Inappropriate Drug Use Research Articles

Prevalence and influencing factors of self-medication during the COVID-19 pandemic in the Arab region: a multinational cross-sectional study

BackgroundThe novel coronavirus pandemic (COVID-19) has begun with a wave of misinformation and fear of infection. This may have led people to self-medicate inappropriately. The World Health Organization describes self-medication (SM) as utilizing medicines to relieve symptoms or health conditions without consulting a physician. Inappropriate drug use is a burden on both health resources and patient health in the Arab region. This study aimed to detect the prevalence and influencing factors of self-medication among the general Arab population during the COVID-19 pandemic.MethodsA multinational cross-sectional study was conducted among the general population of ten Arab countries from early August to late October 2021. Participants aged 18 years or older could join the study via social media platforms. A convenience sampling technique was used. A developed and validated web-based questionnaire was used to collect data on self-medication practice, associated influencing factors, information sources, commonly used medications, and commonly treated conditions. Descriptive, univariate, and multivariate regression analyses were applied using IBM SPSS v 26 and R v 4.0.0 software.ResultsA total of 8163 participants completed the questionnaire, and 518 participants were excluded from the analysis due to inconsistencies in their data. Almost two-thirds (62.7%) of participants reported practicing self-medication during the COVID-19 pandemic. At the country level, Egypt had the highest prevalence of self-medication practice (72.1%), while Palestine had the lowest prevalence (40.4%). The most commonly used drugs were analgesics, antipyretics, and vitamins (86, 65.1, and 57.1%, respectively), while antitussives and antibiotics scored 47.6 and 43.3%, respectively. Experience with similar health conditions (74.6%) and urgency of the problem (47.2%) were the most frequent factors that led to self-medication. Additionally, 38.2% of the self-medicated participants (SMPs) used drugs as prophylaxis against COVID-19. Pharmacist consultation was the most common source of information about self-medication (66.7%). Multivariate analysis showed that predictors of self-medication were older age (p = 0.008), presence of chronic illness (p = 0.015), and having monthly income or medical insurance that does not cover the treatment cost (p = 0.001, p < 0.001, respectively).ConclusionSelf-medication is considered a common practice across the Arab population. It is necessary to regulate policies and raise awareness among the public about self-medication.

The Status of Drug Prescription Based on Beers Criteria (Edition 2022) in the Community-dwelling Older Adults Living in Tabriz, Iran: Data From Tabriz Older People Health Survey (TOPS)

Background: Physiological, physical, and mental changes along with chronic diseases require the elderly to use multiple drugs. In this study, the status of drug administration in the elderly was investigated. Methods: In this retrospective community-based cross-sectional study, the data of 1362 people aged≥60 years in Tabriz were collected by trained interviewers from July 2019 to January 2020. The data received included demographic variables and the status of drugs used, which were evaluated based on the 2022 edition of the Beers Criteria. Data analysis was done by Microsoft Excel version 2016 and Stata statistical software package (Release 16. College Station, TX: StataCorp LP). Results: The mean and standard deviation of the drug number used by participants were estimated to be 3.72±3.09. According to the Beers criteria, 28% of all used drugs were inappropriate for the elderly, and 62% of participants used at least one inappropriate medicine. Furthermore, the most common inappropriate drugs were from the group of non-steroidal anti-inflammatory drugs, benzodiazepines, cardiovascular, and anticonvulsants, including aspirin, gabapentin, diclofenac sodium, glyburide, and triamterene. Conclusion: The use of inappropriate drugs in the elderly had a relatively high prevalence. In addition, the number of drug items used in more than one-third of the elderly indicated polypharmacy. The consequences of taking inappropriate and multiple drugs require the design and implementation of effective interventions in this regard, the findings of this study can provide evidence for policymakers and decision-makers in the health system.

Self-medication for acne among Saudi Undergraduate University Students: A cross-sectional study.

Understanding the perceptions and practices associated with self-medication among undergraduate university students is of significant importance since there is evidence showing that self-medication is prevalent among this group. The aim of this study is to evaluate the perceptions and extent of self-medication among undergraduate university students as well as assess their knowledge and patterns of self-medication for acne. A cross-sectional study was conducted with undergraduate university students aged between 18 and 25 years. Students were briefed about the purpose of the study, and a pretested questionnaire was used for assessment. Statistical analyses were performed using SPSS version 25. Five hundred and nineteen students participated in this study. Approximately 55.3% had self-medicated, and 38.2% of the participants reported self-medicating because they thought the situation was simple and did not require a doctor's visit. Adapalene was the most commonly administered medication (53%). Furthermore, 74.7% of the respondents said that they saw improvement after treatment. A high percentage of students self-medicate their acne, many of whom use medication without a prescription. However, inappropriate use of drugs can increase the risk of adverse effects.

Evaluation of inappropriate drug use in geriatric patients using the TIME-to-STOP/TIME-to-START criteria in a tertiary hospital

Evaluation of inappropriate drug use in geriatric patients using the TIME-to-STOP/TIME-to-START criteria in a tertiary hospital

Autism with co-occurring epilepsy care pathway in Europe.

Autism and epilepsy often occur together. Epilepsy and other associated conditions have a substantial impact on the well-being of autistic people and their families, reduce quality of life, and increase premature mortality. Despite this, there is a lack of studies investigating the care pathway of autistic children with co-occurring epilepsy in Europe. We analyzed the care pathway for autistic children with associated epilepsy in Italy, Spain, and the United Kingdom from the perspective of caregivers (using a survey aimed at caregivers of autistic children 0-18years old), the autistic community, and professionals, in order to identify major barriers preventing caregivers and autistic children from receiving timely screening and treatment of possible co-occurring epilepsy. Across all three countries, an analysis of the current care pathway showed a lack of systematic screening of epilepsy in all autistic children, lack of treatment of co-occurring epilepsy, and inappropriate use of antiepileptic drugs. A major challenge is the lack of evidence-based harmonized guidelines for autism with co-occurring epilepsy in these countries. Our findings show both heterogeneity and major gaps in the care pathway for autism with associated epilepsy and the great efforts that caregivers must make for timely screening, diagnosis, and adequate management of epilepsy in autistic children. We call for policy harmonization in Europe in order to improve the experiences and quality of life of autistic people and their families.

Evaluation of the effectiveness of antimicrobial stewardship program: results from a ten-year study in a multidisciplinary hospital

Objective. To evaluate the results of the implementation of antimicrobial stewardship (AMS) program in a multidisciplinary hospital. Materials and Methods. A retrospective intervention study was performed in the 600-bed multidisciplinary hospital of the Pirogov National Medical and Surgical Center (Moscow, Russia). The study included a number of sequential interventions, aimed at improving the prevention, diagnosis and treatment of infections, with an assessment of the following indicators dynamics: the structure of microorganisms isolated in the hospital, the level of resistance to antimicrobial drugs (AMD) among the pathogens of the ESKAPE group, the structure of prescribed AMD, as well as an assessment of clinical and economic consequences of antimicrobial resistance changes. For a comprehensive assessment of trend in antibiotic resistance and its connection with consumption of antibiotics, the drug resistance index (DRI) was used. DRI is based on the ratio of the level of resistance of the microorganism and the frequency of administration of AMD, potentially effective against this pathogen. The intervention started in 2013, so the data of 2012 (pre-intervention period) and 2022 were compared in this study. Results. The implementation of AMS program measures helped to reduce the relative frequency of ESKAPE group microorganisms in the structure of nosocomial infection pathogens in the hospital from 36.5% to 22% (p &lt; 0.0001). The proportion of gram-negative (Gr-) isolates resistant to meropenem decreased from 32.4% to 10.9% (p &lt; 0.0001). As a result of the introduction of AMS program, DDDh has been reduced almost three times: from 48.1 to 17.2 DDDh. The median duration of the AMT course in a specialized intensive care unit for the treatment of patients with nosocomial infections decreased from 12 to 8 days (p &lt; 0.0001), the number of AMT days per 1 patient decreased from 7.7 to 4.2 (p &lt; 0.0001). The proportion of ESKAPE pathogens in the structure of bloodstream infections in the hospital decreased from 53.1% to 26% (p &lt; 0.0001), which led to decrease in mortality from 28.4% to 12.8%, (p = 0.012) and length of hospital stay from 31 to 22 days (p &lt; 0.001) in this group of patients. Conclusions. The implementation of AMS program in a multidisciplinary hospital helps to reduce the frequency of inappropriate use of antimicrobial drugs and reduces the consumption of antibiotics, decrease the level of antimicrobial resistance, and in such way improves the results of treatment of patients with nosocomial infections.

Prevalence of inappropriate drug dose adjustment and associated factors among inpatients with renal impairment in Africa: A systematic review and meta-analysis.

There is a high prevalence of inadequate dose adjustment among inpatients with renal insufficiency worldwide. There is, however, a paucity of studies that summarizes the topic in the African context. Therefore, this study aims to summarize the prevalence of inappropriate drug dose adjustment (IDDA) and associated factors among inpatients with renal impairment in Africa. A literature search for English-language articles was conducted using reputable databases such as PubMed/MEDLINE, Google Scholar, and Science Direct. The search was carried out between 3 February and 3 March of 2022. All published articles that were online at the time of data collection were considered. Observational studies that examined the prevalence of IDDA for any type of drug in renal impairment as a primary or secondary outcome were included in our analysis. Statistical software such as Open Meta Analyst and Review Manager were used to examine outcome measures. I2 statistics, Logit event rate, and Der Simonian and Laird's random effect models were also used. Seven articles were qualified for the systematic review and meta-analysis. All included studies comprised a total of 1918 patients. A total of 5072 prescriptions were assessed, and 1879 (37%) of them had at least one drug that required a dose adjustment. The pooled prevalence of IDDA among adult patients with renal impairment was 13.7% (95% confidence interval (CI) = 7.9%-19.5%) in Africa. Based on the number of prescriptions containing medications that required dose adjustment, the pooled prevalence accounts for 39.3% (95% CI = 24.1%-54.4%) (932/1879). Factors associated with inappropriate drug prescribing and usage concerning renal function were the number/types of prescribed medicines (most common), age, stage of renal impairment, comorbidity, and unemployment. In this study, IDDA practice appears to be a common challenge among inpatients with renal insufficiency in Africa. The number and type of medications prescribed, age, stage of renal impairment, comorbidity, and unemployment were factors associated with inappropriate drug prescribing and use. In addition to expanding such studies, hospitals across Africa must conduct research on the clinical outcomes of IDDA practices in patients with renal impairment.

Aile Hekimliği Yaşlı Hasta İzlemi Kapsamında Polifarmasinin Değerlendirilmesi

Çalışmamızın amacı Sağlık Bakanlığı Hastane Medulla Sistemi kullanılarak polifarmasiye maruz kalan 65 yaş ve üstü hastalarda, ilaç-ilaç etkileşimlerinin belirlenip, ciddi etkileşimleri olan hastalarda klinik önlem alınması için farkındalık yaratmaktır. Çalışmamız Gebze 1 nolu Aile Sağlığı Merkezi’nden hizmet almakta olan 65 yaş üstü, Hasta Yönetim Platformu veri tabanında yer alan 188 hasta üzerinde yapılmıştır. Lexicomb® ilaç etkileşimi modülü ile hastaların kronik olarak kullandıkları ilaçlar listelenerek etkileşim düzeyleri değerlendirilmiştir. Bununla birlikte yaşlılarda uygunsuz ilaç kullanımı değerlendirilmesinde kullanılan kriterler üzerinde de durulmuştur. Çalışma sonuçlarımıza göre, 167 hastada toplamda 529 potansiyel ilaç-ilaç etkileşimi görüldü. Bu etkileşimlerin 52’sinde (%9,8) bilinen bir etkileşim saptanmadı ve risk kategorisi A olarak tespit edildi. B, C, D ve X risk kategorilerinde ilaç-ilaç etkileşimi sayıları sırasıyla, 74 (%13,9), 363(%68,6), 33 (%6,2) ve 7 (%1,3) idi. Çalışmadaki hastaların %54’ünde esansiyel hipertansiyon tanısı mevcuttu. En çok kullanılan ilaç ise asetilsalisilik asit (%26)’di. C kategorisinde ilaç-ilaç etkileşim potansiyelinin verilerimize göre anlamlı oranda yüksek çıkması, hastaların tedavisinin daha düzenli ve etkili bir şekilde monitorize edilmesinin gerekliliğini vurgulamaktadır. D ve X kategorisinde saptanan ilaç-ilaç etkileşimleri en fazla nonsteroidal antiinflamatuar ilaçlar, antihipertansif ilaçlar, antipelet ilaçlar ve santral sinir sistemi ilaçlar arasında meydana gelmiştir. Bu ilaçların takibine özellikle dikkat edilmelidir.

Prescription pattern and associated factors among pregnant women attending antenatal clinics in University of Gondar, North West Ethiopia

BackgroundAn inappropriate use of drug during pregnancy may harm the fetus. There is no enough study on drug use among pregnant women at the University of Gondar referral hospital. Most studies are carried out in developed countries but not in developing countries. Thus, the aim of this study was to evaluate prescription of drug and associated factors among pregnant women attending antenatal care service in University of Gondar referral hospital. MethodsInstitution based cross sectional study was used among 334 pregnant women who attended antenatal care units of the University of Gondar referral hospital. Data were collected from the pregnant women medical records and registration logbook and analyzed using SPSS version 23. Multivariate logistic regression used to analyze the association of the independent variables with drug use. P-values <0.05 were considered significant. ResultA total of 334 pregnant women's medical records showed a total of 631 drugs prescribed. The average numbers of drugs per pregnant women was 1.88. All pregnant women (100%) were prescribed with iron folat. Most pregnant women 185 (55.2%) were in the third trimester followed by third trimester 91 (27.25%). Moreover, 23.77%, 42.95%, 33%, and 7% pregnant women encountered with drugs from category A, B, C and D respectively. From the bivariate regression analysis, Age of women, maternal illness, trimester at the first visit, and gravidity were significantly associated with exposure to prescribed drug use during pregnancy. ConclusionThe present study showed the deviation of drug use pattern from the WHO optimal levels proposing the hospitals had inappropriate use of drug. Implementing corrective measures are required to achieve the recommended standards of appropriate drug use.

Characterizing the antimicrobial resistance profile of Escherichia coli found in sport animals (fighting cocks, fighting bulls, and sport horses) and soils from their environment.

Antimicrobial resistance (AMR) is a significant threat to global health and development. Inappropriate antimicrobial drug use in animals cause AMR, and most studies focus on livestock because of the widespread use of antimicrobial medicines. There is a lack of studies on sports animals and AMR issues. This study aimed to characterize the AMR profile of E. coli found in sports animals (fighting cocks, fighting bulls, and sport horses) and soils from their environment. Bacterial isolation and identification were conducted to identify E. coli isolates recovered from fresh feces that were obtained from fighting cocks (n = 32), fighting bulls (n = 57), sport horses (n = 33), and soils from those farms (n = 32) at Nakhon Si Thammarat. Antimicrobial resistance was determined using 15 tested antimicrobial agents - ampicillin (AM), amoxicillin-clavulanic acid, cephalexin (CN), cefalotin (CF), cefoperazone, ceftiofur, cefquinome, gentamicin, neomycin, flumequine (UB), enrofloxacin, marbofloaxacin, polymyxin B, tetracycline (TE), and sulfamethoxazole/trimethoprim (SXT). The virulence genes, AMR genes, and phylogenetic groups were also examined. Five virulence genes, iroN, ompT, hlyF, iss, and iutA, are genes determining the phylogenetic groups, chuA, cjaA, and tspE4C2, were identified. The AMR genes selected for detection were blaTEM and blaSHV for the beta-lactamase group; cml-A for phenicol; dhfrV for trimethoprim; sul1 and sul2 for sulfonamides; tetA, tetB, and tetC for TEs; and qnrA, qnrB, and qnrS for quinolones. The E. coli derived from sports animals were resistant at different levels to AM, CF, CN, UB, SXT, and TE. The AMR rate was overall higher in fighting cocks than in other animals, with significantly higher resistance to AM, CF, and TE. The highest AMR was found in fighting cocks, where 62.5% of their isolates were AM resistant. In addition, multidrug resistance was highest in fighting cocks (12.5%). One extended-spectrum beta-lactamase E. coli isolate was found in the soils, but none from animal feces. The phylogenetic analysis showed that most E. coli isolates were in Group B1. The E. coli isolates from fighting cocks had more virulence and AMR genes than other sources. The AMR genes found in 20% or more of the isolates were blaTEM (71.9%), qnrB (25%), qnrS (46.9%), and tetA (56.25%), whereas in the E. coli isolates collected from soils, the only resistance genes found in 20% or more of the isolates were blaTEM (30.8%), and tetA (23.1%). Escherichia coli from fighting cock feces had significantly higher resistance to AM, CF, and TE than isolates from other sporting animals. Hence, fighting cocks may be a reservoir of resistant E. coli that can transfer to the environment and other animals and humans in direct contact with the birds or the birds' habitat. Programs for antimicrobial monitoring should also target sports animals and their environment.

Abstract 9873: Erroneous Electrocardiographic Interpretations and Its Clinical Implications

Introduction: Advancement of artificial intelligence (AI) has aided clinicians in the interpretation of electrocardiograms (ECGs) serving as an essential tool to provide rapid triage and care. However, in some cases, AI can misinterpret an ECG and may mislead the interpreting physician. Therefore, we aimed to describe the rate of ECG misinterpretation and its potential clinical impact in patient's management Methods: We performed a retrospective descriptive analysis of misinterpreted ECGs and its clinical impact from May 28, 2020 to May 9, 2021. An electrophysiologist screened ECGs with confirmed diagnosis of atrial fibrillation (AF), sinus tachycardia (ST), sinus bradycardia (SB), intraventricular conduction delay (IVCD), and premature atrial contraction (PAC) that were performed in the emergency department. We then classified the misinterpreted ECGs as pseudo-AF, ST, SB, IVCD, or PAC into the correct diagnosis, and reviewed the misinterpreted ECGs and medical records to evaluate inappropriate use of antiarrhythmic drugs (AAD), beta-blockers (BB), calcium channel blockers (CCB), anticoagulation, or resource utilization of cardiology and/or electrophysiology (EP) consultation. Results: A total of 4,969 ECGs were screened with diagnoses of AF (2,282), IVCD (296), PAC (972), SB (895), and ST (638). Among these, 101 ECGs (2.02%) were misinterpreted. Pseudo-AF (58%) was the most common followed by pseudo-PAC (15%), pseudo-ST (13%), pseudo-IVCD (8%) and pseudo-SB (6%). Patients with misinterpreted ECGs were aged 76.6±11.6yr with male (52.5%) predominance and hypertension being the most prevalent (83.2%) comorbid condition. The misinterpretation of ECGs led to the inappropriate use of BB (19.8%), CCB (5.0%), AAD therapy (7.9%), anticoagulation (30.7%) in patients with pseudo-AF, as well as inappropriate resource utilization including cardiology (41.6%) and EP (8.9%) consultations. Conclusions: Misinterpretation of ECGs may lead to inappropriate medical therapies and increased resource utilization. Therefore, it is essential to encourage physicians to carefully examine AI interpreted ECG’s, especially those interpreted as having AF.

Association Between Inappropriate Use of Over-The-Counter Drugs for Allergic Rhinitis and Side Effects on the Central Nervous system-a Cross-Sectional Survey.

Antihistamine over-the-counter (OTC) drugs for allergic rhinitis are widely used and cause central nervous system side effects. Most available data on anti-allergic drugs are on controlled usage. It is necessary to investigate the occurrence of side effects in the context of self-medication to avoid inappropriate use. We aimed to clarify the association between the usage of OTC anti-allergic drugs and central nervous system side effects. An online, anonymous, cross-sectional study was conducted using a structured questionnaire. People who had used OTC anti-allergic drugs in the year prior to the study were recruited. To assess the association between inappropriate drug use and the occurrence of side effects, a binary logistics regression analysis was performed according to three dosage forms (oral only, nasal only, and oral and nasal combined use). Somnolence was experienced by 59.1% of the participants using the OTC drug for allergic rhinitis. Using logistic regression analysis, "drug use exceeding the upper limit" was seen to be associated with side effects in only oral (Somnolence: OR = 1.41, 95% CI = 1.17-1.70; Dull head: OR=1.41, 95% CI = 1.16-1.70; Loss of concentration: OR = 1.25, 95% CI = 1.04-1.49) and oral and nasal combined use groups (Somnolence: OR = 1.33, 95% CI = 1.04-1.71; Dull head: OR = 1.47, 95% CI = 1.15-1.89; Loss of concentration: OR = 1.51, 95% CI = 1.19-1.91). Furthermore, "expired drug use" was associated with side effects in the nasal spray-only group (Somnolence: OR = 1.31, 95% CI = 1.07-1.60; Dull head: OR =1.25, 95% CI = 1.02-1.53; Loss of concentration: OR = 1.24, 95% CI = 1.00-1.54). Inappropriate use was common among users of OTC allergic rhinitis drugs. Differences in side effects depending on the dosage form used were observed.

Self-medication practices with conventional and herbal drugs among ear, nose, and throat patients.

This study evaluates the self-practices with conventional and herbal drug use among ear, nose, and throat outpatients. A cross-sectional survey-based study was carried out among all ear, nose, and throat outpatients on their first visit to the otorhinolaryngology department at a tertiary care hospital. The survey comprised a total of 14 questions with 4 different sections, including demographic characteristics, self-medication of conventional medicines, herbal medication usage, and perception regarding herbal medicines. Overall, 255 questionnaires were distributed among patients, of which 183 completed the questionnaire (response rate=71.7%). Respondents reported self-medication (44.8%) with conventional drugs before visiting a hospital. The most commonly used medicine was analgesics (31.7%) and antibiotics (21.9%). Nearly half of the patients (49.2%) used at least one herbal drug. The most commonly used herbal medications were Tilia cordata (78.8%), Zingiber officinale (62.2%), and Camellia sinensis (45.5%). According to the International Union for Conservation of Nature Red List, most of the medicinal herbs were considered as data deficient/least concern. About 36.6% of the participants perceived that herbal drugs are effective for ear, nose, and throat problems. Moreover, 22.9% of the patients did not know about herbal-drug interaction with other medications. This study observed a considerable prevalence of self-based practices with conventional and herbal medications. Strict national regulations on conventional and herbal medication access and long-term actions should be implemented to discourage inappropriate drug use.

Inappropriate drug use determined by TIME criteria and the relation with frailty

Amaç: Çalışmamızın amacı kırılganlık ile çoklu ilaç kullanımı, Potansiyel Uygunsuz İlaç Kullanımı (PUİK) ve Potansiyel Reçete İhmali (PRİ) ilişkisini değerlendirmektedir.&#x0D; Gereç ve Yöntem: Geriatri polikliniğine 1 Ekim 2021 ve 1 Nisan 2022 ayaktan başvuran 65 yaş ve üzeri hastalar retrospektif değerlendirildi. Hastaların demografik verileri, kullandıkları ilaçların etken maddeleri, komorbid hastalıkları ve Klinik Kırılganlık Skalası (KKS) skoru kayıt edildi. KKS skoruna göre hastalar kırılgan ve kırılgan olmayan olarak ikiye ayrıldı. Turkish Inappropriate Medication use in the Elderly (TIME) to STOP kriterleri PUİK değerlendirmek için, TIME to START ise PRİ’yi belirlemek için kullanıldı.&#x0D; Bulgular: Hastaların ortalama yaşı 75,9±8,7 olup, hastaların %63,1 kadın idi. Hastaların kullandığı ortanca ilaç sayısı 7 (0-17) iken, katılımcıların %79,6’sında polifarmasi mevcuttu. Kırılgan hastaların %69,5 (n=42)’ inde polifarmasi mevcut olup, kırılgan olmayan hastalarda bu oran %22,5 (n=18) idi. Kırılgan hastalarda oral beslenme ürünü, 3-hidroksi-3-metil-glutaril-KoA reduktaz inhibitörleri ve demans tedavisi reçete ihmali oranı anlamlı olarak normal popülasyondan daha fazla idi. Proton pompa inhibitörleri, antipsikotikler, asetilsalisilik asit ve betahistinin uygunsuz kullanım oranı kırılgan hastalarda, kırılgan olmayan hastalardan daha fazla idi. &#x0D; Sonuç: Polifarmasi, PRİ ve PUİK hastalarda değerlendirilirken kırılganlık göz önünde bulundurulmalıdır ve her ülkenin farklı reçeteleme alışkanlığı olmasından dolayı ülkemize özel olan TIME kriterlerinin kullanımı önemli bir avantaj sağlayabilir.

Emerging Fungal Infections: from the Fields to the Clinic, Resistant Aspergillus fumigatus and Dermatophyte Species: a One Health Perspective on an Urgent Public Health Problem.

Purpose of ReviewFor this review, we use a One Health approach to examine two globally emerging public health threats related to antifungal drug resistance: triazole-resistant Aspergillus fumigatus infections, which can cause a life-threatening illness in immunocompromised hosts, and antifungal-resistant dermatophytosis, which is an aggressive skin infection caused by dermatophyte molds. We describe the state of current scientific knowledge and outline necessary public health actions to address each issue.Recent FindingsRecent evidence has identified the agricultural use of triazole fungicides as an important driver of triazole-resistant A. fumigatus infections. Antifungal-resistant dermatophyte infections are likely driven by the inappropriate use of antifungal drugs and antibacterial and corticosteroid creams.SummaryThis review highlights the need for a One Health approach to address emerging antifungal resistant infections, emphasizing judicious antifungal use to preserve available treatments; strengthened laboratory capacity to identify antifungal resistance; and improved human, animal, and environmental surveillance to detect emerging resistance, monitor trends, and evaluate the effectiveness of efforts to decrease spread.

Rational medication management mode and its implementation effect for the elderly with multimorbidity: A prospective cohort study in China.

BackgroundAs one of the countries with the most serious degree of aging, the incidence of potentially inappropriate drug use among the elderly is as high as 30. 4% in Chinese communities, and the lack of effective medication management and poor medication compliance at home are the main factors. Given these situations, we constructed a Rational Medication Management Mode based on family physician service, carried out an empirical research and evaluated the implementation effect.MethodsA prospective cohort study was conducted from September to December 2021 to analyze the implementation effect of the Rational Medication Management Mode by comparing the outcome indicators between the intervention group and control group. The primary outcome of this study was medication number and polypharmacy (taking 5 or more medications) at 90 days. The secondary outcomes included the situation for behavioral self-management and knowledge-belief-behavior of rational medication use.ResultsA total of 618 elderly patients (309 in the intervention group and 309 in the control group) with multimorbidity were included in this study, those were all available at follow-up at 90 days. At 90 days, the number of medications was achieved by 3.88 (1.48), and patients with polypharmacy were reduced by 59.55% in the intervention group, having a significant difference compared with the control group (P < 0.001). Patients with medication reminders, intermittent medication and adverse drug reactions were achieved in 294 (95.15%), 47 (15.21%), and 51 (16.51%) respectively in the intervention group (P < 0.001). The knowledge, belief, behavior security and behavior compliance of rational medication use of elderly patients were all greatly improved in the intervention group at 90 days (P < 0.0001).ConclusionThe Rational Medication Management Mode based family physician service, which provides the support of manuals and pillboxes, can decrease the elderly patients' number of drugs with multimorbidity, reduce the incidence of polypharmacy, enhance behavioral self-management, increase the knowledge and belief of rational medication use, and improve the security and compliance of medication usage behavior. In order to provide a practical basis for rational medication management of elderly patients with multimorbidity under the background of long-term prescriptions in China.

Global prevalence of polypharmacy among the COVID-19 patients: a comprehensive systematic review and meta-analysis of observational studies

BackgroundPolypharmacy has traditionally been defined in various texts as the use of 5 or more chronic drugs, the use of inappropriate drugs, or drugs that are not clinically authorized. The aim of this study was to evaluate the prevalence of polypharmacy among the COVID-19 patients, and the side effects, by systematic review and meta-analysis.MethodsThis study was performed by systematic review method and in accordance with PRISMA 2020 criteria. The protocol in this work is registered in PROSPERO (CRD42021281552). Particular databases and repositories have been searched to identify and select relevant studies. The quality of articles was assessed based on the Newcastle–Ottawa Scale checklist. Heterogeneity of the studies was measured using the I2 test.ResultsThe results of meta-analysis showed that the prevalence of polypharmacy in 14 studies with a sample size of 189,870 patients with COVID-19 is 34.6% (95% CI: 29.6–40). Studies have shown that polypharmacy is associated with side effects, increased morbidity and mortality among patients with COVID-19. The results of meta-regression analysis reported that with increasing age of COVID-19 patients, the prevalence of polypharmacy increases (p < 0.05).DiscussionThe most important strength of this study is the updated search to June 2022 and the use of all databases to increase the accuracy and sensitivity of the study. The most important limitation of this study is the lack of proper definition of polypharmacy in some studies and not mentioning the number of drugs used for patients in these studies.ConclusionPolypharmacy is seen in many patients with COVID-19. Since there is no definitive cure for COVID-19, the multiplicity of drugs used to treat this disease can affect the severity of the disease and its side effects as a result of drug interactions. This highlights the importance of controlling and managing prescription drugs for patients with COVID-19.

A cross-sectional study: farmer’s perceptions, practices, and knowledge (PPK) on antimicrobial drug (AMD) and antimicrobial drug resistance (AMDR) at rural households in selected areas of Cumilla district, Bangladesh

In response to unwise and inappropriate antimicrobial drug (AMD) use, antimicrobial drug resistance (AMDR) is rising globally. The present research was performed to find out and evaluate the perceptions, practices, and knowledge (PPK) of the farmers regarding AMD use and AMDR propagation in rural households. The study was conducted using a pre-tested questionnaire upon 200 respondents with a duration of 5 months in selected areas of Cumilla district, Bangladesh. The correlation analysis showed a significant (p&lt;.01) relationship between farmers’ knowledge and practicing proper administration of drugs in the animal. The sex of the respondents was also found to be correlated with the understanding of Antibiotic Resistance (AR) (p&lt;.01), AR transmission (p&lt;.05), and propagation from livestock to humans (p&lt;.01). Additionally, through the qualitative analysis, we found the powerful impacts of media availability and accessibility, participation in the training program, and good quality education on the improvement of farmers' PPK. Therefore, the government must need to emphasize this topic and educate the farmers about AR to control the spread of AR in order to secure both animal and public health. Asian Australas. J. Biosci. Biotechnol. 2022, 7(2), 57-74

Prevalence and patterns of the concurrent use of anticholinergics for the motor symptoms of Parkinson’s disease and acetylcholinesterase inhibitors in Parkinson’s disease patients with dementia: a cross-sectional study using Korea National Health Insurance claims data

BackgroundThe concurrent use of anticholinergics and acetylcholinesterase inhibitors (ACHEIs) in Parkinson’s disease (PD) patients with dementia should be avoided because the opposing pharmacological actions of both drugs reduce the treatment efficacy. We aimed to investigate the prevalence of the concurrent use of these two types of drugs in Korean patients.MethodsIn the 2017 Health Insurance Review and Assessment Service–National Aged Patient Sample data, comprising insurance claims records for a 10% random sample of patients aged ≥ 65 years in Korea, “concurrent use” was defined as the overlapping of anticholinergic and ACHEI doses for at least 2 months.ResultsAmong 8,845 PD patients with dementia, 847 (9.58%) were co-administered anticholinergics, used to treat the motor symptoms of PD, and ACHEIs for a mean duration of 7.7 months. A total of 286 (33.77% of all co-administered) patients used both drug types concurrently all year. About 80% of concurrent users were prescribed each drug by the same prescriber, indicating that coadministration may not be due to a lack of information sharing between providers. Logistic regression analysis showed that patients mainly treated at clinics (odds ratio (OR), 1.541; 95% confidence interval (CI), 1.158–2.059), hospitals (OR, 2.135; 95% CI, 1.586–2.883), and general hospitals (OR, 1.568; 95% CI, 1.221–2.028) were more likely to be co-prescribed anticholinergics and ACHEIs than those mainly treated at tertiary-care hospitals. PD patients with dementia treated at healthcare organizations located in areas other than the capital city had an approximately 22% higher risk of concurrent use (OR: 1.227, 95% CI: 1.046–1.441).ConclusionsThe concurrent use of anticholinergics for the motor symptoms of PD and ACHEIs in elderly Korean PD patients with dementia cannot be ignored, and strategies that mitigate potentially inappropriate concurrent drug use are required.

PHARMACOLOGY IN ENDODONTICS

Aim: This review article focusses on the availability of drugs and their use in Endodontics. Background: This study aimed at reviewing the use of analgesics, antibiotics and their use in Endodontics, in form of oral or its application. Dosage and inappropriate use of drugs was added into this review. Methods: The systematic literature search was performed in three databases from 1993 to 2013.English articles that focused on drugs used in endodontics and their role were searched. Systematic and narrative reviews were included. Result: After evaluation of search papers, 12 relevant articles were used in this review. The importance of drugs with their role, dosage, uses are highlighted in this study. Drugs play an essential role in treatment protocol but at the same time its misuse should be avoided. Conclusion: There is availability of systemic and topical drugs but their use and dose should be assessed before administration and unnecessary use of these should be avoided.