Microbial characterization of biological filters used for drinking water treatment

The impact of preozonation and filter contact time (depth) on microbial communities was examined in drinking water biofilters treating Ohio River water which had undergone conventional treatment (coagulation, flocculation, sedimentation) or solutions of natural organic matter isolated from groundwater (both ozonated and nonozonated). With respect to filter depth, compared to filters treating nonozonated waters, preozonation of treated water led to greater differences in community phospholipid fatty acid (PLFA) profiles, utilization of sole carbon sources (Biolog), and arbitrarily primed PCR fingerprints. PLFA profiles indicated that there was a shift toward anaerobic bacteria in the communities found in the filter treating ozonated water compared to the communities found in the filter treating nonozonated settled water, which had a greater abundance of eukaryotic markers.

Plasma vitamin A levels in measles and malnourished pediatric patients and their implications in therapeutics

Measles and protein energy malnutrition (PEM) in children have been associated with low serum retinol levels. Vitamin A supplementation has reduced mortality and morbidity significantly. The purpose of this study was to determine the effect of vitamin A supplementation on plasma retinol levels in children with these conditions. Black, African children, admitted to Ga-Rankuwa Hospital with measles or PEM, were randomly allocated to either a study or a control group. The study group received, in addition to routine treatment, 150,000 units of vitamin A palmitate IM on day 1 followed by 15,000 units orally for 7 days. The patients in the control group received routine appropriate treatment, which may have included 3000 units vitamin A per day. Retinol plasma concentrations of all patients were measured on days 1, 2, and 8. The mean baseline plasma retinol levels (day 1) of both the measles and PEM patients were lower than 11 micrograms/dl. There was a statistically significant increase in plasma levels in the study and control groups for both conditions by day 8 with the mean plasma retinol levels > 30 micrograms/dl. There was no statistically significant difference between study and control groups. This study has shown that there is a high incidence of baseline hyporetinaemia in these patients. The mean retinol plasma levels return to within normal limits after 8 days of either routine treatment or vitamin A supplementation.

Immunogenicity of recombinant hepatitis B vaccine in urban black children from Ga-Rankuwa, Bophuthatswana, South Africa

Many areas in Southern Africa have a relatively high endemicity for hepatitis B for which the only effective medical measure is vaccination. The aim of this study was to evaluate the antibody response to a recombinant hepatitis B vaccine (Engerix B; Smith Kline-Beecham) in a black urban population, with the use of the recommended regimen and a low dose, short course. One hundred eleven children seronegative for hepatitis B virus (5 to 19 years old) were randomized to receive one of the two vaccination schedules (20 micrograms at zero, 1 and 6 months or 2 micrograms at zero, 1 and 2 months). Antibody to hepatitis B surface antigen was determined 6 to 8 weeks after the last dose by radioimmunoassay (Ausab; Abbott Laboratories). The recommended schedule gave a seroconversion rate of 100% with a geometric mean titer of 585.9 mIU/ml. The low dose, short course schedule produced a seroconversion rate of 63.8% and a geometric mean titer of 73.8 mIU/ml. In the 5- to 9-year-old individuals, however, 71.6% seroconverted (geometric mean titer 114.2 mIU/ml). For cost reasons further investigations on low dose regimens are indicated.

Evaluation of a communications skills workshop for hospital pharmacists

The ability to communicate is an essential requirement for effective practice. Until recently, however, pharmacy students received no training in this area. The resultant inadequacy was carried forward into practice. Only now has the omission been recognized and attempts made to improve the situation among practising pharmacists. We designed an 8-h workshop on communication skills. It covered the basic principles of communication (Workbook A--preparatory work before the workshop) and their application (Workbook B + case studies, exercises and role-playing--during the workshop). The workshop was presented to a group of hospital pharmacists in the Western Cape. At the end of the workshop participants completed a questionnaire on its usefulness, applicability and presentation on a five-point scale. Responses were counted, averaged and analysed by sex and age. Although the ratings were uniformly high (average 4.3 out of a possible 5.0) there were differences between men and women and between older and younger pharmacists. The possible reasons for and implications of these differences are discussed.

Benzodiazepine use in a small community hospital. Appropriate prescribing or not?

Benzodiazepine (BDZ)-prescribing patterns in relation to indications and to drug characteristics in a small short-stay hospital were examined. In a sample of 800 patients, 183 were prescribed BDZs during their stay. Female patients received more BDZs (BDZ:female patients 1.31:1.0) than males (BDZs:male patients 1.02:1.0), particularly in the 21-40-year age group in which polypharmacy was highest. BDZs were classified according to their elimination half-lives. Our data showed that the majority fell into the long-acting (half-life greater than 24 h) (55%) and intermediate-acting (half-life 12-24 h) (20.7%) categories, despite the fact that most indications (pre-anaesthetic and night-time sedation; total 71.6%) called for the shorter-acting drugs. The merits or otherwise of this situation are discussed, and a number of questions put regarding the validity of this approach. Overall, BDZs accounted for 5.8% of the calculated medications given to the 800-patient sample.

Carbamazepine clearance in paediatric epilepsy patients. Influence of body mass, dose, sex and co-medication

Carbamazepine clearance was studied in Black paediatric epilepsy patients, 90 receiving monotherapy and 17 on combination therapy. For patients on monotherapy the following relationship are shown: clearance decreases with increasing body mass (r= 0.87); clearance increases with increasing dose (r = 0.70); and mean clearance for male are higher than those for females throughout the mass ranges, though the difference is not statistically significant. In the case of patients on carbamazepine plus another anticonvulsant, clearance also decreases with increasing body mass, and increases with increasing dose. Furthermore, in the mass groups which corresponded with those on monotherapy, mean carbamazepine clearance higher by a factor varying from 1.3 to 1.7; in the corresponding dosage groups, it is higher by a factor of between 1.4 and 1.7.

Changes in pharmacy practice due to a clinical pharmacy training programme for a group of community hospitals

Education for and the practice of Clinical Pharmacy in South Africa have been neglected. This paper describes one attempt to improve matters. An initial survey of pharmacies, pharmacists and other staff in a small group of private hospitals determined the level of Clinical Pharmacy organization and services. The results were used to design a Clinical Pharmacy (training) Programme for selected pharmacists in the group. The programme consisted of six units, each of which was presented in at least a full-day session, with strong audiovisual support, small group discussion and rigorous exercises. During and after each session, implementation and application in the respective hospitals were monitored, as were participants' reactions. Clinical Pharmacy services increased markedly as a result of the programme, as did job satisfaction and motivation among most of the participating pharmacists.

Drug prescribing for TPN patients at a teaching hospital serving a developing community

Drug prescribing for TPN patients at Ga-Rankuwa Hospital was investigated as part of a larger retrospective survey of TPN products and practices. The medical records of 45 patients who received parenteral nutrition over the period April-August 1985 were examined. Relevant information was transcribed onto survey forms, classified and analysed. The major defined complaints were gastrointestinal (50%) and perinatal (34.5%). Twelve patients had more than one major complaint. Seventy-three per cent of the patients were admitted to paediatric wards and over 24% to (adult) surgical wards. There was one medical patient in the group. The only drug categories that were prescribed in more than 10% of cases were antimicrobial agents (64.9%) and analgesics (10.4%). The most frequently used individual drugs were gentamicin (17.5%), penicillin G (14.3%), piperacillin (17%) and aminophylline (11%). The implications of this pattern of drug use for TPN patient monitoring are discussed.

The effect of a specialist clinic with pharmacist involvement on the management of epilepsy in paediatric patients

At the request of the consultant, a pharmacist attended the paediatric out-patient neurology clinic held at Ga-Rankuwa Hospital, from June 1984. After 6 months of this 'team' approach, its effect on patient care was evaluated. The study consisted of a retrospective survey of approximately 100 patient-visits before and after the establishment of the specialist clinic. Patient medication details and frequency of fits were analysed by a microcomputer. There was an increase in the number of patients seen per session. The results also showed that polypharmacy, dosing frequency and average dose per day were reduced under the new arrangement, whilst disease control, i.e. fit frequency, was no worse. The overall result has been to rationalize and improve anticonvulsant drug therapy at this clinic.

Drug utilization in internal medicine wards at a teaching hospital serving a developing community

Drug utilization, i.e. prescribing, was investigated in four general internal medicine wards at Ga-Rankuwa Hospital, the main teaching hospital for the Medical University of Southern Africa. Survey forms for computer processing were designed to cover important patient parameters (including diagnosis) and to classify drugs into the most frequently used therapeutic groups. There were 154 patients in the survey which took place over a 2-week period in July 1983. Analysis of the diagnosis data showed that cardiovascular disorders (34,4% of the total) and infectious and parasitic diseases (29,2%) predominated. Data for drugs prescribed revealed a preponderance of anti-infective agents (29,7%), diuretics (12,0%), cardiovascular preparations (10,5%) and respiratory medicines (8,1%). The predominant two disease groups and four drug groups were subjected to further analysis. Detailed results which cover specific disease entities and individual drugs are presented. A clear picture of the respective disease patterns and drugs prescribed has emerged. The implications are discussed with reference to the population which the hospital serves, therapeutic needs and medical education.

Treating gonococcal urethritis in men: oral amoxycillin potentiated by clavulanate compared with intramuscular procaine penicillin

In a study of 121 men with uncomplicated gonococcal urethritis, 64 were treated orally with a single dose of 3 g amoxycillin and 250 mg of the specific beta-lactamase inhibitor, clavulanic acid, and 57 with a single intramuscular injection of 2.4 MU procaine penicillin. After seven days, six (9.4%) patients treated with amoxycillin and clavulanic acid were still culture positive for Neisseria gonorrhoeae, compared with 26.3% of those treated with procaine penicillin.

Topical administration of medications in the lungs

A survey has been carried out in Zimbabwe to gain information on pharmacist attitudes and current practice involving patient education in the use of medications for topical administration in the lung. The results of the survey indicated that although there was awareness of patient misuse of the administration devices, most pharmacists did not commonly demonstrate administration techniques to their patients; demonstrations when carried out were predominantly by hospital pharmacists. Few pharmacists were aware of the availability of placebo devices for patient education. Most pharmacists agreed, however, that they would become involved in patient instruction on administration techniques if placebo devices were made available to them. These placebo units, they felt, should be supplied free of charge by the manufacturing companies. Most pharmacists felt that, at present, their patients did not fully understand and were not practising correct administration techniques and therefore required tuition in these matters. The present survey was a pilot study for a larger survey to be carried out in Northern Ireland.

Physical and dissolution characteristics and bio-availability of five brands of digoxin tablets

Five brands of digoxin were investigated and compared for physical and dissolution characteristics and bio-availability. The dissolution characteristics, which are regarded as a measure of bio-availability in the case of digoxin, were investigated with a spectrofluorimeter. Significant differences were found among the five brands. Only one brand met all the various criteria that were investigated.