Stewardship programs aiming at optimizing medication use are a core element of healthcare organizations. It allows for strategic interventions to improve both financial and therapeutic outcomes. The antibiotic and opioid stewardship programs have already been successfully established in several healthcare organizations. In addition to the financial aspect, they have also improved clinical outcomes and minimized harm by reducing antibiotic resistance, opioid use disorders, morbidity, and mortality. Steroids, also known as corticosteroids, are anti-inflammatory medications used to treat a range of conditions. If used inappropriately, they can result in serious and undesirable adverse effects. Steroid stewardship is a rather novel concept that aims to reduce inappropriate prescribing and improve clinical outcomes by creating a careful balance between therapeutic doses vs. doses that may cause adverse effects. The article’s objective is to highlight the need for a comprehensive approach to implement steroid stewardship programs as a multicomponent program involving multidisciplinary teams to identify potential treatment gaps and establish cognitive and practical approaches to overcome them.

Objective: Self-medication prevalence and characteristics during the ongoing pandemic have been assessed and documented in some countries for COVID-19 treatment; little is known of this practice among pharmacy students who are estimated to have higher knowledge of medications and their use. This study aims to assess self-medication prevalence and pattern during COVID-19 pandemic in this population. Materials and Methods: following IRB approval, a descriptive, cross-sectional study was implemented, and a survey link was distributed among pharmacy students enrolled at King Abdulaziz University, from 1/1/2021 to 17/2/2021. Questionnaire items included (1) students’ demographic, (2) self-medication prevalence during the pandemic, (3) medications, vitamins and supplements used (pre and post infection), (4) source of information, and (5) how long they used the medication for. Results: A total of 270 students completed the survey (39.9% response rate). Majority were between 21–23 years of age (63.7%), female (70%), and single (97%). A total of 149 (55.2%) students practiced self-medication during COVID-19 pandemic. Most used supplements were vitamin C (38.9%), followed by multivitamins (22.2%) and vitamin D (18.1%). Most used OTC medication was paracetamol (26.3%) whereas, most prescription medication used was anxiolytics (4.8%), and antibiotics (3.3%). Most relied on personal knowledge for their practice (77.18%) and continued taking the supplement for less than a month (56%). Moreover, 9.3% (n = 25) were tested positive for COVID-19 and self-medicated with: vitamin C 44% (n = 11), zinc 24% (n = 6), and aspirin 12% (n = 3). Conclusion: Although most used supplements and OTC medications during the pandemic; there was a minority who did use prescription medications, such as anxiolytics, antibiotics and antidepressants which raise concerns over their unattended use and mandate awareness of risks associated with these medications.

Background: Middle East respiratory syndrome (MERS) is associated with significant mortality with no approved antiviral therapy. Objectives: The aim of this study was to compare the efficacy and safety of the combination of ribavirin and PEG-interferon α-2a (RIF), oseltamivir, and supportive care (SC) alone in MERS patients. Materials and Methods: Retrospective cohort for all patients admitted to the intensive care unit with severe symptomatic laboratory-confirmed MERS infection between September 2013 and February 2017. Patients were divided into two pairwise comparisons: RIF and oseltamivir combined (antivirals) vs. SC; and RIF vs. oseltamivir. The primary endpoint was 60-day mortality. Secondary endpoints were the requirement for mechanical ventilation (MV) and renal replacement therapy (RRT), and laboratory changes. Results: A total of 113 patients met the study inclusion criteria; 77 received antivirals (47 received RIF and 30 oseltamivir), and 36 SC. The 60-day mortality rate was 36% with antivirals vs. 50% with SC (P = 0.136), and 45% with RIF vs. 23% with oseltamivir (P = 0.092). The MV requirement was 42% with antivirals vs. 65% with SC (P = 0.083), and 54% with RIF vs. 27% with oseltamivir (P = 0.067). The RRT requirement was 29% with antivirals vs. 31% with SC (P = 0.943), and 40% with RIF vs. 14% with oseltamivir (P = 0.019). The median hemoglobin decrease with RIF was 4 g/dL vs. 1 with oseltamivir (P < 0.001); the WBC decrease with RIF was 1.3 vs. 0.2 with oseltamivir (P = 0.007); the blood glucose increase with RIF was 143 mg/dL vs. 89 with oseltamivir (P = 0.036), and the indirect bilirubin increase with RIF was 0.4 mg/dL vs. 0.3 with oseltamivir (P = 0.023). Conclusions: In this study, the use of RIF or oseltamivir in severe MERS infections did not significantly reduce 60-day mortality, nor the requirement for MV or RRT. Furthermore, the subgroup that received oseltamivir had more favorable renal, hepatic, and hematological outcomes than RIF. Larger, prospective, well-designed studies are warranted to confirm these findings.

Objectives: Respiratory tract infections (RTIs) are a significant cause of hospitalization due to morbidity and mortality. The unwise use of antimicrobial agents in RTI management may contribute to the emergence of bacterial resistance. Therefore, we aimed to assess prescription patterns and antibiotic resistance among hospitalized patients with RTIs. Materials and Methods: This retrospective study included patients with any RTI who were hospitalized between 2016 and 2017. Antibiotics prescribed and changes in antibiotic resistance over time were evaluated. Results: The 405 included patients ranged in age from a few months old to over 65 years old. The most common clinical manifestations were fever (98% of patients) and sore throat (57.5%), followed by cough (46.7%) and dyspnea (27.2%). C-reactive protein was elevated in 43%. The most common diagnoses among all the patients were tonsillitis (43.2%), pharyngitis (36%), and pneumonia (23%). The most commonly isolated organisms were Haemophilus influenza (93.2%), Streptococcus pneumoniae (90.9%), Pseudomonas aeruginosa (84.1%), and Klebsiella pneumoniae (84.1%). Amoxicillin/clavulanate was mostly prescribed for upper RTIs, whereas levofloxacin was mostly prescribed for lower RTIs. Amoxicillin/clavulanate was the major antibiotic prescribed for pediatric patients, whereas geriatric patients (≥65 years) were mostly prescribed levofloxacin. No major changes in resistance rates were observed for amoxicillin/clavulanate, levofloxacin, or ciprofloxacin before (in 2015), during the study period (2016–2017), and after the study (2018). Conclusion: Amoxicillin/clavulanate and levofloxacin were the most commonly prescribed antibiotics, but resistance to these antibiotics did not increase over time. However, clinicians should make every attempt to collect cultures from patients with severe RTIs to rule out bacterial involvement.

Background: Hajj pilgrimage is the largest mass gathering worldwide. The Saudi Ministry of Health (MOH) provides free medical services for all pilgrimages. In 2022, MOH incorporated clinical pharmacy services in intensive care units (ICUs) of the sacred rituals hospitals. In addition to their role in ICUs settings, they were involved in other activities related to emergency department admissions as well as conducting several educational services at the hospital level. This study aimed to describe the impact of clinical pharmacy services implementation during the Hajj season and to explore the clinical interventions delivered to ICU patients. Materials and Methods: A multicenter-retrospective, chart-review study including adult critically ill patients (>14 years old) admitted to ICUs of seven sacred rituals hospitals between June 30 and July 14, 2022. Patients were excluded if they were not admitted to the ICU or admitted to an area with no assigned clinical pharmacist. Clinical interventions were categorized based on a modified version of the American Society of Health-System Pharmacists (ASHP) categorization. The study was approved by MOH Central Institutional Review Board (IRB) on September 18, 2022 (Ref. 22-41 E). Results: Clinical pharmacists performed 269 interventions for 82 patients admitted to the ICUs of participating hospitals. Each patient had a median of three interventions (interquartile range 2–5). The most common intervention was the untreated indication (n = 93; 34.5%), followed by dose adjustment (n = 60; 22.3%) and improper drug selection (n = 42; 15.6%). The ICU teams ultimately accepted all interventions. Conclusion: Incorporating clinical pharmacy services into ICU settings during Hajj season optimized patient care. The variety of provided clinical interventions shows the impact of clinical pharmacists’ presence among multidisciplinary teams. Further studies are needed to explore the economic implication of clinical pharmacist services during Hajj.