 % and 10.96 % were reported in Imam Reza and Shohada hospital, respectively. Wrong rate error and controls during administration had the highest rate of errors in Imam Reza and Shohada hospitals, respectively. Streptokinase in Imam Reza hospital and ceftazidime in Shohada hospital were the drugs with highest error rate. Midnight and 10 PM administration rounds had the highest error rate in Imam Reza and Shohada hospitals, respectively. Error rate in Imam Reza hospital was significantly higher.Conclusion: It is concluded that medication errors occur in all stages like preparation and administration mostly related to rate of administration and controls needed while administration; Strict controlling, training programs, and presence of clinical pharmacists are highly recommended.
Efficacy of Diethylcarbamazine in Allergic Rhinitis as an Adjuvant to Antihistamines : A Comparative Study
Background: Allergic rhinitis is a type of inflammation in the nose that occurs when the immune system overreacts to allergens in the air. Underlying mechanism involves IgE antibodies that attach to allergen resulting in release of histamine from mast cells. Signs and symptoms include a runny or stuffy nose, sneezing, redness and watering of eyes. Symptom onset is often within minutes following allergen exposure and can affect sleep and ability to work or study. People with allergic rhinitis may have associated asthma, allergic conjunctivitis, atopic dermatitis. The study aims to know the efficacy of diethyl carbamazine in reducing the severity of symptoms in patients with allergic rhinitis when added to the antihistaminic treatment. Methods: This is a single blind randomized control trial study involving 50 allergic rhinitis patients between 13-60 years as cases and 50 as controls. The patients were classified as mild, moderate and severe based on the severity of symptoms. The cases were prescribed Tablet Diethyl carbamazine 300mg along with Tablet cetrizine 10mg for a period of 21 days. The controls were prescribed Tablet cetrizine 10mg with placebo. Patients were followed up for 3 months and watched for any reduction in the severity of symptoms. Results were compared between the study and control groups. Results: Out of 50 patients in the study group, 20 cases showed improvement, 30 cases did not show any improvement; Out of 50 controls, 6 showed improvement and 44 didn’t show any improvement. P value is significant (0.003). Conclusion: Diethyl carbamazine is an ant filarial drug which is found to have an effect in reducing the mediators of inflammation thereby useful in reducing the severity of symptoms in allergic rhinitis, as an adjuvant.
Pandemic disease, COVID-19, caused by the SARS-CoV-2 virus, which is potentially fatal for vulnerable individuals, generated global panic. Medicinal phytochemicals have a lengthy history of being used to treat a wide range of pathogens and diseases. The utilization of natural plant products will be the subject of this review, based on the results of previous researches in preventing the infection of COVID-19. In this review, all data sources including Google Scholar, Scopus, PubMed, and Science Direct were searched for publications with no particular time restriction to get a holistic and comprehensive view of the research. It was seen that plants natural products like Polyphenols, Alkaloids, Flavonoids, Coumarins and essential oils were able to inhibit main targets in the virus life cycle such as main protease (Mpro), SARS CoV 2 helicase Nsp13 and Angiotensin Converting Enzyme (ACE2). It has been established that natural plant derivatives can be utilized for treating and prevent SARS-CoV-2 and other coronaviruses by inhibiting several prominent viral portions. However, it is imperative to emphasize on standardization and control the quality of medicinal plants-based products in future studies and there should be further properly investigations of these products in order to clinical usage against COVID-19 infection.