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BackgroundTuberculosis (TB) affects millions of people worldwide and is treated with medication including aminoglycosides and polypeptides. Individuals respond differently to medications as a result of their genetic inheritance. These differences in genetic inheritance can result in the underdosing or overdosing of medication, which may affect the efficacy or, in the case of aminoglycosides and polypeptides used in the treatment of all forms of TB, result in ototoxicity. When ototoxicity is detected, physicians should adjust dosages to minimize further ototoxicity and hearing loss; however, there are no suitable grading systems to define significant hearing loss. ObjectiveThe aim of this study was to develop a standardized grading system by making use of an electronic health (eHealth) platform to ensure that a user-friendly method was available to interpret hearing test results, calculate significant hearing loss, and provide recommendations with regard to dosage adjustments and management. It further aimed to establish the sensitivity of the newly developed grading scale. MethodsThis grading system was developed in South Africa based on data that were obtained from an audiology and pharmacokinetic study on patients with drug-resistant TB (DR-TB) at two DR-TB units at state-run hospitals. This feasibility study employed a prospective, cross-sectional, exploratory, descriptive case series research design, with a total of 22 participants. Participants underwent audiological and pharmacological assessments at baseline and every 2 weeks for the first 3 months of treatment. Various professionals (8 in total) were subsequently involved in the development of the eHealth system, including a software engineer, four audiologists, a pharmacist, a medical doctor, and a nurse. The app underwent 14 modifications that involved aspects of data storage, ease of usability, grades, and the risk factor checklist. ResultsAn ototoxicity grading system within a mobile app for use by doctors, nurses, and audiologists was developed for patients with DR-TB. The purpose of this user-friendly ototoxicity calculator, OtoCalc, is to (1) assist health professionals in assessing patients for ototoxicity, (2) establish the clinical significance of ototoxicity by calculating the grade of hearing loss, (3) monitor the progression of hearing loss, and (4) enable systematic referral and management of patients according to their needs. ConclusionsThis newly developed system is more sensitive than the existing grading methods for determining ototoxicity in patients with DR-TB. This app needs to be trialed in a larger sample to establish data security, ease of use, and suitability within this population.

Introduction: There are concerns with rising rates of antimicrobial resistance (AMR) across countries with appreciable impact on morbidity, mortality and costs. Amongst low- and middle-income countries, a key driver of AMR is the excessive use of antibiotics in ambulatory care, with a critical area being the appreciable selling of antibiotics without a prescription often driven by patient demand and limited knowledge. There is currently conflicting evidence in South Africa regarding this practice. Consequently, there is a need to explore these critical issues amongst patients, especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methods: A two-step descriptive approach was undertaken. This involved two questionnaires amongst patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, including 11 for Part 1 of the questionnaire with 3 declining, and 10 for Part 2, with 2 declining. Subsequently 8 patients completed each part of the questionnaire.. On average, it took 2 min 13 s to complete both parts. 3 of the 5 patients being dispensed an antibiotic were dispensed one without a prescription, with all 3 patients exiting from independent pharmacies. Key reasons for self-purchasing included money and convenience. There was mixed knowledge regarding antibiotics and AMR amongst the 8 patients interviewed with Part 2. Overall, there was a satisfactory understanding of the Part 1 questions, although some modifications were suggested. Some participants had difficulty with fully understanding the questions in Part 2, with a number of suggestions made to improve this for the main study. Conclusion: There were concerns with the extent of purchasing antibiotics without a prescription in this pilot study as well as the knowledge of patients regarding antibiotics and AMR. Both areas need addressing and will be explored further in the main study. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: There is considerable concern with rising rates of antimicrobial resistance (AMR) with its subsequent impact on morbidity, mortality and costs. In low- and middle-income countries, a key driver of AMR is the appreciable misuse of antibiotics in ambulatory care, which can account for up to 95% of human utilisation. A principal area is the selling of antibiotics without a prescription. There is conflicting evidence in South Africa regarding this practice alongside rising AMR rates. Consequently, there is a need to explore this further, especially in more rural areas of South Africa. A pilot study was undertaken to address this. Materials and Methods: A two-step descriptive approach involving a self-administered questionnaire amongst pharmacists and their assistants followed by cognitive interviews with some of the participants. Results: Twenty-one responses were obtained from nine of the 11 community pharmacies invited to participate. Participating pharmacies were all independently owned. Ten of the 21 participants admitted dispensing antibiotics without a prescription, including both adults and children, representing five of the nine participating pharmacies. A minority dispensed antibiotics before recommending suitable over-the-counter medicines. These high rates were exacerbated by patient pressure. There were issues with the length of the questionnaire and some of the phraseology, which will be addressed in the main study. Conclusion: There were concerns with the extent of purchasing antibiotics without a prescription in this pilot in South Africa study. Key issues will be explored further in the main study. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses the evolving role of pharmacists in patient care in South Africa. It highlights the challenges faced by pharmacists in expanding their roles beyond traditional dispensing duties and the need for greater integration into the healthcare team. The article also mentions the ongoing PiMART court case, where pharmacists are advocating for the right to prescribe antiretrovirals, and the importance of pharmacists in public health efforts, particularly during the COVID-19 pandemic. It emphasizes the need for interprofessional collaboration and recognition of pharmacists as equal healthcare partners. The article concludes by stating that progress may be slow, but it is necessary for the improvement of patient care and the advancement of the healthcare profession. [Extracted from the article]

The article discusses the challenges and opportunities facing the pharmacy sector in South Africa. It evaluates the profession based on various criteria, including workforce capacity, professional standards, education and training systems, self-regulation, workplace well-being, public trust and value, financial viability, and adaptability to change. The consensus is that South Africa has an inadequate pharmacy workforce, with a skewed distribution of services and a lack of resources in rural areas. Implementation and accountability of professional standards and ethics are weak, and there are concerns about ongoing competence and specialist training. The financial viability of the profession is also a concern, and there is a need for greater adaptability to meet changing health needs. Despite these challenges, there are opportunities to strengthen the pharmacy workforce and improve public health outcomes through expanded access to affordable generics, integration of pharmacists as primary care providers, public-private partnerships, and technology adoption. The article emphasizes the importance of addressing systemic inequities and social determinants of health to achieve equitable and quality pharmacy services for all South Africans. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The article discusses the role of pharmacy assistants in the implementation of the National Health Insurance (NHI) Act in South Africa. The NHI Act aims to provide integrated and coordinated care, which will require pharmacy assistants to work closely with pharmacists and other healthcare providers. The South African Pharmacy Council has made amendments to the Mid-Level Worker Regulations, creating a clear career path for pharmacy support personnel. With the expanded roles and responsibilities under the NHI, there may be a need for enhanced training and skill development for pharmacy assistants. The NHI may also provide funding or resources for training programs to prepare pharmacy assistants for their new roles in the healthcare system. [Extracted from the article]

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. [ABSTRACT FROM AUTHOR]

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 PaO2/FiO2 ratio. Targeting cytokine storms' pathogenesis genetic and molecular apparatus will substantially enhance lung function and reduce mortality due to the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

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 ceftazidimeavibactam 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Hospital‐acquired antimicrobial‐resistant infections are a leading cause of neonatal mortality in South African (SA) neonatal intensive care units (NICU). There is an urgent need for NICU Antibiotic Stewardship Programs (ASP). We describe the development of an international Train‐the‐Trainer (TTT) NICU‐ASP mentoring program for SA pharmacists. A partnership between the South Africa Antimicrobial Stewardship Program (SAASP) and ASP experts from two United States (US) hospitals was formed in 2019. A baseline assessment of four SA NICUs was done to guide the development of a TTT NICU‐ASP mentoring of SA pharmacists utilizing the existing workforce. The program included bilateral site visits. Pre‐post surveys were used to assess SA mentee's NICU experiences, barriers to clinical pharmacy services and confidence to train additional pharmacists in NICU ASP. Four mentees from private (n = 1) and public hospitals (n = 3) completed a 2‐week TTT NICU‐ASP in the US that included; education, patient care rounds, role‐playing, peer‐to‐peer sessions and behavioral interventions followed by ongoing support and mentoring by SAASP mentors. None of the hospitals had pharmacists participating in daily patient care rounds or had multidisciplinary NICU‐ASPs due to lack of NICU trained pharmacists and dedicated time for ASP. Post surveys showed improved confidence to train additional pharmacists in NICU‐ASP. Subsequently, these SA mentees provided NICU‐ASP education to over 700 health care professionals and trained six additional pharmacists in NICU‐ASP. Mentors and mentees developed a comprehensive NICU ASP toolkit for ongoing training of additional pharmacists. A new research collaboration between TTT NICU‐ASP mentors, mentees and physician members of the South Africa National Neonatal Sepsis Task Force has formed and the first national NICU‐ASP study is underway in 12 hospitals. Shared leadership between U.S. and SA mentors led to developing a TTT NICU‐ASP for pharmacists tailored to existing resources and local needs. [ABSTRACT FROM AUTHOR]

The South African Pharmaceutical Journal (SAPJ) is preparing for an eventful year in 2024. The journal plans to introduce new features, including articles on the impact of unprofessional behavior on patient safety, the identity of pharmacists, and the perspectives of young pharmacists. To enhance diversity, an editorial board will be appointed, and every review paper will include three questions for Continuous Professional Development (CPD). In addition, South Africa will host the 82nd International Pharmaceutical Federation's World Congress on Pharmacy and Pharmaceutical Sciences in Cape Town. The journal bids farewell to Mr. Ivan Kotze, the Executive Director of the Pharmaceutical Society of South Africa, who is retiring after 30 years of service. The journal looks ahead with optimism and invites readers to join in shaping the future of pharmacy in South Africa and beyond. [Extracted from the article]

Throughout the SARS‐CoV‐2 (COVID‐19) global pandemic, pharmacists were rarely mentioned as essential frontline health care providers by the news media, the public, or politicians. Around the world, pharmacists are working on the frontlines of health care every day providing essential health care services during the pandemic. Pharmacists are medication experts providing patient care in a variety of settings including hospitals, clinics, community pharmacies, long‐term care, physician offices, and national and public health. In this paper, we describe how pharmacists from high and low‐middle income countries contributed to essential patient care and well‐being of the public during the COVID‐19 pandemic. While the news media, the public, and politicians often overlooked pharmacists as essential frontline health care providers, we hope that this list of contributions by pharmacists from nine countries in this article can help to change this perspective. [ABSTRACT FROM AUTHOR]

The profession of pharmacy is maturing as a clinical profession in South Africa and has experienced significant development over the past 10 years. The development of clinical pharmacy in Southern Africa started in the late 1980s. The Director-General of Health and Welfare requested an expansion of the pharmacist's role in Southern Africa, in 1988, when he challenged pharmacists to be "more than just dispensers." South Africa experience human resource challenges in terms of healthcare service delivery and the shortage of pharmacists has been acknowledged. Due to the human resource shortage, it is very difficult to allocate pharmacists to work in a clinical unit on a daily basis. This document serves to set out practice guidelines for clinical pharmacy in South Africa, and to indicate areas where clinical pharmacist should concentrate to build practice. [ABSTRACT FROM AUTHOR]

Since the outbreak of COVID-19, and its declaration as a pandemic by the World Health Organization (WHO), the reliance on pharmacists as one of the first points of contact within the healthcare system has been highlighted. This evidence-based review is aimed at providing guidance for pharmacists in community, hospital and other settings in South Africa, on the management of patients with suspected or confirmed coronavirus disease 2019, or COVID-19. The situation is rapidly evolving, and new evidence continues to emerge on a daily basis. This guidance document takes into account and includes newly available evidence and recommendations, particularly around the following aspects relating to COVID-19: • Epidemiology • The virus, its modes of transmission and incubation period • Symptom identification, including the differentiation between influenza, allergic rhinitis, sinusitis and COVID-19 • Social media myths and misinformation • Treatment guidelines and medicines that may need to be kept in stock • Treatment and prevention options, including an update on vaccine development • The case for and against the use of NSAIDs, ACE-inhibitors and angiotensin receptor blockers (ARBs) in patients with COVID-19 • Interventions and patient counselling by the pharmacist. It is critical, though, that pharmacists access the most recent and authoritative information to guide their practice. Key websites that can be relied upon are: • World Health Organization (WHO): https://www.who.int/emergencies/diseases/novelcoronavirus- 2019 • National Institute for Communicable Diseases (NICD): https://www.nicd.ac.za/diseasesa- z-index/covid-19/ • National Department of Health (NDoH): http://www.health.gov.za/index.php/outbreaks/145-corona-virus-outbreak/465-corona-virus-outbreak; https://sacoronavirus. co.za/. [ABSTRACT FROM AUTHOR]

This article is aimed at providing a succinct overview of the condition tinea pedis, commonly referred to as athlete's foot. Tinea pedis is a very common fungal infection that affects a significantly large number of people globally. The presentation of tinea pedis can vary based on the different clinical forms of the condition. The symptoms of tinea pedis may range from asymptomatic, to mild-to-severe forms of pain, itchiness, difficulty walking and other debilitating symptoms. There is a range of precautionary measures available to prevent infection, and both oral and topical drugs can be used for treating tinea pedis. This article briefly highlights what athlete's foot is, the different causes and how they present, the prevalence of the condition, the variety of diagnostic methods available, and the pharmacological and non-pharmacological management of the condition. [ABSTRACT FROM AUTHOR]

Fungi normally originate from the environment that surrounds us, and appear to be harmless until inhaled or ingestion of spores occurs. A pathogenic fungus may lead to infection. People who are at risk of acquiring fungal infection are those living with human immunodeficiency virus (HIV), cancer, receiving immunosuppressant therapy, neonates and those of advanced age. The management of superficial fungal infections is mainly topical, with agents including terbinafine, miconazole and ketoconazole. Oral treatment includes griseofulvin and fluconazole. Invasive fungal infections are difficult to treat, and are managed with agents including the azoles, echinocandins and amphotericin B. This paper provides a general overview of the management of fungus infections. [ABSTRACT FROM AUTHOR]

Sport injuries and muscle pain can occur as a result of engagement in exercise and or organised sporting activities. These injuries affect all age groups and gender. The most common types of sporting activities known to cause these injuries include jogging, cycling, volley ball, swimming and heavy weight lifting. Lack of warming-up before participating in sporting activity, overtraining and/or excessive exposure to these physical activities may increase the risk of injury. These factors are categorised as extrinsic factors. Intrinsic factors that may lead to sport injuries or may precipitate these injuries are age, previous injuries and level of flexibility. The most common type of injuries seen are sprains and strains. These injuries are accompanied by pain, swelling and redness of the injured area. Nonpharmacological and pharmacological management is available for the effective management of these injuries. Pain may vary from mild to severe depending on the severity of injury. These varying types of pain can be managed optimally using non-narcotics, such as paracetamol, and non-steroidal anti-inflammatory (NSAIDs), like ibuprofen. Topical therapies of NSAIDs such as ibuprofen, diclofenac and flurbiprofen are often highly effective for managing sports-related muscle sprains and strains. When pain is categorised as moderate to severe, narcotics may be prescribed and administered. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are a common occurrence in paediatrics. UTIs present in children as fever, anorexia, vomiting, lethargy and dysuria. Approximately 80% of the time, Escherichia coli is the causative bacteria in paediatrics, however, fungal UTI caused by Candida species can occur in premature infants. With an estimated 150 million UTIs occurring worldwide annually, this paper aims to establish the ideal management of urinary tract infections in paediatrics. Clinical signs and symptoms of UTI in paediatrics are dependent on age of the child. Neonates (0-27 days old) present with sepsis, vomiting, fever, and prolonged jaundice, while school aged children present with symptoms similar to adults such as dysuria and urgency. Diagnosis of a UTI can be done by using a urine dipstick or using the midstream clean catch method in toilet trained children, and using the transurethral catheterisation or suprapubic aspiration method for infants and young children. In the wake of antibiotic resistance, choosing the best anti-microbial agent for treatment is imperative. Whilst asymptomatic bacteriuria does not require antibiotic treatment, amoxicillin and clavulanic acid combination, cephalexin, cefixime and cefpodoxime are the preferred oral antibiotics, provided there are no known allergies. Ceftriaxone, ampicillin, cefotaxime and gentamycin are the recommended parenteral antibiotics, provided age, allergic status and renal function are considered prior to use. Careful consideration needs to be given before using prophylaxis in UTIs and should be reserved for extreme cases. [ABSTRACT FROM AUTHOR]

Background: Pharmacovigilance (PV) is an important tool in monitoring the quality, efficacy and safety of medicines, with spontaneous reporting being the mainstay system of reporting adverse drug reactions (ADRs) worldwide. ADRs are largely underreported in South Africa. Aim: This study aimed to evaluate the knowledge, attitudes and practices of pharmacists and nurses in the private hospital sector towards ADR reporting. Setting: This study was conducted in six private hospitals and clinics within a single hospital group in Johannesburg, South Africa. Method: A cross-sectional survey was conducted amongst healthcare professionals using a structured multiple-choice questionnaire containing 20 close-ended questions. Both electronic and paper questionnaires were used to obtain as many responses as possible. Results: A total of 233 healthcare professionals participated in the study. Of these, 78.5% were registered nurses and 21.5% were hospital pharmacists. Although three-quarters of participants believed ADR reporting to be important, most had received no previous PV training (76.2%) and did not know how to report an ADR (54.5%). The majority of participants (87.1%) believed that all ADRs should be reported, with 75.5% of participants believing they would report all ADRs they encountered in the future provided they had sufficient training and knowledge. The major factors discouraging participants from reporting was a lack of awareness with respect to the process of reporting as well as a lack of access to the ADR reporting form. Conclusion: The majority of participants require further training regarding ADR reporting. Although the knowledge of most participants was acceptable, the transition into practice needs to be improved. [ABSTRACT FROM AUTHOR]

Influenza, hay fever and sinusitis are all very different upper respiratory tract syndromes that share very similar symptoms. "Flu" is caused by the influenza virus and usually presents with headaches, myalgia, fever and body aches. Hay fever is an allergic response of the body to a trigger, more often treated by removal of the trigger. There is no place for antibiotic usage in flu or hay fever,there is no clinical evidence to suggest that using antibiotics alters the course of the disease or prevents secondary infection. Treatment is mainly symptomatic and includes many over-the-counter medicines, antivirals and herbal treatments. On the other hand, sinusitis is a common inflammatory condition defined by persistent symptomatic inflammation of the sinonasal cavities lasting from less than four weeks to longer than three months. Either a virus or bacteria may cause sinusitis. Appropriate use of medical therapies, including antibiotics for sinusitis is necessary to optimise patient quality of life and daily functioning and minimise the risk of acute inflammatory exacerbations. Patients often present at the pharmacy with complaints of "flu". However, in many instances, symptoms may be confused with those of an allergy or sinusitis. It is important to know and understand the difference between influenza and allergies such as hay fever and sinusitis, in order to ensure correct diagnosis and offer appropriate therapeutic approaches. This article will review the clinical manifestations of influenza, allergic rhinitis (hay fever) and sinusitis, and highlight the differences between these three illnesses. [ABSTRACT FROM AUTHOR]

Probiotics have become well-known and widely-used, especially as supplements or add-on therapy in the prevention and management of antibiotic-associated diarrhoea. Very often, however, the beneficial action and correct use of probiotics may either be seriously misunderstood or not acknowledged at all. This article provides an overview of prebiotics, probiotics and synbiotics, including their mechanisms of action, clinical applications and available products on the local market. [ABSTRACT FROM AUTHOR]

Muscle pain, also known as myalgia, is most commonly associated with sprains or strains. It frequently presents as redness at the site of injury, tenderness, swelling and fever. Muscle pain may occur as a result of excitation of the muscle nociceptor due to overuse of the muscle, viral infections or trauma. The most important endogenous substance released in response to the damaged tissues or nociceptor nerve endings in regards with muscle pain is adenosine triphosphate (ATP). Optimal pain management involves a combination of non-opioid, opioid analgesics, adjuvants, as well as non-pharmacologic strategies. Nonopiod analgesics include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, which are indicated for mild to moderate pain. Whereas moderate to severe pain acquires opiod analgesics. This article provides an overview of muscle pain, the management and treatment thereof. [ABSTRACT FROM AUTHOR]

The common cold and flu are two very different viruses that share very similar symptoms. The common cold is a self-limiting upper respiratory tract infection and it is caused by the rhinovirus, coronavirus or the adenovirus. It usually resolves within 7-10 days. The flu is caused by the influenza virus and usually presents with headaches, myalgia, fever and body aches. There is no place for antibiotic usage in colds and flu and there is no clinical evidence which suggests that using antibiotics alters the course of the disease or prevents secondary infection. Treatment is mainly symptomatic and includes many over the counter medicines for symptomatic relief like Adco Flupain or Corenza C, antivirals and herbal treatment. [ABSTRACT FROM AUTHOR]

Asthma is a chronic inflammatory disease that causes hyperresponsiveness of the bronchial tree, with reversible airflow obstruction. The condition places a significant burden on our healthcare system. Chronic asthma can cause remodelling of the airway. Patients suffering from asthma should be aware of the signs and symptoms thereof, as well as the factors that can precipitate an asthmatic attack. Asthma is a chronic inflammatory disease; the diagnosis of asthma is based on identifying both a characteristic pattern of respiratory symptoms and variable expiratory airflow limitation. Treatment is based on how the patient presents and includes bronchodilators, inhaled corticosteroids and mast cell stabilisers. This article provides an overview on the diagnosis, characterisation and treatment of asthma. [ABSTRACT FROM AUTHOR]