Evidences regarding the efficacy of different antibiotic regimens proposed for treatment of multidrug-resistant (MDR) Gram-negative pathogens have been reviewed. Available data in Scopus, Medline, EMBASE, the Cochrane central register of controlled trials, and Cochrane database of systematic reviews have been collected. Several antibiotic regimens are proposed for treatment of MDR Gram-negative infections (defined as nonsusceptibility to at least one agent in three or more antimicrobial categories). The most challenging issue is the treatment of carbapenem-resistant (CR) Gram-negative pathogens. A carbapenem plus either colistin or tigecycline was the most effective regimen for treatment of CR Gram-negative pathogens with low-level resistance (minimal inhibitory concentration [MIC] ≤ 8 mg/L). However, in high-level resistance (MIC > 8 mg/L), combination of colistin and tigecycline showed promising effect.

Vitamin D deficiency is common in patients admitted to emergency departments, medical and surgical intensive care units. Positive effects of vitamin D on the immune system through decreasing inflammatory cytokines and increasing natural anti-infective molecules have been reported. Patients with low serum vitamin D concentrations experienced longer hospital stay and were more prone to nosocomial infections, including blood stream and respiratory infections. However, a correlation between vitamin D serum level and patients' mortality is not fully described. Limited studies have assessed effects of vitamin D supplementation on morbidity and mortality in critically ill patients. In the future, well-designed randomized clinical trials should describe the best dose, route and duration of vitamin D supplementation in critically ill patients.

Objective:Medication Therapy Management service (MTMs) has been introduced to improve cooperation among pharmacists and other healthcare professionals in the management of chronic diseases, drug therapy, and patients on polypharmacy. One part of MTMs is detection and resolution of possible drug-related problems (DRPs). Nowadays, numerous DRPs classification systems are available, but due to some defects none of them are currently accepted and implemented universally. The purpose of this study is to design and validate a comprehensive system for classification and documentation of possible DRPs for the Iranian patients.Methods:In this methodological study, four classification systems were studied, and their differences were reviewed, compared. Ultimately, a comprehensive documentation system was developed and tested for validity using experts' opinions.Findings:A comprehensive list of 53 DRPs under eight categories was developed and examined for validity. After collecting the data and validity assessment, questions with content validity ratio of <0.4 and content validity index of <70% were excluded and modified. Finally, with the exclusion and modification of eight DRPs, a modified DRPs list was created.Conclusion:According to the universality and validity assessment and based on consensus of 20 experts, this DRPs list can be used to regulate the standard operation procedure of outpatient clinics in Iran, and could act toward standardization of this service.

There are limited evidences regarding safety and efficacy of continuous intravenous infusion of unfractionated heparin for thromboprophylaxis.

In this article, the most evidenced approaches of unfractionated heparin administration for prevention of venous thromboembolism in medical and surgical hospitalized patients will be reviewed. Present data were collected by searching Scopus, PubMed, MEDLINE, Science direct, Clinical trials and Cochrane database systematic reviews. Subcutaneous low doses of unfractionated heparin (10000-15000 IU) in two or three divided doses per day are commonly administrated for venous thromboembolism prevention in different medical and surgical populations. In some populations such as obese surgical and critically ill patients, due to altered pharmacokinetics behavior of unfractionated heparin, continuous intravenous infusion of the low doses of unfractionated heparin has been proposed.

Background: Mentoring is a learning and training process in which a qualified person with more experience (mentor) consults a person with fewer skills or less experience (mentee). The purpose of this study was to design, implement and evaluate the student mentoring program for entry Pharmacy students of academic year 2019-2020 (as mentees) and to use a website to communicate with students in order to use new methods of communication. Methods: In this project, 2015, 2016 and 2017 entry students were used as mentors. After assessing the needs of senior students, the mentoring program was designed and after revision, mentors and mentees were introduced to each other. Considering the outbreak of Corona virus in the middle of the project, the Pharmacist Assistant website was designed as a virtual learning platform and made accessible to students for keeping the mentoring members in touch with each other. Results: Preliminary results of a needs assessment showed that students prefer being consulted by senior students in the times of challenge. A survey of mentees showed that all mentees were satisfied with participating in the program and recommended its implementation, and almost half of them believed that the web design was successful in educating students during the pandemic. Conclusion: Due to the high satisfaction of the mentees with the mentoring program and their familiarity with the academic challenges before facing them, running mentoring programs can be very functional and helpful in Schools of Pharmacy. In the case of coronavirus pandemic, one way to prevent damage to the mentoring program and to keep the mentor and mentees in touch is to design a virtual platform such as the Pharmacist Assistant website.

Background: Oral medication administration through enteral feeding tubes is a challenging issue in critically ill patients, which can lead to medication error. Patients admitted to the intensive care unit may not have the ability to swallow oral medications for various reasons such as lack of consciousness, or the need for mechanical ventilation. Improving the quality of drug administration through enteral feeding tubes is essential. The present study aimed at evaluation of the prevalence of medication errors that occur during the administration of oral medications through enteral feeding tubes in mechanically ventilated critically ill patients. Methods: This study was a cross-sectional observational study conducted in Golestan Educational Hospital, Ahvaz, Iran. Oral medication administration was evaluated in 50 patients within three months; demographic information, medical records and medicine prescribing information about each patient was examined. The errors were measured according to the Handbook of Drugs Administration via enteral feeding tubes. Results: Errors occurred in percentage of total prescriptions as follows: Drug-drug interaction 26%, wrong preparation 22.3%, incorrect dosage form 12.1%, wrong time error 11.6%, drug-food interaction 6.7%, improper dose error 5.5%, wrong route 3.8%, extra dose 0.9%, omission 0.2%, deteriorated drug 0.2%, and unordered drug 0.0%. In our study, it was found that most of the drugs were administered in solid dosage forms, and almost 33% of them could be substituted for injection or oral liquid formulations. Conclusion: Our study indicated the high frequency of drug preparation errors in mechanically ventilated critically ill patients. Close teamwork between pharmacists or pharmacotherapists, physicians, and nurses can result in the appropriate administration of medications by an enteral feeding tube. J Pharm Care 2019; 7(3): 52-56

We aimed to maximize the clinical response and effectiveness of colistin antibiotics in patients with multi-drug (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria, there is an increasing interest in colistin combination therapy with other antibiotics and extended interval dosing regimens. This systematic review and meta-analysis aim is to evaluate if the combination therapy is superior to monotherapy with colistin regarding increased survival and also which dose interval is the most effective to utilize. English language, peer-reviewed journal publications from the first date available to 25 January 2022 were identified by searching the PubMed and Web of Science databases. Forest plots for overall and subgroups and funnel plots were graphed. 42 studies were included in the study. Among them, 38 studies were on combination therapy, and four on dose interval. The overall pooled odds ratio is 0.77 (CI: 0.62; 0.95) (p value < 0.017). The I^2 value was 43% (p value < 0.01). The Begg correlation test of funnel plot asymmetry showed no significant publication bias (0.064). The overall pooled odds ratio for Carbapenem is 0.74 (CI: 0.48; 1.13). A prospective randomized controlled trials (RCT) on 40 adults intensive care unit (ICU) patients with ventilator-associated pneumonia (VAP), comparing the mortality and ICU length of stay of 8- or 24- hour intervals regimens, showed that the ICU length of stay and ICU mortality were; 31.31, 35.3 days, and 32.06, 22.2% in groups 24-h interval and 8- hour interval (p value: 0.39, 0.87), respectively. It seems that combination therapy is associated with drug synergism and increased survival. The extended interval colistin administration may result in higher peak concentration and bacterial eradication. In both cases, we face a dearth of literature.