L'impact des stratégies de gestion des antimicrobiens sur la pertinence des antibiotiques et les comportements en matière de prescription au Moyen-Orient : analyse systématique RÉSUMÉ La résistance aux antimicrobiens est un problème de santé mondial et la gestion des antimicrobiens constitue une composante essentielle des politiques hospitalières dans le monde. Pourtant, il existe actuellement peu d'informations sur l'efficacité des stratégies de mise en oeuvre au Moyen-Orient. Nous avons passé en revue des études conduites dans la région utilisant différentes stratégies de gestion des antimicrobiens afin d'évaluer la pertinence des antimicrobiens et les comportements en matière de prescription. Une recherche dans Medline, Embase, International Pharmaceutical Abstracts, Google et Google Scholar a été effectuée. Vingt articles répondaient au critère d'inclusion, deux études évaluaient les stratégies incluant des audits prospectifs avec rétro-information, tandis que 18 autres évaluaient des stratégies incluant des analyses comparatives de l'utilisation des antimicrobiens par rapport aux procédures. Les recommandations en matière de mise en oeuvre de la gestion des antimicrobiens au Moyen-Orient soulignaient l'importance de développer et de mettre à jour les politiques locales de prescription des antimicrobiens, et de recourir à des approches interdisciplinaires collaboratives, si l'on veut assurer le succès des programmes. ‫يف‬ ‫ـا‬ ‫وصفهـ‬ ‫ـلوكيات‬ ‫وسـ‬ ‫ـة‬ ‫احليويـ‬ ‫ـادات‬ ‫املضـ‬ ‫ـة‬ ‫مالءمـ‬ ‫ـدى‬ ‫مـ‬ ‫ـى‬

Background: Antibiotic misuse is a worldwide public health problem and has been associated with increased morbidity, length of hospital stay, mortality, healthcare costs, and most importantly antibiotic resistance. Aims: We aimed to evaluate the compliance of antibiotic prescribing with national guidelines, assess how educational interventions can best be utilized to make impact and fill gaps for optimal antibiotic utilization, and to identify facilitators and barriers to implementing ASPs in Qatar. Methods: Six cross-sectional baseline audits of antibiotic prescribing were conducted over a two-week period at a tertiary care teaching hospital. A sub-analysis of prescriptions with follow up has followed. An educational intervention utilizing the PDSA (Plan-Do-Study-Act) tool was implemented to address gaps identified. A repeated audit was done to assess the impact of change. Lastly, interviews were conducted to recognize perceived facilitators and barriers for ASP implementation, identify strategies to overcome barriers, and evaluate the effectiveness of educational interventions. Results: The most common indication for antibiotic prescribing was febrile neutropenia (20.7%). The most frequently used class of antibiotics was carbapenems (21.4%). Sixty percent of prescriptions complied with guidelines. The rationale behind choosing not to adhere to guidelines was not documented in 37.2% of cases. Suboptimal documentation in records was targeted through our intervention. The audit post intervention showed slight improvement in documentation. Facilitators and barriers included: collaboration and communication among teams, compliance with guidelines, interventions documented by clinical pharmacists, and electronic system errors. Conclusions: Effective communication, continuous documentation in records, and repetitive education promote rational antibiotic prescribing and enhance ASPs.

Seizures are common complications for patients with brain tumors. No clear evidence exists regarding the use of antiepileptic agents for prophylactic use yet newer agents are being favoured in many clinical settings. The objective of this systematic review was to determine the efficacy of levetiracetam for preventing seizures in patients with brain tumors. A literature search was completed using the databases PubMed (1948 to December 2015), EMBASE (1980 to December 2015), Cochrane Database of Systematic Reviews, and Google Scholar. Studies were included if they reported seizure frequency data pertaining to levetiracetam use in patients with brain tumors as either monotherapy or as an add on agent. The literature search produced 21 articles (3 randomized controlled trials, seven prospective observational studies, and 11 retrospective observational studies). All studies were found to be at high risk of bias. Overall, studies show levetiracetam decreased seizure frequency in brain tumor patients with or without craniotomy. Safety outcomes were also favourable. As such, levetiracetam appears effective for reducing seizures in patients with brain tumors and may be considered a first-line agent. However, there is an urgent need for more high quality prospective data assessing levetiracetam and other antiepileptic drugs in this population.

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Background: Antimicrobial resistance is a public health issue and is the focus of antimicrobial stewardship (AMS) teams within health care institutions. However, AMS is not comprehensively and fully taught in medical or pharmacy curricula and little is known about the relevance of pharmacist training to meet AMS needs in the Middle East region. We aimed to explore the discord that may exist between infectious diseases education and actual clinical practice with regard to AMS knowledge and training skills in Qatar. Then, we sought to further explore pharmacist perceptions of their AMS roles in hospital environments. Methods: A qualitative study was undertaken at Qatar University using three focus groups consisting of 15 pharmacy alumni who are currently practicing as clinical pharmacists in Qatar. Focus groups were facilitated using a topic guide developed by study investigators. Discussions were audio-recorded and transcribed verbatim. Results were analyzed using framework analysis. Results: Two major themes related to the first objective emerged throughout the discussions and associated recommendations made to improve (i) infectious diseases (ID) module content and delivery and (ii) ID knowledge and skills application. Two themes related to the second objective included (i) impact of pharmacist’s interventions on decision-making and (ii) continuing professional development programming. Conclusion: Our findings guide ongoing efforts to enhance ID content in the curriculum and will close gaps related to AMS training. Pharmacists are core AMS team members where there is an ongoing need to align continuing education for health professionals with realities of practice.