Pharmacy’s role in antimicrobial resistance and stewardshipSubscription
This article summarises the evidence supporting the role of pharmacists and pharmacy teams in antimicrobial stewardship and outlines the impact of their activities.
Community pharmacists' contribution to public health: assessing the global evidence base
In the UK, community pharmacies are more accessible to the general population than general practices. Therefore, government white papers and briefing documents from pharmacy professional bodies have advocated the expansion of the role of community pharmacists, particularly in relation to the provision of services that contribute to disease prevention and health improvement. It is unknown whether the same evidence exists globally for the expansion of these roles. This article attempts ...
Glucose-lowering drugs and cardiovascular risk: how recent outcome trials have informed practice
Although large clinical trials with glucose-lowering drugs have consistently shown beneficial reductions in microvascular complications, their effects on macrovascular complications have been controversial. Interpreting these trials is complicated by substantial differences in their design, the populations studied and data analysis. This article examines how the trials have evolved and how they impact the use of glucose-lowering agents in the routine care of patients with type ...
Optimising the health and wellbeing of older people living with HIV in the United Kingdom Subscription
Care for people with HIV has improved, meaning that more people are living with HIV into older age with normal life expectancy. Therefore, there are various challenges and opportunities facing healthcare professionals when providing care to this changing demographic.
Treatments for neuropathic pain
Neuropathic pain (NP) is a common condition characterised by subjective negative and positive symptoms that range from numbness to debilitating pain. NP can have a significant negative impact on a patient’s quality of life. Pharmacotherapy is typically the first step in treating NP. Guidelines and consensus statements from various organisations around the world appear to be consistent with the classes of medications recommended for both general and specific types of NP, which include ...
Pharmacological treatment options for fibromyalgiaSubscription
Fibromyalgia is a high-impact and prevalent condition. Its clinical features include widespread pain and tenderness — often associated with high levels of poor-quality sleep, fatigue and cognitive dysfunction. The mechanism leading to fibromyalgia development is associated with a change in the sensitivity of the pain-related nervous system, as well as other sensory systems. In turn, emotional distress plays a facilitatory role in this process. Non-pharmacological management focuses ...
Pharmacologic treatment options for children and adolescents with autism spectrum disorderSubscription
Autism spectrum disorder (ASD) is a heterogeneous neuropsychiatric condition that is often associated with severe behavioural challenges that can be as diverse in response to treatment as they are in presentation. While environmental, behavioural, communicative, therapeutic and supportive interventions are critical considerations for any individual with ASD, pharmacologic interventions are often helpful and can be necessary for improving level of functioning and quality ...
Antimicrobial therapies for Gram-positive infectionsSubscription
Gram-positive bacteria are among the most common human pathogens associated with clinical infections, which range from mild skin infections to sepsis. In an era defined by antimicrobial resistance (AMR) and an increasing drive toward delivering patient care via ambulatory pathways, the paradigm for the management of infections is changing. Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), the best known cases of ...
An update on the management of chronic hepatitis B and C infectionSubscription
Chronic hepatitis B and C infection are leading causes of liver-related morbidity and mortality worldwide. Current therapies for chronic hepatitis B virus (HBV) infection consisting of nucleos(t)ide analogues (NA) rarely lead to functional cure. With a better understanding of the HBV lifecycle, novel agents have been developed with the hope of achieving functional cure. The development of direct-acting antivirals (DAAs) for hepatitis C virus (HCV) therapy has led to ...
Safe dispensing in community pharmacies: applying the software, hardware, environment and liveware (SHELL) model
The human aspects of the community pharmacy work system are vulnerable to medication-related errors. Established models of human error can identify actual or potential hazards, and are important in our understanding of the interaction between human and system factors that influence performance. The software, hardware, environment and liveware (SHELL) model, a traditional human factors framework, is used in this article to classify potential sources of error in community ...
Examining the implications of analytical and remote monitoring in pharmacy practiceSubscription
Remote patient monitoring (RPM) incorporates digital technology that collects health data from individuals in one location and electronically transmits secure data to healthcare providers in a different location for review and assessment. This allows healthcare professionals to make recommendations to optimise patient care without the patient having to be in the healthcare setting. With the implementation of RPM, pharmacists can use objective data obtained by remote ...
Ceftazidime-avibactam: a novel cephalosporin/β-lactamase inhibitorSubscription
Over the past decade, infections caused by multidrug-resistant Gram-negative organisms have increased. The limited availability in treatment options for these infections prompted both the UK to create a five-year antimicrobial resistance strategic plan to stimulate the development of new antibiotics, and the Infectious Diseases Society of America to call for ten new antimicrobial agents to be developed by 2020. Ceftazidime-avibactam is a combination of a third-generation ...
Management of patients with inflammatory bowel disease: current and future treatmentsSubscription
Inflammatory bowel disease (IBD) is characterised by chronic inflammation of the gastrointestinal tract and affects patients’ quality of life. Treatment of IBD involves induction and maintenance of remission. Current available therapies include anti-inflammatory aminosalicylates and corticosteroids, immunosuppressive agents, antibiotics and biologic agents. Some patients are not fully responsive to conventional treatment or lose efficacy over time. Recently approved ...
TNFα-inhibitors for ankylosing spondylitis and non-radiographic axial spondyloarthritisSubscription
Spondyloarthropathy refers to a group of articular inflammatory diseases that share common genetic, clinical and radiological features in addition to their association with human leucocyte antigen (HLA)-B27 antigen. The aim of therapeutic management of patients with spondyloarthritis is to improve quality of life, control the symptoms of articular inflammation, prevent the structural damage of joints, and preserve the functional abilities, autonomy and social participation of patients. Although
Establishing the risk related to hormone replacement therapy and cardiovascular disease in womenSubscription
Hormone replacement therapy (HRT) has a profound impact on the cardiovascular system in postmenopausal women, achieved through its effects on metabolic risk factors for coronary heart disease (CHD) and on arterial function. Observational studies have consistently shown an association between postmenopausal HRT use and a reduced incidence of CHD. However, the largest randomised trial initially reported no overall benefit on CHD risk. Subsequent analyses and follow-up of the study have ...
Conventional therapies and emergent precision medicines for cystic fibrosis: challenges and opportunitiesSubscription
Around 27 years ago, the discovery of the cystic fibrosis transmembrane conductance regulator (CFTR) gene – responsible for causing cystic fibrosis (CF) – marked a significant moment in the history of the condition. Despite the early promise of this target for gene therapy, a universally successful treatment has proven elusive in the ensuing years. While clinical trials involving gene therapy continue to make progress, the ‘magic bullet’ remains some way off. Survival continues to ...
Role of coronary drug-eluting stents in current clinical practiceSubscription
Percutaneous coronary intervention (PCI) has continued to evolve, from its origins in balloon angioplasty and bare metal stent (BMS) implantation, to the development and application of contemporary drug-eluting stents (DESs). While first generation DESs significantly decreased risk of in-stent restenosis observed with BMSs, their use was complicated by late and very late stent thrombosis. Second generation DESs have dramatically decreased this risk and the rate of one-year stent thrombosis ...
Cardiovascular side effects of cancer treatmentsSubscription
The cardiovascular side effects of cancer treatments remain a challenge in oncologic care. Patients with cancer and cancer survivors have an increased risk of adverse cardiovascular outcomes, including left ventricular (LV) dysfunction, heart failure (HF) and acute coronary events. The treatments most frequently associated with cardiovascular side effects include anthracyclines, monoclonal antibodies (mAbs) targeting the HER2 pathway, and small molecule tyrosine kinase inhibitors (TKIs), ...
Allergic rhinitis: impact, diagnosis, treatment and managementSubscription
Allergic rhinitis results from an immunological abnormality in which atopic individuals produce immunoglobulin E (IgE) to allergens (e.g. pollen, house dust mites, animal dander and moulds). IgE activates mast cells, which respond by releasing inflammatory mediators. Histamine stimulates the early symptoms, predominately mucus production, nasal itching and sneezing. Leukotrienes and cytokines attract and activate eosinophils to cause allergic inflammation, which is primarily responsible ...
Statins: general safety profile and association with myopathySubscription
Statin therapy has demonstrated remarkable efficacy in reducing mortalities associated with cardiovascular diseases through preventing myocardial infarction and ischaemic stroke. Despite the proven benefits of statins in this context, there are growing concerns among patients and physicians on the safety of short-term and long-term use and their adverse effects, especially muscle toxicity, resulting in non-adherence and withdrawal of the treatment. Reports and publications ...
