ObjectivesPatients with diabetes are at high risk for polypharmacy (ie, use of multiple medications) for treatment of diabetes, associated comorbidities and other coexisting conditions. This study aims to estimate the prevalence of polypharmacy and factors associated with polypharmacy among adult patients with diabetes.MethodsA cross-sectional retrospective observational study of adults with diabetes, who visited the outpatient clinic of a tertiary teaching hospital in Saudi Arabia, was conducted. Data were extracted from the Electronic Health Record database for a period of 12 months (January–December 2016). Polypharmacy was defined as the cumulative use of five or more medications. Polypharmacy among adults with diabetes was measured by calculating the average number of medications prescribed per patient. A multivariable logistic regression model was used to examine the factors associated with polypharmacy.ResultsA total of 8932 adults with diabetes were included in this study. Of these, nearly 78% had polypharmacy which was more likely among women as compared with men and more likely among older adults (age ≥60 years) as compared with the adults. Also, polypharmacy was two times as likely among patients with coexisting cardiovascular conditions (adjusted OR (AOR)=2.89; 95% CI 2.54 to 3.29), respiratory disease (AOR=2.42; 95% CI 1.92 to 3.03) and mental health conditions (AOR=2.19; 95% CI 1.74 to 2.76), and three times as likely among patients with coexisting musculoskeletal disease (AOR=3.16; 95% CI 2.31 to 4.30) as compared with those without these coexisting chronic conditions categories.ConclusionsPolypharmacy is common among patients with diabetes, with an even higher rate in older adults patients. Healthcare providers can help in detecting polypharmacy and in providing recommendations for simplifying medication regimens and minimising medications to enhance the outcome of diabetes care.

BACKGROUNDDrug shortages are a serious and complex issue in any healthcare system. We conducted this study because the prevalence of drug shortages in Saudi Arabia is largely unknown, while there have been reports of shortages.OBJECTIVETo explore the prevalence and characteristics of drug shortages as well as identify strategies to minimize their impact on patient care and safety in large hospitals.DESIGNQuestionnaire-based cross-sectional study.SETTINGPharmacy departments in secondary and tertiary care hospitals in the city of Riyadh.SUBJECTS AND METHODSPharmacists in ten hospitals, categorized as Ministry of Health [MOH], MOH-affiliated medical cities, and non-MOH, were recruited using convenience sampling. The European Association of Hospital Pharmacists drug shortage questionnaire was administered to survey pharmacists about drug shortages in their hospitals.MAIN OUTCOME MEASURESPercentages of drug class shortages, characteristics, and strategies to minimize impact on patient care and safety across each hospital sector.RESULTSOf 200 pharmacists invited to participate, 120 pharmacists completed the questionnaire (60% response rate). Twenty-four percent were from MOH hospitals, 32% from MOH-affiliated medical cities, and 44% from non-MOH hospitals. A significantly higher percentage of pharmacists from MOH-affiliated medical cities (42.11%) reported encountering drug shortages on a daily basis compared to 13.79% and 15.09% of participants from MOH-hospitals and non-MOH hospitals, respectively (P=.001). The top three drug classes that ≥ 25% of participants reported having shortages of were cardiovascular, antineoplastic, and endocrine drugs. The two most common strategies that were reported to minimize the impact of drug shortages on patient care by more than 70% of participants were informing prescribers and recommending alternative drugs, and alerting hospital staff about the presence of drug shortages using new communication tools.CONCLUSIONSThe relatively high reported rates of drug shortages in some hospitals should encourage health policymakers to address this serious public health problem.LIMITATIONSThe generazibility of the study’s findings were limited by the small sample size, convenience sampling technique, self-reported data, and the fact that only pharmacists were invited to participate.

cancer patients may require higher than usual dosing regimens to ensure optimal therapeutic concentrations, since vancomycin CL and Vd is significantly higher in these patients, a dosing schedule as high as 60 mg/kg/day may be needed for cancer patients.

Background Leukotriene receptor antagonists (LTRAs) are recommended as alternative treatment in patients with mild asthma, but their effect compared with placebo is unclear. Purpose To determine the benefits and harms of LTRAs as monotherapy or in combination with inhaled corticosteroids compared with placebo in adults and adolescents with asthma. Data sources MEDLINE and the Cochrane Central Register of Controlled Trials from inception through June 2015. Study selection Peer-reviewed, English-language, randomized controlled trials in patients with asthma that reported the effect of LTRAs versus placebo on measures of asthma control. Data extraction Three researchers extracted data on the study population, interventions, outcome measures, adverse events, and study methodology were extracted in duplicate. Data synthesis Of 2008 abstracts screened, 50 trials met eligibility criteria. Random-effects meta-analyses and meta-regression were performed. In six trials of LTRA monotherapy, LTRAs reduced the risk of an exacerbation (summary risk ratio [RR] = 0.60, 95% CI 0.44, 0.81). In four trials of LTRA as an add-on to inhaled corticosteroids, the summary RR for exacerbation was 0.80 (95% CI: 0.60, 1.07). LTRAs significantly increased FEV1 either as monotherapy or as add-on to inhaled corticosteroids, whereas FEV1 % predicted was only improved in trials of LTRA monotherapy. Adverse event rates were similar in the intervention and comparator groups. Limitations Variation in definitions and reporting of outcomes, high risk of bias, heterogeneity, and possible selective outcome reporting bias. Conclusions LTRAs as monotherapy improved asthma control compared to placebo. It remains unclear however, which patients with asthma are more likely to respond to treatment with LTRAs.