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Resistance to antibiotics is a worldwide concern and community pharmacies can play a strategic role in controlling this issue through rationalizing antibiotic consumption. Considering that dispensing any type of antibiotics without a prescription is prohibited according to Iran's regulations, this study was conducted to quantify the rate of antibiotic dispensing without a prescription by pharmacists in Tehran, Iran. A descriptive cross-sectional study was conducted from September 2016 through May 2017. Two scenarios of common infectious symptoms including sore throat and dysuria were simulated by pharmacy student in three different regions of Tehran. Each scenario was performed in three levels of demand including requesting for any medicine, asking for a stronger medicine, and direct request for an antibiotic. A total of 388 pharmacy visits were acceptable including 195 and 193 pharmacies for dysuria and sore throat, respectively. Antibiotics were provided in 39.9% of dysuria (67.5% in the first level of demand) and in 52.3% of sore throat (49% in the first level of demand) simulations. The time devoted by the pharmacists to each case was less than 60 second in more than 90% of the cases. The completion of the course of antibiotic therapy was emphasized by pharmacists in only 18% of cases in both scenarios. Our findings revealed that antibiotic dispensing without a prescription is a routine practice in community pharmacies in Tehran, Iran. Unfortunately, patient assessment and evaluation of the symptoms are not performed properly by pharmacists as well. [ABSTRACT FROM AUTHOR]

Cisplatin-induced nephrotoxicity (CIN) is a major dose-limiting factor in cisplatin use for the management of human cancers. This study was designed to evaluate the effect of melatonin on CIN as the first clinical trial in humans. This pilot, randomized, double-blinded, placebo-controlled clinical trial was conducted with cancer patients. Participants were randomly assigned to receive either 20 mg/day oral melatonin or placebo from 24 to 48 hours before cisplatin therapy. Urine samples were collected at 0, 6 and 24 h following cisplatin infusion to evaluate urinary neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and creatinine. Serum creatinine (SCr) levels were assessed at baseline and 72 h after cisplatin administration. Fifty-five patients were randomly assigned to receive either melatonin (n = 25) or placebo (n = 30), where 3 (7.5 %) versus 9 (21.4 %) acute kidney injury (AKI) episodes were reported in each group respectively. Although urinary biomarkers increased in both groups, the magnitude of the increase was smaller in the melatonin group compared to placebo. In addition, differences of urine KIM-1/creatinine ratio at 6 h and 24 h from baseline were significantly lower in the melatonin group (2.37(−71.16 to 63.70) ng/mg and −1.45(−80.28 to 48.76) ng/mg) compared to placebo (3.83(−11.19 to 37.05) ng/mg and 0.38(−5.42 to 70.00) ng/mg). This study showed that the number of AKI episodes in patients who received melatonin was lower compared to the placebo group, although it was not found to be statistically significant due to the small sample size. Moreover, melatonin administration in cisplatin recipients reduced tubular kidney injury, evidenced by less increase in KIM-1/creatinine and NGAL/creatinine ratios. [ABSTRACT FROM AUTHOR]

Objective: Venous thromboembolic events (VTEs) are one of the main causes of death in cancer patients. About one-third of newly diagnosed VTEs are later proved to be associated with cancers. Attempts have been made to prevent these events and reduce substantial burden on patient health. Previous studies have revealed underutilization of thromboprophylaxis in cancer patients. With respect to the high rate of enoxaparin prescription in our institute, irrational utilization of prophylactic measures was anticipated. This study aimed to evaluate the appropriateness of thromboprophylaxis in hospitalized cancer patients., Methods: Medical records of 199 cancer patients hospitalized in two oncology wards of a tertiary care teaching hospital were investigated retrospectively. Data extraction was performed by two clinical pharmacists. Appropriateness of thromboprophylaxis was determined using a local protocol prepared based on international guidelines., Findings: Forty-seven out of 199 prescriptions (23.5%) were appropriate according to the local protocol. About 76% (149/199) of patients did not have any acute medical illness or risk factors for thromboembolism and were admitted only to receive short-course chemotherapy. Enoxaparin was the drug used for 197 patients and unfractionated heparin was used for only 2 patients. Dose adjustment was not performed in three patients who needed dose modification with respect to renal impairment or obesity., Conclusion: This study has found that the frequency of thromboprophylaxis was considerably high in the study population. In the absence of an acute medical illness or other risk factors, hospitalization per se does not justify the administration of pharmacologic agents for thromboembolism prophylaxis. Implementation of local protocols prepared based on international guidelines seems necessary to rationalize thromboprophylaxis., Competing Interests: There are no conflicts of interest.

Objective: With respect to the high cost and limited availability of albumin, its use must be restricted to indications strongly supported by solid scientific evidence. It was anticipated that with the implementation of the National Health Reform Plan (NHRP), the consumption of albumin would increase as the result of decreasing patients' out-of-pocket costs. This study aimed to evaluate the efficacy of protocol implementation on the rationalization of albumin use in surgery wards of Cancer Institute of Imam Khomeini Hospital Complex, Tehran, Iran., Methods: This pre-post interventional study was conducted in 32-month phases from January to November 2014 in an Iranian University hospital. The first phase was before the implementation of NHRP, the second phase was after NHRP, and the last one was after the intervention. The first and second phases were conducted retrospectively. Data extraction was performed by a hospital pharmacist. During the third phase, the physicians were mandated to adhere to a local albumin protocol which had been prepared by clinical pharmacy service and approved by drug and therapeutic committee. Appropriateness of prescriptions regarding indication, dose, and duration based on local guideline was compared among groups., Findings: Although hospital bed-days of care remained consistent among phases, albumin was prescribed for 40, 45, and 8 patients during first, second, and third phases, respectively. This shows about 80% reduction of drug prescriptions in the last phase. The mean duration/dose of albumin in inappropriate indications reduced significantly from 11.3 ± 8.2 days/24.7 ± 21.2 vials in the second phase to 2.6 ± 1.7 days/5.6 ± 3.5 vials in the third phase, respectively ( P = 0.001 and P = 0.003)., Conclusion: Interactive collaboration through guideline implementation seems effective in rationalizing the use of high-cost medications such as albumin., Competing Interests: There are no conflicts of interest.

Objective: This study aimed to determine the portion of Iranian patients who attain therapeutic serum concentrations of voriconazole (VRCZ) following administration of fixed doses. In addition, the effect of CYP2C19 polymorphism on serum levels of VRCZ was also investigated., Methods: Forty-eight adult patients of Iranian origin with hematologic malignancies, who received VRCZ for treatment of invasive aspergillosis, were recruited into the study. Blood samples were drawn at day 4 of treatment to measure trough drug concentrations and determine genotyping of CYP2C19 polymorphisms of each patient. High-performance liquid chromatography method was used for measuring VRCZ serum level and CYP2C19 polymorphisms were conducted by Sanger sequencing. Demographic and clinical characteristics of patients alongside with CYP2C19 polymorphisms were assessed to determine the effective factor/s on VRCZ serum concentration., Findings: Seventy-three percent of patients achieved therapeutic serum concentrations of VRCZ with administration of usual fixed doses in clinical practice. There was no correlation between weight-adjusted dose and serum concentrations of VRCZ. Mean serum levels were significantly different neither in genders nor in routes of administrations. Extensive and ultrarapid metabolizers (URMs) comprised 48.7% and 21.6% study population, respectively. CYP2C19 polymorphism dramatically influenced the trough levels of VRCZ, so that all patients with subtherapeutic levels expressed URM phenotype., Conclusion: With respect to high incidence of URM phenotype in Iranian population, and observed association of this phenotype with sub-therapeutic levels in our study, performing therapeutic drug monitoring is strongly recommended for all patients., Competing Interests: There are no conflicts of interest.