تقييم حساسية المضادات الحيوية من ضمنها الفوسفومايسين في خليا الزائفة الزنجارية البكتيرية لمرضى التليف الكيسي في مستشفى فلسطيني خلال خمس سنوات

Background: Antipseudomonal agents, like other antibiotics, will develop a resistance when taken continuously for many years. In diseases like cystic fibrosis (CF),the most dangerous pathogen colonizing the lungs is Pseudomonas aeruginosa and antibiotic resistance has a high chance to occur. In Palestine, there is no accurate data about resistance in these bacteria among CF patients. The increased prevalence of multi-drug resistant strains, allergic reactions, nephrotoxicity and other side effects of antibiotic used among patients with CF limits the number of antibiotics available to treat pulmonary exacerbations. Fosfomycin, a unique broad spectrum bactericidal antibiotic, might offer an alternative therapeutic option in such cases. Objectives: The aim of this study was to determine the level and change in the rates of resistance over the years for mostly commonly used antibiotics in Pseudomonal infection in CF patients. In addition, the study evaluated the effect of fosfomycin on this bacteria. Methods: To study antibiotics resistance tested in sputum samples over the past 5 years, a retrospective study was carried out in the Department of Microbiology at Caritas Baby Hospital. Clinical and microbiological data were extracted from medical database for pediatric CF patients. The results were analyzed using Microsoft Excel Software 2010 and Statistical Package for Social Sciences (SPSS) program version 20. In addition, 129Pseudomonas aeruginosa sputum samples from CF patients were tested for fosfomycin sensitivity by using two different methods minimum inhibitor concentration (MIC) and disc diffusion(DD). Results: The sensitivity to commonly used antibiotics in treatment P.aeruginosa infection in CF pediatric patients in Palestine was92.3%, 91.9%, 89.1%, 87.7%, 76.5% and 73.5% for ciprofloxacin, ceftazidime, piperacillin-tazobactam, meropenem, amikacin and gentamicin; respectively. Over the past 5 years, the sensitivity was oscillating slightly with no deterioration in sensitivity toward these antibiotics. The vast majority of patients are from the south of the west bank (70.1%), and also the resistance in this area is higher for all antibiotics. Males are slightly more sensitive than females. Regarding ages, as the age increased, resistance to antibiotics increased. In vitro, due to the lack of susceptibility breakpoint of fosfomycin for P.aeruginosa in CLSI and EUCAST, sensitivity to fosfomycin according to MIC results was determined based on the existing CLSI breakpoints for the Enterobacteriaceae; ≤64 is sensitive. MIC method showed good activity for fosfomycin toward P.aeruginosa isolates from CF patients; nearly 40% sensitive, the most sensitivity was in mucoid type (57.5%). DD method showed a strong correlation with MIC method, Pearson Correlation between MIC and DD 200 μg was -0.889, between MIC and DD 50 μg was -0.768, and also 0.932 between DD 200μg and DD 50μg. Conclusions: In Palestine, the sensitivity to commonly used antibiotics in treatment P.aeruginosa infection in CF pediatric patients was stable, and there was no deterioration in sensitivity toward these antibiotics over the past 5 years. Fosfomycin showed a good sensitivity towards Palestinian P.aeruginosa isolates in CF patients, so it can be considered as a choice in the antibiotics used in treating P.aeruginosa infection (particularly the mucoid type) in CF patients in the future, but it still needs more research. Keywords: Cystic Fibrosis, Pseudomonas Aeruginosa , Fosfomycin, Bacterial Resistance

Knowledge and Adherence to Medications among Palestinian Geriatrics Living with Chronic Diseases in the West Bank and East Jerusalem.

Adequate patient knowledge about medications is essential for appropriate drug taking behavior and patient adherence. This study aims to assess and quantify the level of knowledge and adherence to medications among Palestinian geriatrics living with chronic diseases and to investigate possible associated socio-demographic characteristics.We conducted a cross-sectional study during June 2013 and January 2014 among Palestinian geriatrics ≥ 60 years old living with chronic disease in the West Bank and East Jerusalem. A stratified random sample was selected and a questionnaire-assisted interview was applied for data collection. T-test was applied for bivariate analyzing and one-way ANOVA test was applied for multivariate analyses.A total of 1192 Palestinian geriatrics were studied. The average age was 70.3 (SD = 8.58) years and ranged from 60-110 years. The sample comprised 659 (55.3%) females and 533 (44.7%) males. The global knowledge and global adherence scores were (67.57%) and (89.29%), respectively. Adequate levels of knowledge were 71.4%, and of adherence 75%, which were recorded for 705 (59.1%) and 1088 (91.3%) participants, respectively. Significant higher levels of global knowledge and global adherence were recorded for males, and for participants who hold a Bachelor's degree, those who live on their own, and did physical activity for more than 40 hours/week (p-value < 0.05). Furthermore, workers, participants with a higher monthly income, and non-smokers have a higher knowledge level with (p-value < 0.05). We found positive correlation between participants' global adherence and global knowledge (r = 0.487 and p-value < 0.001). Negative correlation was found between participants' global knowledge and adherence with age (r = -0.236, p-value < 0.001 and r = -0.211 and p-value < 0.001, respectively. Negative correlation between global knowledge and the number of drugs taken (r = -0.130, p-value < 0.001) was predicted.We concluded that patients with a higher level of knowledge are more adherent to their medications and that better understanding of socio-demographic factors has a clear influence on the level of knowledge and adherence to medications and thus contributes to the development of guidelines for treatment and may consequently lead to favourable clinical outcomes and savings of health care costs

Prevalence of chronic diseases in older Palestinian adults and common pharmacological interventions: a cross-sectional study

Background Older people (aged 60 years and older) are more susceptible than younger people to multiple medical disorders and are therefore more frequently exposed to polypharmacy. We investigated prevalence of chronic diseases and medical conditions, medications used, and associated sociodemographic factors among older adults of the Palestinian population.Methods A cross-sectional study was done between June, 2013, and January, 2014. The study population was Palestinians aged 60 years and older living in the West Bank and East Jerusalem. Study participants were selected in a stratified random manner. The sample was selected from all governorates (strata) according to the size of the population of each governate on the basis of census data from the Palestinian Central Bureau of Statistics. The research team visited and interviewed older residents in their houses.Questionnaire items were explained in informal language to participants by the interviewer, to ensure complete understanding, and answers were recorded by the interviewer. Informed written consent was obtained from each participant. The study design and protocols were revised and approved by the Research Ethics Committee at Al-Quds University.Findings 1574 older Palestinian adults were invited to participate, of whom 1192 (76%) enlisted. The mean age was 70·3 years (SD8·58, range 60–110 years). 55% (659 of 1192) were female and 45% (533) were male. The majority (84%; 996) were non-workers or retired; monthly income for 78% of participants (930) was less than 2500 NIS, which falls in the low-income group. More participants (78%; 934) had governmental health insurance than had private insurance (8%; 89) or no insurance (14%; 169). 40 chronic diseases and conditions were reported. The mean number of diseases reported per participant was 2·33 (SD1·68, range 0–11). Cardiovascular, endocrine, and musculoskeletal conditions were the most frequently reported. 66% of participants (787 of 1192) reported at least one cardiovascular condition, 40% (480) at least one endocrine condition, and 32% (385) at least one musculoskeletal condition. The most prevalent cardiovascular condition was hypertension, which affected 54% of participants (647); the most prevalent endocrine condition was diabetes (38·2%, 455); and the most prevalent musculoskeletal condition was arthritis (13·7%, 163). The total number of different types of medication (both prescribed and over-the-counter drugs) was 175. The mean number of medications per participant was 4·54 (SD2·83), and the highest number of different medications being taken by one participant was 17. Commonly prescribed therapeutic agents were aspirin (prescribed to 48% of participants, 575 of 1192), angiotensin-converting-enzyme inhibitors (34%, 403), diuretics (34%, 409), metformin (27%, 323), paracetamol (23%, 270), and protein pump inhibitors (23%, 275).Interpretation The findingsprovide insights into the most prevalent chronic diseases and conditions, as well as the most commonly used medications among older Palestinians. Cardiovascular, endocrine, and musculoskeletal conditions were the most prevalent diseases. Older Palestinians adults are subjected to polypharmacy, which should be assessed whenever they are evaluated for health problems, and drug interactions should be carefully checked. Physicians, pharmacists, health professionals, and health policymakers in Palestine should consider increasing citizens’ health awareness and encourage healthy lifestyles to decrease the incidence of these diseases.In addition, intersectoral cooperation between the governmental and non-governmental organisations will be key in the fight against chronic diseases in older Palestinian adults.Non

Scores of knowledge and adherence measures ranked from highest to lowest score.

<p>*Global adherence and global knowledge were calculated as the average of all adherence and knowledge measures respectively. The cut-off for adequate level of knowledge and adherence is (71.4%) and (75%) respectively.</p><p>Scores of knowledge and adherence measures ranked from highest to lowest score.</p