Prevalence and pattern of prescription errors in a Nigerian kidney hospital

Objectives: To determine (i) the prevalence and pattern of prescription errors in our Centre and, (ii) appraise pharmacists’ intervention and correction of identified prescription errors.Design: A descriptive, single blinded cross-sectional study.Setting: Kidney Care Centre is a public Specialist hospital. The monthly patient load averages 60 General Outpatient cases and 17.4 in-patients.Participants: A total of 31 medical doctors (comprising of 2 Consultant Nephrologists, 15 Medical Officers, 14 House Officers), 40 nurses and 24 ward assistants participated in the study. One pharmacist runs the daily call schedule. Prescribers were blinded to the study. Prescriptions containing only galenicals were excluded.Interventions: An error detection mechanism was set up to identify and correct prescription errors. Life-threatening prescriptions were discussed with the Quality Assurance Team of the Centre who conveyed such errors to the prescriber without revealing the on-going study.Main outcome measures: Prevalence of prescription errors, pattern of prescription errors, pharmacist’s intervention.Results: A total of 2,660 (75.0%) combined prescription errors were found to have one form of error or the other; illegitimacy 1,388 (52.18%), omission 1,221(45.90%), wrong dose 51(1.92%) and no error of style was detected. Life-threatening errors were low (1.1-2.2%). Errors were found more commonly among junior doctors and nonmedical doctors. Only 56 (1.6%) of the errors were detected and corrected during the process of dispensing.Conclusion: Prescription errors related to illegitimacy and omissions were highly prevalent. There is a need to improve on patient-to-healthcare giver ratio. A medication quality assurance unit is needed in our hospitals.Funding: No financial support was received by any of the authors for this study.Keywords: Doctors, drugs, hospitals, Nigeria, prescription errors

Susceptibility patterns of Escherichia coli and streptococcal isolates from bovine mastitis cases to antibiotics and selected South African plant extracts with known antibacterial activities

Bovine mastitis, an inflammatory condition affecting the mammary glands of dairy cattle, poses a significant economic burden on the dairy industry. Staphylococcus species, Streptococcus species and Escherichia coli are common pathogens. Managing mastitis typically involves antibiotics, but antimicrobial resistance (AMR) is a growing concern, promoting further research exploring alternative treatments including plant extracts. This study aimed to determine the antibiotic resistance of E. coli and streptococcal isolates from mastitis cases, and to investigate four indigenous South African plants for their selective antibacterial activities against these pathogens. The antimicrobial susceptibility of the bacterial strains was determined using a standard disc diffusion method. Minimum inhibitory concentration (MIC) values of acetone and ethanol extracts of Searsia lancea, Indigofera frutescens, Erythrina caffra and Antidesma venosum were determined against the bacterial isolates using a serial microdilution assay, and cytotoxicity was also investigated. The results showed that 82.14% of the clinical isolates tested were resistant to at least one antimicrobial agent used, and 52.17% of the antibiotic resistant isolates were multidrug resistant. All plant extracts had antibacterial activity against all the bacterial isolates, but S. lancea demonstrated higher efficacy compared to other plants. The MIC values ranged from 0.01 to 2.50 mg/mL, with the lowest range obtained with the acetone extract of S. lancea (0.01 to 0.57 mg/mL). Furthermore, the extracts were relatively non-cytotoxic to bovine dermis and Vero cells, with the highest mean selectivity index value of 25.70 recorded with S. lancea. This study highlights the growing concern of AMR in livestock management, and demonstrates the promising therapeutic potential of the selected plant species, particularly S. lancea, in treating bovine mastitis. Further exploration of S. lancea is recommended to develop novel alternative or complementary formulations for mastitis management.The National Research Foundation and the University of Pretoria for providing a PhD scholarship.http://www.elsevier.com/locate/sajbhj2024Paraclinical SciencesProduction Animal StudiesSDG-03:Good heatlh and well-bein

In vitro antibiofilm and quorum sensing inhibition activities of selected South African plants with efficacy against bovine mastitis pathogens

Bovine mastitis is a critical pathology in global dairy herds, causing economic losses due to decreased production and increased culling. The continuous use of conventional antibiotics has led to antimicrobial resistance and treatment failures. The ability of mastitis bacteria to form biofilms is associated with resistance, while quorum sensing plays a vital role in biofilm formation. This complex interplay between quorum sensing (QS) and biofilm formation challenges mastitis management, necessitating the development of alternative therapeutics to combat this microbial threat effectively. This study aimed to investigate the biofilm forming ability (BFA) of 29 bacterial strains isolated from milk from cattle diagnosed with clinical cases of mastitis in Brain Heart Infusion broth (BHI) and Tryptic Soy broth (TSB). Of these strains, 93.10 % (27) and 68.97 % (20) demonstrated BFA in TSB and BHI, respectively. Compared to BHI, TSB appeared to enhance BFA of the bacteria except for Streptococcus (Str.) uberis strains. Four selected South African plants with known antibacterial activities were tested for their antibiofilm and antiquorum sensing activities against the biofilm-forming mastitis isolates. Searsia lancea demonstrated antibiofilm forming activity against all organisms tested. All the plants demonstrated good biofilm disruption ability (BDA) against 24 h preformed biofilms of the isolates except for Erythrina caffra, while S. lancea displayed good BDA against all the 48 hour preformed biofilms of the bacteria. Generally, the plants' antibiofilm activities appeared to improve as the biofilm matured, with few exceptions. The ethanol extracts of S. lancea demonstrated MQSIC activity at 2.50 mg/mL, and the lowest MQSIC50 value (< 0.08 mg/mL), demonstrating its quorum quenching ability. The ability of these plants, especially S. lancea, to inhibit QS and biofilms at various developmental stages may play a pivotal role in managing mastitis infections and curbing the emergence of antimicrobial resistance. Nonetheless, further research is needed to elucidate the precise mechanisms underlying the inhibition of quorum signaling and biofilms, and to identify the specific compounds responsible for the observed activities.The National Research Foundation and the Translational Medicine Research Theme, University of Pretoria.http://www.elsevier.com/locate/sajbhj2024Paraclinical SciencesProduction Animal StudiesSDG-03:Good heatlh and well-bein

In Vitro Antibacterial Activity of Selected South African Plants against Drug-Resistant Staphylococci Isolated from Clinical Cases of Bovine Mastitis

Bovine mastitis in dairy livestock production is a serious economic problem causing milk production losses and increased management costs. Staphylococcus aureus and non-aureus staphylococcus (NAS) are important causes of bovine mastitis. Antimicrobial resistance can limit the control of mastitis pathogens. Antibacterial and cytotoxic activities of acetone and ethanol extracts of nine South African plants were determined against reference and drug-resistant staphylococci isolated from clinical cases of bovine mastitis. The nine plants, namely, Antidesma venosum, Elaeodendron croceum, Erythrina caffra, Indigofera frutescens, Pleurostylia capensis, Searsia lancea, Searsia leptodictya, Trichilia emetica, and Ziziphus mucronata, were chosen for research material. The antibacterial activity of extracts was determined using a serial microdilution method, while a tetrazolium-based assay was used to determine their cytotoxicity against Vero cells. The values of antibacterial minimum inhibitory concentration (MIC) obtained were promising, with MIC ranging between 0.01 and 1.41 mg/mL. Generally, acetone extracts of most plants had better activity than their ethanol counterparts. The S. aureus strains were more susceptible to all the extracts than the NAS strains. The plant extracts’ half-maximal toxicity (LC50) was higher than 0.02 mg/mL, which is the recommended cytotoxic cut-off concentration. The ethanol extract of E. caffra, which showed better MIC values than its acetone extract, had the highest mean selectivity index (SI) of 8.30. Among the plants tested, S. lancea exhibited the most potent antibacterial activity, suggesting its potential usefulness as a broad-spectrum antibacterial agent against staphylococci associated with bovine mastitis, at relatively non-cytotoxic concentrations. Therefore, it is recommended for further investigation