Journal of Research in Pharmacy Practice

Abstract Objective: The objective was to quantify the specialists’ prescription pattern in Iran and 
to point out the prescribing behavioral differences among several specialties.
Methods: A retrospective cross‑sectional study was carried out on the claim data. National 
prescription data were obtained on the basis of the claims that the pharmacies submitted 
to the insurers during 1 year period of the study. More than 85 million prescriptions were 
analyzed using “Rx‑Analyst” software that is designed and applied by National Committee 
of Rational Use of Medicines in Iran. Specified medical specialties were considered and the 
World Health Organization prescription indicators were used to evaluate the physicians’ 
prescribing behavior.
Findings: Average items per prescription were ranged from 3.68 in cardiologists’ to 2.06 
in dermatologists’ prescriptions. The highest and the lowest mean price were belonged to 
neurologists’ and ophthalmologists’ prescriptions, respectively. In addition, 45% of patients 
received antibiotics, 41% of patients received injectable form of drugs, and 23% received 
corticosteroids. A high tendency toward prescribing corticosteroids and antibiotics as well 
as an injectable form of medicines was observed among general physicians.
Conclusion: There is an inevitable need to improve prescription habits among different 
specialties, especially among general practitioners. This causes the policymakers to put more 
emphasis on priorities such as continuous education.

Abstract
Objective: Antipsychotics have revolutionized psychiatry by allowing significant numbers 
of patients in long‑term hospital settings to be discharged and successfully maintained in the 
community. However, these medications are also associated with a range of adverse events 
ranging from mostly annoying to rarely dangerous. This study is carried out to identify the 
adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients.
Methods: Prospective interventional study was conducted in the psychiatric unit of a tertiary 
care hospital. Patients of any age and either sex prescribed with at least one antipsychotic 
were included and monitored for ADRs.
Findings: Among the 517 patients receiving antipsychotics, a total of 289 ADRs were 
identified from 217 patients at an overall incidence rate of 41.97%. Sixty‑seven different 
kinds of ADRs were observed in the study patients. Central and peripheral nervous system 
was the most commonly affected system organ class (n = 59) and weight gain (n = 30) was 
the most commonly observed ADR. Olanzapine was most commonly implicated in reported 
ADRs(n = 92) followed by risperidone (n = 59). Of the 289 ADRs, 80% required interventions 
including cessation of drug and/or specific/symptomatic/nonpharmacological treatment.
Conclusion: This post marketing surveillance study provides a representative data of the 
ADR profile of the antipsychotics likely to be encountered in psychiatric patients in an 
Indian tertiary care hospital.

Abstract Objective: Ventilator‑associated pneumonia (VAP) described as a secondary and preventable 
consequence in mechanically ventilated patients, emerges 48 h or more after patients 
intubation. Considering the high morbidity and mortality rate of VAP and the fact that VAP 
is preventable, it seemed necessary to evaluate care bundle compliance rate and effect of 
education on its improvement.
Methods: This observational study was conducted on 10 Intensive Care Units (ICUs) of 
four university affiliated hospitals in three steps. In the first step, VAP care bundle compliance 
including head of bed (HOB) elevation, endotracheal cuff pressure (ETCP), mouthwash time, 
utilizing close suction systems, subglottic secretion drainage, type of suction package, and 
hand wash before suctioning was evaluated. In the second and third steps, ICU staffs were 
trained and its effect on VAP care bundle compliance was investigated. Finally, an inquiry 
from nurses was conducted to evaluate the obtained results.
Findings: A total of 552 checklists consisting of 294 observations in the pre‑education 
group and 258 observations in the posteducation group were filled. Mean VAP care 
bundle compliance in pre‑education and posteducation stages was 36.5% and 41.2%, 
respectively (P > 0.05). Except for patients’ mouth washing, there were no improvement 
in HOB elevation (>30°), hand washing and ETCP after education. Based on the results of 
questionnaire received from nurses at the end of study, more than 90% of nurses believed 
that lack of rigid monitoring of VAP care bundle is a main reason of low adherence for VAP 
care bundle compliance.
Conclusion: The adherence to VAP care bundle was inappropriate. Education seems to be 
ineffective on improving VAP care bundle compliance. Frequent recall of the necessity of 
the VAP care bundle and the continuous supervision of ICU staffs is highly recommended.

Abstract Objective: Persons experiencing homelessness are a vulnerable population and are at 
increased risk for morbidity and all‑cause mortality compared to the general population. 
This study sought to evaluate medication use, regular physician visits, and identify health 
conditions among the homeless population of Long Beach, California.
Methods: Two “brown bag” medication review events were held at homeless shelters in 
the Long Beach area. Demographic information, medication use, and comorbid disease states 
were obtained through surveys.
Findings: Three‑fourths of the cohort (95 participants) consisted of males, and the 
average age of participants was 48 years. Psychiatric disorders and cardiovascular disease 
were the most common disease states reported at 32% and 46%, respectively and so were 
medications used in treating these chronic diseases. Medication adherence was found to be a 
significant problem in this population, where more than 30% of patients were nonadherent to 
medications for chronic diseases. Furthermore, foot problems, hearing and vision difficulties 
constitute the most commonly overlooked health problems within the homeless population.
Conclusion: Based on this and other similar finding, we must accept that the homeless 
represent a vulnerable population, and that because of this fact, more programs should be 
focused at improving availability and access to health care among the homeless. Regarding 
the high number of reported health problems in the study, more studies are needed and 
more studies should incorporate screening for foot, hearing, and vision issues, both to 
increase awareness and to provide an opportunity for devising possible solutions to these 
highly preventable conditions.

Abstract Objective: Surgical site infections are the second most common type of adverse events 
occurring in hospitalized patients, whereas an estimated 40-60% of these infections are thought 
to be preventable. Choice of regimen, administration timing or duration of antibiotic prophylaxis 
is reported to be inappropriate in approximately 25-50% of cases. We tried to evaluate an 
antibiotic administration pattern for surgical antibiotic prophylaxis in a teaching hospital.
Methods: This study was conducted at the general surgery and orthopedic wards 
of a teaching hospital affiliated with Mazandaran University of Medical Sciences. The 
medical records of admitted patients who underwent different surgical procedures were 
reviewed. Compliance was assessed with the recommendations of the American Society 
of Health‑System Pharmacists’ guidelines for every aspect of antibiotic prophylaxis. All data 
were coded and analyzed by SPSS16 software using Student’s t‑test and Chi‑square test.
Findings: During 1 year, 759 patients who underwent different surgeries were included in 
the study. Mean age of patients was 32.02 ± 18.79 years. Hand and foot fractures repair were 
the most frequent surgery types. About 56.4% of administered prophylactic antibiotics were 
in accordance with the American Society of Health System Pharmacists (ASHP) guidelines 
regarding prophylaxis indication. The most commonly antibiotic used was cefazolin and 
antibiotic choices were appropriate in 104 of 168 surgical procedures (62%). Gentamicin, 
metronidazole and ceftriaxone were the most frequently antibiotics that used inappropriately. 
Only in 100 of 168 procedures, duration was concordant with the ASHP guideline, whereas 
in 68 procedures, duration was longer than recommended time. In 98 procedures, the dose 
was lower and in one procedure, it was higher than recommended doses.
Conclusion: Although such guidelines have been in place for many years, studies showed 
that much inappropriate antibiotic use as prophylaxis and poor adherence to guidelines 
are still major issues. It is essential for surgeons to be aware to consider the best antibiotic 
choices, dose and duration based on reliable guidelines for antibiotic prophylaxis.

Abstract Objective: Recent advances in the field of alternative medicine introduced various herbal 
products for the treatment of periodontitis. The purpose of this study was to evaluate the 
effects of combined extracts from Quercus brantii and Coriandrum sativum on periodontal 
indices in adult periodontitis patients.
Methods: In this randomized, double‑blinded clinical trial, performed in Isfahan Dental 
School in 2012, a new herbal medicament containing combined extracts from Q. brantii and 
C. sativum was formulated in the gel form for subgingival application. Following scaling 
and root planing (SRP), both herbal and placebo gels were delivered at the experimental 
and control sites, respectively. Periodontal pocket depth, clinical attachment level, papilla 
bleeding index, and plaque index were measured at baseline, 1 month and 3 months later. 
Both intra‑and inter‑groups changes were registered. The obtained data were analyzed by 
SPSS software, using repeated measure analysis of variance, paired t‑test, Mann-Whitney, 
Friedman, and Wilcoxon tests. Differences with P < 0.05 were considered to be significant.
Findings: Both groups indicated statistically significant improvements in the periodontal 
indices (P < 0.05), but there were no significant differences between two study groups with 
this regard.
Conclusion: The herbal gel does not have considerable advantages over SRP alone as an 
adjunct in periodontal treatment.

Abstract Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a drug reaction 
commonly occurring in association with aromatic anticonvulsants and allopurinol. It is 
characterized by triad of fever, skin eruption, and systemic involvement. DRESS is rare with 
beta‑lactam antibiotics and even rarer with ceftriaxone. We describe a case of pneumonia 
who developed ceftriaxone‑induced rash, bicytopenia, eosinophilia, transaminitis and was 
eventually diagnosed and managed successfully as a case of DRESS.