Natalie Schellack

An overview of pharmacotherapy-induced ototoxicity

Abstract This article provides an overview of ototoxic medication, as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine, they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies, further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team.This article provides an overview of ototoxic medication, as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine, they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies, further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team.

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.

Cardiovascular effects and the use of nonsteroidal anti-inflammatory drugs

Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs) include the nonselective and the cyclo-oxygenase-2-specific inhibitors. These agents are used for pain associated with musculoskeletal conditions. The nonselective anti-inflammatory drugs are still widely used, and are also freely available as over-the-counter analgesics. However, they carry the risk of serious cardiovascular adverse effects, especially in patients who have a high, pre-existing cardiovascular risk profile. It is imperative that physicians are aware of these risk factors and choose agents that have the best benefit-to-risk profile, while taking into consideration the patients individual risk profile.

Caffeine versus aminophylline for the prevention of apnoea of prematurity in a teaching hospital in South Africa

Study objectives: To determine the safety and efficacy of the use of oral anhydrous caffeine and intravenous aminophylline in the neonatal population using therapeutic drug levels and clinical effects as markers for determination. Design: Prospective randomised study. Patients: Thirty-one neonates admitted (aminophylline n = 16, caffeine n = 15) with a gestational age of less than or equal to 34 weeks for prevention of apnoea of prematurity (AOP) were enrolled. Results: Oral anhydrous caffeine or intravenous aminophylline were administered using prescribed study regimens. One peak level was taken for the two drugs on day 4 of treatment 2 hours after the maintenance dose was administered. The two regimens were clinically monitored using cardiovascular, respiratory, gastro-intestinal and central nervous system parameters four hourly. The two groups did not differ significantly for gestational age (p = 0.782), birth weight (p = 1), gender (p = 0.722), and Apgar scores determined at 5 minutes (p = 0.068). Serum concentrations were within range (5–20 μg/ml) for both study groups. The median pulse rate (beats per minute) for two days; day 7: 160 vs. 148 (p = 0.019); day 9: 168 vs. 147 (p = 0.020) and median respiratory rate (breaths per minute) for five days; day 3: 68 vs. 61 (p = 0.039); day 4: 67 vs. 57 (p = 0.014); day 5: 64 vs. 58 (p = 0.045); day 7: 65 vs. 50 (p = 0.021); day 8: 66 vs. 56 p = 0.014) were significantly higher in the aminophylline study arm. Conclusion: The findings of the study indicated that caffeine is an effective alternative for intravenous aminophylline in prevention of AOP. The oral administration of caffeine may also have an advantage in a resource-poor setting.

An overview of fixed-dose combinations of antihypertensive drugs in South Africa

Hypertension is a pressing global health issue, contributing to an increase in cardiovascular risk, as well as being the most common condition seen in South Africa. Lack of compliance with the prescribed therapy is one of the largest obstacles to achieving goal blood pressure in antihypertensive patients. The complexity of the drug therapy is a very important factor that is associated with noncompliance, as most patients require treatment with two or more drugs. The use of fixed-dose combination (FDC) therapy has various advantages, including simplification of the regimen, resulting in improved adherence. However, there are also disadvantages, e.g. the inability to provide individualised dose flexibility. This article provides an overview of available FDC therapy for hypertension in South Africa and the rational use thereof, by taking into account each combination’s complementary action, efficacy, safety and tolerability.

A review of phosphodiesterase type 5 inhibitors

Abstract Currently, three phosphodiesterase type 5 (PDE5) inhibitors are available for clinical use in South Africa; sildenafil, vardenafil and tadalafil. The PDE inhibitors are used in males to treat erectile dysfunction. However, sildenafil is also registered for use in the treatment of pulmonary hypertension. Newer studies are investigating the use of these drugs for other conditions, including hypertension, ischaemia or reperfusion injury, myocardial infarction, cardiac hypertrophy, heart failure and other peripheral circulatory conditions, e.g. Raynauds disease. The article provides a broad overview of the mechanism of action, indications, pharmacokinetics and side-effects of these agents.

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.