Compliance with short-term antibiotic therapy among patients attending primary health centres in Riyadh, Saudi Arabia

Non-compliance results in several undesired consequences. Admissions due to non-compliance have been estimated to account for up to 10.5% of all admissions to hospital. There seems to be very little data about compliance in Saudi Arabia. The present study addressed the problem of non-compliance with short-term antibiotic therapy in patients attending Primary Health Centres (PHC). The data were collected from five different centres selected randomly from the 53 centres in the Riyadh area, Saudi Arabia. A five-part questionnaire was designed and used to collect data. Different parts were required to be completed by patient, doctor, pharmacist and social worker. At the end of the study period 414 questionnaires were suitable for evaluation. Paediatric patients (< 15 years old) constituted 65.9% of the sample. Compliance was noted in 67.8%. Those who missed three doses or less and more than three doses were 22.7% and 9.4% respectively. Factors which appeared to enhance patient compliance were: parental involvement (p < 0.001), unemployment (p < 0.01), absence of psychiatric illness (p < 0.02) and early improvement of symptoms (p < 0.05). Reasons most frequently mentioned by patients for non-compliance were: rapid improvement of symptoms, bitter taste of drug(s), forgetfulness and frequent dosing. These reasons accounted for 73.7% of reasons for non-compliance. Our findings suggest that approximately two thirds of patients were compliant with their medications. It is also worth noting that approximately three quarters of patients were not compliant for reasons which could be minimised or removed by good patient counselling and effective communication with patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of the effects of three haemodialysis membranes on vancomycin disposition

Polysulfone (PSF) and polyacrylonitrile (PAN) were recently introduced haemodialysis (HD) membranes. The effect of each on vancomycin disposition was compared with cuprophan (SCE) in 12 chronic HD patients who received 14 infusions. Vancomycin (1 g) was infused over 1 hour, followed by three 4-hour HD sessions over 5 days, beginning 1 hour after the end of infusion. The intradialytic clearances of vancomycin were 73, 54 and 15 ml/min for PSF, PAN and SCE, respectively. At the end of the third HD session, vancomycin concentration dropped to subtherapeutic level (< 7.5 micrograms/ml) only in patients dialysed with PSF and PAN. The corresponding elimination half-lives (t1/2 beta) were 61, 60 and 86 hours for the three membranes, respectively. According to these findings, vancomycin should be given every three HD sessions for PSF and PAN. The dosage interval should be extended up to every 5 HD sessions for patients on SCE. The peak (mean +/- S.D.) obtained one hour after the end of infusion was 34.2 +/- 11.4 micrograms/ml, which is within the therapeutic range.

Intralesional treatment of cutaneous leishmaniasis with sodium stibogluconate antimony

BACKGROUND

Cutaneous leishmaniasis represents a difficult disease to manage in endemic areas. Systemic treatment is hampered by both expense and compliance. Side effects may play a major role in this aspect as well.

METHODS

The effectiveness of intralesional treatment of leishmaniasis was investigated. Seven hundred and ten patients were treated with injections of sodium stibogluconate intralesionally. The clinical diagnosis was confirmed by demonstrating the parasite in the smears obtained from the lesion. Fine insulin needle was used to infiltrate the lesion with sodium stibogluconate (0.5 to 1.0 mL).

RESULTS

Generally eight injections were sufficient, but some of the complicated lesions needed up to 24 injections. Sixty-two percent of patients were men. The majority of the study population (64%) were children below 15 years of age. The results showed that 72% of lesions healed completely, 23.9% showed some improvement, while 4.1% showed some deterioration. Lesions of the lips, cheeks, chin, and neck healed faster than lesions in other parts of the body. Side effects were mild and limited to pain at the site of the injection and hyperpigmentation in those who were treated by folk medicine.

CONCLUSIONS

Intralesional treatment is as effective as the standard systemic antimonials. It offers a less expensive alternative and a low side effects profile. Our findings confirmed the findings of earlier workers. It is recommended for treatment of cutaneous leishmaniasis in endemic areas.

Experimental treatment of Brucella melitensis infection in sheep with oxytetracycline alone or combined with streptomycin

The efficacy of oxytetracycline (OTC) alone or combined with streptomycin in the treatment of 118 Najdi ewes believed to have been naturally infected with Brucella melitensis, was evaluated by culture of selected tissues and organs at slaughter. Groups of sheep were given 250, 500 or 1,000 mg of OTC intraperitoneally (i/p) daily for six weeks and in the respective groups at necropsy 52, 69 and 100% of sheep were found to be Brucella-free. Treatment with 250 mg OTC (daily for six weeks i/p) combined with 1,000 mg streptomycin (daily for three weeks intramuscularly) increased the percentage of Brucella-free sheep to 82%. When a group of sheep were each inoculated i/p with 1,000 mg of long-acting OTC every three days over a period of six weeks, 75% of them were Brucella-free at necropsy. B. melitensis was isolated from all (24) non-treated (control) sheep. The results showed that long-term treatment with a high dose of OTC alone had succeeded in eliminating B. melitensis from a group of 16 naturally infected sheep.