Accreditation Standards of Clinical Pharmacy Education in Three Leading Countries

Background: Proton Pump Inhibitors (PPIs) are often prescribed inappropriately among hospitalized patients and same is often continued even after their discharge from the hospital. The inappropriate use of PPIs leads to an increased risk of adverse effects, drug interaction, and unnecessary hospital expenditure for such patients. Aim of this study was to determine the appropriateness of PPIs use among hospitalized patients. Methods: A cross sectional observational study was conducted on hospitalized patients in a tertiary care hospital in Northern India. The clinical records of adult patients hospitalized during April- May 2022 were assessed for the prescribing pattern and appropriateness of PPI use as per the National Institute of Health and Care Excellence (NICE) guidelines. Results: A total of 192 patient’s records were included in this study with the mean age 57 years and 61% of the study participants were males. Overall, 72% (138) of the study participants were prescribed PPIs by intravenous route and only in 28% (54) cases an oral route was preferred. Pantoprazole was the most commonly prescribed PPI in 112 (58%) patients and it was administered by intravenous route among 87 patients (78%) and by oral route in 25 (22%) patients. PPI use was appropriate in 54% of the cases and they were most commonly prescribed for ulcer prophylaxis. This study identified higher use of PPIs was seen in low risk patients for longer duration than indicated. Conclusion: PPIs are being prescribed inappropriately among hospitalized patient unrelated to their widely accepted clinical indications and are often continued unnecessarily once patient is discharged. These results suggest the need of regular audits on use of PPIs clubbed with educational initiatives to promote rational use of PPIs among hospitalized patients.

Background: To analyse the trend and pattern of antibiotic consumption rates over a period of five years in a secondary care hospital in Qatar. Consumption of antibiotics is a crucial factor in the evaluation of antibiotic usage.

Methods: To measure and compare a five-year antibiotic consumption trend in inpatient department wards using Defined Daily Dose (DDD) per 100 bed days (DDD/100-BD). Antibiotics dispensed between January 2018 and December 2022 were evaluated. Data collection was done using Microsoft Excel. The analysis was done using the World Health Organization (WHO) AWaRe classification of antibiotics.

Results: The analysis showed that antibiotic consumption significantly increased from 2018 (4.11 DBD) to 2020 (15.55 DBD) and then sustained thereafter. Widely used antibiotic belongs to the third generation cephalosporins which is under Watch class of antibiotics. Ceftriaxone, cefuroxime, and amoxicillin clavulanate were the most consumed antibiotics in the hospital throughout the study period at 53.92 DBD, 32.22 DBD and 21.65 DBD respectively.

Conclusion: Establish benchmarking at the facility level. We observed the use of ceftriaxone is more as surgical prophylaxis, which is a Watch group of antibiotics, however there is zero use of restricted antimicrobials. Increase in parenteral fluroquinolone especially levofloxacin needs monitoring, which is not included in WHO essential list of medication. There is a scope to measure the appropriateness of antibiotics, as well as the duration of therapy. The goal of WHO Target ≥60% of total antibiotic consumption being Access group antibiotics can be used as an index to analyse the comparative use Watch and Access group of antibiotics.

Background: Methicillin-resistant Staphylococcus Aureus (MRSA) stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics. Non-intact skin, such as when there are abrasions or incisions, is often the site of an MRSA infection. MRSA has become endemic in hospitals over the past years. The current recommendation for MRSA decolonization is to use a daily chlorohexidine skin wash for five days. Tea Tree Oil (TTO) can also be considered for the eradication of MRSA on the skin. However, no study has evaluated the TTO potential for MRSA decolonization in hospitalized children. Methods:In this single-center, comparative prospective, open-label clinical trial, the effect of TTO body wash on MRSA decolonization was compared to that of chlorhexidine body wash at Loghman-e-Hakim Hospital (Tehran, Iran). Several samples were taken from the catheter sites of children for MRSA detection. Patients were assigned to receive either TTO or chlorhexidine. After five days of applying the solutions, resampling was conducted to assess the colonization of MRSA. Results: Both TTO and chlorhexidine groups showed favorable results for MRSA decolonization. From 382 patients, 91 were MRSA-positive (about 23.82%), and of these 91 patients, 41 (45%) were female and 59 (55%) were male. The mean ± SD of the growth inhibition zone against MRSA was 19.20 ± 3.73 and 33.41 ± 9.53 for chlorhexidine and TTO, respectively. Conclusion: TTO body wash proved to be more effective than chlorhexidine in MRSA decolonization in hospitalized children. Implementation of such decolonization can improve patients’ outcomes and prevent MRSA transmission.

Background: The decoding of human genome helped to design pharmacological agents like Biologicals and Biosimilars which can target the affected etiological aberrations. Biological agents are large complex molecules produced by recombinant techniques in a living system for therapeutic or diagnostic uses and have revolutionized treatment of many diseases. Patent expiry of Biologicals has led to the development of Biosimilars which are similar in efficacy & safety and have no clinically meaningful differences, but are not identical to Biologicals and undergo fewer clinical trials than their reference biologicals. Clinicians’ in- depth knowledge of these agents is important to optimize the use of cost-effective & easily accessible options. Methods: This is a cross sectional observational study conducted between Feb-March 2020 in Radiotherapy/Chemotherapy Oncology Department of Dr B.R.A.M. Hospital & Pt. J. N. M. Medical College, Raipur, Chhattisgarh, using a self-administered, structured questionnaire consisting of 15-question among 30 clinicians prescribing Biologicals and Biosimilars. Results: 83.3% of clinicians were familiar with the term ‘Biologicals’ & ‘Biosimilars’. 60% believed that Biosimilars are same as Generic Medicines and have the same potency as Biologicals. 53% assumed that Biologicals & Biosimilars can be switched. 50% were able to explain the difference or similarity between Biologicals and Biosimilars. Conclusion: The findings reveal that the clinicians had good knowledge about Biologicals and Biosimilars but lacked application of this knowledge in clinical practice. This highlights a need for regular educational initiative to reduce the knowledge deficit & its application in clinical practice. Further, there must be a National Treatment Guidelines on use of Biologicals  and Biosimilars.

Background: The availability of energy drinks on the global market result from intensive marketing campaigns in the media. The purpose of this study was to evaluate the consumption of energy drink and its potential effect on sleep patterns of consumers. Methods: A descriptive cross-sectional design with self-administered questionnaire was used for this survey. An online survey using google forms was created for the validated questionnaires after pre-testing and the link shared on different social media platforms. Period of data collection lasted between January and September, 2020. Results: A total of 384 participants were involved in this study. From the study, prevalence of energy drink consumption in the metropolis is 61.5% (n=236). A percentage of 69.1 % (n=163) of the consumers are males relative to 30.9% (n=73) who are females. Results from the study indicate that most patronized energy drink in the metropolis has energy value per 100 ml of 158 kJ with no proteins and fats but an 8.9 g of carbohydrate. The caffeine content of this energy drink is 0.012% and 13% glucose syrup. A total of 29.6% (n=70) of energy drink consumers indicated it to be their preference. Least consumed energy drink (0.85%) has 30-35 mg/100 ml of caffeine with about 192 kJ energy value. Furthermore, results point out that 70.8% (n=167) of the consumers experienced change in sleep pattern. Although other factors may have caused this change in sleep pattern, Pearson Chi-Square result (x² = 83.277, p≤0.01) reveals that indeed there is association between energy drink consumption and change in sleep pattern as majority of energy drink consumers indicated that they usually experience changes in wake-up time and/or bedtime. Conclusion: The study has demonstrated that majority of the youth in the Kumasi Metropolis consume energy drinks which ultimately causes change in their sleep pattern. This change can alter their daily activities and health status. 

Thalidomide was widely used to avoid morning sickness in pregnant women, but was recalled due to its teratogenic effects and malformations in thousands of children. However, potential beneficial effects such as anti-inflammatory, system regulatory activities and the anti-angiogenic effect of thalidomide have been reported. As the studies about thalidomide continued, its new effects and applications made researchers more interested in it and became a promising agent in the treatment of a variety of clinical situations where standard treatments have failed. To make this purpose more achievable, Scopus, Science Direct, Google Scholar, and PubMed were searched. After obtaining and reviewing articles related to thalidomide and its indications, different therapeutic uses of thalidomide for pulmonary diseases are classified on mechanisms. In recent years, thalidomide has been an effective agent in treating cough associated with pulmonary fibrosis and the main suggested mechanism refers to regulation production of inflammatory mediators, including cytokines and chemokines, which trigger Epithelial-Mesenchymal Transition (EMT). The mechanism of EMT is related to the inhibition of Transforming growth factor-beta (TGF-β1)-mediated signaling pathways, Smad2 (Suppressor of Mothers against decapentaplegic homolog 2) / 3, Akt / Glycogen synthase kinase 3 beta (GSK-3β), and Mitogen-activated protein kinase (MAPK). Thalidomide is also involved in paraquat-induced and bleomycin-induced pulmonary fibrosis. Also, Thalidomide gained attention as a suitable agent for the treatment of cough associated with idiopathic pulmonary fibrosis (IPF) and for severe pulmonary damage cause by severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2), responsible for the global pandemic in 2020, due to its anti-inflammatory-anti-angiogenesis and pro-apoptotic properties.

Pediatric patients have very different pharmacokinetic and pharmacodynamic profiles compared to adults. A number of anatomical and physiological factors determine the pharmacokinetic profile of a drug. Differences in physiology in pediatric populations compared with adults can influence the concentration of drug within the plasma or tissue. When considering medication for a child or adolescent, one should be cautious about extrapolating from adult studies or practices. Always remember, children are not small adults. Children tend to have higher rates of metabolism and elimination than adults. As a result, children generally require higher weight-adjusted doses of most medications to achieve similar blood levels as adults. As pharmacokinetics is hard to predict in children, and thus a 'start low and go slow' approach is important. This review details key pharmacological and practical considerations which a healthcare professional should be aware of to understand consequences of drug use and dose adjustments in infants and children.

Background: Red man syndrome (RMS) is frequently reported from pediatric ward in patients receiving vancomycin, at the medical store of SGH, Pune. Though common in pediatric patients, not all patients receiving vancomycin developed Red man syndrome. Hence, this study was done to analyse the demographic, pathophysiological, and pharmacological aspects of the subject who experience adverse drug reactions with vancomycin and to determine if this predisposition is associated with any of these factors. Methods: All adverse drug reactions (ADR) to injection vancomycin in the pediatric ward that were reported from April 2018 - January 2022 were included. Controls were a similar number of randomly selected pediatric cases from the same ward who had received Intravenous vancomycin during the same period but did not experience the adverse drug reactions Results: The mean age was 29.91 ± 34.87 months in subjects who experienced ADR and 57.37 ± 41.58 months, in non-ADR group (p=0.0286). 37.4% were infants, 29.69% toddlers in ADR Group. Seventy four percent of patients who manifested with ADR were below age of 3 compared to barely 38% in controls (p=0.03). 66.6% were malnourished in the ADR group compared to 27.6% in controls (p=0.007). There was no association between the ADR and ethnicity, religion, gender, diagnosis, co-morbidities, co-administered drugs, or administered dose of vancomycin among the children. There was no apparent seasonal variation in occurrence of the ADR.Conclusion: RMS is more common in paediatric population than adults and is usually uneventful. Around 75% of the reactions occur within first 4 days of start of Vancomycin and usually occurs within 30 min of the preceding dose. Younger age groups (infants) and malnourishment were the two factors significantly associated with occurrence of RMS. We may also consider using lower than conventional doses and much slower infusions in such at-risk population.