Pharmacy faculty experiences with student academic entitlement: a multinational study from the Arab world.

Academic Entitlement (AE) is the expectation by students to receive high grades or preferential treatment without significant effort. Exploring AE from faculty perspective has not been investigated in Arab colleges of pharmacy. The aim of this study was to explore experiences and perceptions towards student AE among pharmacy faculty in the Arab World. A cross-sectional, self-administered, anonymous, electronic survey was sent to pharmacy faculty across pharmacy colleges in Arab countries. The survey collected demographic data, an AE measure including 17 items reflecting seven AE components, and faculty perceptions and perceived reasons for AE. A total of 345 responses were collected. The AE level was moderate (46.05 ±7.29), and the highest scores among its components were for customer service expectation (62%) and responsibility avoidance (59%). In multiple linear regression, AE showed positive significant association with faculty in clinical pharmacy departments and those having fewer years of experience. Most common complaints heard by faculty from students were requests to turn in assignments late (90%), while the most common communication issues faculty faced with students were unprofessional verbal communication (58%) and unprofessional messages on social media (57%). Poor admission criteria (40%) and existence of multiple private colleges of pharmacy (37%) were the most common perceived reasons for AE by participating faculty. This study reveals moderate AE experienced by pharmacy faculty in the Arab World, as well as common complaints, communication issues, and AE reasons. In collaboration with other stakeholders, faculty play an important role in indicating expectations from students regarding AE, and research is warranted to check if such interventions reduce AE among pharmacy students.

Factors impacting job satisfaction among pharmacists in the Arab world: A qualitative study.

Purpose: This study was undertaken to investigate in-depth the factors impacting job satisfaction among pharmacists in the Arab world and the challenges they encounter in their career path. The outcome of this study should help the local policymakers to take corrective actions to improve pharmacist's satisfaction and therefore enhance quality of patient care. Method: This qualitative study collected responses of pharmacists from 12 Arab countries, as part of a large quantitative survey. Participants added comments to an optional open-ended question regarding work satisfaction. The Qualtrics Survey Software was used to collect the responses. The survey was distributed from March to May 2021 through multiple online channels for filling. The responses collected were analysed to develop themes. An inductive constructivist approach was used for the conceptual thematic analysis as the methodological orientation. Results: A total of 110 responses/comments were received from the study participants. The two largest practice settings of the participants were from hospitals (44.5%) and community pharmacies (28.2%). Almost 40% of responses came from pharmacists practising in Qatar (21.8%) and UAE (18.1%). The survey data demonstrated several reasons impacting job satisfaction among pharmacists practising in the Arab countries. Underestimation of the pharmacists' role, low salaries, lack of motivation and excessive workload were reported as major contributors to job dissatisfaction. On the other hand, professional commitment and the culture of the work setting were the major contributors to job satisfaction. Conclusions: The study provides valuable insights into the aspects concerning pharmacists' satisfaction in the Arab world. Policymakers and other stakeholders need to act upon aspects of pharmacists' job satisfaction and dissatisfaction to ensure potentially better working environment and patient outcomes.

Influence of medications on fall risk assessment in maintenance hemodialysis patients: A cross-sectional study.

Background: Multiple factors influence the fall risk in end-stage kidney disease. This study aims to investigate how medication factors influence the interpretation of fall risk due to age, gender, and years of dialysis treatment among patients undergoing hemodialysis (HD). Methods: A cross-sectional study was carried out in 2023 using the Johns Hopkins Fall Risk Assessment tool. Participants were recruited from the HD unit at a tertiary care academic medical center in Ajman, UAE. Data were analyzed between different ages, genders, and years on HD categories with or without medication factors. Results: Data were collected and analyzed for 44 patients. The fall risk of the study population assessed with the Kruskal-Wallis test showed no difference between different age groups (P = 0.43) but did show a significant difference when the score of medication factor was removed from the fall risk estimation (P = 0.002). A pairwise analysis showed fall risk score of the age group 46-60 years was differing from the age cohort >60 (P < 0.001). A positive moderate correlation (Spearman's correlation coefficient 0.514 was found, with a P < 0.001) was seen with an increase in age and fall risk only when the medication factor was removed from the fall risk estimation. Results on gender or duration of dialysis were insignificant. Conclusion: Medication factors being a significant contributor to fall risk among the study population was found to mask the fall risk difference between age groups 46-60 years and >60 years. Such influence was not found for gender or duration of dialysis.

Evaluation of the Impact of a Pharmacist-Conducted Hypertension Clinic.

Background: Hypertension can lead to cardiovascular and other health complications. Many hypertensive patients in the community may receive poor care and monitoring due to financial and other concerns. Pharmacists could support patients in improving their health outcomes. This research aims to assess the impact of pharmacist-led hypertensive clinics in a community pharmacy setting. Methods: The study was an interventional exploratory design in a community pharmacy in Dubai, UAE. All eligible patients who consented were enrolled in the study, making it a population-based study. Patients' blood pressure (BP) was measured before starting the intervention and measured monthly for a minimum of 6 months of care. Measuring BP, physician referral for management of hypertension, lifestyle, diet, and medication counseling were the interventions provided by the researcher on a case-to-case basis as needed in each patient encounter. Toward the end of the study, a patient satisfaction survey was conducted. The survey form showed internal consistency, Cronbach's alpha = 0.895. Results: About 30 patients were provided pharmacy services by a pharmacist for 613 months. All patients'' BP were monitored monthly. Patients showed reductions in their systolic and diastolic BP levels with the continued care of the pharmacist. (The mean systolic BP significantly decreased from 155 mmHg (standard deviation (SD) = 14.4, median = 151) at baseline to 128 mmHg (SD = 3.1, median = 129) with a P = 0.001. The mean diastolic BP showed a decrease from 95 mmHg (SD = 8.4, Median = 93) at baseline to 82 mmHg (SD = 1.2, Median = 81) with a P = 0.17. The participants showed a high level of patient satisfaction. Some were willing to pay for the pharmacist's professional service. Conclusion: In conclusion, the study has shown the impact of pharmacist-led antihypertensive clinics in systolic BP control and achieving high patient satisfaction. The study generated insights into participant cooperation with pharmacist services and needs. More research on different outcomes is planned for future studies, including systematic pharmacotherapy work-up, patient medication adherence, and other clinical outcomes in the study population.

Academic Entitlement Among Pharmacy Students in the Arab World: A Multi-National Exploratory Study.

OBJECTIVE: The study's aim was to explore academic entitlement among pharmacy students in different pharmacy colleges in the Arab World and assess associated factors. METHODS: This study design was a cross-sectional survey. Data were collected using a self-administered electronic questionnaire posted across pharmacy college networks in 10 Arab countries (Egypt, Iraq, Jordan, Lebanon, Libya, Oman, Palestine, Qatar, Saudi Arabia, and United Arab Emirates). The electronic survey was administered through Qualtrics Survey Software, and its link was open from January 23, 2022 to May 13, 2022. The multiple linear regression measured the association between different predictors and the academic entitlement. RESULTS: A total of 2386 surveys were received from students studying in 10 different Arab countries. The majority of responding students were male and studying in a Bachelor of pharmacy program. Students reported an agreeable attitude in 4 areas: rewards for efforts, customer orientation, customer service expectation, and general academic entitlement. In accommodation, a neutral attitude was reported, while they reported a disagreeing attitude in the responsibility avoidance domain. In grade haggling, the 3 items of the domain had different attitudes. Only 3 factors had a significant negative association with student entitlement (professionalism, GPA, and year in the study program). CONCLUSION: The academic entitlement scores among pharmacy students in the Arab World were high and had a negative association with professionalism perceptions. This study finding is a call for pharmacy programs to consider the effect of academic entitlement on pharmacy education and to obtain in-depth evidence on its magnitude and associated factors.

Pharmacists' readiness and willingness to vaccinate the public in United Arab Emirates community pharmacies: A cross-sectional study.

Background: Pharmacist-administered vaccination is currently implemented in many countries worldwide. It has contributed to increased vaccine access and vaccine uptake. This observational cross-sectional study assessed community pharmacists' willingness, and readiness to administer vaccines to the public in the United Arab Emirates (UAE) and relate it to national and international policies on vaccination. Methods: This research was an online survey of 24-questions that was made available to community pharmacists via social media and WhatsApp. The survey was open for six weeks (from April to June 2022). Descriptive and inferential analysis was performed. Results: The questionnaire was completed by 374 of 575 (65%) respondents. More than half (64.2%) of the respondents agreed or strongly agreed that pharmacists should be able to vaccinate and 68.4% responded that they were willing to administer vaccines if local regulations allowed them to vaccinate. Most (81.8%) expressed willingness to complete training required to be able to administer vaccines in their pharmacies. Logistic regression showed that pharmacists defined as having high readiness were significantly more willing to undergo all essential training to start a vaccination service in their pharmacies than were pharmacists with poor readiness (OR 2.647; 95% CI: 1.518-4.615; p=0.001). High readiness was also significantly associated with agreement on safety of pharmacy-based vaccination (p=0.027). Conclusions: The majority of community pharmacists surveyed showed readiness to commence pharmacy-based vaccination services. Those with high readiness characteristics are amenable to receiving essential training and consider that vaccination in the community pharmacy setting would be safe.

Impact of an educational flyer and sensitization on performance-enhancement attitudes of bodybuilders in United Arab Emirates.

Background: A high proportion of bodybuilders use supplements to improve performance, with some turning to prohibited substances and methods. The attitudes of bodybuilders towards performance enhancement may be gauged through surveys such as the Performance Enhancement Attitude Scales (PEAS). Educational interventions are recommended as part of anti-doping measures. The objective of this project was to assess the impact of a pharmacy-led intervention using an antidoping educational flyer and the performance enhancement attitude scale to measure the attitude of bodybuilders in the United Arab Emirates (UAE). Methods: The PEAS eight-item short form questionnaire was administered to male bodybuilders in the UAE. The PEAS was conducted before and after administration of an educational flyer concerning the problems associated with supplement use among bodybuilders. The Wilcoxon Signed-Rank and Kruskal Wallis tests were used for data analysis. Results: A total of 218 bodybuilders, who reported taking dietary supplements, filled out the survey both pre and post viewing the antidoping educational flyer. A difference was observed between the full-time professional bodybuilders, students, and part-time bodybuilders with other primary occupations (p-value <0.05). In addition, PEAS score decreased among the study population for all eight PEAS items (p-value <0.05). Conclusions: The pharmacy-led intervention using an antidoping educational flyer and sensitization by PEAS achieved more favorable scores, suggesting a significant shift of opinion toward avoiding use of performance enhancing substances among the bodybuilder study population. More research is required on sustaining the attitude and demonstrating the impact on doping behavior.

Comparison of essential drug list in a rural secondary care hospital in south India with Indian & World Health Organization list 2011.

OBJECTIVE: Fixed drug combinations are a major marketing strategy in India but it can compromise the rational use of medicines. In this study we compared the fixed drug combinations and dosage forms in the hospital pharmacy before and after introducing the essential drug list. We also compared the Hospital Essential Drug List (HEDL) 2011 with the World Health Organization (WHO) Essential Drug List (EDL) 2011 and the National Essential Drug List of India (NEDL) 2011. METHODS: The study was done in a secondary level care charity hospital at Anantapur, AP with a bed size of 315 and an average OP per day of 1200-1700 visits. We compared the three essential drug lists (HEDL, WHOEDL and NEDL) and the hospital drug list before introducing EDL. Drugs which were present in NEDL and not present in the HEDL were also screened. Microsoft excel was used to tabulate the results and for graphs. RESULTS: The number of medicines used in the hospital before and after the introduction of the HEDL was 1627 and 424 respectively. On comparison, WHOEDL 2011 have 350 and NEDL of India have 348 medicines. While preparing the HEDL, 46 double drug combinations decreased to 15 and 9 triple drug combinations decreased to 1. In the case of injections, 20 double drug combinations decreased to 6 and 1 triple drug combination increased to 2. The number of tablets, capsules, injections, syrups, powders and inhalers was reduced to almost half. The great reductions were in 51 ointments to 9, 69 drops to 5, 11 paste to 0, 21 solutions to 3 and 14 creams to 1. The dosage forms removed included elixirs, insulin pens, gums, paste, paints, gargles and mouthwashes. CONCLUSIONS: There was drastic reduction in the number of medicines and dosage forms when the HEDL was implemented. Many of the fixed drug combinations were also removed for improving the rational use of medicines. The WHO essential drug list 2011, national essential drug list of India 2011 and the hospital essential drug list 2011 were comparable with few exceptions.

Standard-Setting for Continuing Education Assessment of Select New Competencies.

INTRODUCTION: Completion of continuing education hours might not guarantee the achievement of new competencies. Influenza vaccination training was provided to pharmacists in the United Arab Emirates (UAE), who had no similar training in their pharmacy degree. The training was developed and conducted at Gulf Medical University, UAE. Influenza vaccine administration is not yet a privilege for pharmacists in the UAE. This study focuses on determining whether a defensible cut score for the influenza vaccination training multiple-choice questions examination is feasible. METHODS: Influenza vaccination training and assessment happened on the same day. The Angoff (modified), Beuk, and Hofstee methods were used for standard-setting. Six subject matter experts who were involved in developing and conducting the first influenza vaccination training in the UAE evaluated the cut score using the Angoff method with the Delphi technique. RESULTS: The criterion-based cut score was 34.23 of 46 questions, with mean 74% and SD 2.24. Inter-rater reliability was 0.92 with standard errors of judgment 0.29 (0.63%). DISCUSSION: The modified Angoff is a credible method to set cut scores, reassured with Beuk and Hofstee methods for assessment of influenza continuing education. It is feasible and perhaps essential to determine a formal cut score for the continuing education assessment of health professionals on select new competencies.

Choice of Antimicrobials in Surgical Prophylaxis - Overuse and Surgical Site Infection Outcomes from a Tertiary-Level Care Hospital.

Background: This study was aimed to describe the choice of Surgical Antimicrobial Prophylaxis at a tertiary-level care hospital in United Arab Emirates. It also associated the choice between two leading antimicrobials for the SAP to the site of surgery. Methods: A descriptive drug use evaluation was performed retrospectively to study choices of antimicrobials in surgical antibiotic prophylaxis. An analytical cross-sectional study design was used to develop a hypothesis regarding the choice of ceftriaxone. Data were collected from the medical records of Hospital from July 2020 to December 2020. Results were presented in numbers and percentages. Results: SAP data were collected from 199 patients, of which 159 were clean or clean-contaminated. Dirty surgeries (18) needed a higher level of antimicrobials as there were infections to be treated. For other surgeries with no infection, overuse of antimicrobials was found regarding the choice of antimicrobials. Surgical antibiotic Prophylaxis was administered within the recommended time prior to surgeries. Ceftriaxone was preferred over cefuroxime in all types of surgeries based on the timing of Surgical Antibiotic Prophylaxis, wound classification, and the surgical site. A statistically significant association for choice of ceftriaxone over cefuroxime was found regarding surgical sites (p-value <0.05). About 99% of the patients were prescribed discharge antimicrobials when 158 (80%) surgeries were clean or clean-contaminated. Conclusion: Overuse of antimicrobials was found in surgical antimicrobial prophylaxis. Ceftriaxone was preferred more than cefuroxime in all types of surgeries. No surgical site infections were reported. A follow-up comparative study is recommended to decrease antimicrobial use without increasing risk of surgical site infection.

Exploring job satisfaction among pharmacy professionals in the Arab world: a multi-country study.

OBJECTIVES: The study objectives were to (1) describe the characteristics of the pharmacy professionals and (2) explore the association between job satisfaction and factors, such as work control, work stress, workload and organization and professional commitments. METHODS: This study was a cross-sectional design. The survey items were mainly adapted from the US National Pharmacist Workforce Survey. An electronic (Qualtrics) questionnaire was posted on pharmacist social media in several Arab countries. The survey link was posted from 22 March 2021 to 1 May 2021. The multiple linear regression measured the association between 12 independent variables and pharmacist job satisfaction. KEY FINDINGS: A total of 2137 usable surveys were received from pharmacists (54.7% female) working in 18 Arabic countries. The job satisfaction rate varied among countries in the Arab world. The fields with the highest satisfaction average included pharmaceutical marketing, academia and the pharmaceutical industry. At the same time, pharmacists working in community pharmacy and Ministry of Health/administrative positions had the lowest satisfaction rates. Overall, pharmacist satisfaction was average (3.1 out of 5). The pharmacists had the lowest satisfaction averages with income and job expectations. The pharmacists with bachelor's degrees had significantly lower satisfaction than pharmacists with postgraduate degrees. Male pharmacists had significantly higher job satisfaction compared with female pharmacists. Workload and the feelings of organization and professional commitments had significant positive associations with job satisfaction. CONCLUSIONS: The pharmacy profession in Arabic countries faced several challenges that negatively impacted job satisfaction. Improving work environment, professional management, income and organization loyalty is necessary to enhance pharmacist job satisfaction.

Shortcoming of Measuring Patient Satisfaction's Association With Anemia-Based Cardiovascular Risk in End-Stage Kidney Disease Patients.

BACKGROUND: Patient-reported humanistic outcomes like patient satisfaction are becoming more important in clinical practice, but their use has limitations. Improvements are needed to better demonstrate how patient satisfaction and clinical outcomes are associated. The objective of the study was to observe the correlation between patient's hemoglobin and patient satisfaction. METHODS: A cross-sectional study was conducted at a University Hospital hemodialysis unit among end-stage kidney disease (ESKD) patients on maintenance hemodialysis in February and March, 2021. During this time period patient satisfaction was measured using an instrument from the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study. Spearman's correlation coefficient was used to find a correlation between patient satisfaction domains and hemoglobin. P value was set at 0.05, and SPSS version 26 was used for the analysis. RESULTS: Out of 41 patients studied, their satisfaction on care by interprofessional staff was 77.3%, information received was 68.8%, and effectiveness of care was 71.3% for "very good" and "excellent" responses combined. Out of 40 patients, hemoglobin levels were lower in 17 (42.5%) and higher in seven (17.5%) patients than the optimal range of 10 - 12 g/dL. Spearman's correlation coefficients were not statistically significant for anemia and any patient satisfaction domain (rs: 0.244, 0.101, 0.048, respectively for the three domains). Spearman's correlation coefficients were high or moderate between patient satisfaction domains; interprofessional staff with information (rs: 0.745, P value < 0.001) and interprofessional staff with the effectiveness of care (rs: 0.619, P value < 0.001). Information domain had a moderate correlation with the effectiveness of care (rs: 0.527, P value < 0.001). CONCLUSIONS: No correlation was observed between patient satisfaction with hemoglobin. Although patient satisfaction among hemodialysis patients was mostly "very good" or "excellent", nearly half of the patients were anemic, and some had higher hemoglobin than the target. Since both of these groups have higher cardiovascular risk this provides an opportunity for the development of patient satisfaction tools with greater sensitivity to awareness of patients' cardiovascular risk.

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.

Neuron Model of Interprofessional Education and Evidence-Based Practice.

Interprofessional education (IPE) and evidence-based practice (EBP) are relatively new concepts in health professions education in many parts of the world. These critical reforms are implemented with great effort. As clinical practice has become more collaborative and evidence-based, teamwork and research need to be well integrated in the curriculum. However, many stakeholders struggle to visualize the work of IPE and EBP in the context of health professions education and practice. The Neuron Model, using parts of the neuron, is designed to detail how IPE and EBP integrate in health professions curriculum design or reveal a hidden curriculum. Evidence-based interprofessional care has been implemented with limitations in academic health systems. Lack of a common understanding of how it works is a limitation. The neuron model thus aims to visualize IPE and EBP in health professions education and practice.

Decentralize-Change-Recentralize Model of Drug Information Networks in Health Centers: Decentralized Drug Information Services.

Large health centers usually decentralize their services to small self-sufficient sub-centers of care delivery. These small centers are part of an extensive network of practitioners who are connected. The drug information services of independent clinical pharmacists in a health center could be fragmented. Drug information centers thus need to have a new definition of the mode of operation. While maintaining autonomy in information exchange, professionals are integrated to form a large community of practitioners. Technological advancements in communication and access to resources enable efficient collaborations to happen. Immersed in patient-centered collaborative practice environments, networks of professionals integrate drug information services. Drug information networks thus hold a similar philosophy of health centers to decentralize-change-centralize its services. Further research is required to measure the impact of this model of drug information services.

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.

Coxibs Refocus Attention on the Cardiovascular Risks of Non-Aspirin NSAIDs.

Non-steroidal anti-inflammatory drugs (NSAIDs) were differentiated from steroidal anti-inflammatory medicines to help clinicians who needed to use anti-inflammatory agents that were safer than steroids. With market entry of rofecoxib in 1999, NSAIDs were then further classified into traditional NSAIDs and cyclooxygenase (COX)-2 inhibitors (coxibs), the latter posing potentially fewer gastrointestinal risks. In 2005, rofecoxib was withdrawn from the market because of concerns about the risk of heart attack and stroke with long-term use, and clinical practice began focusing more on the cardiovascular versus gastrointestinal safety of coxibs. Since then, many coxibs have remained unapproved by the US FDA or have been removed from the market. This article explains how coxibs refocused attention on the cardiovascular safety of NSAIDs and the general implications of that. COX-2 activity/specificity is one factor associated with increased cardiovascular risks; however, these risks cannot be attributed to coxibs alone. The traditional NSAIDs (i.e., meloxicam, etodolac, and nabumetone) have significant COX-2 specificity, but naproxen and ibuprofen have less specificity. All NSAIDs, whether traditional or a coxib, pose some cardiovascular risks. It is possible that clinicians continue to focus more on decreasing the immediate gastric risks than preventing the later cardiovascular risks. The cardiovascular risks posed by NSAIDs should not be disregarded for the sake of achieving gastrointestinal benefits. Current recommendations suggest NSAIDs should be considered a single class of non-aspirin NSAIDs. Preferred NSAIDs are ibuprofen and naproxen. Coxibs are preferred in patients with low cardiovascular risk and high gastrointestinal risk who are intolerant to anti-dyspepsia therapy.

Therapeutic failure of primaquine and need for new medicines in radical cure of Plasmodium vivax.

Primaquine has been the drug of choice for the prevention of Plasmodium vivax relapse for more than 60 years. Primaquine tolerant strain of P. vivax was identified in 1944. Significant mortality and disease burden of P. vivax calls for the need of new drugs. Primaquine resistance is a complex issue, as the mechanism of resistance is not clear. Direct evidence of resistance to primaquine by hypnozoites has not yet been shown. There are some reports detailing risk of primaquine resistance in specific regions, but the overall distribution of primaquine resistance in P. vivax-infected people is largely unknown. Confounding factors contribute to treatment failures; such as inadequate doses, inappropriate dosing intervals, risk of reinfection, combinations with blood schizontocidals, and compliance. Therefore, primaquine resistance needs to be addressed along with additional important confounding factors. Tafenoquine is the most studied drug in replacing primaquine for the radical cure of P. vivax malaria. It has comparable efficacy with primaquine. The potential advantage of tafenoquine is better compliance with a single dose regimen. Rational use of primaquine can secure its effectiveness, but it is essential in the future to have better or similar alternatives to treat P. vivax.