Browsing by Author "Decloedt, E. H."

Now showing 1 - 4 of 4
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    A cross-sectional descriptive study of breastfeeding behaviour and galactogogue use among private-sector patients in Cape Town, South Africa
    (Health and Medical Publishing Group, 2017-05) Steyn, N.; Zunza, Moleen; Decloedt, E. H.
    Background. Failure to exclusively breastfeed is often caused by a perception of insufficient breastmilk supply. Galactogogues are frequently prescribed in these circumstances, but this is supported by sparse scientific data with safety concerns for both mother and infant. The exact extent of galactogogue use in South Africa (SA) is not well known. Objectives. To assess breastfeeding behaviour, galactogogue use and perceived galactogogue side-effects among patients attending International Board Certified Lactation Consultant (IBCLC) private practices. Methods. We administered a self-developed, expert-reviewed questionnaire in five IBCLC private practices within the Cape Town Metropole, SA. All patients attending the practices during an 8-week period were invited to participate. Results. Data from 104 participants were included in the study. An exclusive breastfeeding rate of slightly more than 50%, associated with greater parity (p=0.029), was found. Perceived lack of breastmilk predicted galactogogue use (p=0.013). There was a high prevalence of galactogogue use (54%), with 80% of these participants using non-prescription medication. Sulpiride was the most common prescription medication used. Increased milk production was reported by 41% (n=23) of galactogogue users, while 30% (n=17) reported no effect. Most reported side-effects were minor. Conclusions. Prevalence of galactogogue use exceeded other published data. Sulpiride was most frequently prescribed, despite not being recommended during breastfeeding. A large group of participants reported poor efficacy. The effect of vaginal delivery and immediate skin-to-skin contact after delivery on milk production might be smaller than previously reported in mothers who are personally motivated to breastfeed. Healthcare practitioners should acknowledge breastfeeding mothers’ concerns regarding insufficient milk supply and emphasise correct breastfeeding technique.
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    Current evidence for directed and supportive investigational therapies against COVID-19
    (Health & Medical Publishing Group, 2020-04-30) Van Rensburg, R.; Pillay-Fuentes Lorente, V.; Decloedt, E. H.
    ENGLISH ABSTRACT: Coronavirus disease 2019 (COVID-19) is a global health crisis. There is currently a great need for effective and safe therapies directed at the disease, but no drugs are presently registered for use in COVID-19. Several directed therapies have been proposed, and most are still in clinical trials. Currently available published, peer-reviewed results mostly involve small sample sizes with study limitations restricting the interpretation of the findings. Many trials currently published also do not have a control group, limiting the interpretation of the effect of the intervention. Investigational directed therapies as well as investigational supportive therapies against COVID-19 are reviewed here. Chloroquine and hydroxychloroquine show promise as directed therapies, but current trial results are conflicting. Lopinavir/ritonavir also shows potential, but was started late in the disease course in most trials. No randomised controlled evidence is currently available for remdesivir and favipiravir. Corticosteroid use is not recommended for directed therapy against COVID-19, and the role of tocilizumab is currently unclear, based on limited evidence. Early initiation of investigational directed therapies may provide benefit in selected patients. The results from larger randomised controlled trials will clarify the place of these therapies in COVID-19 treatment.
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    Paediatric antimicrobial use at a South African hospital
    (Elsevier, 2018) Koopmans, L. R.; Finlayson, H.; Whitelaw, A.; Decloedt, E. H.; Dramowski, Angela
    Background: Data on antimicrobial use among hospitalized children in Africa are very limited due to the absence of electronic prescription tracking. Methods: This study evaluated antimicrobial consumption rates, the antimicrobial spectrum used, and the indications for therapy on a paediatric ward and in the paediatric intensive care unit (PICU) at Tygerberg Hospital, Cape Town, South Africa. Antimicrobial prescription and patient demographic data were collected prospectively from May 10, 2015 to November 11, 2015. For the same period, data on antimicrobials dispensed and costs were extracted from the pharmacy electronic medicine management system. The volume of antimicrobials dispensed (dispensing data) was compared with observed antimicrobial use (prescription data). Results: Of the 703 patients admitted, 415/451 (92%) paediatric ward admissions and 233/252 (92%) PICU admissions received ≥1 antimicrobials. On the ward, 89% of prescriptions were for community-acquired infections; 29% of PICU antimicrobials were prescribed for healthcare-associated infections. Ampicillin and third-generation cephalosporins were the most commonly prescribed agents. Antimicrobial costs were 67 541 South African Rand (ZAR) (5680 United States Dollars (USD)) on the ward and 210 484 ZAR (17 702 USD) in the PICU. Ertapenem and meropenem were the single largest contributors to antimicrobial costs on the ward (43%) and PICU (30%), respectively. The volume of antimicrobials dispensed by the pharmacy (dispensing data) differed considerably from observed antimicrobial use (prescription data). Conclusions: High rates of antimicrobial consumption were documented. Community-acquired infections were the main indication for prescription. Although pharmacy dispensing data did not closely approximate observed use, this represents a promising method for antimicrobial usage tracking in the future.
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    Therapeutic drug monitoring of amlodipine and the Z-FHL/HHL ratio : Adherence tools in patients referred for apparent treatment-resistant hypertension
    (Health & Medical Publishing Group, 2017) Jones, E. S. W.; Lesosky, M.; Blockman, M.; Castel, S.; Decloedt, E. H.; Schwager, S. L. U.; Sturrock, E. D.; Wiesner, L.; Rayner, B. L.
    Background. Non-adherence to antihypertensives is a cause of ‘pseudo-treatment-resistant’ hypertension. Objective. To determine whether monitoring plasma amlodipine concentrations and inhibition of angiotensin-converting enzyme (ACE) can be adjunct adherence tools. Methods. Patients with hypertension who were prescribed enalapril and amlodipine were enrolled. Blood pressures (BPs) were monitored and an adherence questionnaire was completed. Steady-state amlodipine was assayed using liquid chromatography-mass spectrometry and degree of ACE inhibition using the Z-FHL/HHL (z-phenylalanine-histidine-leucine/hippuryl-histidine-leucine) ratio. Results. One hundred patients (mean (standard deviation) age 50.5 (12) years, 46% male) were enrolled. Based on plasma assays, 26/97 patients (26.8%) were unsuppressed by enalapril and 20/100 (20%) were sub-therapeutic for amlodipine. There were significant BP differences based on plasma levels of the medication: 21/20 mmHg lower in the group with suppressed ACE and 26/20 mmHg in the group with steady-state amlodipine concentrations. Conclusions. Monitoring antihypertensive adherence by assaying plasma medication concentrations is a feasible option for evaluating true v. pseudo-resistant hypertension.