Browsing by Author "Abulfathi, Ahmed Aliyu"

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    Drug repurposing and optimisation to improve tuberculosis treatment
    (Stellenbosch : Stellenbosch University, 2021-03) Abulfathi, Ahmed Aliyu; Svensson, Elin M.; Reuter, Helmuth; Diacon, Andreas H.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medicine: Clinical Pharmacology.
    ENGLISH ABSTRACT: Tuberculosis, a leading infectious cause of mortality, morbidity, and reduced quality of life with loss of income, remains a huge public health burden particularly in resource-limited settings. The golden thread throughout this dissertation, was improving tuberculosis treatment through repurposing and optimisation of existing medicines. For that purpose, we sought to improve our understanding of the pharmacokinetics and pharmacodynamics of selected anti-tuberculosis drugs.
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    Evaluation of the effectiveness of dose individualisation to achieve therapeutic vancomycin concentrations
    (Stellenbosch : Stellenbosch University, 2017-12-05) Abulfathi, Ahmed Aliyu; Decloedt, Eric; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Biomedical Sciences. Dept. of Medicine. Division of Clinical Pharmacology.
    ENGLISH ABSTRACT: Background The glycopeptide antibiotic vancomycin is used for treatment of methicillin resistant Gram positive cocci. Adequate vancomycin plasma concentrations are related to bacterial cure. However, inter- and intra-patient variability make it difficult to achieve therapeutic vancomycin concentrations. The primary objective of this study was to determine the effectiveness of using computerised therapeutic drug monitoring (TDM) to assist in achieving therapeutic vancomycin concentrations at a tertiary hospital in South Africa. Method This was a 2-period study consisting of a retrospective 1-month observational period followed by a prospective 1-month period where computerised TDM was implemented as an intervention to assist with vancomycin dose individualisation. Prescribers were provided with guidelines on vancomycin dosing and TDM results during both study periods. During the prospective period, all vancomycin TDM results were followed by dose individualisation using computerised TDM. In addition, the area under the-concentration-time curve over minimum inhibitory concentration (AUC/MIC) was calculated to ensure a ratio of ≥400. Results The retrospective study included 77 patients with 292 vancomycin concentrations: 69% (53/77) adult and 31% (24/77) paediatric patients. The prospective study included 80 patients with 217 vancomycin concentrations measured: 69% (55/80) adult and 31% (25/80) paediatric patients. Less vancomycin TDM data were requested during the prospective period with a median (interquartile range) of 2 (1-3) samples per patient compared with 3 (1- 5) during the retrospective period. The odds ratio of achieving therapeutic trough concentrations was 3.63 (95% confidence interval (CI): 1.81 - 7.3) in the prospective period when TDM-adjusted vancomycin dosing and correct TDM procedures were applied. The use of computerised TDM in patients on continuous infusion resulted in 26% improvement in achieving therapeutic vancomycin concentrations in the prospective period (odds ratio 2.96; 95% CI: 1.19 - 7.36). In the prospective period, AUC0-24 was 400 mg·h/L or above in 71% of occasions. Conclusion The correct use of computerised TDM results in a higher frequency of therapeutic vancomycin concentrations in a middle income setting. Trough vancomycin concentrations alone correlate poorly with AUC0-24. Achieving therapeutic vancomycin concentration may strengthen antibiotic stewardship and save on TDM resources.