Andries Gous

The need for pharmaceutical care in an intensive care unit at a teaching hospital in South Africa

Background. The role of the pharmacist has evolved over the last 2 decades beyond traditional functions such as stock control and dispensing. Objectives. To describe the functions performed by a clinical pharmacist while based in a surgical and trauma intensive care unit of a teaching hospital. Methods. An operational research study that included indications of programme success was conducted. Interventions to assess therapy and achieve definite outcomes to satisfy patients’ medicine needs were documented for 51 patients over a study period of 8 weeks. Results. A total of 181 interventions were suggested by the pharmacist, with 127 (70%) accepted and implemented by the medical and nursing staff of the unit. The most frequent interventions were related to: untreated medical conditions (15.5%), appropriate therapy or course (13.8%), investigations indicated or outstanding (12.2%), and inappropriate doses and dosing frequency (11%). Interventions were also made regularly to address system errors or non-compliance and factors hindering therapeutic effect. Of the 250 h the pharmacist spent in the ward, most time was used for pharmaceutical care (28%) and ward rounds (21%) with members of the multidisciplinary team. Conclusions. The study results demonstrated that a clinical pharmacist’s contribution to patient care at ward level resulted in improved monitoring of pharmacotherapy. Medicine-related problems were identified and addressed.

Antibiotic Prescribing Patterns in a Neonatal Intensive Care Unit

An outbreak of invasive candidiasis in the neonatal intensive care unit (NICU) of the Dr George Mukhari Academic Hospital in Ga-Rankuwa necessitated evaluation of the antibiotic prescribing practices in the unit. A selective randomised sample of 100 patients was followed up over a nine-month period to evaluate prescribing patterns. The existing antibiotic policy was used to compare the prescription practices and use of antibiotics. The frequency of use, number of antibiotics per patient and duration of use were documented. Of the 100 patients followed, 95 were prescribed intravenous antibiotics. All prescribed antibiotics for 77 patients are listed in the antibiotic policy. Nineteen different antibiotics were prescribed, and 11 of the 19 prescribed antibiotics appear in the antibiotic policy. Most patients received more than two antibiotics during their stay, as the average number of antibiotics used per patient during the study period was 3.4. The average duration of use for all antibiotics, except cefepime and ceftriaxone, was for longer than seven days. Although antibiotics were used according to the ward protocol in the majority of patients, deviations from the protocol were associated with patients’ clinical condition and/or results from blood cultures. The duration of antibiotic use needs to be monitored to prevent unnecessary prolonged use, as in this investigation. An antibiotic policy may be useful to guide and measure rational antibiotic therapy in a NICU.

COLISTIN: adult and paediatric guideline for South Africa, 2016

This document was created to serve as a guideline for colistin prescribing in South Africa. Antimicrobial resistance is threatening the effective prevention and treatment of a wide variety of infections, especially those that are caused by multi-drug-resistant (MDR) gram-negative bacteria. Colistin is typically used as salvage therapy, or last-line treatment, for MDR gram-negative infections. The dosing regimen should be optimised to be therapeutic and halt the emergence of resistance, whilst minimizing toxicity. This document provides evidence-based recommendations for adult and paediatric dosing, dosing in renal impairment, and the use of combination therapy to increase synergistic effects, as well as guidelines on the reconstitution and administration of colistin. This guideline is specifically aimed at healthcare workers who routinely treat patients with MDR gram-negative infections, especially in the intensive care setting.

Amphotericin B in the management of fungal infections in a neonatal intensive care unit: experiences in a teaching hospital

Invasive systemic fungal infections have emerged as serious nosocomial threats to neonates in the neonatal intensive care unit (NICU). Candidaemia due to fluconazole-resistant Candida krusei necessitated the use of amphotericin B in the NICU at Dr George Mukhari Hospital. The use of amphotericin B 1 mg/kg/dose in the first 20 patients was monitored. Response to treatment and side effects related to the use of amphotericin B in this population were documented and described. Nephrotoxicity, a common and well described side effect of amphotericin B, was not observed in this study - rather hepatotoxicity. To ensure uniformity in monitoring adverse effects, a monitoring tool has been developed for use in the NICU.