Purpose: To study the prescribing pattern of antibiotics in outpatients and emergency departments in the Gulf region. To compare the appropriateness of prescriptions and antibiotics commonly prescribed for respiratory tract infection.Method: The search was limited to the years 2008–2020, and articles had to be in English. Articles were searched from various resources and evaluated using PRISMA. Forty-one articles were selected and screened, and in the end, 17 articles were included in the study. All articles were selected from the gulf region of six countries: UAE, Saudi Arabia, Qatar, Oman, Yemen, and Bahrain. Only primary literature were included. Inpatient and literature from other countries outside the gulf region were excluded.Result: Penicillins, cephalosporins, and macrolides are highly useful antibiotics for respiratory tract infections. Ceftriaxone IV is recommended in acute respiratory tract infection if therapy with penicillin fails. Most of the antibiotic prescriptions in Gulf countries are inappropriate. Inappropriate antibiotic prescribing in the gulf region varies from place to place and reaches a maximum of 80%. Antibiotics may be prescribed with the wrong dosage or frequency and inappropriate guidelines. Penicillins are prescribed at about 50–60%; the most common penicillins prescribed are amoxicillin and co-amoxiclave. Cephalosporins are prescribed at about 30%, and the most common are third-generation. Macrolides are prescribed at about 17–20%, and the most common macrolides are azithromycin and clarithromycin. Fluoroquinolones are prescribed at about 10–12%, of which levofloxacin and ciprofloxacin are more commonly prescribed with metronidazole at 10%.Conclusion: It is suggested that the antibiotic-prescribing pattern in outpatient and emergency departments in the Gulf region are highly inappropriate and need improvement through education, following guidelines, annual vaccination, and stewardship programs; the most prescribed antibiotic is amoxicillin/co-amoxiclave, and the most often encountered infection in outpatients is acute respiratory tract infection.

Purpose This meta-analysis aims to find out the impact of pharmacists on clinical outcomes of antimicrobial stewardship (AMS). Method Articles were searched and analyzed based on quality assessed through the JSM quality assessment tool to filter articles with a low level of bias. Two thousand three hundred sixty articles were reviewed for initial screening and 28 articles were included for critical analysis. Statistical analysis used to risk ratio (RR) and standard mean differences calculated using Review manager 5.4. Confidence intervals (CI 95%) were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. A random-effect model performed in the case of statistical heterogeneity, subgroup and sensitivity analyses. The primary outcome is mortality and inappropriateness, whereas the secondary outcome is cost, readmission, length of stay, consumption and duration of therapy. Result A detailed review and analysis of 28 AMSs programs led by pharmacists showed low inappropriateness with pharmacist versus without pharmacist RR = 0.36 with 95% CI of (0.32 to 0.39) and mortality RR is 0.68 with 95% CI of 0.59 to 0.79. Secondary outcomes such as consumption, length of stay, duration of therapy and cost are standard mean difference of −1.61 with 95% CI (−1.72 to −1.50), −0.58 with 95% CI (−0.62 to −0.53), −0.95 with 95% CI (−1.01 to −0.89) and −0.99 with 95% CI (−1.12 to −0.86), respectively, whereas for 30 days readmission is RR = 0.81 with 95% CI (0.70 to 0.93). Conclusion AMS with pharmacist effectively reduces mortality, inappropriateness, cost, length of stay, duration of treatment, consumption of antimicrobials and the return rate to hospital. So it is suggested pharmacists should lead or play a vital role in antimicrobial stewardship programs to get better outcomes.

To assess the efficacy of garlic in comparison with pitavastatin in reducing hypercholesteremia. Databases that include PubMed/Medline, Cochrane, TRIP and SCOPUS were searched. All randomised controlled trials selected for the study. Studies comparing garlic with placebo and pitavastatin with either placebo or other drugs were selected to treat hypercholesteremia. Statistical analysis done using a random-effect model, and results expressed in Mean difference and variance for continuous data with 95% confidence intervals (CI). Twelve studies analysed the efficacy of garlic compared to pitavastatin. Total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides assessed for garlic and pitavastatin's comparative efficacy. Mean difference noticed in total cholesterol in garlic arm was -13.604 with 95% CI = -22.246, -4.962 while in pitavastatin group was -28.205 (95% CI = -29.016,-27.394). The LDL-c reduction not recorded in the garlic arm where the mean increase was recorded of 0.309 (95% CI = -12.502, 13.120) while in the pitavastatin group was -35.538 (95% CI = -39.992, -31.084). Similarly, the increase in HDL was more in the pitavastatin group 5.308 (95% CI = 0.906, 9.710 compared to garlic (2.754 with 95% CI = 1.069, 4.440). Triglycerides level reduction was also low in whereas pitavastatin was -24.210 with 95% CI = -29.249, -19.171.The analysis showed that garlic has a significant effect on lipid profile. The comparison profile of garlic with pitavastatin showed clinical application in the treatment of mild-moderate hypercholesteremia—further studies required the investigator to use the combination therapy in controlled trials. Keywords: Allicin, Allium sativum, Dyslipidemia, Garlic, Hypercholesteremia, Hyperlipidemia Pitavastatin