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Abstract Background Drug-related problems (DRPs) are frequently observed in intensive care units, resulting in a higher occurrence of drug side effects and increased treatment expenses. This study aimed to assess the prevalence of DRPs in pediatric patients admitted to the most prominent surgical and medical pediatric intensive care units (PICUs) in southern Iran, given the susceptibility of children to the effects of DRPs. Method This cross-sectional study was conducted at Namazi Hospital, which is affiliated with Shiraz University of Medical Sciences in Shiraz, Iran, from June 2022 to March 2023. The research focused on identifying and detecting drug-related problems (DRPs) among pediatric patients during their hospital stays across three medical wards, two pediatric intensive care units, and a surgical intensive care unit. The identification process occurred concurrently with patient treatment and utilized the Pharmaceutical Care Network of Europe’s data collection form for DRPs version 8.01. Before any documentation, all cases were thoroughly reviewed and validated by a professional focus group. The data gathered were then statistically analyzed using SPSS to evaluate the study’s outcomes. Result During the study, 323 pediatric patients were involved, of whom 57% experienced at least one DRP. The primary issues identified during the study were suboptimal drug treatment, accounting for 41.13% of cases, followed by concerns related to treatment safety, which constituted 38.53% of cases. Drug-drug interactions were found to be the leading cause of DRPs, accounting for 36.26% of cases. Two significant factors associated with DRP occurrence were the number of prescribed drugs and the number of prescribed anticonvulsants. Out of all clinical pharmacist interventions, 97% were accepted. Conclusion Patients admitted to the PICUs experience a high occurrence of DRPs. It is essential to consider optimal dosage adjustment, particularly for pediatric patients with impaired kidney function.

In adults with acute and chronic end-stage liver disease, liver transplantation (LT) is the only treatment option for these patients. On the other hand, one of the substantial causes of death in these patients is bacterial infection after transplantation, which should be considered as well as appropriate antibacterial treatment. For this reason, this study was designed to provide a multi-faceted review of different types of infections after transplantation and their treatment options during one year of experience in the largest LT center for adult patients in Iran. In this retrospective cohort study, records from all individuals over 18 years of age candidates for liver transplantation in Abu-Ali Sina hospital, Shiraz, Fars, Iran from 2018 March to 2019 March , were assessed. Demographic, laboratory, and clinical data were extracted in addition to the antimicrobial therapy. In this study, 412 patients included. 15.77% of patients were infected after transplantation, of which 61.17% of the isolated pathogens were gram-negative and 38.83% were gram-positive. The most common isolated gram-positive and gram-negative microorganisms include staphylococci (27.69%) and Klebsiella (27.69%), respectively. Urinary tract infection was the most common type of infection after transplantation in adult liver transplant recipients, and length of stay in ICU, length of hospital stay, length of mechanical ventilation are among the risk factors affecting bacterial infection after LT.

Abstract Background Using Antimicrobial stewardship programs (ASP) to monitor the use of antibiotics can lead to improved antibiotic use and reduced costs. Methods This retrospective cohort study was done at Shiraz Organ Transplant Center, the largest transplant center in Asia. Antimicrobial use, cost, clinical outcomes, and antibiotic resistance pattern were evaluated before and after ASP. Results This study included 2791 patients, 1154 of whom were related to the time before ASP and 1637 to the time after ASP. During the period of the research, a total of 4051 interventions were done. The use of all classes of antibiotics was significantly reduced by ASP, with 329 DDD/100PD before the intervention compared to 201 DDD/100PD after it (p = 0.04). In addition, the overall cost of antibiotics purchased was much lower after the ASP measures were implemented ($43.10 per PD) than before implementation of the ASP measures ($60.60 per PD) (p = 0.03). After the implementation of ASP, the number of MDR isolates was significantly reduced. Conclusion The results of our study showed that the implementation of ASP significantly reduced the number and costs of antibiotics and also the number of resistant pathogens, but did not affect the patients’ length of stay.

Stroke-related atrial fibrillation (AF), deep vein thrombosis (DVT), and pulmonary thromboembolism (PE) are among the most common thromboembolic events. recently, direct oral anticoagulants (DOACs) have been slowly replacing warfarin. Rivaroxaban is a DOAC frequently prescribes to control thrombotic events. The safety and efficacy of Rivaroxaban are dependent on appropriate prescription, dosage, and other factors. This study is aimed to evaluate the Rivaroxaban utilization based on the standard protocol in both inpatient and outpatient settings. This cross-sectional/observational study was conducted for six months from 1st August 2018 to 1st February 2019 at a private hospital and also an outpatient clinic in Shiraz, Iran. First, a clinical pharmacist defined a standard protocol for Rivaroxaban utilization and several indexes (9 indexes for Non-valvular AF (NVAF) patients and 10 indexes for DVT/PE patients). Second, participants were classified into three groups (NVAF inpatients, NVAF outpatients, and DVT/PE patients). Finally, the adherence of Rivaroxaban utilization indexes in each group to was evaluated accordingly. Two hundred and forty one eligible patients were recruited into this study. Most patients (N=208), were NVAF. Rivaroxaban utilization was appropriate in 71.9%, 65.8%, and 50.6% of patients within groups 1, 2, and 3, respectively. Although medication interaction, administration regarding time/meal, and dose adjustment based on renal function showed the lowest compliance, the monitoring laboratory data and considering the underlying disorders were completely matched with the protocol. This study showed some critical errors in both settings, especially in DVT/PE patients (49.4% no match). Hence, the most productive collaboration must be developed between clinical pharmacists and clinical practitioners.

Objective: Postoperative atrial fibrillation (POAF) is the most frequent dysrhythmias observed following coronary artery bypass graft (CABG) surgery. Several studies have shown the beneficial effects of curcumin on cardiovascular diseases; however, there is no clinical trial to examine its effect on POAF. This randomized, double‐blind, placebo‐controlled clinical study was designed to evaluate the prophylactic effects of a nano-formulation of curcumin (SinaCurcumin™) versus placebo on POAF and levels of biomarkers of inflammation and oxidative stress in patients undergoing CABG surgery.Materials and Methods: A total of 234 eligible patients were randomized to receive 240 mg curcumin nano-formulation or placebo three days prior to the surgery and on the first four postoperative days. The occurrence of POAF was monitored for at least 96 hr after the surgery. Also, C-reactive protein (hs-CRP), malondialdehyde (MDA) and glutathione (GSH) levels were assessed at baseline and the end of the study.Results: Analyses were done in the intention-to-treat population. No significant difference was observed in the occurrence of POAF between the treatment (9.5%) and placebo (11.5%) groups. Also, curcumin intervention did not alter serum concentration of the hs-CRP, MDA, or GSH in comparison with placebo.Conclusion: In conclusion, it seems that perioperative treatment with SinaCurcumin™ did not prevent POAF after CABG surgery.

In December 2019, the coronavirus disease-2019 (COVID-19) outbreak emerged in Wuhan, China. The World Health Organization officially declared it a pandemic on March 11, 2020. Reports indicated that the associated mortality of the infection is quite higher in the elderly, individuals with specific comorbidities (such as diabetes mellitus), and generally the ones with a compromised immune system. A cohort study in Wuhan, China, reported a dysregulated immune response in 452 patients with laboratory-confirmed COVID-19. As a result of this suppressed immune response, an increase in neutrophil to lymphocyte ratio, T lymphopenia, and a decrease in CD4+ T cells were all common laboratory findings, especially in severe cases.On the other hand, there is substantial evidence of T cell exhaustion in critically ill patients. Accordingly, the immune system seems to play an important role in the prognosis and pathogenesis of the disease. Therefore, this study aims to review the evidence on the immune response dysregulation in COVID-19 infection and the potential role of immunoregulatory treatments such as immune checkpoint inhibitors, interferons, and CD200 inhibitors in altering disease prognosis, especially in critically ill patients.

Abstract Background Colistin is a polymyxin antibiotic which has been used for treatment of Gram-negative infections, but it was withdrawn due to its nephrotoxicity. However, colistin has gained its popularity in recent years due to the reemergence of multidrug resistant Gram-negative infections and drug-induced toxicity is considered as the main obstacle for using this valuable antibiotic. Results In total, 30 articles, including 29 animal studies and one clinical trial were included in this study. These compounds, including aged black garlic extract, albumin fragments, alpha lipoic acid, astaxanthin, baicalein, chrysin, cilastatin, colchicine, curcumin, cytochrome c, dexmedetomidine, gelofusine, grape seed proanthocyanidin extract, hesperidin, luteolin, lycopene, melatonin, methionine, N-acetylcysteine, silymarin, taurine, vitamin C, and vitamin E exhibited beneficial effects in most of the published works. Conclusions In this review, the authors have attempted to review the available literature on the use of several compounds for prevention or attenuation of colistin-induced nephrotoxicity. Most of the studied compounds were potent antioxidants, and it seems that using antioxidants concomitantly can have a protective effect during the colistin exposure.

Objectives. Drug utilization evaluation (DUE) studies aim to survey the appropriateness of drug use. DUE is an executive approach used to improve the use of medications as well as reduce the cost of treatment, ensure drug adequacy, and improve patient safety. The aim of this study was to evaluate the pattern of erythropoietin use, according to standard guidelines, in patients admitted to Namazi Hospital in Shiraz, Iran. Methods. In this descriptive, retrospective study, 230 patients were assessed. All patients who were hospitalized in different wards of Namazi Hospital, affiliated to Shiraz University of Medical Sciences, and received at least three doses of erythropoietin from September 2019 to March 2020 participated in this study. The following standard indicators of erythropoietin use were evaluated through reviewing medical charts of the cohort: drug dose, dosing intervals, route of administration, indication, monitoring of laboratory parameters, drug dose adjustment based on the response rate as well as target hemoglobin ≥12 g/dl, attention to major drug interactions, and administration of injectable or oral iron supplementation during treatment. Results. Most (65.2%) of the participants were male. The mean ± SD age of the patients was 47.55 ± 22.71 years. More than half (51.3%) of the included subjects were hospitalized in the nephrology ward. PDpoetin® and Cinnapoietin® were given to 52.6% and 47.4% of the study participants, respectively. Treatment of anemia due to chronic kidney disease was the most frequent indication of erythropoietin. The time interval of erythropoietin administration was three times a week for 68.3% of the patients. The most frequently administered weekly dose of erythropoietin was 12,000 units. The weekly dose, dose interval, and route of administration of erythropoietin were appropriate in 52.6%, 77.4%, and 100% of the patients, respectively. Dose adjustment based on the response rate, attention to major drug interactions as well as absolute-relative contraindications, and attention to the target hemoglobin ≥12 g/dl to decide whether or not to continue treatment were based on standard guideline in 98.1%, 98.7%, and 93% of the patients, respectively. The sum indexes of erythropoietin use were in line with standard guidelines in 75.84% of the cases. Conclusion. According to our results, in the setting of erythropoietin use in hospitals, physicians need more attention and education in areas such as selecting the proper dose of medication, correct indication of the drug, temporal arrangement of monitoring laboratory items, and the patient’s need for iron supplements.

Coronavirus can negatively affect the immune system. This complication can be exaggerated in pregnant women with micronutrient and elemental deficiencies. Also, coronavirus itself can induce micronutrients malabsorption and result in their severe deficiencies that can lead to increased risk of infection in these groups of patients. Serum calcium, zinc, iron, and selenium values have a positive correlation with PO2 values and a negative correlation with severe COVID-19 infection, lung involvement, fever, and C-reactive protein (CRP) concentration. In this mini-review study, the safety and efficacy of different suggested micronutrients including zinc, selenium, iron, vitamin A, C, D, E, and myo-inositol in pregnant women with COVID-19 have been discussed. According to the clinical practice findings and previous reports, administration of essential micronutrients including zinc, selenium, and iron and vitamins including vitamin A, B8, C, D, and E with optimum recommended dietary allowances (RDAs) during pregnancy would be promising and suggestive to improve maternal/neonatal complications during COVID-19 infection due to the enhanced immunity system against viral infection and COVID-19 pneumonia.

Antimicrobial prophylaxis used for surgical procedures remains one of the measures for the prevention of surgical site infections (SSIs). The present study was designed to assess the compliance with clinical practice guideline for antimicrobial prophylaxis in variable surgeries conducted in the intensive care units (ICUs) of a major referral hospital. This cross-sectional investigation was carried out by prospective data collected from October 2017 to March 2018 in the intensive care unit (ICU) of Nemazi hospital in Shiraz. Demographic characteristics, surgery type as well as antibiotic treatment were gathered from medical records and entered in data collection forms. We reviewed compliance and adherence of prophylactic antibiotic administration to the Infectious Diseases Society of America (IDSA) guideline and evaluated the courses of antimicrobial drugs. If an antibiotic administrated for surgical prophylaxis was different from the guideline, the antibiotic was classified as non-guideline-based antibiotics. Most patients participated in this study were male (64.5%). Only 8.75% of the administrated antibiotics chosen for surgical prophylaxis were found to be appropriate antibiotic prescriptions; however, those patients receiving appropriate antibiotics prescribed an inappropriate dosage. In addition, the antibiotics were administrated with inappropriate durations in all cases. Our findings indicated that adherence to the IDSA international guideline seems to be far from ideal in Namazi hospital for antimicrobial prophylaxis, resulting in the unsuitable administration of a wide variety of antibiotics.

Introduction: Therapeutic drug monitoring (TDM) and pharmacokinetic assessments of vancomycin would be essential to avoid vancomycin-associated nephrotoxicity and obtain optimal therapeutic and clinical responses. Different pharmacokinetic parameters, including trough concentration and area under the curve (AUC), have been proposed to assess the safety and efficacy of vancomycin administration.Methods: Critically ill patients receiving vancomycin at Nemazee Hospital were included in this prospective study. Four blood samples at various time intervals were taken from each participated patient. Vancomycin was extracted from plasma samples and analyzed using a validated HPLC method.Results: Fifty-three critically ill patients with a total of 212 blood samples from June 2019 to June 2021 were included in this study. There was a significant correlation between baseline GFR, baseline serum creatinine, trough and peak concentrations, AUCτ, AUC24h, Cl, and Vd values with vancomycin-induced AKI. Based on trough concentration values, 66% of patients were under-dosed (trough concentration 600 μg h/ml) that emphasizes on the superiority of AUC-based monitoring approach for TDM purposes to avoid nephrotoxicity occurrence.Conclusion: The AUC-based monitoring approach would be superior in terms of nephrotoxicity prediction. Also, to avoid vancomycin-induced AKI, trough concentration and AUCτ values should be maintained below the cut-off points.

Purpose: Proper diagnosis of the corneal ulcer is one the most important efforts in the eyes medical urgencies. The aim of this study was to determine the bacteriological profile and in vitro antibiotic resistance of the bacteria isolated from the eyes of patients with infectious corneal ulcers Methods: In this study, 94 patients with corneal ulcer disease participated. After differential diagnosis of potentiated corneal ulcer infection and sampling of the active area of the wounds, the sample was transferred to the laboratory for cultivation in the suitable culture medium and finally incubatedin proper temperature. In cases of positive culture, the type of bacteria and antibiotic sensitivity test of the broth micro-dilution method was performed and evaluated for five antibiotics including ciprofloxacin, levofloxacin, gentamycin, erythromycin, and chloramphenicol. Results: our results indicated that patients consisted of 55% male and 45% female, 51% of whom were positive and the most common bacterium was staphylococcus negative coagulase with 48% prevalence. The isolated bacteria sensitivity for levofloxacin, ciprofloxacin, gentamycin, erythromycin and chloramphenicol was 94%, 79%, 67%, 33%, 27%, respectively.In vitro study for levofloxacin and ciprofloxacin showed ahigher percentage of antibiotic sensitivity in patients with corneal infectious ulcers in comparisonto other antibiotics. However, Erythromycin and chloramphenicol were not suitable for the bacterial corneal ulcer treatment due to the high microbial resistance. Conclusions: Accurate and precise training of physicians in the prescribing of ocular antibiotics as well as the prevention of arbitrary use of these drugs is important for reducing the microbial resistance.

Evaluation of stress ulcer prophylaxis guideline in the intensive care units of a Namazi Hospital, Shiraz, Iran: A Retrospective survey Afsaneh Vazin1,Seyed Ruhollah Mousavinasab1*, Golnar Sabetian2* 1 Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran. 2 Department of Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Abstract Background: Ureasonable medicine use is widespread in hospitals around the world and has raised concerns especially in developing countries due to financial constraints in the field of health care. One of the complications of Critical ill Patients Admitted to intensive care units (ICU) are stress-related mucosal damage. Stress ulcer prophylaxis should be administered to all critically ill patients at least one major risk factor and two or more minor criteria are present. Various medications are used to prevent ulcerative prophylaxis in critically ill patients admitted to ICU, Including: Antacids، sucralfate, Histamine-2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). When economic and financial considerations are taken into account, many clinicians prefer intravenous H2 blockers (usually famotidine) administration. In situations where cost is not an issue, an intravenous PPI is an appropriate choice Methods: This Survey was designed to evaluate appropriate Stress Ulcer Prophylaxis (SUP) practice during 6 months from October 2013 to December 2013 in the intensive care units of a Namazi Hospital. To assess the appropriate administration of SUP, was performed based on ASHP protocol (Table 1). Results: Among 94 patients included in this study, more than half, 48 (51%), were female, and an average stayed in the hospital for more than 14 days. Fewer than half, 46 (49%), were male and an average stayed in the hospital for more than 10 days. The mean age of study subjects was 51.5 ± 21.12 years (54±24 for female and 49.23±18.9 for men). The most major risk factor to stress ulcer is Mechanical Ventilation> 48 h (24.1%), followed by Coagulopathy (10.9%). Among the minor risk factors, the most minor risk factor to stress ulcer is ICU admission lasting >1 week, followed by Glucocorticoid therapy (10.3%). Most prescribed medication for stress ulcer prophylaxis (SUP) was IV (intravenous) Pantoprazole (44.7%) and lowest prescribed medication for stress ulcer prophylaxis (SUP) was omeprazole po (means the medication is taken by mouth) (7.4%).90 (95.7%) of the study participants were given SUP, among which 66 (70.2%) were given with indication of treatment according ASHP protocol and 28 (34%) given without indication. In total, 4 (4.3%) of the study subjects were not given SUP. Conclusion: The results of this study showed that the most major risk factor to stress ulcer in our study was a Mechanical Ventilation > 48 h (24.1%), the most minor risk factor to stress ulcer in our study was a ICU admission lasting >1 week (23.6%).92% of patients admitted were not eligible for SUP and in 58% of cases, SUP administration was incorrect. Keywords:: Stress Ulcer Prophylaxis, Major risk factor, critically ill patients, Retrospective survey *Corresponding Author, Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz, Iran. Telephone Number: +98 71 3242 4126.Fax Number: +98 71 3242 4127. Postal Code: 7146864685. Email:mousavinasab@sums.ac.ir. Golnar Sabetian MD; Trauma Research Center, Rajaee Hospital, Chamran Blvd., Shiraz, Iran Tel: +98 71 36360697 Fax: +98 71 36248980. Postal Code: 7193613311 Email:gsabetian@yahoo.com

Background and purpose: Vancomycin is a glycopeptide antibiotic which is the drug of choice against methicillin-resistant Staphylococcus aureus. It has a narrow therapeutic index, and thus therapeutic drug monitoring (TDM), and clinical pharmacokinetic assessment are necessary in order to prevent adverse drug reactions such as nephrotoxicity. In this study, we aimed to develop a simple and validated HPLC method for vancomycin assay in order to establish a TDM center for patients admitted to the ICU of Nemazee Hospital in southern Iran. Experimental approach: In this study, a brief review of different parameters and variables which could affect the sensitivity, selectivity of the validated HPLC method for vancomycin determination were considered. According to the previous studies a simple, fast, and the relatively low-cost method was established for vancomycin determination in plasma samples. Findings/Results: The developed HPLC assay indicated a calibration curve with R-square of > 0.999, acceptable selectivity, the accuracy of 90-105%, CV% of less than 15%, the limit of quantification of 1 μg/mL, and limit of detection of 300 ng/mL. Vancomycin trough level, the area under the curve, renal clearance, the volume of distribution,, and elimination constant were measured in patients using this validated method. Conclusion and implications: Validated method for assay of vancomycin plasma levels was used to quantify vancomycin levels of four patients who were admitted to the ICU of Nemazee Hospital. According to the results, two of these patients showed lower levels than recommended therapeutic purposes while one of them showed a toxic level. According to the results, the TDM assessment of vancomycin is strongly recommended for patients who are hospitalized in ICU.

Background: Medication errors may prolong hospitalization period, enhance its costs and make harmful impacts on health. Inappropriate drug history taking is a type of medication errors which may occur on admission, resulting in medication discrepancies. Objective: This work presents a report of discrepancies between the drug history acquired by pharmacists and the drugs administered by the physicians at a teaching hospital in Shiraz, Iran. Method: This prospective study was conducted from October 2016 to March 2017 in 7 wards of Namazi hospital affiliated to Shiraz University of Medical Sciences. Both the physicians/nurses and pharmacists obtained medication history from patients recruited in this study during the first 24 hours of their admission. The medications were classified according to the ATC classification.Results: Totally, 103 patients were recruited and 557 medications were recorded in this study. The mean±standard deviation age of patients was 58.52±18.75 years. Comparing pharmacist drug history with medication lists obtained by nurses or physicians revealed 353 discrepancies. On average, 3.42 discrepancies were identified per patient (ranged from 0 to 12). Most (85.8%) of medication discrepancies were related to omission errors. Metformin and aspirin were the most common medications involved in omission errors.Conclusion: The rate of medication discrepancies at admission in our hospital was high. Active contribution of pharmacists and providing accurate medication histories at the time of hospital admission can be considered as possible solutions for this problem.

Colistin (COL) belongs to the polymixin class of antibiotics used as the last line antibiotic against drug-resistant infections. However, nephrotoxicity is the major deleterious and dose-limiting side effect associated with COL therapy. Oxidative stress and mitochondrial impairment are suspected mechanisms involved in COL-induced nephrotoxicity. Taurine is one of the most abundant amino acids in the human body with antioxidant and mitochondria protecting properties. The current study was designed to evaluate the potential nephroprotective properties of taurine against COL-associated nephrotoxicity. Mice were treated with COL (15 mg/kg/day, i.v, for 7 consecutive days) alone or in combination with taurine (500 and 1000 mg/kg, i.p). Plasma biomarkers of nephrotoxicity in addition of kidney tissue markers of oxidative stress were evaluated. Additionally, kidney mitochondria were isolated, and several mitochondrial indices were assessed. The COL-associated renal injury was evident by a significant increase in plasma markers of renal injury including creatinine (Cr), and blood urine nitrogen (BUN). COL treatment also caused a significant increase in kidney reactive oxygen species (ROS) and lipid peroxidation (LPO). Renal GSH reservoirs and antioxidant capacity were also decreased in COL-treated animals. Mitochondrial parameters including mitochondrial dehydrogenase activity, membrane potential, GSH, and ATP were significantly decreased while mitochondrial LPO, permeabilization, and GSSG content were increased in the kidney of COL-treated mice. It was found that taurine (500 and 1000 mg/kg, i.p) treatment alleviated COL-induced oxidative stress and mitochondrial dysfunction in the kidney tissue. The data obtained from the current study suggest mitochondrial dysfunction and oxidative stress as fundamental mechanisms of renal injury induced by COL. On the other hand, taurine supplementation protected kidney through decreasing oxidative stress and regulating mitochondrial function.

Aim: Prophylaxis against stress ulcer in mechanically ventilated patients is one of the causes for ventilator-associated pneumonia (VAP). Our aim was evaluating the effect of intravenous pantoprazole and ranitidine in the incidence of VAP in critically ill patients. Materials and Methods: Patients with at least 48 h of expected mechanical ventilation were allocated randomly to receive either 50 mg ranitidine (R) every 8 h or 40 mg pantoprazole (P) every 12 h intravenously from admission. VAP diagnosis was according to the Clinical Pneumonia Infection Score and positive culture. Results: Eighty-six patients during a 15-month period were analyzed; the study showed a low difference between VAP incidence in the ranitidine and pantoprazole groups. No significant difference was observed in terms of gastrointestinal bleeding, intensive care unit, hospital length of stay, and mortality between the groups. Conclusion: VAP incidence is hardly related to the type of stress ulcer prophylaxis agent with a high rate of VAP and low utilization of VAP prophylaxis bundle.

Background: Drug–drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academic versus non-academic (therapeutic) intensivist as well as hours of coverage and attendance of intensivist on potential DDIs (pDDIs) was evaluated in six adult trauma ICUs of a level one trauma center. Methods: In this 6-month cross-sectional study, 200 patients were included. The DDIs were classified into five groups, including type A, B, C, D, and X. pDDIs were defined as interactions belonged to C, D and X categories. Patients in six adult ICUs with three different patterns of intensivist staffing models including type A (once-daily therapeutic intensivist visit followed by 24 h on-call), B (twice-daily academic intensivist visit, 8 h of attendance in ICU and 16 h on-call) and C (all criteria just like ICU type B, except for the presence of therapeutic instead of academic intensivist) were screened for pDDIs. Results: In total, 3735 drug orders and 3869 drugs (193 different types) were screened and 1826 pDDIs were identified. Type C, D and X interactions accounted for 60.6%, 35.5%, and 3.9% of all pDDIs, respectively. The mean of pDDI per patient was significantly higher ( p -value

Background: Carbapenems is frequently prescribed for treatment or prophylaxis in neutropenic patients. It is cleared that antimicrobial misuse can cause poor patient outcomes, through raise of antibiotic resistance, increased adverse events, and prolonged length of hospital stay. Objectives: to evaluate the rational use of Imipenem- Cilastatin and Meropenem for empirical antibacterial therapy in neutropenic patients based on IDSA guideline. Methods: through this cross-sectional study, we assessed the appropriateness of administration of Carbapenems in neutropenic patients admitted in hematology–oncology and bone marrow transplant wards in Namazee hospital, Shiraz, Iran, from March 2012 to May 2013. Results: Total of 90 patients were enrolled. Drug therapy duration was appropriate in 69.6% of Imipenem-Cilastatin and 75% of Meropenem groups. Sampling time of culture was appropriated in 59.1% of Imipenem-Cilastatin and 78.3% of Meropenem group, interval of drug administration was correct in 74.5% at initiation and 79.4% during therapy in Imipenem-Cilastatin group. For dosing these values were 74.5% and 72.2%, respectively. These values were evaluated in patients who received Meropenem too, interval was correct in 89.5% at initiation and 90.3% during therapy, dosing was correct in 12.3% either at initiation and during therapy. Conclusion: These finding suggest that attention to correct dose, correct interval, renal dose adjustment, logical indication for administration of carbapenem should be considered by health care system

Abstract Background Irrational drug use is a global health challenge in all healthcare settings, such as hospitals. This study evaluated the impact of an intervention by the pharmaceutical care unit on the use pattern of high-value medications and their direct costs in a referral hospital. Methods This interventional, prospective study was carried out in clinical wards of Namazi Hospital (Shiraz University of Medical Sciences) during six months from May 2015 to October 2015. Clinical pharmacists completed the checklists for albumin, intravenous (IV) pantoprazole, and IV immune globulin (IVIG), as three high-cost medications. When ordering these medications, the physicians were asked to complete the checklists. Then, trained pharmacists examined the checklists, based on the clinical and paraclinical conditions. Results The total number of administered medications and their relative cost decreased by 50.76% through guideline implementation; the difference was significant (P

Purpose: To evaluate colistin use according to global standard drug consumption in intensive care units of a referral hospital in Shiraz, Iran Methods: A prospective, interventional study was performed during an 11 month period on 100 patients admitted to ICUs of a teaching hospital being treated with colistin for at least 3 subsequent doses. Required demographic, clinical, and paraclinical data were gathered by a pharmacist. Fifteen indexes were considered to evaluate colistin use. A clinical pharmacist reviewed indication and dose of colistin at the time of prescribing this agent. Results: In our study population, pneumonia (69%) was the main indication of colistin. In 87% of patients, colistin administration was based on microbiological laboratory evidence. Continuation of therapy was inappropriate in 5% of cases. By the intervention of the clinical pharmacist, colistin was discontinued in all patients in whom empirical therapy was continued incorrectly. None of the patients received loading dose of colistin. The maintenance dose, dose interval, and duration of treatment of colistin were appropriate in 76%, 71%, and 100% of patients, respectively. For none of the patients, the pharmacokinetic dosing method was used. In all patients, serum creatinine and WBC count were evaluated on daily basis. The sum indexes of colistin use were relevant to standard guidelines in 67.33% of the cases.Conclusion: The results of this study highlight the necessity of the pharmaceutical care team participation in all stages of treatment with antibiotics. After pharmacist interventions, some criteria of colistin utilization were corrected and brought closer to standard values.

Introduction : The purpose of the study was to evaluate Intensive Care Unit nurses’ knowledge, attitude, self-reported practice, and observed practice regarding medication administration via enteral feeding tube.Method:in this cross sectional study, a questionnaire and a checklist was developed for evaluating the nurses' knowledge, attitude, self-reported practice and real practice regarding medication administration via enteral feeding tube. Mean score of knowledge, and the percentage of different domains of attitude and practice was reported.Results: 53 nurses were included in this study. The mean number of medications which were prescribed for each patient was 15.8±4.5. From these medications, 5.5±2.8 drugs were administered via enteral feeding tube. There were few nurses (5%) with proper knowledge regarding correct dosage forms selection. About half of the nurses had proper knowledge regarding tube flushing and drug dilution,however according to direct researcher’s observation, 11% of nurses flushed the tubes before medication administration.Conclusion:The current study showed the disparity between the nurses' knowledge, self-reported practice, and proper performance in drug administration through enteral feeding tube. The most important problems in knowledge and attitude of nurses included crushing the dosage forms and in real practice in diluting medications and tube flushes domain.

Background: Drug and Poison Information Centers (DPICs) provide quick, easy, valid and reliable access to medication and toxin information for professionals, health workers and the public. The purpose of this study is to report the services provided by a university hospital DPIC within 1 year. Methods: This descriptive study reports all scientific questions asked from DPIC of Namazi hospital in Shiraz from the September 2016 to the August 2017. The information include the number of questions, the ward that ask the question, the questioner's profession, the method of asking questions, the method of responding, the type of question, and the resources used to answer them. After extraction of duplicates, data were analyzed by using the Excel software. Results: The total number of contacts registered during the study period was 485. The most number of questions were received in July and the lowest in November. Major questions were asked from the health-care team working in Namazi hospital and mostly from the nursing group (44.7%). Most of the questions (79.6%) were asked and responses were provided (67.1%) by the telephone device. Of all incoming inquiries, drug indication (13.3%), adverse drug reactions (ADR) (13.3%), storage (11.8%), and the method of preparation as well as administration (11.7%) were among the most common types of questions. The most frequent ward in asking questions was the pediatric intensive care unit (13.1%). The most widely used drug information resource to answer questions was the UptoDate® (47.5%). Conclusion: DPIC services in the hospital settings can decrease or prevent ADRs as well as medication errors, improve the pattern of medication use, and result in cost saving.

Purpose: children are a large group of patients receiving medications. Since pediatric dosageforms are generally not available, adult dosage forms have to be used for children instead, which leads to large amounts of drug wastage, and high costs are imposed on the healthcare system. This study was carried out to evaluate the amount of medication waste and the cost in pediatric wards of two major pediatric referral centers in southern Iran. The results were compared with an adult ward in the same hospital.Method: This comparative cross-sectional study was carried out during a three-month period, from April to June 2014, assigning one month to each ward. A trained pharmacist collected the data using direct observational method during morning shifts. All the drug preparation processes were evaluated by direct visual observation. During this supervision, factors involved in medication waste and also the dose of drug prescribed and wasted were evaluated.Results: The percent of medication waste in pediatric wards of Nemazee and “Shiraz Ghadir Mother and Child” hospital was 17.4% and 18.05%. The cost of wastage was estimated to be 568.11 USD and 368.11 USD for each hospital during one-month. According to the results, in pediatric wards of “Nemazee” and “Shiraz Ghadir Mother and Child” hospitals 101 out of 290 and 45 out of 80 prescriptions consisted of at least one antibiotic. In both hospitals the most prescribed antibiotic was vancomycin.Conclusion: The results indicated that medication waste in pediatric ward of Nemazee hospital was not significantly different in comparison with pediatric ward of Shiraz Ghadir Mother and Child hospital, but the waste was calculated to be more in the pediatric ward in comparison with the adult ward of Nemazee hospital. The most wasted group of medication was reported to be antibiotics. Vancomycin was reported to have the highest consumption and gentamicin was the leading wasted medication.

Medication Errors (MEs) play a significant role in mortality and morbidity of hospitalized patients. Therefore, it seems advisable to determine types and consequences of such errors when addressing patient safety. The aim of this study was to determine the incidence, types, outcomes of errors in a 10 bed pediatric Intensive Care Unit at a large teaching hospital from September 2013 to February 2014 in southern Iran.The occurrence of errors was detected with direct observation method. A trained pharmacist selected 41 patients randomly in forty one working shifts. No patient arrived the study twice. In each shift, patient’s medications were observed from prescription, administration, transcription, and dispensing. The pharmacist would intervene only if the ME could cause substantial harms to a patient. All data were reviewed by a clinical pharmacist and a pediatric intensivist to confirm the type of the errors.Of the 512 drug dosages observed, 48.8 errors/100 orders were detected, Administration errors occurred on 148 occasions, with 28.9 chances to occur in each 100 orders. Prescription, transcription and dispensing errors came next with 14.25, 4.88 and 0.78 chance in each 100 orders, respectively. Wrong time, wrong technique, and wrong preparation were among the commonest types of administration errors with 14.1%, 5.7% and 4.9%, respectively. Monitoring errors group with 11.3% was the most common type of prescribing errors.The results of this study highlights the high medication error rates in pediatric ICU under the study, with administration and prescription errors marked the highest share of them. Hence implementing the effective strategies to reduce them are needed.

Medication errors account for about 78% of serious medical errors in intensive care unit (ICU). So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6%) occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

Medication errors account for about 78% of serious medical errors in intensive care unit (ICU). So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6%) occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.

We examined epidemiological aspects and bacterial resistance patterns of bacteria isolated from intensive care unit (ICU) patient samples. During a 10 month period (from June 2006 to March 2007), 812 samples of blood, urine and cerebral spinal fluid (CSF) from 553 hospitalized patients, in ICU wards, including pediatric surgical, neonatal, adult surgical I, adult surgical II, general pediatrics, neurosurgical I, neurosurgical II, and internal medical, were collected. Minimum inhibitory concentration (MIC) of antibiotics for bacteria isolates was determined by the E-test method. The internal medicine ICU with 28.7% admissions gave the largest contribution. Coagulase negative staphylococci at frequencies of 66.7 % and 36.5 % and E. coli at 20.9% were the bacteria most frequently isolated from the blood, CSF and urine samples, respectively. Samples taken from patients 20-40 years old were the most frequent (32.2%), while the group of patients over sixty years contributed least (18.5%). Both Gram-positive and - negative isolates expressed resistance to most of the penicillins and cephalosporins tested. Combined therapy with vancomycin and meropenem or imipenem gave the most effective treatment against Gram-positive and Gram-negative isolates based on empirical therapy. High frequencies of multiresistant bacteria in ICUs warn us to administer a few effective antibiotics in our hospitals more wisely in order to reduce selective pressure on sensitive strains. This could help save the life of ICU patients and prevent of spread of resistant isolates in these critical wards. Due to continuous changes in antibacterial susceptibility patterns, periodical antibacterial sensitivity assessment in ICUs should be mandatory.