Antibiotic utilization study in a teaching hospital in Nigeria.

Background: Antibiotics have been the bedrock of modern medical care, particularly bacterial infections. However, globally, antimicrobial resistance has become a well-recognized public health threat in recent years, and interventions to reduce its burden have been launched worldwide. Objectives: The present study evaluated antibiotic utilization in both hospitalized patients and outpatients in a University Hospital in Nigeria. Methods: In a 3 year retrospective study between January 2017 and December 2019, 246 case files of patients were selected for the study based on inclusion and exclusion criteria. In addition, the antibiotic consumption rate for hospitalized and outpatients was determined. Results: The total antibiotic consumption for hospitalized patients in this study was 260.9 DDD/100 bed-days, while the outpatient department's patients were 72.3 DDD/1000 inhabitants per day. Peptic ulcer disease was the most frequent indication for antibiotic use for outpatients, with the fluoroquinolones and macrolides being the most prescribed antibiotic class and antibiotic class with the highest DDD, respectively. The most frequent indication for antibiotic use for hospitalized patients was chronic kidney diseases, with the fluoroquinolones and second-generation cephalosporins being the most prescribed antibiotic class and antibiotic class with the highest DDD, respectively. DDD per 100 bed-days and DDD per 1000 patient-days were highest in 2018. The P values for the years were 0.019, 0.195 and 0.001 for 2017, 2018 and 2019, respectively. Conclusions: Our findings revealed irrationality in antibiotic use. Therefore, antimicrobial stewardship programmes should be implemented.

COVID-19 Pandemic: A Case for Phytomedicines.

Coronavirus disease 2019 (COVID-19) is an infection caused by a newly discovered coronavirus which was identified in Wuhan, China. The race is on globally to repurpose drugs for COVID-19 and develop a safe and effective vaccine against the disease. There is an urgent need to search for effective remedies against COVID-19 from the rich and extensive flora of Africa and the world. A literature search was conducted to obtain information on drugs with the potential for effectiveness in the treatment of COVID-19 based mostly on outcomes of preclinical studies and a few clinical investigations. This was considered important to this perspective as some of the identified mechanisms of action may be related to potential anti-COVID-19 actions of phytomedicines. The findings from the literature search were also used to establish the need for exploration of phytomedicines in the fight against COVID-19. This perspective identifies the need to preserve the rich tradition of herbal medicine in Africa, repositioning it by inculcating all aspects of discovery, development, and chemical evaluation of pharmaceuticals from medicinal plants for effective management of prevalent diseases. The identified mechanisms of action of current drugs under consideration for the treatment of COVID-19 include preventing fusion of SARS-CoV-2 with human cells; decrease acidity in endosomes, cell membrane-derived vesicles for transportation of the virus within the host cell and within which the virus can replicate; and blockade of the production of proinflammatory cytokines. Phytomedicines may possibly elicit either one or a combination of these effects. The case for the exploration of phytomedicines against COVID-19 is strengthened by the emergence of a number of conventional drugs from medicinal plants and the emergence of botanicals with proven efficacy for some medical conditions. Caution against indiscriminate use of medicinal plants in the guise of treating COVID-19 has been highlighted and the need for reliable preclinical and clinical studies.

High Risk of Drug-drug interactions among Hospitalized Patients with kidney Diseases at a Nigerian Teaching Hospital: A Call for Action.

BACKGROUND: Potential drug-drug interactions (DDIs) are increasingly common in clinical practice, especially among individuals with chronic conditions, such as chronic kidney dysfunction. However, data relating to DDIs among chronically ill patients are limited in Nigeria. We, therefore, investigated the prevalence and pattern of DDIs among patients with kidney diseases on admission at a tertiary hospital in Lagos, Nigeria. MATERIALS AND METHODS: This was a prospective observational study involving 61 adults with kidney diseases and on admission in medical wards of the study center, over a 3-month period. Data extractions were with a purposefully designed pro forma to extract relevant data on demographic, clinical, and dosing regimens of the prescribed drugs for individual patients. Potential DDIs were identified, and their severity was rated using the MICROMEDEX® software database (IBM® Watson-Truven Health Analytics), which is available online with limited access. RESULTS: Of the 61 patients evaluated, majority were males (34; 55.7%), were elderly (26; 42.6%), and had chronic kidney disease Stage 3 (40; 65.5%). The most common cause of kidney disease was hypertension (20; 32.8%). Out of the 542 prescriptions received by the patients, potential DDI was observed in 508 (93.7%) prescriptions. Clinically significant drug interactions (CSDIs) were detected in 486 (85.7%) prescriptions. Pharmacodynamic DDIs (466; 91.7%) were the most common. Pill burden exceeding 25 pills/day was present in nine (14.8%) patients. The severities of the potential DDIs were major (135; 24.9%), moderate (333; 61.4%), and minor (38; 7.1%). Only two different potential DDIs were rated X (contraindicated). CONCLUSION: Exposure to drugs with potential DDIs was very common among patients with kidney diseases. Most of the CSDIs observed were of major severity. The use of DDI checker before prescribing drugs for individuals with kidney diseases could avert clinically significant interactions.

Protective but Non-Synergistic Effects of Nigella Sativa and Vitamin E against Cisplatin-Induced Renal Toxicity and Oxidative Stress in Wistar Rats.

BACKGROUND: Cisplatin is an anti-cancer drug that causes nephrotoxicity and oxidative stress. Extracts of Nigella sativa is nephroprotective. Vitamin E is also a potent antioxidant. This study sought to determine a possible synergistic effect of administering the two agents prior to cisplatin use on nephrotoxicity and oxidative stress. METHODS: 48 male Wistar rats were randomly divided into 6 groups of 8 rats each. Group I served as the control. Group II received cisplatin without any treatment for 6 days. Groups III, IV, V and VI received 100 mg/kg Nigella sativa (NS), 200 mg/kg NS, 100 mg/kg Vitamin E and 200 mg/kg NS+100 mg/kg Vitamin E respectively for 5 days prior to 6 days administration of cisplatin. On the last day of the experiment, all the animals were sacrificed and serum samples collected for analysis. RESULTS: Cisplatin administration caused a significant increase in creatinine level (p<0.01), urea level (p<0.01), sodium concentration and malondialdehyde level (p<0.001). Pre-administration with NS caused a significant reduction in creatinine level (p<0.001), urea level (p<0.001), sodium concentration (p<0.001) and malondialdehyde (p<0.01) level. Pre-administration with vitamin E caused a significant reduction in creatinine level (p<0.001), urea level (p<0.01), sodium concentration (p<0.001) and malondialdehyde level. They both also caused a significant increase in superoxide dismutase, reduced glutathione and catalase (CAT) levels. The combination of NS and vitamin E however did not show significant synergistic effects. CONCLUSION: These results suggest that even though pre-administration of the two agents protect against renal toxicity and oxidative stress, the effects are however not collaborative.

Adverse reactions to fluoroquinolones in the Nigerian population: an audit of reports submitted to the National Pharmacovigilance Centre from 2004 to 2016.

Adverse drug reactions (ADRs) recorded in national pharmacovigilance databases in developed countries have been analyzed. However, adverse reactions to fluoroquinolones were observed globally despite their wide use and safety concerns. We provided information on the pattern of adverse reactions to fluoroquinolones reported spontaneously to the National Pharmacovigilance Centre (NPC), Nigeria. ADRs to fluoroquinolones reported to the NPC, over a period of 12 years, were analyzed. Evaluation was done for annual reports, age and gender of patients, type of reporter, suspected fluoroquinolones and adverse reactions, onset and outcome of ADRs, and causality. A total of 18527 ADR reports were received by the NPC. Antibiotics accounted for 1371(7.4%) of the total reports and fluoroquinolones accounted for 256 (18.7%) cases. A total of 540 ADRs due to fluoroquinolones was experienced by the patients. Multiple ADRs were experienced by 165 (65%) patients. Norfloxacin (2; 0.8%), moxifloxacin (3; 1.2%), ofloxacin (10; 3.9%), ciprofloxacin (112; 43.8%), and levofloxacin (129; 50.4%) were responsible for the ADRs. Neurological disorders (121; 22.4%), gastrointestinal disorders (118; 21.9%), and skin-appendage disorders (116; 21.5%) were the most reported ADRs, while pruritus (41; 7.6%), abdominal pain (34; 6.3%), vomiting (34; 6.3%), and skin rash (27; 5.0%) were the most frequently reported specific ADRs. Thirty-four (6.4%) patients experienced serious ADRs. Fluoroquinolones accounted for a small but significant proportion of ADRs spontaneously reported to the NPC in Nigeria. Ciprofloxacin and levofloxacin were the two most culpable fluoroquinolones due to their inappropriate use or increased use in multi-drug resistant tuberculosis (MDR-TB) treatment.

Medication errors among health professionals in Nigeria: A national survey.

BACKGROUND: Medication errors are preventable causes of patient harm with significant contributions to adverse drug events but they remain understudied in Nigeria. OBJECTIVES: To estimate the prevalence of self-reported medication errors among health professionals and examine their knowledge of medication errors with the hope of identifying appropriate measures to promote medication safety. METHODS: A cross sectional survey among doctors, pharmacists and nurses in 10 tertiary hospitals. Information was obtained using a self-administered structured questionnaire. Correct responses evaluating the knowledge of prescription, dispensing and administration errors were scored one mark each and the composite scores computed. Appropriate statistics were applied to summarize and establish the relationship between variables at 5% level of significance using SPSS 17.0. RESULTS: A total of 2,386 professionals participated in the study (46.3% nurses, 44.9% doctors, 8.8% pharmacists).The prevalence of self-reported medication errors was 47%.The professional groups differ in their knowledge of all the aspects of medication errors with professional cadres influencing knowledge.Overwork was the most reason for being error prone (59.2%) and only 35.5% had ever reported medication error. 33.4% did not think reporting was necessary. CONCLUSIONS: The prevalence of medication errors is high among health care professionals in Nigeria. Knowledge gaps and practice deficiencies were identified requiring interventions.

Antinociceptive and anti-arthritic properties of hydroethanolic leaf extract of Clausena anisata (Willd.) Hook. f. ex Benth (Rutaceae) in Rodents: possible mechanism of actions.

The leaves of Clausena anisata (Willd.) Hook. f. ex Benth (Rutaceae) is used in Traditional African medicine for the treatment of various ailments including arthritis. The present study sought to investigate the antinociceptive and anti-arthritic properties of hydroethanolic leaf extract of Clausena anisata (HeCA). HeCA (100, 200 or 400 mg/kg, p.o.) was administered 1 h before intraplantar injection of formalin 1%v/v in saline to evaluate antinociceptive effect. Moreover, its possible mechanism of antinociceptive action was investigated through pretreatment of mice with antagonists of receptors implicated in nociception. Anti¬inflammatory effect of the extract was investigated using the carrageenan-induced paw oedema and complete Freund's adjuvant (CFA)-induced arthritis models in rats. HeCA (400 mg/kg) treatment significantly reduced the duration of paw licking/biting during both in the early (42.12%) and late (75.79%) phases of formalin-induced nociception. However, the antinociceptive effect elicited by HeCA was reverse by pretreatment of mice with naloxone, prazosin, yohimbine, ketanserin, L-arginine, and parachlorophenylalanine (PCPA). HeCA produced dose-dependent and time course decrease in carrageenan-induced paw oedema. Pre- and post-treatment of rats with HeCA ameliorated CFA-induced arthritis evidenced in the significant decrease in arthritic index comparatively similar to the effect of celecoxib. CFA- induced oxidative and nitrosative stress were attenuated by subchronic treatment with HeCA. Findings from this study shows that C. anisata possesses antinociceptive activity through possible interaction with opioidergic, noradrenergic, L-arginine-nitric oxide and serotonergic pathways as well as anti-arthritic property which could be attributed to its ability to prevent the release of inflammatory mediators and oxidative stress.

Analgesic and anti-inflammatory actions of Alafia barteri: Involvement of monoaminergic, nitrergic and opioidergic pathway.

BACKGROUND: We have earlier reported the antinociceptive and anti-inflammatory effects of Alafia barteri Oliver (Apocynaceae) in rodents but its mechanism of actionsare yet to be elucidated. OBJECTIVE: This study sought toinvestigate the involvement of monoaminergic, nitric oxide-cyclic GMP-K+ channel and opioidergic pathways in its mechanism of actions. METHODS: methanol root extract of Alafia barteri (ALA) (100-400 mg/kg, p.o.) was given 1 h before administration of chemical or thermal-induced nociception andhistamine/serotonin-induced inflammation. The mechanism of the antinociceptive effect was investigated through intraperitoneal injection of prazosin (62.5 pg/kg; alpha1-adrenoceptor antagonist), yohimbine (1 mg/kg; alpha2 adrenoceptor antagonist) N(G)-nitro-L-arginine (L-NNA) (20 mg/kg; nitric-oxide-synthase inhibitor), c y p r o h e p t a d i n e (10 mg/kg; 5-HT2R antagonist), glibenclamide (10 mg/kg; ATP-sensitive K+ -channel inhibitor), or naloxone (5 mg/kg; opioid-receptor antagonist) before the nociceptive models. RESULTS: ALA(100-400 mg/kg)treatment produced dose and time dependent (P<0.001; 87.11%)increase in pain threshold in acetic acid-induced-writhing, inhibition of neurogenic (50.96%), and inflammatory (70.02%) phases of formalin test, and 41.75% maximum possible effect (MPE) in tail immersion testat 400 mg/kg in comparison with vehicle-treated control. The antinociceptive-effect was blocked by pretreatmentof mice withprazosin, yohimbine or L-NNA, (P<0.001) in writhing-assay. Similarly, naloxone pretreatment blocked the inhibition of neurogenic- and inflammatory-pain induced by ALA in formalin test. Interestingly, ALA produced dose related time course inhibition (P<0.05) of histamine and serotonin-induced paw inflammation with peak effects (57.89, and 81.82%), respectively, at 400 mg/kg. CONCLUSION: Findings from these studies suggest central and peripheral arralgesic effect of A. barteri through interaction with L-arginine-nitric-oxide pathway, alpha(1/2)-adrenoceptors, and/or, opioidergic pathway, while, the anti-inflammatory effect involves marked inhibition of histamine and serotonin release.

Potential drug-drug interactions in HIV-infected children on antiretroviral therapy in Lagos, Nigeria.

BACKGROUND: Multi-therapy is common in HIV-infected children, and the risk for clinically significant drug interactions (CSDIs) is high. We investigated the prevalence of CSDIs between antiretroviral (ARV) and co-prescribed drugs for children attending a large HIV clinic in Lagos, Nigeria. METHODS: The case files of pediatric patients receiving treatment at the HIV clinic of the Lagos University Teaching Hospital (LUTH), Idi-Araba, between January 2005 and December 2010 were reviewed. The ARV and co-prescribed drug pairs were evaluated for potential interactions using the Liverpool HIV Pharmacology Group website. The potential interactions were rated as A (no known interaction), B (minor/no action needed), C (moderate/monitor therapy), D (major/therapy modification), and X (contraindicated/avoid combination). RESULTS: Of the 310 cases reviewed, 208 (67.1%) patients were at risk of CSDIs. Artemisinin-based combination therapy was prescribed for over one-half of the patients, accounting for 40% of the CSDIs. Excluding this drug class, the prevalence of CSDIs reduced from 67.1% to 18.7% in 58 patients. Most of the CSDIs (579; 97.2%) were moderately significant and frequently involved nevirapine and fluconazole (58; 9.7%), zidovudine and fluconazole (55; 9.2%), zidovudine and rifampicin (35; 5.9%), and nevirapine and prednisolone (31; 5.2%). Age (P=0.392), sex (P=0.783), and moderate (P=0.632) or severe (P=0.755) malnutrition were not associated with risk for CSDIs. CONCLUSION: There is a tendency for CSDIs between ARV and co-prescribed drugs among the group of children evaluated in this study. Measures are necessary to prevent important drug interactions and to manage those that are unavoidable.

Herbal medicines supplied by community pharmacies in Lagos, Nigeria: pharmacists' knowledge.

BACKGROUND: The use of herbal medicines is on the increase globally and they are usually supplied in pharmacies as non-prescription medicines. Pharmacists are, therefore, responsible for educating and informing the consumers about rational use of herbal medicines. OBJECTIVE: To evaluate the knowledge of pharmacists in Lagos, Nigeria with regards to the herbal medicines they supplied by their pharmacies. METHODS: Pharmacists in charge of randomly selected 140 community pharmacies from 20 Local Government Areas in Lagos were required to fill out a self-administered questionnaire. We gathered information on their knowledge of the indications, adverse effects, potential drug-herb interactions and contraindications of the herbal medicines they supply in their pharmacies. RESULTS: Of the 140 questionnaires distributed, 103 (72.9%) participants completed the questionnaire appropriately. The majority (74; 71.8%) of the participants were males and 36-50 years (56; 54.4%). The pharmacies supplied mostly Yoyo cleanser bitters® (101; 98.5%), ginseng (97; 98.5%), Jobelyn® (91; 88.3%), Ciklavit® (68; 66.6%), gingko (66; 64.1%), herbal tea (66; 64.1%), and Aloe vera (57; 55.3%). The pharmacists self-rated their knowledge of herbal medicines mostly as fair (39%) and good (42%), but they exhibited poor knowledge with regards to the indications, contraindications and safety profiles. Seventy participants consulted reference materials such as leaflet insert in the herbal medicines (56%) and internet (20%) before supplying herbal medicines. The information most frequently sought was herb-drug interactions (85%), contraindications (75%) and adverse effects (70%). CONCLUSIONS: Community pharmacists need to be informed about the indications and safety profiles of herbal medicines.

Herbal medicines supplied by community pharmacies in Lagos, Nigeria: pharmacists’ knowledge / Plantas medicinales suministradas por farmacias comunitarias en Lagos, Nigeria: conocimiento de los farmacéuticos

Background: The use of herbal medicines is on the increase globally and they are usually supplied in pharmacies as non-prescription medicines. Pharmacists are, therefore, responsible for educating and informing the consumers about rational use of herbal medicines. Objectives: To evaluate the knowledge of pharmacists in Lagos, Nigeria with regards to the herbal medicines they supplied by their pharmacies. Methods: Pharmacists in charge of randomly selected 140 community pharmacies from 20 Local Government Areas in Lagos were required to fill out a self-administered questionnaire. We gathered information on their knowledge of the indications, adverse effects, potential drug-herb interactions and contraindications of the herbal medicines they supply in their pharmacies. Results: Of the 140 questionnaires distributed, 103 (72.9%) participants completed the questionnaire appropriately. The majority (74; 71.8%) of the participants were males and 36-50 years (56; 54.4%). The pharmacies supplied mostly Yoyo cleanser bitters® (101; 98.5%), ginseng (97; 98.5%), Jobelyn® (91; 88.3%), Ciklavit® (68; 66.6%), gingko (66; 64.1%), herbal tea (66; 64.1%), and Aloe vera (57; 55.3%). The pharmacists selfrated their knowledge of herbal medicines mostly as fair (39%) and good (42%), but they exhibited poor knowledge with regards to the indications, contraindications and safety profiles. Seventy participants consulted reference materials such as leaflet insert in the herbal medicines (56%) and internet (20%) before supplying herbal medicines. The information most frequently sought was herbdrug interactions (85%), contraindications (75%) and adverse effects (70%). Conclusions: Community pharmacists need to be informed about the indications and safety profiles of herbal medicines (AU)

Antecedentes: El uso de plantas medicinales está en aumento en todo el mundo y son vendidas en farmacias comunitarias como medicamentos sin receta. Los farmacéuticos son, por tanto, responsables de educar e informar a los consumidores sobre el uso racional de las plantas medicinales. Objetivos: Evaluar el conocimiento de los farmacéuticos de Lagos, Nigeria sobre las plantas medicinales suministradas en sus farmacias. Métodos: Se pidió a los farmacéuticos encargados de 140 farmacias comunitarias aleatoriamente seleccionadas en las 20 áreas de Gobiernos locales de Lagos que rellenasen un cuestionario autoadministrado. Recogimos información sobre su conocimiento de las indicaciones, efectos adversos, potenciales interacciones planta-medicamento y contraindicaciones de las plantas medicinales que suministraban en sus farmacias. Resultados: De los 140 cuestionarios distribuidos, 103 participantes (72,9%) lo completaron adecuadamente. La mayoría (74; 71,8%) de los participantes eran hombres y tenían entre 36-50 años (56; 54,4%). Las farmacias suministraban en su mayoría Yoyo cleanser bitters® (101; 98,5%), ginseng (97; 98,5%), Jobelyn® (91; 88,3%), Ciklavit® (68; 66,6%), gingko (66; 64,1%), herbal tea (66; 64,1%), and Aloe vera (57; 55,3%). Los farmacéuticos auto-calificaron su conocimiento sobre plantas medicinales mayoritariamente como escaso (39%) y bueno (42%), pero demostraron poco conocimiento en relación a las indicaciones, contraindicaciones y perfiles de seguridad. 70 participantes consultaban materiales de referencia como los prospectos (56%) e Internet (20%) antes de suministrar una planta medicinal. La información vista más frecuentemente fueron las interacciones planta-medicamento (85%), contraindicaciones (75%) y efectos adversos (70%). Conclusiones: Los farmacéuticos comunitarios necesitan más información sobre indicaciones y perfiles de seguridad de las plantas medicinales (AU)

Antinociceptive, anti-inflammatory and antiulcerogenic activities of ethanol root extract of Strophanthus hispidus DC (Apocynaceae).

BACKGROUND: Strophanthus hispidus DC (Apocynaceae) is a medicinal plant widely used in traditional African medicine in the treatment of rheumatic afflictions, ulcer, conjunctivitis, leprosy and skin diseases. This study sought to investigate the antinociceptive, anti-inflammatory and antiulcer properties of the ethanol root extract of S. hispidus. METHODS: Antinociceptive activity was evaluated using acetic acid-induced writhing and formalin tests in mice. The carrageenan- and egg albumin-induced rat paw edema tests were used to investigate the anti-inflammatory actions, whereas the antiulcer activity was investigated using ethanol-, HCl- and pyloric ligation-induced gastric ulcer models in rats. RESULTS: S. hispidus [100-800 mg/kg orally (po)] produced significant (p<0.05) inhibition of writhing reflex with peak effect of 74.13% inhibition observed at 800 mg/kg. Similarly, S. hispidus significantly (p<0.05) attenuated formalin-induced early and late phase of nociception with peak effect of 61.84% and 89.43%, respectively, at 200 mg/kg. S. hispidus (25-800 mg/kg po) caused significant (p<0.05) inhibition of edema development in the carrageenan and egg albumin models with peak effect (93.40% and 90.10% inhibition of edema formation) observed at 50 mg/kg. With respect to antiulcer activity, S. hispidus (100-800 mg/kg) showed potent antiulcer activity with respective peak effects of 96% (ethanol-induced), 99% (HCl-induced) and 70.60% inhibition of ulcer. CONCLUSIONS: The findings in this study suggest that the ethanol root extract of S. hispidus possesses antinociceptive, anti-inflammatory and antiulcerogenic activities. This justifies the use of the extract in folklore medicine for the treatment of ulcer and inflammatory disorders.

Clinically significant interactions between antiretroviral and co-prescribed drugs for HIV-infected children: profiling and comparison of two drug databases.

BACKGROUND: Drug-drug interactions are an important therapeutic challenge among human immunodeficiency virus-infected patients. Early recognition of drug-drug interactions is important, but conflicts do exist among drug compendia on drug interaction information. We aimed to evaluate the consistencies of two drug information resources with regards to the severity rating and categorization of the potential interactions between antiretroviral and co-prescribed drugs. METHODS: We reviewed the case files of human immunodeficiency virus-infected children who were receiving treatment at the human immunodeficiency virus (HIV) clinic of the Lagos University Teaching Hospital, Idi Araba, between January 2005 and December 2010. All of the co-prescribed and antiretroviral drug pairs were screened for potential interactions using the Medscape Drug Interaction Checker and the Monthly Index of Medical Specialties Interaction Checker. Drug-drug interaction (DDI) severity and categorization were rated on a scale of A (no known interaction); B (minor/no action needed); C (moderate/monitor therapy); D (major/therapy modification); and X (contraindicated/avoid combination). RESULTS: A total of 280 patients were at risk of 596 potential DDIs. The databases showed discrepancies, with Medscape database identifying 504 (84.6%) and USA MIMS database identifying 302 (50.7%) potential DDIs. Simultaneous identification of DDIs by both databases occurred for only 275 (46.1%) listed interactions. Both databases have a weak correlation on the severity rating (rs = 0.45; P < 0.001). The most common DDIs identified by the databases were nevirapine and artemisinin-based combination therapy (170; 28.5%), nevirapine and fluconazole (58; 9.7%), and zidovudine and fluconazole (55; 9.2%). There were 272 (45.6%) interaction severity agreements between the databases. CONCLUSION: Discrepancies occurred in DDI listings between Medscape and USA MIMS databases. Health care professionals may need to consult more than one DDI information database to ensure safe concomitant prescribing for HIV patients.

The antiplasmodial effect of the extracts and formulated capsules of Phyllanthus amarus on Plasmodium yoelii infection in mice.

OBJECTIVE: To investigate the antiplasmodial activity of the extracts of Phyllanthus amarus (P. amarus) on Plasmodium yoelii (P. yoelii) (a resistant malaria parasite strain used in animal studies) infection in mice. METHODS: The aqueous and ethanol extracts of the whole plant of Phyllanthus amarus was administered to Swiss albino mice at doses of 200 mg/kg/day, 400 mg/kg/day, 800 mg/kg/day and 1600 mg/kg/day and the prophylactic and chemotherapeutic effect of the extracts against P. yoelii infection in mice was investigated and compared with those of standard antimalaria drugs used in the treatment of malaria parasite infection. Acute toxicity test was carried out in mice to determine the safety of the plant extract when administered orally. RESULTS: The results showed that the extracts demonstrated a dose-dependent prophylactic and chemotherapeutic activity with the aqueous extracts showing slightly higher effect than the ethanol extract. The antiplasmodial effects of the extracts were comparable to the standard prophylactic and chemotherapeutic drugs used in chloroquine resistant Plasmodium infection although the activity depended on the dose of the extract administered. The extracts showed prophylactic effect by significantly delaying the onset of infection with the suppression of 79% at a dose of 1600 mg/kg/day. CONCLUSIONS: The results obtained indicate that the extracts of the whole plant of P. amarus possess repository and chemotherapeutic effects against resistant strains of P. yoelii in Swiss albino mice. The findings justify the use of the extract of P. amarus in traditional medicine practice, for the treatment of malaria infections.