Shane Ashley Pawluk

A Review of Pharmacokinetic Drug–Drug Interactions with the Anthelmintic Medications Albendazole and Mebendazole

Medications indicated for helminthes and other parasitic infections are frequently being used in mass populations in endemic areas. Currently, there is a lack of guidance for clinicians on how to appropriately manage drug interactions when faced with patients requiring short-term anthelmintic therapy with albendazole or mebendazole while concurrently taking other agents. The objective of this review was to systematically summarize and evaluate published literature on the pharmacokinetics of albendazole or mebendazole when taken with other interacting medications. A search of MEDLINE (1946 to October 2014), EMBASE (1974 to October 2014), International Pharmaceutical Abstracts (1970 to October 2014), Google, and Google Scholar was conducted for articles describing the pharmacokinetics of albendazole or mebendazole when given with other medications (and supplemented by a bibliographic review of all relevant articles). Altogether, 17 articles were included in the review. Studies reported data on pharmacokinetic parameters for albendazole or mebendazole when taken with cimetidine, dexamethasone, ritonavir, phenytoin, carbamazepine, phenobarbital, ivermectin, praziquantel, diethylcarbamazine, azithromycin, and levamisole. Cimetidine increased the elimination half-life of albendazole and maximum concentration (Cmax) of mebendazole; dexamethasone increased the area under the plasma concentration–time curve (AUC) of albendazole; levamisole decreased the Cmax of albendazole; anticonvulsants (phenytoin, phenobarbital, carbamazepine) decreased the AUC of albendazole; praziquantel increased the AUC of albendazole; and ritonavir decreased the AUC of both albendazole and mebendazole. No major interactions were found with ivermectin, azithromycin, or diethylcarbamazine. Future research is required to clarify the clinical relevance of the interactions observed.

The Therapeutic Effects of Camel Milk A Systematic Review of Animal and Human Trials

The clinical effectiveness and value of camel milk as a therapeutic agent is currently unclear. MEDLINE (1946 to March 2016), EMBASE (1974 to March 2016), and Google Scholar were searched using the following terms: milk, bodily secretions, camels, camelus, camelini, camelidae, dromedary, bactrian camel, body fluid, and bodily secretions. Articles identified were reviewed if the study was investigating the use of camel milk for the potential treatment of diseases affecting humans. Of 430 studies, 24 were included after assessment. Identified studies highlighted treatment with camel milk of diseases, including diabetes, autism, cancer, various infections, heavy metal toxicity, colitis, and alcohol-induced toxicity. Although most studies using both the human and animal model do show a clinical benefit with an intervention and camel milk, limitations of these studies must be taken into consideration before widespread use. Based on the evidence, camel milk should not replace standard therapies for any indication in humans.

A description of medication errors reported by pharmacists in a neonatal intensive care unit

Background Patients in the Neonatal Intensive Care Unit (NICU) are at an increased risk for medication errors. Objective The objective of this study is to describe the nature and setting of medication errors occurring in patients admitted to an NICU in Qatar based on a standard electronic system reported by pharmacists. Setting Neonatal intensive care unit, Doha, Qatar. Method This was a retrospective cross-sectional study on medication errors reported electronically by pharmacists in the NICU between January 1, 2014 and April 30, 2015. Main outcome measure Data collected included patient information, and incident details including error category, medications involved, and follow-up completed. Results A total of 201 NICU pharmacists-reported medication errors were submitted during the study period. All reported errors did not reach the patient and did not cause harm. Of the errors reported, 98.5% occurred in the prescribing phase of the medication process with 58.7% being due to calculation errors. Overall, 53 different medications were documented in error reports with the anti-infective agents being the most frequently cited. The majority of incidents indicated that the primary prescriber was contacted and the error was resolved before reaching the next phase of the medication process. Conclusion Medication errors reported by pharmacists occur most frequently in the prescribing phase of the medication process. Our data suggest that error reporting systems need to be specific to the population involved. Special attention should be paid to frequently used medications in the NICU as these were responsible for the greatest numbers of medication errors.

Healthcare professionals’ perspectives on a mental health educational campaign for the public

Objective: To explore barriers and facilitators in implementing an educational campaign in mental health for the public in Qatar. Design: Qualitative study. Setting: Healthcare facilities across Qatar were used as the setting. Methods: Semi-structured interviews were conducted with 35 healthcare providers from a variety of professions, including physicians, pharmacists, nurses, dietitians, psychologists and administrators. Results: Findings indicate that these healthcare providers support the concept of public mental health education but feel that several factors need to be considered before any educational campaign is undertaken. A public mental health education campaign should target improving the public’s mental health literacy as well as describing appropriate pathways to mental health care. Health care providers believe such educational campaigns should be started in schools so that mental health awareness can have a positive influence from a young age. The social media were viewed as a suitable platform to deliver positive messages relating to mental health to the public. Any educational campaign in mental health should consider the cultural context with which it is being delivered. In conclusion, healthcare providers appeared to have similar views on the importance of public mental health education but differed in their opinions of the challenges faced. Conclusion: Consideration of the message intended and how it is delivered should be addressed as part of a successful public mental health educational campaign.

Ceftaroline fosamil for community-acquired pneumonia.

We have concerns related to the Article by Nan Shan Zhong and colleagues assessing the noninferiority and superiority of ceftaroline fosamil versus ceftri axone for the management of communityacquired pneumonia in Asian patients. First, regarding the timing of assessment of clinical cure between groups, the authors define clinical cure as “resolution of all signs and symptoms of community-acquired pneumonia or improvement to such an extent that further antimicrobial treatment was unnecessary” and state that this was assessed for all patients 8–15 days after the last dose of antibiotics. However, the authors did not report any differences in assessment times between groups, which can be prone to reporting bias. As shown by El Moussaoui and colleagues, many symptoms (including those of wellbeing) take up to 14 days or longer for resolution, which should be accounted for by Zhong and colleagues. Second, on the basis of the results obtained and Zhong and colleagues’ arguments, we are not convinced that ceftaroline fosamil is superior to ceftriaxone for Asian patients and we believe that the authors’ overgeneralise the results outside of what was studied. Instead, we interpret the fi ndings to be relevant to the geographical regions, rather than patient ethnic origin, and would not generalise these results to Asian patients living outside of the studied regions, including our own centre. The results of this study are not convincing enough to modify our treatment approach for Asian patients as a whole. We also need to mention concerns with respect to Zhong and colleagues’ conclusions. Ceftaroline fosamil is a new drug and this is the 4 Low DE, File TM Jr, Eckburg PB, et al. FOCUS 2: a randomized, double-blinded, multicentre, phase III trial of the effi cacy and safety of ceftaroline fosamil versus ceftriaxone in community-acquired pneumonia. J Antimicrob Chemother 2011; 66 (suppl 3): iii33–44. only large randomised controlled trial so far to show superiority over a standard treatment for community-acquired pneumonia. Previous studies were only able to show non-inferiority with a similar comparator. Although we agree with Zhong and colleagues that ceftaroline fosamil is probably effective for community-acquired pneumonia, we fear that widespread use will increase resistance when the drug has the potential to be reserved for treatment of meticillinresistant Staphylococcus aureus (MRSA). Additionally, to call for use as a comparator in future trials is not supported by study findings (ceftaroline fosamil has not yet become a standard therapy for community-acquired pneumonia) and is suspect in view of the industry support declared. Our conclusions from this Article are that ceftaroline fosamil is probably an effective option for community-acquired pneumonia (PORT class III and IV) but should not be recommended for widespread use until its ability to treat MRSA-related communityacquired pneumonia is known.