S.N. Abdu-Aguye

Bio: S.N. Abdu-Aguye is an academic researcher from Ahmadu Bello University. The author has contributed to research in topics: Medicine & Pharmacy. The author has an hindex of 4, co-authored 12 publications receiving 170 citations.

An assessment of antimicrobial prescribing at a tertiary hospital in north-western Nigeria

Abstract: Background: Inappropriate antibiotic use is a public health problem worldwide. Misuse of these agents is one of the drivers of antimicrobial resistance (AMR), which is believed to be the next pandemic. Consequently, auditing antimicrobial prescription patterns can provide useful information on the scope and extent of this problem. Objective: The aim of this study was to describe outpatient antimicrobial drug prescribing at the National Health Insurance Scheme (NHIS) unit of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methodology: This was a descriptive drug utilization study carried out prospectively during a 2 week period in May 2015. Six objective World Health Organization (WHO) indicators were used to assess the rationality of antimicrobial prescribing at the site. Data collected on antimicrobials included type, route of administration, dose and dosing frequency as well as length of therapy. Average costs (both prescription and antibiotic) were obtained by dividing the total drug costs by the relevant number of drugs. Results: A total of 167 prescriptions were analyzed. The average number of drugs per encounter in the facility was 3.7. Fifty seven percent of antimicrobials were prescribed using their generic names, while the average duration of treatment was 8.9 days. Thirty seven prescriptions (22%) contained more than one prescribed antimicrobial, out of which 7 were potentially pharmacologically antagonistic. Only 21% of the prescriptions had indications in line with the National Standard Treatment Guidelines (STG’s). Average cost of prescribed antimicrobials was about NGN 2,238 (approximately US$11). Conclusion: Several problems associated with rational antimicrobial prescribing were identified. There is a definite need for suitable interventions to help improve antimicrobial drug prescribing at the site. Keywords: Anti-infective agents, Costs, Drug use review, National Health Insurance, Nigeria

Behavioural studies on the methanol leaf extract of Securinega virosa (Euphorbiaceae) in mice

Abstract: Securinega virosa is used traditionally in the West African region as sedative in children and in mental illnesses. In this study, the behavioural effects of the methanol leaf extract of S. virosa were investigated in mice at doses of 25, 50 and 100 mg/kg, using diazepam-induced sleeping time, hole board and beam walking assay, all in mice. The results revealed that the extract at the highest dose tested (100 mg/kg) significantly (p ≤ 0.001) prolonged the duration of diazepam-induced sleep without any effect on the latency to sleep at all the doses tested. The extract did not have any effect on the exploratory behaviour of mice in the hole board test; it also had no effect on the motor coordination of the mice in the beam walking assay. The intraperitoneal LD50 was found to be 1265 mg/kg while the preliminary phytochemical screening of the extract revealed the presence of alkaloids, tannins, saponins and flavonoids. These results suggest that the methanol leaf extract of S. virosa contains biologically active principles that are sedative in nature.

Management of musculoskeletal pain in retail drug outlets within a Nigerian community: a descriptive study

Abstract: Objective : This work aimed to describe attitudes and practices of both community pharmacies and patent and proprietary medicine vendor (PPMV) outlets towards over-the-counter (OTC) analgesic use for musculoskeletal pain states within Zaria, Nigeria. Methods : The study was carried out in 2 phases from May to August 2016. Phase one was a cross-sectional survey of 40 retail drug outlets (10 community pharmacies and 30 PPMVs). A simulated patient scenario of a young adult male complaining of acute onset back pain was used to collect data on the type and quality of analgesic recommended, duration of consultation, as well as nature of information provided during the drug dispensing process. The second phase involved semi structured interviews with 7 drug vendors (4 pharmacists and 3 patent medicine vendors). The interviewees were asked questions to assess their knowledge of analgesics as well as what type of analgesic they would recommend in three hypothetical patient scenarios. Results : A wide variety of therapeutic agents were recommended for the simulated patient. Majority of these drugs were oral analgesics and contained NSAIDS either alone or in combination. Less than half of both patent medicine outlets and pharmacies (26.7% and 40% respectively) provided the simulated patient with information on duration of therapy, and asked the patient questions about their past medical and medication history (30% and 33.3% respectively). All analgesics purchased from the pharmacies were registered with the Nigerian drug regulatory agency and had expiry dates compared to only 66.7% and 90% of those bought from patent medicine outlets. Interviewed drug vendors admitted to obtaining a large amount of their knowledge on analgesics from drug information leaflets and prior learning. They also showed some knowledge deficits when questioned on side effects of analgesics and appropriate drug selection in the hypothetical scenarios. Conclusions : There are problems with both the OTC analgesics recommended, and the counselling provided for these medicines by drug vendors within the Zaria community. While both pharmacies and patent medicine outlets had shortcomings in several of the areas assessed by the simulated patient, the pharmacies performed better.

Availability and rationality of fixed dose combinations available in Kaduna, Nigeria

Abstract: Background: Fixed-dose drug combinations (FDCs), are combinations of two or more active drugs in a single dosage form. Despite the advantages obtained from the use of these agents, there is increasing evidence questioning the rationality of several FDCs found in pharmaceutical markets-especially those in developing countries like Nigeria. Objectives: To describe the availability of FDCs in drug retailing outlets located in Kaduna Nigeria, and to assess FDC registration status and inclusion on national and international essential medicines lists (EMLs). Rationality of selected FDCs was also assessed. Methods: A cross-sectional survey was carried out from June to September 2018 in 60 registered pharmacies and patent medicine shops selected through multi-stage sampling. A data collection form was used to obtain information on the generic names and strengths of the active ingredients of the FDCs, their country of manufacture and evidence of registration with the Nigerian drug regulatory agency. To assess rationality, a scoring rubric developed from earlier studies was used. Data collected was coded and entered into a Microsoft excel 2016 spreadsheet for analysis. Descriptive statistics (frequencies and percentages) were used to report the data collected. Results: FDCs encountered included 74 oral tablets/capsules, 52 oral liquids and 23 topical semi solids. Majority of the available FDCs were registered by Nigerian drug regulatory agency (91.5%), although only 8.5% and 6.5% in total were included on the Nigerian EML and the WHO model list respectively. Of the 99 FDCs assessed for rationality, 58 (58.6%) were found to be rational. Irrational FDCs included drugs acting on the respiratory tract (29.3%), analgesics (26.8%) and anti-infectives (22%). Conclusions: A wide variety of FDCs were available in the study area, even though not all of them were rational. There is an urgent need for policy makers within the country to develop better detailed guidelines for FDC registration.

European Position Paper on Rhinosinusitis and Nasal Polyps 2020

Abstract: The European Position Paper on Rhinosinusitis and Nasal Polyps 2020 is the update of similar evidence based position papers published in 2005 and 2007 and 2012. The core objective of the EPOS2020 guideline is to provide revised, up-to-date and clear evidence-based recommendations and integrated care pathways in ARS and CRS. EPOS2020 provides an update on the literature published and studies undertaken in the eight years since the EPOS2012 position paper was published and addresses areas not extensively covered in EPOS2012 such as paediatric CRS and sinus surgery. EPOS2020 also involves new stakeholders, including pharmacists and patients, and addresses new target users who have become more involved in the management and treatment of rhinosinusitis since the publication of the last EPOS document, including pharmacists, nurses, specialised care givers and indeed patients themselves, who employ increasing self-management of their condition using over the counter treatments. The document provides suggestions for future research in this area and offers updated guidance for definitions and outcome measurements in research in different settings. EPOS2020 contains chapters on definitions and classification where we have defined a large number of terms and indicated preferred terms. A new classification of CRS into primary and secondary CRS and further division into localized and diffuse disease, based on anatomic distribution is proposed. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, allergic rhinitis, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. All available evidence for the management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is systematically reviewed and integrated care pathways based on the evidence are proposed. Despite considerable increases in the amount of quality publications in recent years, a large number of practical clinical questions remain. It was agreed that the best way to address these was to conduct a Delphi exercise . The results have been integrated into the respective sections. Last but not least, advice for patients and pharmacists and a new list of research needs are included. The full document can be downloaded for free on the website of this journal: http://www.rhinologyjournal.com.

Defining and combating antibiotic resistance from One Health and Global Health perspectives

Abstract: Several interconnected human, animal and environmental habitats can contribute to the emergence, evolution and spread of antibiotic resistance, and the health of these contiguous habitats (the focus of the One Health approach) may represent a risk to human health. Additionally, the expansion of resistant clones and antibiotic resistance determinants among human-associated, animal-associated and environmental microbiomes have the potential to alter bacterial population genetics at local and global levels, thereby modifying the structure, and eventually the productivity, of microbiomes where antibiotic-resistant bacteria can expand. Conversely, any change in these habitats (including pollution by antibiotics or by antibiotic-resistant organisms) may influence the structures of their associated bacterial populations, which might affect the spread of antibiotic resistance to, and among, the above-mentioned microbiomes. Besides local transmission among connected habitats-the focus of studies under the One Health concept-the transmission of resistant microorganisms might occur on a broader (even worldwide) scale, requiring coordinated Global Health actions. This Review provides updated information on the elements involved in the evolution and spread of antibiotic resistance at local and global levels, and proposes studies to be performed and strategies to be followed that may help reduce the burden of antibiotic resistance as well as its impact on human and planetary health.

Pharmaceutical pollution of the world’s rivers

Abstract: Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.

A New Era of Antibiotics: The Clinical Potential of Antimicrobial Peptides.

Abstract: Antimicrobial resistance is a multifaceted crisis, imposing a serious threat to global health. The traditional antibiotic pipeline has been exhausted, prompting research into alternate antimicrobial strategies. Inspired by nature, antimicrobial peptides are rapidly gaining attention for their clinical potential as they present distinct advantages over traditional antibiotics. Antimicrobial peptides are found in all forms of life and demonstrate a pivotal role in the innate immune system. Many antimicrobial peptides are evolutionarily conserved, with limited propensity for resistance. Additionally, chemical modifications to the peptide backbone can be used to improve biological activity and stability and reduce toxicity. This review details the therapeutic potential of peptide-based antimicrobials, as well as the challenges needed to overcome in order for clinical translation. We explore the proposed mechanisms of activity, design of synthetic biomimics, and how this novel class of antimicrobial compound may address the need for effective antibiotics. Finally, we discuss commercially available peptide-based antimicrobials and antimicrobial peptides in clinical trials.