The prevalence of self-medication with medicines including herbs in urban areas of Khartoum State is high. Self-medication behaviour varies significantly with a number of socio-economic characteristics. Our findings have major public health policy implications for countries like Sudan.

Aims  To develop a systematic generic method of enabling patients to report symptoms which they believe to be due to a particular prescribed drug. Methods  A piloted body system‐based questionnaire was distributed to patients registered with 79 medical practices in Grampian prescribed one of nine recently marketed ‘black triangle’ drugs. These comprised four antidepressants, three antiepileptics and two analgesics. This requested respondents to identify any symptoms experienced over the previous year which they thought could be due to the ‘black triangle’ drug they had used. A sample of medical records was examined to compare symptoms recorded with those reported by patients. A classification system was developed for the study to enable the assessment of symptoms reported for their potential relationship to patients' drug therapy. All symptoms reported were classified, taking into account information provided by patients on their concomitant drugs and diseases. A specialist pharmacist independently re‐classified a sample of the symptoms to validate the process. Results  A 36.3% response rate was obtained (837/2307) with 742 respondents (88.6%) reporting at least one symptom. The median per patient was 6.0 (range 0–71), with almost half (406, 48.5%) reporting fewer than five symptoms. Most symptoms (71.0%) were classified as being probably or possibly related to the drugs studied. Agreement between researcher and specialist on the classification of 75.3% of 716 symptoms was obtained (Kappa=0.563). Responses from patients prescribed antidepressant drugs were more likely to include symptoms potentially caused by these drugs (74.5% of all symptoms reported) than those from patients prescribed analgesics (67.4%) or antiepileptics (65.1%, χ2 = 23.858, d.f. = 2, P < 0.001). Patients reporting large numbers of symptoms were more likely to report some which were classed as unlikely to be an ADR or unattributable (χ2 = 80.587, d.f. = 3, P < 0.001). Of the 742 reporting symptoms in questionnaires, 402 (54.2%) claimed to have reported some or all of these to their doctor. Only 162 (22.6%) of 716 patient‐reported symptoms were documented in the primary care medical records of 103 patients prescribed tramadol or venlafaxine. Conclusions  Respondents were clearly willing to report symptoms, the majority of which were classed as possibly/probably related to the drugs studied. The results suggest that patients do not report all symptoms they suspect to be ADRs to their GP and that GPs do not record all symptoms which may be reported to them. The method could help to identify problems which patients perceive as being related to their drug therapy and contribute to increased ADR reporting.

Respondents appeared receptive to most statements regarding expectations of pharmacists, suggesting that many elements of patient-centred pharmaceutical care could be introduced with the co-operation of physicians. A key to extending the role of pharmacists in Sudan teaching hospitals should involve making pharmacists more accessible to doctors and patients, ideally, supported by an organised program of continuing professional development.

Symptoms were reported by the majority of respondents and for many symptoms the frequency was high. Many patients did not report symptoms they perceived to be adverse effects to their doctor. The results indicate that patient perceptions of potential ADRs are relevant and should be an integral part of a pain management strategy.

Objective: To compare five published nomograms (Thomson guidelines, Mawer nomogram, rule of eights, Hull-Sarubbi table and Dettli method) for calculating the initial gentamicin dosage regimen in a Kuwaiti population. Materials and Methods: Based on measured peak and trough gentamicin concentrations, the elimination rate constant and volume of distribution of gentamicin were calculated for each patient (n = 56), using a modified two-point Sawchuk-Zaske method. The calculated individual set of pharmacokinetic parameters and the initial dose regimen recommended by each of the five methods were used to predict the steady-state peak and trough of gentamicin concentrations. Results: The Thomson guidelines produced consistent results in predicting gentamicin concentrations within the target ranges of peak plus trough, peak only and trough only (63, 75 and 75%, respectively). The Mawer nomogram, Hull-Sarubbi table and Dettli methods achieved similar percentages of patients (46–50%) within the target ranges (5–10 mg · l^–1 for peak and 0.5–2 for trough), whereas empirical dosing and the rule of eights showed the lowest percentages of patients within the peak plus trough target range (25 and 37%, respectively). However, with respect to the underdosing target range (predicted concentration <5 mg · l^–1), the Thomson guidelines showed that 21% of patients were underdosed. Conclusion: The results show that a large number of patients (37–63%) were outside the target ranges in all initial gentamicin dosing methods evaluated in this study. Therefore, serum concentration measurement can be advised to assist in the optimization of gentamicin dose selection.

Objective: To determine the types of devices for self-monitoring of blood pressure available to consumers in Kuwait and the pharmacists’ knowledge and level of information provided to consumers when purchasing such devices.Materials and Methods: It was possible to contact 196 of the 230 eligible pharmacies from five governorates in Kuwait. Ten of these were used to pretest the questionnaire and six declined to participate. Another six did not carry any blood pressure monitoring devices and hence were excluded. Data was then collected from pharmacists at the 174 remaining community pharmacies via face-to-face structured interview of the respondents at their work sites. Results: Of the 174 pharmacists, 173 (99.4%) claimed to offer or provide advice to clients at the time of purchasing devices, 117 (67.1%) of them stating that they did so even if the patients did not ask. Although 147 (84.5%) respondents correctly identified the mercury sphygmomanometer as the most reliable device for measuring blood pressure, less than half (86, 49.4%) claimed to know how to check the accuracy of the devices they sold. Only 25 (14.4%) pharmacists could actually identify the correct procedure for checking the accuracy of the devices and only 25 (14.4%) pharmacists could correctly identify cutoff points for systolic and diastolic blood pressure delineating clinical hypertension. Only 1 pharmacist could correctly name a reference source for blood pressure measurement. Conclusion: There is a need for improvement of community pharmacists’ competence in supporting patients and in providing them with information regarding devices for measuring blood pressure in Kuwait.

Focal points □ A systematic questionnaire was found to be a feasible method of facilitating patients to report symptoms they perceived to be potential adverse effects of drugs □ Although 89 per cent of patients who had taken tramadol and venlafaxine reported at least one symptom in questionnaires, only 58 per cent of these claimed to have reported their symptoms to their doctor □ Only 22 per cent of symptoms reported by a sample of patients were found to be recorded in medical records and only 23 yellow card reports were submitted to the CSM for the same period □ Low reporting rates to GPs and low recording rates would appear to be contributory factors to low rates of reporting to the CSM.

Objective: To report the pharmacokinetics of gentamicin using traditional multiple daily doses and a high-dose regimen in an elderly patient. Clinical Presentation and Intervention:An 80-year-old male who presented with mild renal failure received two different gentamicin dosing regimens, 60 mg every 8 h for septicemia and a high dose of 400 mg with extended interval for suspected endocarditis. Based on population parameters of k_e (0.1030 h^–1) and V_d (18.1 liters), the initial gentamicin dosage regimen was calculated to be 80 mg every 12 h. The measured peak and trough concentrations were used to calculate the individual parameters of k_e (0.0749 h^–1) and V_d (30.9 liters). After a 5-mg·kg^–1 gentamicin dose, the Hartford nomogram was used to estimate the extended dosage interval. Conclusion: The Hartford nomogram may be a valid tool for estimating the dosage interval after a 5-mg·kg^–1 single dose of gentamicin.