Elmien Bronkhorst

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.

Fluoroquinolone-resistant Salmonella typhi infection: a report of two cases in South Africa

Typhoid and paratyphoid fever are acute, life-threatening febrile illnesses caused by systemic infection with the bacterium Salmonella enterica. Nineteen cases were reported in South Africa in 2016. We report on two cases of bacteraemic invasive S. typhi with fluoroquinolone resistance.

Creating and evaluating an opportunity for medication reconciliation in the adult population of South Africa to improve patient care

ABSTRACT Objective: Adverse drug events (ADEs) are a major cause of morbidity and mortality, with more than 50% of ADEs being preventable. Adverse Drug Reactions (ADRs) are typically the result of an incomplete medication history, prescribing or dispensing error, as well as over- or under-use of prescribed pharmacotherapy. Medication reconciliation is the process of creating the most accurate list of medications a patient is taking and subsequently comparing the list against the different transitions of care. It is used to reduce medication discrepancies, and thereby ultimately decreasing ADEs. However, little is known about medicine reconciliation activities among public hospitals in South Africa. Methods: Prospective quantitative, descriptive design among Internal and Surgical wards in a leading public hospital in South Africa. Results: 145 study participants were enrolled. Over 1300 (1329) medicines were reviewed of which there was a significant difference (p = 0.006) when comparing the medications that the patient was taking before or during hospitalisation. A total of 552 (41.53%) interventions were undertaken and the majority of patients had at least 3.96 medication discrepancies. The most common intervention upon admission was transcribing the home medication onto the hospital prescription (65.2%) followed by medication duplication (13.44%). During patient’s hospital stay, interventions included patient counselling (32.5%) and stopping the previous treatment (37.5%). Conclusion: To ensure continuity of patient care, medication reconciliation should be implemented throughout patients’ hospital stay. This involves all key professionals in hospitals.