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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]

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]

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]

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]

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]

Rotavirus disease is known to be the most important cause of severe gastroenteritis in children worldwide. It affects nearly all children by the age of five years. Transmission of the virus occurs mainly through the faecal-oral route. Complications that are associated with rotavirus infection include malnutrition and dehydration. These may have a fatal outcome. Vaccination against rotavirus disease is the most efficient way to protect children against rotavirus infection and can save many lives. Primarily, treatment is aimed at rehydration to replace fluid and electrolyte losses. [ABSTRACT FROM AUTHOR]

The Global Action Plan on antimicrobial resistance calls for the use of antimicrobial medicines in human and animal health to be optimized, in tandem with a strengthening of the knowledge and evidence base through surveillance and research. However, there is a paucity of consumption data for African countries such as South Africa. Determining antimicrobial consumption data in low-resource settings remains a challenge. This article describes alternative mechanisms of assessing antimicrobial consumption data, such as the use of Intercontinental Marketing Services (IMS) data and contract data arising from tenders (an open Request for Proposal, RFP), as opposed to the international norms of daily defined doses per 100 patient-days or per 1000 population. Despite their limitations, these serve as indicators of antimicrobial exposure at the population level and represent an alternative method for ascertaining antimicrobial consumption in human health. Furthermore, South Africa has the largest antiretroviral treatment programme globally and carries a high burden of tuberculosis. This prompted the inclusion of antiretroviral and anti-tuberculosis antibiotic consumption data. Knowledge of antimicrobial utilization is imperative for meaningful future interventions. Baseline antimicrobial utilization data could guide future research initiatives that could provide a better understanding of the different measures of antibiotic use and the level of antibiotic resistance. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition which affects the respiratory system and worsens over time. Cigarette smoking and advancing age are the two major risks associated with this disease. It is concerning that the global incidence of this chronic illness is on the rise. Current projections indicate that it will become the third leading cause of death by the year 2020. Inflammatory changes underlie the pathophysiology of COPD. Irreversible damage and progressive narrowing of the air passages follow. COPD is characterised by the progressive loss of lung function. In addition, the Global Initiative for Chronic Obstructive Lung Disease released the latest update on its global strategy for the diagnosis, management, and prevention of COPD in 2015. This article provides an overview of the causative risk factors, underlying disease process, pathophysiological changes, and the classification and management of COPD, including the latest perspectives on this highly prevalent condition. [ABSTRACT FROM AUTHOR]

Gastric pain may be generalised, diffused, specific to the right or left upper quadrant (or both), and may be attributed to a range of possible causes. Types of gastric pain include dyspepsia and epigastric pain. The term "gastric pain" is not frequently encountered in the literature. Therefore, the main focus of this review is on epigastric pain and dyspepsia, both of which are frequently encountered in the clinical setting. For example, it is estimated that dyspepsia affects a quarter of the global population. Several drugs and drug classes are also linked to a range of mechanisms through which the drugs induce mucosal injury in the upper gastrointestinal tract. Therefore, this article provides an overview of the aetiology, classification, risk factors, diagnostic criteria and management strategies aimed at gastric pain, and its two more distinct gastrointestinal-related manifestations, namely epigastric pain and dyspepsia. [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 caused by the rhinovirus, coronavirus or the adenovirus. It usually resolves within 7-10 days. 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, antivirals and herbal treatments. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition which affects the respiratory system and worsens over time. Cigarette smoking and advancing age are the two major risks associated with this disease. It is concerning that the global incidence of this chronic illness is on the rise. Current projections indicate that it will become the third leading cause of death by the year 2020. Inflammatory changes underlie the pathophysiology of COPD. Irreversible damage and progressive narrowing of the air passages follow. COPD is characterised by the progressive loss of lung function. In addition, the Global Initiative for Chronic Obstructive Lung Disease released the latest update on its global strategy for the diagnosis, management, and prevention of COPD in 2015. This article provides an overview of the causative risk factors, underlying disease process, pathophysiological changes, and the classification and management of COPD, including the latest perspectives on this highly prevalent condition. [ABSTRACT FROM AUTHOR]

In the era of antimicrobial resistance, where the choice of antibiotics that we have to treat infections is becoming limited, infection control and hospital epidemiology are moving from being the orphan child of antimicrobial stewardship to becoming the necessity we can't live without. The responsibility lies with every healthcare worker to know the what, when and how of infection control as we have to pursue different avenues to not only safeguard the antibiotics we have left but also to maintain a healthy environment for our patients. This article explores issues around infection control and hospital epidemiology. [ABSTRACT FROM AUTHOR]

Tobacco smoking is a global public health problem, estimated to cause over 6 million deaths per year, including more than half a million non-smokers, dying of second-hand tobacco smoke. Smoking rates in South Africa have been declining over the last 20 years since the implementation of tobacco control measures, although the current prevalence of smoking is high (18.9%) with rates amongst males being five times higher than females. Similar to the rest of the world, smoking is also a leading cause of death in South Africa, with its risk factors exacerbated by tuberculosis, human immunodeficiency virus infection and non-communicable diseases. Tobacco control has major economic benefits for the health system, hence the importance of key policies combatting tobacco use as well as smoking cessation interventions. An overview of the pharmacological and non-pharmacological treatment interventions is provided, with a focus on the application of smoking cessation interventions in routine practice to ensure successful quitting. [ABSTRACT FROM AUTHOR]

The introduction of antiretroviral therapy transformed the resultant acquired immunodeficiency syndrome (AIDS) from a disease of high morbidity and mortality to a manageable chronic condition, with a subsequent reduction in the negative impact thereof on the world's economy and global healthcare systems. However, patients living with AIDS have now become vulnerable to an increase in morbidity and mortality due to non-AIDS related illness, such as metabolic syndrome, liver and renal failure, and premature cardiovascular disease (CVD); with antiretroviral therapy being especially prone to causing iatrogenic dyslipidaemia, which increases the risk of CVD. This article provides an overview of the nature and management of dyslipidaemia associated with HIV-infection and AIDS. [ABSTRACT FROM AUTHOR]

The key to optimal pain management is the ability to effectively monitor the patient to ensure pain relief, whilst minimising or managing the side-effects of pain medication. This will only be possible through the collaborative work of all healthcare professionals managing the patient. This article provides an overview of the requirements for optimising pharmacotherapeutic pain management. [ABSTRACT FROM AUTHOR]

The term "diabetes mellitus" refers to a group of disorders that relate to carbohydrate metabolism. The condition is characterised by hyperglycaemia due to decreased and therefore inadequate levels of insulin in the body, resistance to the effects of insulin, or a combination of both. The symptoms of marked hyperglycaemia include polyuria, polydipsia, weight loss, polyphagia and blurring of vision. The aetiological types of diabetes mellitus are type 1, type 2, gestational diabetes mellitus and other specific types. However, the two major categories of diabetes mellitus are type 1 and type 2. Type 1 (formerly known as insulin-dependent diabetes mellitus) patients are usually at risk of developing ketoacidosis and require insulin therapy. Patients who suffer from type 2 diabetes mellitus, formerly known as noninsulin-dependent diabetes mellitus, as opposed to those suffering from type 1 diabetes mellitus, still have functional pancreatic ß cells which produce insulin. However, they suffer from a relative lack of insulin, i.e. a combination of insulin resistance and the impaired secretion thereof. These patients may require oral hypoglycaemic agents, or a combination of both oral hypoglycaemic agents and insulin. The effective management of diabetes mellitus is dependent upon three main aspects, namely appropriate dietary modification, suitable exercise and appropriate pharmacotherapy. The more progressive forms of this disease require combination therapy. Uncontrolled diabetes mellitus may lead to the development of micro- and macrovascular complications. Patient compliance is very important in achieving the goal target and positive treatment outcomes. Multiple co-morbid conditions often complicate diabetic treatment and increase the risk of complications. Hypertension and dyslipidaemia are the most common co-morbid conditions. Therefore, tight glycaemic and blood pressure control is important in order to prevent disease progression and the development of complications. Important aspects that require consideration when managing individuals with diabetes mellitus are reviewed in this article. The effective management of patients with diabetes mellitus involves a complex decision-making process. The ultimate goal is to attain good glycaemic control. A unique management plan for each patient can be devised through the adoption of a personalised approach to the care of these individuals, which can result in improved outcomes. [ABSTRACT FROM AUTHOR]

Allergic diseases are increasing all over the world, now affecting up to 40% of the population. The most frequently occurring allergic conditions include allergic rhinitis (hay fever), chronic sinusitis, atopic dermatitis, and chronic urticaria. The literature suggests that second-generation histamine 1 (H1) antihistamines are the preferred first-line therapy for most chronic allergic conditions, including allergic rhinitis and chronic urticaria. Patients taking these antihistamines report little to no adverse effects with long-term continuous treatment. Second-generation H1-antihistamines have been shown to exert an anti-inflammatory effect, and continuous administration may improve their efficacy. [ABSTRACT FROM AUTHOR]

Allergic diseases are on the increase globally. There has been a doubling in the number of scholars suffering from allergy-related disease in the past two decades. This article describes the predisposing factors which contribute to an increased incidence of allergies within the population. These factors include a genetic predisposition, allergen exposure, abnormalities in the bowel flora and infection exposure. Some of these relate to the hygiene hypothesis and the microflora hypothesis, which are discussed in this article. Treatment options for those suffering from allergic disease are also discussed, with an emphasis on asthma, anaphylaxis, allergic rhinitis and atopic dermatitis. [ABSTRACT FROM AUTHOR]

Study objectives: To determine the safety and efficacy of the use of oral anhydrous caffeine and intravenous aminophylline in the neonatal population using therapeutic drug levels and clinical effects as markers for determination. Design: Prospective randomised study. Patients: Thirty-one neonates admitted (aminophylline n = 16, caffeine n = 15) with a gestational age of less than or equal to 34 weeks for prevention of apnoea of prematurity (AOP) were enrolled. Results: Oral anhydrous caffeine or intravenous aminophylline were administered using prescribed study regimens. One peak level was taken for the two drugs on day 4 of treatment 2 hours after the maintenance dose was administered. The two regimens were clinically monitored using cardiovascular, respiratory, gastro-intestinal and central nervous system parameters four hourly. The two groups did not differ significantly for gestational age (p = 0.782), birth weight (p = 1), gender (p = 0.722), and Apgar scores determined at 5 minutes (p = 0.068). Serum concentrations were within range (5-20 μg/ml) for both study groups. The median pulse rate (beats per minute) for two days; day 7: 160 vs. 148 (p = 0.019); day 9: 168 vs. 147 (p = 0.020) and median respiratory rate (breaths per minute) for five days; day 3: 68 vs. 61 (p = 0.039); day 4: 67 vs. 57 (p = 0.014); day 5: 64 vs. 58 (p = 0.045); day 7: 65 vs. 50 (p = 0.021); day 8: 66 vs. 56 p = 0.014) were significantly higher in the aminophylline study arm. Conclusion: The findings of the study indicated that caffeine is an effective alternative for intravenous aminophylline in prevention of AOP. The oral administration of caffeine may also have an advantage in a resource-poor setting. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is a chronic condition that affects the respiratory system and worsens over time. The two major risks that are associated with this disease are cigarette smoking and an advancing age. It is concerning that the global incidence of this chronic illness is on the rise, with current projections indicating that it will become the third-leading cause of death by the year 2020. Inflammatory changes underlie the pathophysiology of COPD, with irreversible damage and a progressive narrowing of the air passages that follow. COPD is characterised by a progressive loss of lung function. In addition, the Global Strategy for the Diagnosis, Management, and Disease Prevention of Chronic Obstructive Pulmonary Disease, or GOLD, released the latest update of their Global Strategy for the Diagnosis, Management, and prevention of Chronic Obstructive Pulmonary Disease in 2015. This article provides an overview of the causative risk factors, the underlying disease process and pathophysiological changes, the classification and the management of COPD, including the latest perspectives on this highly-prevalent condition. [ABSTRACT FROM AUTHOR]

Glaucoma is a complex condition of the eye. It is an ophthalmic neurodegenerative condition and is characterised by raised intraocular pressure. When left untreated, patients may gradually experience visual field loss, and even lose their sight completely. It is the second leading cause of blindness around the globe. The article provides a brief, synoptic overview of this condition and its pharmacological treatment options. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) include the nonselective or traditional NSAIDs, as well as the cyclo-oxygenase-2- specific ones. These agents are most often used to manage pain associated with musculoskeletal conditions. The nonselective or traditional agents are still widely used, and are also freely available as over-the-counter analgesics. However, they carry the risk of serious cardiovascular, gastrointestinal and renal adverse effects, such as peptic ulcers and gastrointestinal bleeding, especially in patients who have a pre-existing high-risk profile. It is imperative that physicians are aware of these risk factors and choose agents that will provide the best benefit-to-risk profile, while taking into consideration the patient's individual needs and risk profile. [ABSTRACT FROM AUTHOR]

This article provides an overview of the changes that have taken place in the diagnosis and management of hypertension over the past decade. Hypertension remains a very common condition seen in South Africa. The approach to the management of hypertension includes necessary lifestyle modifications and a decisive, stepwise escalation process in the pharmacotherapeutic management thereof. Thiazide diuretics are still being promoted by most guidelines to be the initial (first-line) drug of choice, with the addition of other suitable antihypertensive agents, if necessary, and according to any relevant co-morbid conditions. [ABSTRACT FROM AUTHOR]

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) pose a significant burden to the healthcare system annually. A positive impact on, and a reduction, in the mortality rate can be achieved through an understanding of the most common microorganisms that cause these two closely-associated conditions, identifying the associated risk factors and co-morbidities, and making a timely diagnosis. With the correct understanding of these conditions, proper preventative strategies can be implemented and treatment provided according to the severity of the specific condition in question. Better outcomes for infected individuals are likely to result from newer strategies involving novel antibiotics, as well as new approaches to the use of older antibiotics for different purposes. This article provides a general overview of the nature and management of HAP and VAP. [ABSTRACT FROM AUTHOR]

Hypertension is a pressing global health issue, contributing to an increase in cardiovascular risk, as well as being the most common condition seen in South Africa. Lack of compliance with the prescribed therapy is one of the largest obstacles to achieving goal blood pressure in antihypertensive patients. The complexity of the drug therapy is a very important factor that is associated with noncompliance, as most patients require treatment with two or more drugs. The use of fixed-dose combination (FDC) therapy has various advantages, including simplification of the regimen, resulting in improved adherence. However, there are also disadvantages, e.g. the inability to provide individualised dose flexibility. This article provides an overview of available FDC therapy for hypertension in South Africa and the rational use thereof, by taking into account each combination's complementary action, efficacy, safety and tolerability. [ABSTRACT FROM AUTHOR]

Allergic disease decreases the daily quality of life of many people, and can increase the number of working days lost owing to sick leave. Associated symptoms with allergic disease depend on the origin of the disease, and can either be allergic, non-allergic and purulent, or can cause rhinitis as a result of a common cold. Treatment depends on the origin of the rhinitis. However, an antihistamine is indicated in most instances. Combination treatment includes sympathomimetic drugs (either local or systemic) and corticosteroid medication (when indicated, and in most instances, used locally). The article provides an overview of the nature and the management of allergic disease and the histamine 1 antihistamines. [ABSTRACT FROM AUTHOR]

The common cold is a viral infection that requires symptomatic treatment. It is usually self-limiting. Influenza is often referred to as the flu. There are several differences between the common cold and the flu, including the onset of the condition as influenza is typically more acute in onset and more debilitating. Treatment of both these conditions requires a symptomatic approach that should be evidence-based, including herbal remedies, over-the-counter medicines, antiviral agents and analgesics for pain and fever.This will be discussed in more detail in the ensuing section. [ABSTRACT FROM AUTHOR]

"Psychosis" is an umbrella term used in the description of various conditions that involve delusions and hallucinations. This article will focus on the management of schizophrenia. Schizophrenia is a complex disorder, which provides many pharmacotherapy-related challenges. Advances have been made in the treatment of the condition. However, this requires a team approach, with the pharmacist monitoring treatment, both for safety and efficacy. The involvement of medicines that might possibly modulate the N-methyl-D-aspartate receptors is an exciting development that should be monitored. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common cardiac rhythm disorder and patients with this condition are at an increased risk of strokes and other thromboembolic events. Available treatment options for the prevention of strokes in patients with AF include warfarin, aspirin and the novel oral anticoagulants (NOACs). Warfarin and aspirin reduce the risk of strokes in patients with AF and have been studied extensively. The NOACs are slowly beginning to make their way onto the South African market and are specifically highlighted in this article. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common cardiac rhythm disorder. Patients suffering from this condition are at an increased risk of stroke and other thromboembolic events. Available treatment options for the prevention of strokes in patients suffering from AF include warfarin, aspirin and the novel oral anticoagulants. Warfarin and aspirin reduce the risk of strokes in patients with AF and have been studied extensively. The novel oral anticoagulants are slowly beginning to make their way onto the South African market and are specifically highlighted in this article. [ABSTRACT FROM AUTHOR]

This article provides an overview of ototoxic medication, as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine, they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies, further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team. [ABSTRACT FROM AUTHOR]

Vulvovaginal candidiasis (VVC) is part of a group of infections termed the superficial fungal infections. These can be classified as complicated or uncomplicated, sporadic or recurrent. Some patients are difficult to diagnose, and may not respond to standard therapies. These patients suffer from recurrent or chronic VVC. Recurrent VVC is defined as more than four episodes of VVC within a 12-month period. Patients normally present with a white, cheesy discharge and vulvovaginal itching. Clinical findings (itching or a cheesy discharge) or laboratory tests (potassium hydroxide, Gram stains and vaginal pH) are not sensitive or specific predictors of Candida vaginitis. Treating recurrent VVC requires an aggressive treatment plan using two stages, namely an induction and a maintenance stage. A high incidence of recurrent VVC requires a thorough understanding of the epidemiology and pathophysiology of the condition. Treatment with azole antifungals and nystatin derivatives may provide relief if given for an adequate period of time. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a well-known group of drugs that are most widely used for a variety of inflammatory conditions and pain. However, their gastrointestinal side-effects, i.e. ulcers and gastrointestinal bleeding, hamper their usefulness in many clinical settings. The selective cyclo-oxygenase 2 (COX-2) inhibitors (the coxibs) promised to be a group of antiinflammatory drugs with significantly fewer, or no gastrointestinal side-effects. Nevertheless, more recent research into their effectiveness and safety profiles revealed that they are also associated with an increased risk of upper- and lower-gastrointestinal toxicity. Guidelines suggest that patients at risk of NSAID-induced gastrointestinal ulcers and toxicity should be given preventative treatment. However, only a small percentage of these patients receive any therapeutic intervention. Multiple strategies exist for reducing the risk of NSAIDinduced gastrointestinal complications. An overview of these strategies and treatment options is provided in the article, as well as novel approaches to developing gastrointestinal-sparing NSAIDs (using selective inhibition of terminal prostaglandin synthases, and modified NSAIDs to slowly release gastroprotective gaseous mediators, e.g. nitric oxide and hydrogen sulphide). [ABSTRACT FROM AUTHOR]

Background Nigeria is the most populous country in Africa and has high rates of antimicrobial resistance (AMR). The practice of antimicrobial stewardship in Nigerian hospitals is very limited and the subject is rarely included in undergraduate medical and pharmacy curriculums. To further acceptance and implementation of antimicrobial stewardship programs (ASP) in Nigeria health system, baseline measurements of the knowledge and perceptions held by graduating medical and pharmacy students was deemed essential. This study evaluated the knowledge and perceptions of a cohort of Nigerian medical and pharmacy students in concepts of AMR and ASP. Methods This was a cross-sectional questionnaire-based study of final year medical and pharmacy students from the two largest schools in the southeastern region of Nigeria. A previously published 20-items questionnaire measuring knowledge and perceptions toward AMR and ASP was adopted for the study. Results were expressed as frequencies and percentages. Results Completed questionnaires were received from 79.3% (361 of 455 students), over half (60%) were male, and mostly between 22 and 25 years old (68.7%). More pharmacy students had formal training on ASP compared with medical students (41.3% vs. 27.5%, P < 0.05). Pharmacy students (n = 84.3% and 90.5%) were significantly more knowledgeable of factors that promote the spread of AMR and interventions to combat resistance than medical students (n = 73.9% and 82.3%), P < 0.05, respectively. Interestingly, 23.3% of medical students thought pharmacists should lead ASP teams, while 5.8% of pharmacy students thought doctors should lead ASP. However, both held poor perceptions of each other's roles in the ASP team. Conclusion Knowledge of AMR and ASP among medical and pharmacy students in Nigeria is lacking. Inter-professional collaboration to change perceptions and drive ASP in urgently needed. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

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]

Pharmacy has evolved over several centuries from the traditional role of dispensing and compounding a physician's order, to include modern day services, such as patient care. The underlying philosophy of clinical pharmacy is pharmaceutical care. This is a patientcentred approach which addresses all possible pharmaceutical interventions in the context of a fully integrated multidisciplinary plan of care. The most effective pharmaceutical care is achieved when pharmacists become part of the clinical team caring for patients. Clinical pharmacists are not currently part of ward staff in South Africa, as seen in the USA or the UK. This may be because of human resources and an inadequate number of trained clinical pharmacists. This has an impact on the effectiveness of the pharmacist, as he or she should be based in the wards so as to become an effective member of the healthcare team. A high-impact unit that would benefit greatly from pharmaceutical care is the neonatal intensive care unit, which has been shown to be highly vulnerable to medication errors, and in which a clinical pharmacist could play a role in decreasing medication errors. [ABSTRACT FROM AUTHOR]

• Global antimicrobial resistance is increasing. • Antimicrobial stewardship is critical for optimizing the safe and effective use of antimicrobials and for limiting antimicrobial resistance. • Low- to middle-income countries can effectively utilize antimicrobial stewardship but face unique challenges. • Key resources exist to help establish antimicrobial stewardship programs in low- to middle-income countries. Antimicrobial resistance is a global public health crisis. Antimicrobial Stewardship involves adopting systematic measures to optimize antimicrobial use, decrease unnecessary antimicrobial exposure and to decrease the emergence and spread of resistance. Low- and middle-income countries (LMICs) face a disproportionate burden of antimicrobial resistance and also face challenges related to resource availability. Although challenges exist, the World Health Organization has created a practical toolkit for developing Antimicrobial Stewardship Programs (ASPs) that will be summarized in this article. [ABSTRACT FROM AUTHOR]

Travelling, especially to international destinations, has increased significantly over the years and is expected to increase even more over the next two decades. As a result, more people are exposed to travel-related risks, influenced by the travel destination, itinerary, duration of the trip, and the medical history of the traveller. With adequate pre-travel planning and a timeous pre-travel risk assessment, measures can be taken to mitigate risks and safeguard the traveller's health. This paper provides an overview of the continuum of travel medicine with a focus on interventions to prevent and manage travel-related infectious diseases, common conditions related to travel as well as specific travel needs and risks. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) (also known as spastic colon) is a chronic condition that affects the large intestine (colon) and seems to be more prevalent among women. It is often associated with cramping, abdominal pain, bloating, flatulence, diarrhoea and/or constipation (depending on which sub-type the patient suffers from). Certain alarm features (e.g. rectal bleeding, nocturnal symptoms and family history of colorectal cancer or inflammatory bowel disease) should be ruled out first before IBS can be diagnosed, following an approach of exclusion. The exact pathogenesis of IBS is not clear, but psychosocial factors, abnormal gastrointestinal motility and visceral hypersensitivity play an important role. Psychological distress such as anxiety and depression have also been linked to IBS and are potentially exacerbated by the patients' impaired quality of life whilst living with the condition. Treatment of IBS is directed towards encouraging physical exercise, advising the patient on dietary modification, providing psychosocial support and alleviating the patients' symptoms. [ABSTRACT FROM AUTHOR]

Patients can develop pregnancy related conditions during pregnancy, from minor ailments to conditions that can cause adverse risks to mother and/or foetus, presenting unique challenges for healthcare providers for effective and safe treatment of pregnant patients. This review paper focusses on three common diseases in pregnancy – gestational diabetes, heartburn, nausea and vomiting – and outlines appropriate treatment options for pregnant patients. [ABSTRACT FROM AUTHOR]