Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: a systematic review.

OBJECTIVE: The objective was to compare the efficacy of azithromycin and clarithromycin in combination with beta-lactams to treat community-acquired pneumonia among hospitalized adults. METHODS: Five databases (PubMed, Google Scholar, Trip, Medline, and Clinical Key) were searched to identify randomized clinical trials with patients exposed to azithromycin or clarithromycin in combination with a beta-lactam. All articles were critically reviewed for inclusion in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: Seven clinical trials were included. The treatment success rate for azithromycin-beta-lactam after 10 to 14 days was 87.55% and that for clarithromycin-beta-lactam after 5 to 7 days of therapy was 75.42%. Streptococcus pneumoniae was commonly found in macrolide groups, with 130 and 80 isolates in the clarithromycin-based and azithromycin-based groups, respectively. The length of hospital stay was an average of 8.45 days for patients receiving a beta-lactam-azithromycin combination and 7.25 days with a beta-lactam-clarithromycin combination. CONCLUSION: Macrolide inter-class differences were noted, with a higher clinical success rate for azithromycin-based combinations. However, a shorter length of hospital stay was achieved with a clarithromycin-beta-lactam regimen. Thus, a macrolide combined with a beta-lactam should be chosen using susceptibility data from the treating facility.

Assessment Methods and Competency Mapping in Pharmacy Education: Understanding of Components and Quality Parameters.

Centre of advanced pharmaceutical education have developed 15 subsets of competencies required to be competent pharmacist and able to provide optimum care. These competencies were further categorized; Level 1 intermediate, Level 2 efficient, and Level 3 professional. These competencies are cross-mapped to achieve desirable outcomes. Where personal and professional development skills incorporate knowledge, for being a holistic pharmacist. In healthcare education curriculums, active learning tools such as simulation-based patient cases and other innovative learning activities are used to teach clinical skills, patient assessments, and pharmacotherapy concepts. The advance team-based learning technique for the development of stepwise understanding of disease management (simple-complex cases) and students can communicate and collaborate for the critical thinking and decision-making process. Many studies showed the positive impact of the peer teaching on the students; enhanced their academic performance, increase the cognitive congruence, and allows the students to share their own learning struggles to come up with solutions to overcome these challenges. Pharmacy is a healthcare professional required intensive training and professional skills to provide optimum care to patients. The emerging clinical role of pharmacy focused on the patient-centered model, comprehensive assessment, and teaching methods are required to fulfill the professional competencies.

Role and Services of a Pharmacist in the Prevention of Medication Errors: A Systematic Review.

OBJECTIVE: This systematic review aims to investigate the role and responsibilities of pharmacists in the prevention of medication errors. The study also aims to evaluate pharmacist-centered strategies that have an impact on medication error reduction and prevention. METHODS: A search was conducted through the following databases PubMed Central, Scopus, Trip, Prospero, Medline and Google Scholar using terms related to "medication errors prevention" or "pharmacist-related errors". Other search terms included "pharmacist(s)", "prevention", "medication error(s)", "dispensing error(s)", "drug incidence(s)", "medication malpractice(s)". Included studies were prospective and retrospective cohort, case-control and cross-sectional full-text studies published in the last 10 years (2010-2020). The review team screened the articles for inclusion criteria and evaluated the quality of the articles. The PRISMA guidelines were used to report the selected articles and screening process. Then, the articles were sent to a third independent reviewer for the quality assessment using the STROBE Checklist. RESULTS: A clinical pharmacist's duties are to supervise the medication treatment of admitted patients and to notify the healthcare team when a discrepancy is found. A total of seven reviewed studies highlighted the importance and positive impact of increasing the number of clinical pharmacist's interventions. Literature showed that an average of 64.9% of medication discrepancies happen during patient discharge, highlighting the necessity of a clinical pharmacist intervention at that stage. The systematic review focused on the significant impact of clinical pharmacists' role in preventing errors (studies reported=5); encouraging pharmacist-led education to increase medication error awareness (studies reported =5), incorporating better and innovative pharmacy-related work approaches (studies reported =4); and implementing appropriate and secured policies for medication error reporting (studies reported =1). The screened literature highlighted the significant reduction in the number of medication errors and an increase in medication error identification and awareness. These findings suggest the crucial role of a pharmacist in healthcare policies for the prevention of medication errors and patient safety. CONCLUSION: This systematic review suggests multiple pharmacist-centered strategies that have been implemented in several studies showing the positive impact on the reduction and prevention of medication errors commenced by not only the pharmacist but the rest of the healthcare team.

Comparative Efficacy of Beta-Lactams and Macrolides in the Treatment of Pediatric Pneumonia: A Systematic Review.

BACKGROUND: Pneumonia is an acute infection of the lung parenchyma that is differentiated among three main diagnoses: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and healthcare-associated pneumonia (HCAP). Though CAP is initially presented as a mild infection, it contributes to childhood mortality rates globally. A vast number of pathogens are the cause of CAP, but the two main causative organisms include Streptococcus pneumoniae and Haemophilus influenzae, with the former causing up to 50% of all childhood cases. In the current treatment guidelines from the Infectious Diseases Society of America (IDSA), amoxicillin is the recommended treatment choice for mild-to-moderate CAP while ampicillin is recommended for cases of severe CAP. Previous studies compared treatment between macrolides and beta-lactams to provide more information on the effectiveness in the pediatric population. OBJECTIVE: The objective of this article is to systematically review the literature on the comparative efficacy of beta-lactams and macrolides in the treatment of community-acquired pneumonia among children and to evaluate the outcomes that are used to determine drug efficacy in order to provide medication recommendations. METHODS: A systematic literature search was conducted in PubMed, TRIP, Cochrane and SCOPUS. Cohort studies and randomized controlled trials between the years 2000 and 2020 that compared the efficacy of amoxicillin and macrolides in treating pediatric pneumonia were included in the systematic review. Eligible patients included patients who were 17 years and younger, diagnosed with community-acquired pneumonia, and were given beta-lactams or macrolides, either as monotherapy or combination. Two reviewers were involved in the appraisal process to assess the quality of the methods used in the selected studies. RESULTS: A total of six articles were eligible according to the inclusion criteria and quality assessment. Four articles compared beta-lactam monotherapy with beta-lactam and macrolide combination therapy, while Kogan R et al. compared macrolide therapy monotherapy with beta-lactam and macrolide combination therapy and Leyenaar JK et al. compared ceftriaxone monotherapy to ceftriaxone plus macrolide combination therapy. The studies defined treatment failure as either a change in antibiotic therapy or hospital admission within 14 days of CAP diagnosis. Three studies used the length of hospital stay as their primary outcome for comparison of treatment efficacy. Four studies showed that the use of macrolides provided better treatment outcomes by reducing hospital stay and treatment failure rates. Beta-lactam and macrolide combination therapy did not show a significant effect on treatment failure compared to beta-lactam monotherapy regimens and it did not affect mortality compared to placebo or diet alone. Within the macrolide class, azithromycin was more clinically significant compared to erythromycin. CONCLUSION: The use of macrolides as monotherapy or add-on therapy to beta-lactams is more effective in the treatment of community-acquired pneumonia in the pediatric population.

Interprofessional Care of Emergency Department Doctors and Pharmacists: Crossing a Collaboration Chasm.

Role clarity of emergency department doctors and pharmacists is essential to provide collaborative care. Evidence is available that interprofessional care of doctor-pharmacist collaboration improves patient care in emergency settings. Pharmacists need to improve their knowledge and skill in emergency practice to be more productive and sought after. Team dynamics, training, and administrative support are critical. Interprofessional collaboration should not be programmed to fail for the short-term convenience of any profession. With more considerable effort from different stakeholders, once a collaborative system is established that will sustain improved patient care and the public trust of healthcare. Crossing a collaboration chasm takes time and effort. Interprofessional education should be built-in essential competencies to be collaborative with role clarity, teamwork, better communication, and ultimately patient-centeredness.