98 results on '"Schellack, N."'
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2. Vaccines in the fight against antimicrobial resistance – perspectives from South Africa.
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Brink, A., Kgasi, A., Musyoki, A., Kagina, B., Feldman, C., Reddy, D., du Toit, E., Kalanxhi, E., Meyer, J., Impalli, I., Schönfeldt, M., Sibanda, M., Schellack, N., Skosana, P., Essack, S., Dlamini, S., and Ramsamy, Y.
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- 2024
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3. Antibiotic prescribing practices in the presence of extended-spectrum β-lactamase (ESBL) positive organisms in an adult intensive care unit in South Africa – A pilot study
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Fourie, T., Schellack, N., Bronkhorst, E., Coetzee, J., and Godman, B.
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- 2018
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4. Lack of knowledge of hepatitis B vaccine the main reason for poor vaccine uptake among healthcare workers caring for the South African elderly
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Sibanda, M, Meyer, JC, Schellack, N, Godman, B, and Burnett, RJ
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RS - Abstract
Introduction: A 3-dose hepatitis B vaccine (HepB) series is recommended for healthcare workers (HCWs) who continue to be at risk of nosocomial hepatitis B virus (HBV) infection due to poor vaccination rates. Data on reasons for HepB decision-making amongst HCWs caring for the elderly are limited. Consequently, a need to investigate and provide future guidance. Objectives: To investigate HepB uptake and reasons for vaccination decision-making amongst HCWs caring for the South African elderly. Method: Descriptive study using a self-administered structured questionnaire, conducted among 360 HCWs present on the day of data collection at 18 community health centres and 44 public and private sector old age homes. Data were captured using Microsoft Excel® and imported to Epi InfoTM 7 for descriptive statistical analysis. Ethics approval to conduct the study was obtained. All participants provided informed consent. Results: The response rate was 76.7% (276/360). Only 29.7% (82/276) were fully vaccinated while 70.3% (194/276) of the respondents were not vaccinated at all against HBV. The main reason for accepting HepB (90.2% [74/82]) was to protect themselves. For those who did not receive HepB, the main reason was lack of knowledge about HepB (63.4% [123/194]), while 35.1% (68/194) reported HepB stock-outs at their facilities. Conclusions: HepB uptake by HCWs caring for the elderly was sub-optimal. Lack of knowledge about HepB and the non-availability of the vaccine were the main reasons for non-vaccination. Training for HCWs should underscore the importance, safety, effectiveness and acceptance of HepB.
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- 2022
5. Pharmacist-initiated antiretroviral therapy (PIMART)
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Moodley, S, primary, Gray, A, additional, Schellack, N, additional, Venter, F, additional, Suleman, F, additional, Walker, R B, additional, Choonara, Y, additional, Truter, I, additional, Maimin, J, additional, Malan, S F, additional, Hattingh, J, additional, Meyer, J C, additional, Demana, P, additional, Kotzé, I, additional, Kubashe, N, additional, Komape, T K, additional, Van Wyk, S, additional, and Eksteen, M, additional
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- 2021
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6. Current antimicrobial stewardship programmes in public sector facilities across South Africa: Has the National AMR Strategy Framework made an impact?
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Engler, D., primary, Meyer, J., additional, and Schellack, N., additional
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- 2020
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7. Development of a web-based application to improve data collection for antimicrobial point prevalence surveys in the public health care system in South Africa; findings and implications
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Dlamini, NN, Meyer, JC, Kruger, D., Godman, B, Kurdi, A., Bennie, M., and Schellack, N.
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RA0421 - Abstract
Background: Surveillance of antimicrobial use is one of the main recommended strategies in combating growing antimicrobial resistance (AMR) rates and a key part of developing pertinent policies and initiatives to reduce growing AMR rates in South Africa and wider. However, determining antimicrobial utilisation at a patient-level among public hospitals in South Africa can be a challenge given personnel and resource constraints. There are also currently no standardized data collection tools. Most countries in Africa currently undertake antimicrobial utilisation surveillance using paper-based data collection tools including point prevalence surveys (PPS). Unfortunately, paper-based systems have disadvantages including the time taken to complete the forms and analyse the findings, increasing costs and manpower hurdles. Electronic tools offer many advantages including mobile and real time data collection and also the opportunity for rapid analytics. Objectives: Develop and test a web-based application (APP) for future PPS studies to successfully address identified challenges. Methods: A web based application (APP) was developed based on previous PPS in Botswana and South Africa using a paper-based data collection tool and tested during July 2017 in a leading public hospital in South Africa. The developed APP was also evaluated for data quality by measuring the number of errors, work flow, and time taken for the survey versus the previous paper-based system. User acceptance was also measured via a questionnaire to the data collectors. Results: A total of 187 patients' files were surveyed in this leading hospital using the APP whilst also documenting the challenges and areas of improvement for the APP. The identified areas of improvement have now been incorporated into the revised APP for future studies. The data collectors agreed that surveying the patients' files took appreciably less time with the APP compared to the paper based tool, and should be used in the future. In addition, data analysis was hastened using the APP. Conclusions: The APP development process has been successful and the APP is a potential tool for future PPS in South Africa and wider. The APP methodology is now being tested in new studies across South Africa to help instigate pertinent educational and other interventions to improve the future use of antimicrobials among public hospitals in South Africa.
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- 2018
8. Prevention of treatment-induced ototoxicity: An update for clinicians
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Ramma, L, primary, Schellack, N, additional, and Heinze, B, additional
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- 2019
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9. Evaluating initial antimicrobial use in an adult intensive care unit at an academic teaching hospital in Pretoria, South Africa
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Bester, T., Schellack, N., Gous, A.G.S., Meyer, J.C., and Godman, B.
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RS - Abstract
Antimicrobial resistance is increasing globally. It is estimated that in hospitals around the world 50% of antimicrobial usage is either unnecessary or inappropriate. The study aimed to explore factors surrounding initially prescribed antibiotics and direct medicine related costs in the adult Medical Intensive Care Unit (MICU), at Steve Biko Academic Hospital (SBAH). A clinically trained pharmacist was included as part of the multi-disciplinary team and evaluated antibiotics prescribed after admission. These were considered as the initial course of antibiotics. The antimicrobial agents that the patient was admitted with were documented and are referred to as “antibiotics prior to review”. Just less than half of the patients, 23 (44.2%; n = 52) were initiated on antibiotics on the first day of admission to the MICU. The majority of antibiotics 46 (60.5%) were prescribed appropriately during the study period. The total cost of initial antibiotic use for the treatment period during the study was R209 140.40, with an average cost of R31 240.77 per day for all initial antibiotics. A coordinated effort from the infectious diseases specialist and clinical pharmacist within the multi-disciplinary team, assisted in appropriate prescribing of antibiotics to patients that were admitted to the MICU.
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- 2017
10. Fluoroquinolone-resistant Salmonella typhi infection: a report of two cases in South Africa
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Schellack, N., primary, Bronkhorst, E., additional, Maluleka, C., additional, Hunt, L., additional, Srinivas, P., additional, Grootboom, W., additional, Goff, D., additional, Naicker, P., additional, Modau, T., additional, and Babarinde, O., additional
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- 2018
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11. SASOCP position statement on the pharmacist’s role in antibiotic stewardship 2018
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Schellack, N., primary, Bronkhorst, E., additional, Coetzee, R., additional, Godman, B., additional, Gous, A. G. S., additional, Kolman, S., additional, Labuschagne, Q., additional, Malan, L., additional, Messina, A. P., additional, Naested, C., additional, Schellack, G., additional, Skosana, P., additional, and Van Jaarsveld, A., additional
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- 2018
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12. Fluoroquinolone-resistant Salmonella typhi infection: a report of two cases in South Africa
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Schellack, N, primary, Bronkhorst, E, additional, Maluleka, C, additional, Hunt, L, additional, Srinivas, P, additional, Grootboom, W, additional, Goff, D, additional, Naicker, P, additional, Modau, T, additional, and Babarinde, O, additional
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- 2017
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13. Neuropathic pain: targeting the melatonin MT2 receptor
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Smith, N, Ismail, H, and Schellack, N
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melatonin, neuropathic pain, MT2 receptor, opioids, NSAIDs - Abstract
Neuropathic pain affects a large proportion of the population and reduces a person’s ability to perform optimally. In South Africa, there are a host of factors that hinder the correct diagnosis and treatment of neuropathic pain. Patients suffering from neuropathic pain are treated suboptimally with NSAIDS and opioids as first-line therapy. In 2012, a South African guideline on neuropathic pain was released, which stated that opioid therapy should be reserved for last-line treatment only. More recently, melatonin, commonly known as the neurohormone that regulates the circadian rhythm, has come to light as a therapeutic treatment option in the neuropathic pain setting. Early clinical trials showed a link between melatonin and chronic pain, which includes neuropathic pain. The MT2 receptor has also been specifically linked to the control of neuropathic pain and inflammation.Keywords: melatonin, neuropathic pain, MT2 receptor, opioids, NSAIDs
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- 2016
14. Gastro-oesophageal reflux: An overview of the cost-effectiveness of pharmacotherapeutic treatment options
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Schellack, G., Johanna Meyer, and Schellack, N.
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GORD, gastro-oesophageal reflux, PPIs, proton-pump inhibitors, cost effectiveness ,Public Health, Environmental and Occupational Health ,Family Practice - Abstract
Gastro-oesophageal reflux disease (GORD) produces symptoms that cause great irritation to the patient. Pharmacotherapeutic management is directed at minimising these symptoms and reducing the causative factors, e.g. acid production, thereby providing relieve. Currently available agents include simple antacids and acid suppression therapy, including histamine 2-receptor antagonists, proton pump inhibitors, mucosal or cytoprotective agents, pro-motility agents. Deciding on appropriate therapy will be dependent on the diagnosis, side-effects and cost-effectiveness of the treatment.Keywords: GORD, gastro-oesophageal reflux, PPIs, proton-pump inhibitors, cost effectiveness
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- 2016
15. Gastro-oesophageal reflux: an overview of the pharmacotherapeutic treatment options
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Malan, L, primary, Labuschagne, Q, additional, Schellack, N, additional, Schellack, G, additional, and Meyer, J C, additional
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- 2017
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16. Identifying medication errors in the neonatal intensive care unit and paediatric wards using a medication error checklist at a tertiary academic hospital in Gauteng, South Africa
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Truter, A, primary, Schellack, N, additional, and Meyer, J Catharina, additional
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- 2017
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17. Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN): an update
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Mogole, O., primary, Schellack, N., additional, and Motswaledi, M. H., additional
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- 2016
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18. ‘Esprit de corps’: Towards collaborative integration of pharmacists and nurses into antimicrobial stewardship programmes in South Africa
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Schellack, N, primary, Pretorius, R, additional, and Messina, A P, additional
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- 2016
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19. Pharmacotherapy during pregnancy, childbirth and lactation: points and principles to consider (a 2015 update)
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Schellack, G., primary, Schellack, N., additional, and Kriel, M., additional
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- 2015
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20. The allergic scholar
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Schellack, N., Upton, E., and Schellack, G.
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atopy, allergy, scholars, corticosteroids, antihistamines ,Public Health, Environmental and Occupational Health ,Family Practice - Abstract
Allergic diseases are on the increase globally. There has been a doubling in the number of scholars suffering from allergy-related disease in the past two decades. This article describes the predisposing factors which contribute to an increased incidence of allergies within the population. These factors include a genetic predisposition, allergen exposure, abnormalities in the bowel flora and infection exposure. Some of these relate to the hygiene hypothesis and the microflora hypothesis, which are discussed in this article. Treatment options for those suffering from allergic disease are also discussed, with an emphasis on asthma, anaphylaxis, allergic rhinitis and atopic dermatitis.Keywords: atopy, allergy, scholars, corticosteroids, antihistamines
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- 2015
21. A review of phosphodiesterase type 5 inhibitors
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Schellack, N, primary and Agoro, A, additional
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- 2014
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22. Cardiovascular effects and the use of nonsteroidal anti-inflammatory drugs
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Schellack, N, primary
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- 2014
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23. Pharmacist-initiated management of antiretroviral therapy (PIMART).
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Moodley, S., Gray, A., Schellack, N., Venter, F., Suleman, F., Walker, R. B., Choonara, Y., Truter, I., Maimin, J., Malan, S. F., Hattingh, J., Meyer, J. C., Demana, P., Kotzé, I., Kubashe, N., Komape, T. K., van Wyk, S., and Eksteen, M.
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- 2021
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24. Fluoroquinolone-resistant <italic>Salmonella typhi</italic> infection: a report of two cases in South Africa.
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Schellack, N, Bronkhorst, E, Maluleka, C, Hunt, L, Srinivas, P, Grootboom, W, Goff, D, Naicker, P, Modau, T, and Babarinde, O
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SALMONELLA enterica serovar Typhi ,DRUG resistance - Abstract
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 invasiveS. typhi with fluoroquinolone resistance. [ABSTRACT FROM AUTHOR]- Published
- 2018
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25. Antibiotic Prescribing Patterns in a Neonatal Intensive Care Unit
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Schellack, N., primary and Gous, A G S, additional
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- 2011
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26. The need for pharmaceutical care in an intensive care unit at a teaching hospital in South Africa.
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Bronkhorst, E., Schellack, N., Gous, A. G. S., and Pretorius, J. P.
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ACADEMIC medical centers , *DRUGS , *HOSPITAL pharmacies , *INTENSIVE care units , *LONGITUDINAL method , *NEEDS assessment , *PHARMACISTS , *RESEARCH funding , *OCCUPATIONAL roles , *CROSS-sectional method , *DESCRIPTIVE statistics - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2014
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27. Fluoroquinolone-resistant Salmonella typhiinfection: a report of two cases in South Africa
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Schellack, N, Bronkhorst, E, Maluleka, C, Hunt, L, Srinivas, P, Grootboom, W, Goff, D, Naicker, P, Modau, T, and Babarinde, O
- Abstract
AbsractTyphoid 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. typhiwith fluoroquinolone resistance.
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- 2018
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28. Amphotericin B in the management of fungal infections in a neonatal intensive care unit: experiences in a teaching hospital.
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Schellack, N., Gous, A. G. S., Engler, D., Mothobi, L., and Chale, M.
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MYCOSES ,COMMUNICABLE disease treatment ,AMPHOTERICIN B ,NEONATAL intensive care ,TEACHING hospitals ,NEPHROTOXICOLOGY ,DRUG side effects - Abstract
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. [ABSTRACT FROM AUTHOR]
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- 2012
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29. Part III. Antibiotic supply chain and management in human health.
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Essack, S. Y., Schellack, N., Pople, T., and Merwe, L. van der
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- 2011
30. Part II. Health and economic context.
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Schellack, N., Meyer, J. C., and Gous, A. G. S.
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- 2011
31. An overview of anti-allergic drug therapy and the histamine-1 antihistamines
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Schellack, N., Schellack, G., and Rensburg, M. J.
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anti-allergic drug therapy, H1 antihistamines, histamine receptors, allergic rhinoconjunctivitis, allergy health - Abstract
Allergic disease decreases the daily quality of life of many people, and can increase the number of working days lost owing to sick leave. Associated symptoms with allergic disease depend on the origin of the disease, and can either be allergic, non-allergic and purulent, or can cause rhinitis as a result of a common cold. Treatment depends on the origin of the rhinitis. However, an antihistamine is indicated in most instances. Combination treatment includes sympathomimetic drugs (either local or systemic) and corticosteroid medication (when indicated, and in most instances, used locally). The article provides an overview of the nature and the management of allergic disease and the histamine 1 antihistamines.Keywords: anti-allergic drug therapy, H1 antihistamines, histamine receptors, allergic rhinoconjunctivitis, allergy health
32. Point prevalence survey of antimicrobial utilisation patterns among public hospitals in South Africa using a newly developed app; findings and implications
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Godman, B., Pp, Skosana, Schellack, N., Amanj Kurdi, Marion Bennie, Kruger, D., and Jc, Meyer
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RS - Abstract
Background and objectives: Antimicrobial use is growing world-wide driven by increasing demand especially in developing countries. Concerns with rising antimicrobial resistance rates (AMR) have resulted in national action plans (NAPs) to improve future prescribing. A key element of NAPs is understanding current prescribing patterns. In hospitals, this typically involves point prevalence surveys (PPS). In sub-Saharan African countries, PPS study forms were updated to include Human Immunodeficiency Virus (HIV), tuberculosis, malaria and malnutrition as these were absent from Global and ECDC studies. Concerns with the length of time for data collection, need for rapid feedback and costs to undertake PPS studies amongst African countries, led to the development of a specific web-based App. The pilot study with the App in a tertiary hospital in South Africa signalled good acceptance and appreciably reduced data collection and feedback times. Additional PPS studies using the refined App have now been undertaken among a range of public hospitals in South Africa including paediatric populations, and we wish to consolidate the findings. Method: A purpose-built web-based application was used to collect PPS data among 18 public sector hospitals including paediatric populations involving over 5600 patients. Quality indicators included adherence to current guidelines and prescribing broken down by WHO AWaRe classification. Results: A third (33.6%) of adult patients were treated with an antimicrobial, similar to the initial study (37.7%) involving the group. The rate was higher among the paediatric population with nearly half (49.7%) receiving at least one antimicrobial. In the adult study, in the medical and surgical wards, antimicrobials from the Access group were mostly used (54.1%), while in ICUs, antimicrobials from the Watch list were mostly used (51.5%). Compliance with the South African Standard Treatment Guidelines and Essential Medicines List was 90.2%. Among paediatric patients, penicillins with/ without an enzyme inhibitor and gentamicin were the most prescribed antibiotics, with 55.9% from the Access group, 27.8% from the Watch group, and only 3.1% from the Reserve group. There were concerns with prolonged antibiotic administration for surgical prophylaxis and high use of IV administration that needs addressing. Conclusion: The web-based PPS App was successful in capturing PPS data, able to reduce data collection time, produce rapid feedback and easy to use. Furthermore, the PPS provided targets to improve future antimicrobial prescribing among public sector hospitals in South Africa including IV administration and surgical prophylaxis. The web-based tool is now being used in Eswatini, with potentially wider applications.
33. An update on chronic obstructive pulmonary disease
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Schellack, N., Schellack, G., and Omoding, R.
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chronic bronchitis, chronic obstructive pulmonary disease, COPD, emphysema, LABA, SABA, SAMA, LAMA, methylxanthines ,Public Health, Environmental and Occupational Health ,Family Practice - Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition which affects the respiratory system and worsens over time. Cigarette smoking and advancing age are the two major risks associated with this disease. It is concerning that the global incidence of this chronic illness is on the rise. Current projections indicate that it will become the third leading cause of death by the year 2020. Inflammatory changes underlie the pathophysiology of COPD. Irreversible damage and progressive narrowing of the air passages follow. COPD is characterised by the progressive loss of lung function. In addition, the Global Initiative for Chronic Obstructive Lung Disease released the latest update on its global strategy for the diagnosis, management, and prevention of COPD in 2015. This article provides an overview of the causative risk factors, underlying disease process, pathophysiological changes, and the classification and management of COPD, including the latest perspectives on this highly prevalent condition.Keywords: chronic bronchitis, chronic obstructive pulmonary disease, COPD, emphysema, LABA, SABA, SAMA, LAMA, methylxanthines
34. Prospective antimicrobial stewardship interventions by multidisciplinary teams to reduce neonatal antibiotic use in South Africa: The Neonatal Antimicrobial Stewardship (NeoAMS) study.
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Dramowski A, Prusakov P, Goff DA, Brink A, Govender NP, Annor AS, Balfour L, Bekker A, Cassim A, Gijzelaar M, Holgate SL, Kolman S, Messina A, Tootla H, Schellack N, van Jaarsveld A, Reddy K, Pillay S, Conradie L, van Niekerk AM, Bester T, Alexander P, Andrews A, Dippenaar M, Bamford C, Brits S, Chirwa P, Erasmus H, Ekermans P, Gounden P, Kriel T, Mawela D, Moncho M, Mphuthi T, Nhari R, Charani E, Sánchez PJ, and Bergh DVD
- Subjects
- Humans, South Africa, Infant, Newborn, Prospective Studies, Female, Male, Pharmacists, Patient Care Team, Sepsis drug therapy, Antimicrobial Stewardship methods, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents administration & dosage, Intensive Care Units, Neonatal
- Abstract
Background: Hospitalized neonates are vulnerable to infection and have high rates of antibiotic utilization., Methods: Fourteen South African neonatal units (seven public, seven private sector) assembled multidisciplinary teams involving neonatologists, microbiologists, pharmacists, and nurses to implement prospective audit and feedback neonatal antimicrobial stewardship (NeoAMS) interventions. The teams attended seven online training sessions. Pharmacists conducted weekday antibiotic prescription reviews in the neonatal intensive care unit and/or neonatal wards providing feedback to the clinical teams. Anonymized demographic and NeoAMS interventions data were aggregated for descriptive purposes and statistical analysis., Findings: During the 20-week NeoAMS intervention in 2022, 565 neonates were enrolled. Pharmacists evaluated seven hundred antibiotic prescription episodes; rule-out sepsis (180; 26%) and culture-negative sepsis (138; 20%) were the most frequent indications for antibiotic prescription. For infection episodes with an identified pathogen, only 51% (116/229) of empiric treatments provided adequate antimicrobial coverage. Pharmacists recommended 437 NeoAMS interventions (0·6 per antibiotic prescription episode), with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations most frequent. Neonatal clinicians' acceptance rates for AMS recommendations were high (338; 77%). Mean antibiotic length of therapy decreased by 24% from 9·1 to 6·9 days (0·1 day decrease per intervention week; P = 0·001), with the greatest decline in length of therapy for culture-negative sepsis (8·2 days (95% CI 5·7-11·7) to 5·9 days (95% CI 4·6-7·5); P = 0·032)., Interpretation: This neonatal AMS programme was successfully implemented in heterogenous and resource-limited settings. Pharmacist-recommended AMS interventions had high rates of clinician acceptance. The NeoAMS intervention significantly reduced neonatal antibiotic use, particularly for culture-negative sepsis., Funding: A grant from Merck provided partial support., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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35. Challenges and success stories of the implementation of infection control and antimicrobial stewardship strategies: proceedings of the 5th Global Ministerial Summit on Patient Safety, 2023.
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Büchler AC, Haddad Galas M, Buetti N, Alp E, Apisarnthanarak A, Dziekan G, Fabre V, Gottwalt S, Jindai K, Ndoye B, Márquez Villareal H, Otaiza F, Pittet D, Schellack N, Gardiol C, and Harbarth S
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- Humans, Patient Safety, Pandemics prevention & control, Anti-Bacterial Agents therapeutic use, Infection Control, Antimicrobial Stewardship, Cross Infection prevention & control, Cross Infection drug therapy, COVID-19 prevention & control
- Abstract
The 5th edition of the Global Ministerial Summit on Patient Safety was held in Montreux, Switzerland, in February 2023, delayed by three years due to the COVID-19 pandemic. The overarching theme of the summit was "Less Harm, Better Care - from Resolution to Implementation", focusing on the challenges of implementation of infection prevention and control (IPC) strategies as well as antimicrobial stewardship programs (ASP) around the world. IPC strategies and ASP are of increasing importance due to the substantial burden of healthcare-associated infections and antimicrobial resistance threatening patient safety. Here, we summarize countries' and regional experiences and activities related to the implementation of IPC strategies and ASP shared at the meeting. Full implementation of effective programs remains a major challenge in all settings due to limited support by political and healthcare leaders, and human and financial constraints. In addition, the COVID-19 pandemic challenged already well-established programs. By enforcing sustained implementation by dedicated, cross-disciplinary healthcare personnel with a broad skill set, a reduction in healthcare-associated infections and multidrug-resistant pathogens can be achieved, leading ultimately to improved patient safety., (© 2024. The Author(s).)
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- 2024
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36. Off-Label and Unlicenced Medicine Use among Hospitalised Children in South Africa: Practice and Policy Implications.
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Mathevula H, Schellack N, Orubu S, Godman B, and Matlala M
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Background: Information regarding off-label and unlicensed medicine use among South African children is limited. This is a concern as the prescribing of off-label and unlicensed medicines can lead to issues of effectiveness and safety as well as raise liability issues in the event of adverse events. This potentially exposes physicians to legal penalties. Consequently, we sought to determine the prevalence of off-label and unlicensed medicine use among paediatric patients in South Africa to provide future direction., Methods: This study retrospectively examined the use of medicine in a point-prevalence survey study (PPS) involving paediatric patients aged (0-2 years) admitted to selected public hospitals in Gauteng Province, South Africa. Data were collected per hospital over two days between February 2022 and July 2022. Demographics, duration of treatment, diagnosis, and medicines prescribed were collected from patient medical records using a mobile application. Prescribed medicines were reviewed against the medicine formularies and other databases to assess their appropriateness., Results: From three academic hospitals, 184 patient records were reviewed. A total of 592 medicines were dispensed, of which 379 (64.0%) were licensed and 213 (36.0%) were used off-label/unlicensed for paediatric patients 0-2 years of age. The most prevalent off-label and unlicensed medicines were multivitamins (n = 32, 15.0%) and ampicillin injections (n = 15, 7.0%)., Conclusion: The frequency of unlicensed and off-label medicine prescribing shown in this study is consistent with the literature and can be considered high. This practice can pose a risk because it adversely affects patients if not properly regulated. Attention is needed to ensure future high-quality, safe, and effective use of medicines.
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- 2023
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37. A Narrative Review of Antibiotic Prescribing Practices in Primary Care Settings in South Africa and Potential Ways Forward to Reduce Antimicrobial Resistance.
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Chigome A, Ramdas N, Skosana P, Cook A, Schellack N, Campbell S, Lorenzetti G, Saleem Z, Godman B, and Meyer JC
- Abstract
There are concerns with the current prescribing of antibiotics in both the private and public primary care settings in South Africa. These concerns need to be addressed going forward to reduce rising antimicrobial resistance (AMR) rates in South Africa. Concerns include adherence to current prescribing guidelines. Consequently, there is a need to comprehensively summarise current antibiotic utilization patterns from published studies as well as potential activities to improve prescribing, including indicators and antimicrobial stewardship programs (ASPs). Published studies showed that there was an appreciable prescribing of antibiotics for patients with acute respiratory infections, i.e., 52.9% to 78% or more across the sectors. However, this was not universal, with appreciable adherence to prescribing guidelines in community health centres. Encouragingly, the majority of antibiotics prescribed, albeit often inappropriately, were from the 'Access' group of antibiotics in the AWaRe (Access/Watch/Reserve) classification rather than 'Watch' antibiotics to limit AMR. Inappropriate prescribing of antibiotics in primary care is not helped by concerns with current knowledge regarding antibiotics, AMR and ASPs among prescribers and patients in primary care. This needs to be addressed going forward. However, studies have shown it is crucial for prescribers to use a language that patients understand when discussing key aspects to enhance appropriate antibiotic use. Recommended activities for the future include improved education for all groups as well as regularly monitoring prescribing against agreed-upon guidelines and indicators.
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- 2023
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38. International survey of antibiotic dosing and monitoring in adult intensive care units.
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Williams PG, Tabah A, Cotta MO, Sandaradura I, Kanji S, Scheetz MH, Imani S, Elhadi M, Luque-Pardos S, Schellack N, Sanches C, Timsit JF, Xie J, Farkas A, Wilks K, and Roberts JA
- Subjects
- Humans, Adult, Meropenem, Cross-Sectional Studies, Piperacillin, Tazobactam Drug Combination, Surveys and Questionnaires, Intensive Care Units, Aminoglycosides, Critical Illness therapy, Piperacillin, Anti-Bacterial Agents, Vancomycin therapeutic use
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Background: In recent years, numerous dosing studies have been conducted to optimize therapeutic antibiotic exposures in patients with serious infections. These studies have led to the inclusion of dose optimization recommendations in international clinical practice guidelines. The last international survey describing dosing, administration and monitoring of commonly prescribed antibiotics for critically ill patients was published in 2015 (ADMIN-ICU 2015). This study aimed to describe the evolution of practice since this time., Methods: A cross-sectional international survey distributed through professional societies and networks was used to obtain information on practices used in the dosing, administration and monitoring of vancomycin, piperacillin/tazobactam, meropenem and aminoglycosides., Results: A total of 538 respondents (71% physicians and 29% pharmacists) from 409 hospitals in 45 countries completed the survey. Vancomycin was mostly administered as an intermittent infusion, and loading doses were used by 74% of respondents with 25 mg/kg and 20 mg/kg the most favoured doses for intermittent and continuous infusions, respectively. Piperacillin/tazobactam and meropenem were most frequently administered as an extended infusion (42% and 51%, respectively). Therapeutic drug monitoring was undertaken by 90%, 82%, 43%, and 39% of respondents for vancomycin, aminoglycosides, piperacillin/tazobactam, and meropenem, respectively, and was more frequently performed in high-income countries. Respondents rarely used dosing software to guide therapy in clinical practice and was most frequently used with vancomycin (11%)., Conclusions: We observed numerous changes in practice since the ADMIN-ICU 2015 survey was conducted. Beta-lactams are more commonly administered as extended infusions, and therapeutic drug monitoring use has increased, which align with emerging evidence., (© 2023. Crown.)
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- 2023
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39. Treatment of the common cold with herbs used in Ayurveda and Jamu: monograph review and the science of ginger, liquorice, turmeric and peppermint.
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Wardani RS, Schellack N, Govender T, Dhulap AN, Utami P, Malve V, and Wong YC
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Background: The common cold is typically managed with decongestants, antihistamines, antitussives and antipyretics. In addition to these established medications, herbal ingredients have been used over centuries to help treat common cold symptoms. The Ayurveda and Jamu systems of medicine, originating from India and Indonesia, respectively, have leveraged herbal therapies to treat many illnesses., Method: An expert roundtable discussion comprising specialists in Ayurveda, Jamu, pharmacology and surgery along with a literature review was conducted to evaluate the use of four herbs - ginger, liquorice, turmeric and peppermint - for common cold symptom management in Ayurvedic texts, Jamu publications and monographs from the World Health Organization, Health Canada and various European guidelines., Discussion: Due to a lack of antivirals, common cold management revolves around maintaining personal hygiene and symptom management. Herbal medicines have been an integral part of many cultures worldwide. Despite its growing acceptance, there is a perception that healthcare providers lack interest and may prevent patients from discussing the use of herbal medicines. Limited education and training may also widen the communication gap between patients and healthcare providers, hindering effective management., Conclusion: Evaluation of scientific evidence and the standing in international monographs can offer perspectives on the use of herbal medicines for common cold management., Competing Interests: Disclosure and potential conflicts of interest: RSW, NS, TG, AND and PU have received honoraria for expert roundtable participation from Procter & Gamble Health. VM and YCW are employees of Procter & Gamble. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2023/05/dic.2023-2-12-COI.pdf, (Copyright © 2023 Wardani RS, Schellack N, Govender T, Dhulap AN, Utami P, Malve V, Wong YC.)
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- 2023
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40. Knowledge, Attitude and Practices of Self-Medication Including Antibiotics among Health Care Professionals during the COVID-19 Pandemic in Pakistan: Findings and Implications.
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Mustafa ZU, Iqbal S, Asif HR, Salman M, Jabbar S, Mallhi TH, Khan YH, Sono TM, Schellack N, Meyer JC, and Godman B
- Abstract
Since the emergence of COVID-19, several different medicines including antimicrobials have been administered to patients to treat COVID-19. This is despite limited evidence of the effectiveness of many of these, fueled by misinformation. These utilization patterns have resulted in concerns for patients' safety and a rise in antimicrobial resistance (AMR). Healthcare workers (HCWs) were required to serve in high-risk areas throughout the pandemic. Consequently, they may be inclined towards self-medication. However, they have a responsibility to ensure any medicines recommended or prescribed for the management of patients with COVID-19 are evidence-based. However, this is not always the case. A descriptive cross-sectional study was conducted among HCWs in six districts of the Punjab to assess their knowledge, attitude and practices of self-medication during the ongoing pandemic. This included HCWs working a range of public sector hospitals in the Punjab Province. A total of 1173 HCWs were included in the final analysis. The majority of HCWs possessed good knowledge regarding self-medication and good attitudes. However, 60% were practicing self-medication amid the COVID-19 pandemic. The most frequent medicines consumed by the HCWs under self-medication were antipyretics (100%), antibiotics (80.4%) and vitamins (59.9%). Azithromycin was the most commonly purchase antibiotic (35.1%). In conclusion, HCWs possess good knowledge of, and attitude regarding, medicines they purchased. However, there are concerns that high rates of purchasing antibiotics, especially "Watch" antibiotics, for self-medication may enhance AMR. This needs addressing.
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- 2023
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41. Assessing the Clinical Characteristics and Management of COVID-19 among Pediatric Patients in Ghana: Findings and Implications.
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Sefah IA, Sarkodie SA, Pichierri G, Schellack N, and Godman B
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There is an increasing focus across countries on researching the management of children admitted to hospital with COVID-19. This stems from an increasing prevalence due to new variants, combined with concerns with the overuse of antimicrobials driving up resistance rates. Standard treatment guidelines (STGs) have been produced in Ghana to improve their care. Consequently, there is a need to document the clinical characteristics of children diagnosed and admitted with COVID-19 to our hospital in Ghana, factors influencing compliance to the STG and treatment outcomes. In all, 201 patients were surveyed between March 2020 and December 2021, with males accounting for 51.7% of surveyed children. Those aged between 6 and 10 years were the largest group (44.8%). Nasal congestion and fever were some of the commonest presenting complaints, while pneumonia was the commonest (80.6%) COVID-19 complication. In all, 80.0% of all admissions were discharged with no untreated complications, with a 10.9% mortality rate. A combination of azithromycin and hydroxychloroquine (41.29%) was the most prescribed antimicrobial regimen. Compliance to the STG was variable (68.2% compliance). Increased compliance was associated with a sore throat as a presenting symptom. Mortality increased following transfer to the ICU. However, current recommendations to prescribe antimicrobials without demonstrable bacterial or fungal infections needs changing to reduce future resistance. These are areas to address in the future.
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- 2023
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42. Best practices: Appropriate use of the new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South Africa.
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Brink AJ, Coetzee J, Richards GA, Feldman C, Lowman W, Tootla HD, Miller MGA, Niehaus AJ, Wasserman S, Perovic O, Govind CN, Schellack N, and Mendelson M
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Antibiotic stewardship of hospital-acquired infections because of difficult-to-treat resistant (DTR) Gram-negative bacteria is a global challenge. Their increasing prevalence in South Africa has required a shift in prescribing in recent years towards colistin, an antibiotic of last resort. High toxicity levels and developing resistance to colistin are narrowing treatment options further. Recently, two new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam were registered in South Africa, bringing hope of new options for management of these life-threatening infections. However, with increased use in the private sector, increasing levels of resistance to ceftazidime-avibactam are already being witnessed, putting their long-term viability as treatment options of last resort, in jeopardy. This review focuses on how these two vital new antibiotics should be stewarded within a framework that recognises the resistance mechanisms currently predominant in South Africa's multi-drug and DTR Gram-negative bacteria. Moreover, the withholding of their use for resistant infections that can be treated with currently available antibiotics is a critical part of stewardship, if these antibiotics are to be conserved in the long term., Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article., (© 2022. The Authors.)
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- 2022
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43. Targeting Specific Checkpoints in the Management of SARS-CoV-2 Induced Cytokine Storm.
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Rabiu Abubakar A, Ahmad R, Rowaiye AB, Rahman S, Iskandar K, Dutta S, Oli AN, Dhingra S, Tor MA, Etando A, Kumar S, Irfan M, Gowere M, Chowdhury K, Akter F, Jahan D, Schellack N, and Haque M
- Abstract
COVID-19-infected patients require an intact immune system to suppress viral replication and prevent complications. However, the complications of SARS-CoV-2 infection that led to death were linked to the overproduction of proinflammatory cytokines known as cytokine storm syndrome. This article reported the various checkpoints targeted to manage the SARS-CoV-2-induced cytokine storm. The literature search was carried out using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Journal articles that discussed SARS-CoV-2 infection and cytokine storm were retrieved and appraised. Specific checkpoints identified in managing SARS-CoV-2 induced cytokine storm include a decrease in the level of Nod-Like Receptor 3 (NLRP3) inflammasome where drugs such as quercetin and anakinra were effective. Janus kinase-2 and signal transducer and activator of transcription-1 (JAK2/STAT1) signaling pathways were blocked by medicines such as tocilizumab, baricitinib, and quercetin. In addition, inhibition of interleukin (IL)-6 with dexamethasone, tocilizumab, and sarilumab effectively treats cytokine storm and significantly reduces mortality caused by COVID-19. Blockade of IL-1 with drugs such as canakinumab and anakinra, and inhibition of Bruton tyrosine kinase (BTK) with zanubrutinib and ibrutinib was also beneficial. These agents' overall mechanisms of action involve a decrease in circulating proinflammatory chemokines and cytokines and or blockade of their receptors. Consequently, the actions of these drugs significantly improve respiration and raise lymphocyte count and PaO
2 /FiO2 ratio. Targeting cytokine storms' pathogenesis genetic and molecular apparatus will substantially enhance lung function and reduce mortality due to the COVID-19 pandemic.- Published
- 2022
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44. Social Media and COVID-19-Perceptions and Public Deceptions of Ivermectin, Colchicine and Hydroxychloroquine: Lessons for Future Pandemics.
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Schellack N, Strydom M, Pepper MS, Herd CL, Hendricks CL, Bronkhorst E, Meyer JC, Padayachee N, Bangalee V, Truter I, Ellero AA, Myaka T, Naidoo E, and Godman B
- Abstract
The capacity for social media to influence the utilization of re-purposed medicines to manage COVID-19, despite limited availability of safety and efficacy data, is a cause for concern within health care systems. This study sought to ascertain links between social media reports and utilization for three re-purposed medicines: hydroxychloroquine (HCQ), ivermectin and colchicine. A combined retrospective analysis of social media posts for these three re-purposed medicines was undertaken, along with utilization and clinical trials data, in South Africa, between January 2020 and June 2021. In total, 77,257 posts were collected across key social media platforms, of which 6884 were relevant. Ivermectin had the highest number of posts (55%) followed by HCQ (44%). The spike in ivermectin use was closely correlated to social media posts. Similarly, regarding chloroquine (as HCQ is not available in South Africa), social media interest was enhanced by local politicians. Sentiment analysis revealed that posts regarding the effectiveness of these repurposed medicines were positive. This was different for colchicine, which contributed only a small number of mentions (1%). Of concern is that the majority of reporters in social media (85%) were unidentifiable. This study provides evidence of social media as a driver of re-purposed medicines. Healthcare professionals have a key role in providing evidence-based advice especially with unidentifiable posts.
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- 2022
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45. Using mystery shoppers to determine practices pertaining to antibiotic dispensing without a prescription among community pharmacies in South Africa-a pilot survey.
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Mokwele RN, Schellack N, Bronkhorst E, Brink AJ, Schweickerdt L, and Godman B
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Background: Inappropriate use of antimicrobials is a key factor increasing antimicrobial resistance, a major global public health problem including in South Africa. Key drivers include antibiotics being dispensed without a prescription., Objectives: To determine the accessibility of antibiotics without a prescription in community pharmacies in urban areas in South Africa and determine whether counselling was provided when antibiotics were dispensed., Patients and Methods: Prospective, observational study, employing simulated patients (SPs), presenting with upper respiratory tract infections (URTIs) and urinary tract infections (UTIs), undertaken to establish whether antibiotics can be obtained without a valid prescription in South Africa. This pilot study was conducted in privately owned ( n = 20) and corporate (franchised, n = 14) community pharmacies in three regions in Gauteng Province., Results: Antibiotics were sold in privately owned pharmacies without a prescription in 80% (16/20) of cases while no antibiotics were dispensed in corporate (franchised) pharmacies. Of the 16 pharmacies selling antibiotics without a prescription, pharmacist assistants were involved in 37.5% ( n = 6) and counselling was not provided to 19% of SPs. Ciprofloxacin (42.9%) and metronidazole (28.6%) were the most common antibiotics dispensed. No antibiotics were dispensed for URTIs, only UTIs., Conclusions: Dispensing antibiotics without prescriptions can be common among privately owned pharmacies in urban areas in South Africa. Corporate pharmacies, which probably have a greater income, appear to follow current legislation banning such activities. To limit selling with no prescription, community pharmacists and assistants especially in urban areas should be educated on appropriate patient care and legal requirements, with dispensing electronically monitored., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.)
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- 2022
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46. Management of Children Admitted to Hospitals across Bangladesh with Suspected or Confirmed COVID-19 and the Implications for the Future: A Nationwide Cross-Sectional Study.
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Chowdhury K, Haque M, Nusrat N, Adnan N, Islam S, Lutfor AB, Begum D, Rabbany A, Karim E, Malek A, Jahan N, Akter J, Ashraf S, Hasan MN, Hassan M, Akhter N, Mazumder M, Sihan N, Naher N, Akter S, Zaman SU, Chowdhury T, Nesa J, Biswas S, Islam MD, Hossain AM, Rahman H, Biswas PK, Shaheen M, Chowdhury F, Kumar S, Kurdi A, Mustafa ZU, Schellack N, Gowere M, Meyer JC, Opanga S, and Godman B
- Abstract
There is an increasing focus on researching children admitted to hospital with new variants of COVID-19, combined with concerns with hyperinflammatory syndromes and the overuse of antimicrobials. Paediatric guidelines have been produced in Bangladesh to improve their care. Consequently, the objective is to document the management of children with COVID-19 among 24 hospitals in Bangladesh. Key outcome measures included the percentage prescribed different antimicrobials, adherence to paediatric guidelines and mortality rates using purposely developed report forms. The majority of 146 admitted children were aged 5 years or under (62.3%) and were boys (58.9%). Reasons for admission included fever, respiratory distress and coughing; 86.3% were prescribed antibiotics, typically parenterally, on the WHO 'Watch' list, and empirically (98.4%). There were no differences in antibiotic use whether hospitals followed paediatric guidance or not. There was no prescribing of antimalarials and limited prescribing of antivirals (5.5% of children) and antiparasitic medicines (0.7%). The majority of children (92.5%) made a full recovery. It was encouraging to see the low hospitalisation rates and limited use of antimalarials, antivirals and antiparasitic medicines. However, the high empiric use of antibiotics, alongside limited switching to oral formulations, is a concern that can be addressed by instigating the appropriate programmes.
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- 2022
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47. Challenges and Innovations Brought about by the COVID-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future.
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Etando A, Amu AA, Haque M, Schellack N, Kurdi A, Alrasheedy AA, Timoney A, Mwita JC, Rwegerera GM, Patrick O, Niba LL, Boahen-Boaten BB, Tabi FB, Amu OY, Acolatse J, Incoom R, Sefah IA, Guantai AN, Opanga S, Chikowe I, Khuluza F, Kibuule D, Kalemeera F, Hango E, Lates J, Fadare J, Ogunleye OO, Saleem Z, Oosthuizen F, Cordier W, Matlala M, Meyer JC, Schellack G, Massele A, Malande OO, Kalungia AC, Sichone J, Banda SS, Zaranyika T, Campbell S, and Godman B
- Abstract
Background: Multiple measures introduced early to restrict COVID-19 have dramatically impacted the teaching of medical and pharmacy students, exacerbated by the lack of infrastructure and experience with e-learning at the start of the pandemic. In addition, the costs and reliability of the Internet across Africa pose challenges alongside undertaking clinical teaching and practical programmes. Consequently, there is a need to understand the many challenges and how these were addressed, given increasingly complex patients, to provide future direction., Method: An exploratory study was conducted among senior-level medical and pharmacy educators across Africa, addressing four key questions, including the challenges resulting from the pandemic and how these were dealt with., Results: Staff and student members faced multiple challenges initially, including adapting to online learning. In addition, concerns with the lack of equipment (especially among disadvantaged students), the costs of Internet bundles, and how to conduct practicals and clinical teaching. Multiple activities were undertaken to address these challenges. These included training sessions, developing innovative approaches to teaching, and seeking ways to reduce Internet costs. Robust approaches to practicals, clinical teaching, and assessments have been developed., Conclusions: Appreciable difficulties to teaching arising from the pandemic are being addressed across Africa. Research is ongoing to improve education and assessments.
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- 2021
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48. Contextualising the Perceptions of Pharmacists Practicing Clinical Pharmacy in South Africa-Do We Practice what We Preach?
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Bronkhorst E, Schellack N, and Gous AGS
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The National Department of Health published their Quality Standards for Healthcare Establishments in South Africa and introduced the National Health Insurance, with the pilot phase that commenced in 2012. The system requires an adequate supply of pharmaceutical personnel and the direct involvement of clinical pharmacists throughout the medication-use process to ensure continuity of care, minimised risk with increasing improvement of patient outcomes. The study aimed to provide insight into the pressing issues of clinical pharmacy practice in South Africa, and sets out to contextualise the current profile of the pharmacist performing clinical functions. The study used a quantitative, explorative, cross-sectional design. The population included pharmacists from private and public tertiary hospitals. A questionnaire was administered, using Typeform™. Ethics approval was obtained from Sefako Makgatho Health Sciences University, National Department of Health and Private Healthcare groups. Categorical data were summarised using frequency counts and percentages; continuous data were summarised by mean values and standard deviations. The sample size included 70 pharmacists practicing clinical pharmacy (private sector n = 59; public sector n = 11). Most participants hold a BPharm degree (busy with MPharm qualification) (64%; n = 70). No statistical significance was found between participants in private and public practice. Most pharmacist agreed (32% (private); n = 59) and strongly agreed (45% (public); n = 11) to have sufficient training to perform pharmaceutical care. The majority respondents felt that interventions made by the pharmacist improved the rational use of medicine (47% (private); 55% (public). Pharmacist interventions influence prescribing patterns (42% (private); 64% (public); and reduce polypharmacy (41% (private); 55% (public). The clinical functions mostly performed were evaluation of prescriptions (private 90%; public 82%), while the top logistical function is daily ordering of medication (40.7%; private), and checking of ward stock (36%; public). Although not all pharmacists appointed in South Africa has completed the MPharm degree in clinical pharmacy, the pharmacists at ward level perform numerous clinical functions, even if only for a small part of their workday. This paper sets the way to standardise practices of clinical pharmacy in South Africa, with a reflection on the differences in practice in different institutions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Bronkhorst, Schellack and Gous.)
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- 2021
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49. Antimicrobial Stewardship Activities in Public Healthcare Facilities in South Africa: A Baseline for Future Direction.
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Engler D, Meyer JC, Schellack N, Kurdi A, and Godman B
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Antimicrobial resistance (AMR) is a growing problem worldwide, including South Africa, where an AMR National Strategy Framework was implemented to instigate antimicrobial stewardship programmes (ASPs) and improve antimicrobial prescribing across sectors. To address the need to assess progress, a sequential mixed methodology with an explanatory research design was employed. In Phase 1, a self-administered questionnaire was completed by healthcare professionals (HCPs) from 26 public sector healthcare facilities across South Africa to assess compliance with the Framework. The results were explored in Phase 2 through 10 focus group discussions and two in-depth interviews, including 83 participants. Emerging themes indicated that public healthcare facilities across South Africa are facing many challenges, especially at entry level primary healthcare (PHC) facilities, where antimicrobial stewardship activities and ASPs are not yet fully implemented. Improved diagnostics and surveillance data are a major shortcoming at these facilities. Continuous education for HCPs is deficient, especially for the majority of prescribers at PHC level and health campaigns are nearly non-existent. Involvement and visibility of management at certain facilities is a serious shortfall. Consequently, it is important to call attention to the challenges faced with improving antimicrobial prescribing across countries and address these to reduce AMR, especially in PHC facilities, being the first point of access to healthcare for the vast majority of patients in developing countries.
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- 2021
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50. Driving antibiotic stewardship awareness through the minibus-taxi community across the Tshwane District, South Africa-a baseline evaluation.
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Mokoena TTW, Schellack N, and Brink AJ
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Background: The minibus-taxi community plays an integral role within society, and for years this community has been neglected. Of late, studies on minibus-taxi operators' health and their perceptions of HIV have emerged. Antibiotic resistance is a global problem and to help curb its spread studies have looked into the knowledge, attitude and perceptions amongst students and healthcare professionals, and yet little to nothing is known about the minibus-taxi community., Objectives: To assess the knowledge and understanding of the minibus-taxi community on antibiotics and antibiotic resistance, and document indigenous antibiotic terminology used across the Tshwane District in Gauteng, South Africa., Methods: A semi-structured questionnaire was adopted from WHO, translated into commonly spoken languages and administered to 83 minibus-taxi community members: 27 minibus-taxi operators and 56 commuters. A convenience sampling method was utilized in selecting the minibus-taxi ranks and routes. The questionnaire was later adapted to the minibus-taxi community's busy lifestyle and a section added to document antibiotic terms., Results: Seventy-one percent ( n = 59) of the participants knew the importance of taking antibiotics as directed, while 64% ( n = 53) believed it's correct to share antibiotics. Seventy-five percent ( n = 62) thought antibiotic resistance occurred in the human body. One misconception noted was that the minibus-taxi community thought antibiotics treated cold/flu and fever. Over 80% of the community were unfamiliar with antibiotic terminology., Conclusions: Several misconceptions were documented amongst the minibus-taxi community and, whilst highlighting the linguistic barriers for the term antibiotic resistance, we identified several enablers for public awareness and empowerment. Further studies are required to define appropriate indigenous terms for future educational antibiotic campaigns., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy.)
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- 2021
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