Summary Background Therapeutic drug monitoring (TDM) is essential to ensure that aminoglycoside peak concentrations are high enough for effective antimicrobial treatment and trough levels are low enough to minimise toxicity. Inappropriate utilisation of TDM may lead to suboptimal therapy, toxicity and waste of resources. This study aimed to investigate the standard of aminoglycoside TDM performed in adult hospitalised patients. Design An observational, descriptive, cross-sectional study. Setting A 221-bed private hospital. Participants All patients, older than 18 years, on intravenous aminoglycosides for more than 48 hours were included. Interventions None, was observational. A computerised database and patient files were used to obtain the information required for this study. Descriptive statistical analysis was used. Main outcomes measures Aminoglycoside blood levels and estimated glomerular filtration rate (eGFR) in the patients. Results One hundred and three (103) patients were included: 65 on gentamicin and 38 on amikacin. Blood levels were performed in only 19 gentamicin (29.23%) and 22 amikacin (57.89%) patients. Trough levels were taken more than 2 hours before the next dose in 12 gentamicin (63.16%) and 12 amikacin (54.54%) patients. The majority of patients (96.92% on gentamicin and 84.21% on amikacin) received once daily doses. TDM was performed in all patients with an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73m 2 and in 23.31% of gentamicin patients and 56.76% of amikacin patients with an eGFR higher than 60 mg/min/1.73m 2 . Conclusions Incorrect sampling times and unnecessary levels taken in patients with normal renal function indicate a need for aminoglycoside treatment guidelines in the private hospital. Funding None
Background: The efficacy of antiretroviral therapy (ART) is monitored using clinical markers such as viral load (VL) and CD4 counts. Adherence to ART has been associated with viral suppression and improved clinical outcomes.Objectives: To determine the relationship between adherence status with multiple-tablet regimens (MTR) and fixed-dose combination (FDC) regimens, to weight, CD4 count and VL of patients living with HIV.Method: An observational, descriptive study was conducted on a closed cohort of patients living with HIV and attending a primary health care clinic in Northern Cape in South Africa between 01 January 2013 and 31 December 2015. Patients were on an MTR and changed to an FDC regimen. Adherence was measured using the medicine possession ratio (MPR).Results: Statistically significant differences exist between the mean MPR of the 30-day (p = 0.0308) and 28-day supply (p 0.0001) of the MTR when compared to FDC regimen. No statistically significant differences could be found between adherence and clinical outcomes such as weight, CD4 count and VL for either MTR or FDC regimens. The suppressed VL values measured for MTR were n = 299 (89.25%) and n = 415 (93.05%) for FDC regimen.Conclusion: Adherence improved when patients were switched to FDC, but no statistically significant differences in clinical outcomes measured as weight, CD4 count and VL between adherence status and regimen type could be found.Contribution: This study contributes to much-needed information about ART adherence and clinical outcomes (such as weight, CD4 count and VL) of adult HIV-positive patients in a public healthcare clinic in the Northern Cape, South Africa.
Although TDF use has been associated with acceptable safety, reports of rare manifestation of renal disease in HAART regimens that include TDF have been documented. The study was conducted at Paballong HIV/AIDS care centre in Berea, Lesotho. The aim of the study was to evaluate clinical outcomes and renal safety in HIV/AIDS patients taking TDFcontaining HAART regimens. Descriptive, observational, longitudinal retrospective design was followed on 255 adults on TDF-containing HAART regimens at the study area; from October 2015 to March 2016. Data captured on a data collection tool included baseline, follow-up and end-line characteristics of clinical outcomes and renal safety. Patients gained an estimated body weight of to 0.10 kg from baseline (p < 0.05) at any age. Females were on average 2.49 kg heavier than males (p < 0.05). The CD4 cell count results estimated a daily increase of 0.20 cells/mm 3 at any age. The mean CD4 cell count of female patients was 69.13 cells/mm 3 higher than for males (p = 0.02). The eGFR results contended that sex, age and body weight are risk factors to developing renal insufficiency. The eGFR declined by 0.78 ml/min/1.73m 2 over the treatment duration at any age of treatment initiation (p < 0.05), while the average eGFR for females was lower (13.05 ml/min) (p < 0.05). Clinical outcomes manifesting by weight gain and CD4 cell count elevation improve at any age and better in females. The renal function is progressively deteriorated at any age and worsened in females.
The general objective of this study was to investigate the prescribing patterns and cost of antiretroviral (ARV) drugs in the private health care sector in South Africa by using a medicine claims database. <b>Opsomming</b> Die doel van hierdie studie was om die voorskryfpatrone en medisynekoste van antiretrovirale (ARV) geneesmiddels in die private gesondheidsorgsektor in Suid-Afrika te ondersoek. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text
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