Search Results (80)

Medical errors are inevitable and will happen to almost every specialist. In anesthesiology, one of the main concerns is the inappropriate application of muscle relaxants (MRs). As this group of drugs plays a significant role in facilitating endotracheal intubation and optimizing surgical conditions, it is widely and commonly used in the medical field. To prevent residual neuromuscular block, anesthesiologists may pharmacologically reverse the neuromuscular block (NMB) by administering reversal agents. Lately, sugammadex is becoming more popular due to its ability to reverse various levels of NMB more rapidly than traditionally used acetylcholinesterase inhibitors such as neostigmine. The common challenges and errors associated with the administration of neuromuscular blocking agents (NMBAs) and muscle reversal agents include the absence of neuromuscular monitoring, underestimation of the residual block (RB), misinterpretation of DUR25, inappropriate size descriptors for muscle relaxants and reversal agents requiring weight-based dosing, the wrong dosing of rocuronium, poor usage of cisatracurium among patients with renal or hepatic failure, and the wrong usage of succinylcholine. Another source of mistakes may be inaccurate knowledge about the pharmacokinetics and pharmacodynamics of the administered drugs. Medication errors may occur not only when it comes to the usage of muscle relaxants but also with the use of reversal agents, including lack of neuromuscular monitoring, choosing the wrong antagonist strategy, “too early” administration of neostigmine, inappropriate dosing, and insufficient knowledge about drug interactions. Improving the knowledge of administered drugs and adhering to the latest recommendations could prevent many complications. This article aims to review the current challenges in the use of muscle relaxants and reversal agents in anesthesia. Full article

Anti-inflammatory agents, antipyretics, and antibiotics are commonly used to manage fever and pain associated with infectious diseases in both adults and children. Despite their effectiveness, inappropriate and unnecessary prescriptions remain widespread, leading to adverse patient outcomes and, in the case of antibiotics, contributing to antimicrobial resistance. Addressing these issues requires effective stewardship programs focused on educating healthcare professionals and the public on evidence-based guidelines for optimal prescribing practices. This paper explores the five “A”s fundamental to infection management in pediatric and adult patients: appropriateness, abuse, antipyretics, anti-inflammatory agents, and antibiotics. Through a comprehensive literature review, expert perspectives, and clinical guidelines, the study evaluates the roles of anti-inflammatory agents (e.g., ibuprofen), antipyretics (e.g., paracetamol), and antibiotics in clinical practice, highlighting best practices for their use. Current guidelines emphasize that antipyretics should only be administered when fever is accompanied by significant discomfort or pain, as fever itself plays a role in the immune response. Based on the available literature, experts also suggest that paracetamol should be preferred as a first-line antipyretic due to its favorable safety profile, while ibuprofen should be used with caution, particularly during respiratory infections, varicella, and severe bacterial infections, due to its potential to exacerbate complications. According to experts, special consideration is also required for patients with renal or gastrointestinal comorbidities to prevent toxicity. Regarding antibiotics, prescriptions should be limited to clear evidence of bacterial infection to avoid unnecessary patient exposure and the development of antimicrobial resistance. Stewardship programs underscore the importance of selecting the right agent, optimizing dosing, and introducing shorter treatment regimens where supported by evidence, to improve therapeutic outcomes while minimizing resistance risks. Ultimately, this paper provides practical, evidence-based recommendations to support rational prescribing of antipyretics, anti-inflammatory drugs, and antibiotics, aiming to optimize patient outcomes, prevent unnecessary toxicity, and contribute to global efforts against antimicrobial resistance. Full article

Background and Objectives: Appropriate antimicrobial dosing according to kidney function is essential to ensure therapeutic efficacy while minimizing toxicity and antimicrobial resistance. Despite established dosing guidelines and electronic prescribing systems, errors in renal dose adjustment of antimicrobials, particularly in the setting of acute kidney injury, remain common among hospitalized patients. Materials and Methods: A point-prevalence study was conducted on 31 October 2024 at a tertiary-care hospital in Greece to evaluate the appropriateness of antimicrobial dosing in relation to renal function. Patient characteristics, renal parameters, and antimicrobial prescriptions were extracted from electronic medical records. Glomerular filtration rate (GFR) was estimated using the MDRD formula. Comparative analyses were performed between correctly and incorrectly dosed cases, and between overdosing and underdosing episodes. Results: A total of 235 hospitalized patients were evaluated (mean age 64.8 ± 18.6 years; 43.4% female). Overall, 15.7% (37/235) received at least one antimicrobial dose inappropriate for their renal function. Among 37 patients where dosing errors were identified, overdosing was noted in 23 (62.2%), underdosing in 16 (43.2%), adding up to 39 prescriptions, while in 2 patients (5.4%), both mistakes were noted in different prescribed antimicrobials. Drug-specific error rates varied considerably: ceftazidime and cefuroxime showed the highest rates of inappropriate dosing (40% each), followed by colistin (33.3%) and acyclovir (33.3%). Piperacillin/tazobactam, the most frequently prescribed agent (n = 50), had a 14% error rate, mainly due to underdosing (10%). Patients with dosing errors were significantly older (71.5 vs. 64.1 years, p = 0.0220) and had worse renal function, including higher serum creatinine (1.68 vs. 1.19 mg/dL, p = 0.0174), lower GFR (58.5 vs. 75.9 mL/min/1.73 m², p = 0.0009), and more frequent dialysis (13.5% vs. 4.3%, p = 0.0422). They also received a higher median number of antimicrobials (2 vs. 1, p = 0.0185). Conclusions: Inappropriate antimicrobial dosing based on kidney function remains common in hospitalized patients, particularly among older individuals and those with impaired renal function or polypharmacy. Targeted antimicrobial stewardship strategies focusing on renal dose adjustment and agents that are more frequently dosed inappropriately, such as colistin, acyclovir, cefuroxime, and ceftazidime, as well as agents that are frequently prescribed despite a relatively lower rate of inappropriate dose, such as piperacillin/tazobactam, are needed to enhance prescribing safety and optimize therapeutic outcomes. Full article

Background: Medication use in paediatric populations is inherently complex and carries a heightened risk of prescribing errors, particularly within primary health-care settings. Despite this concern, evidence describing paediatric prescribing errors in Saudi Arabia remains scarce. Hence, the present study aimed to evaluate the prevalence and patterns of prescribing errors in paediatric primary care and to characterize the pharmacist-led interventions undertaken to resolve these errors. Methods: A prospective, mixed-methods cross-sectional study was conducted over three months at a primary health-care centre. Paediatric outpatient prescriptions were systematically reviewed during routine practice by trained clinical pharmacists. All suspected errors were independently validated and classified for severity by a multidisciplinary expert panel. Descriptive statistics were used to summarise prescribing errors, and associations with patient and prescription characteristics were assessed using chi-square tests. Qualitative data were analysed using a descriptive thematic approach to explore mechanisms of error identification and the nature of corrective pharmacist interventions. Results: A total of 545 paediatric outpatient prescriptions were reviewed, of which 142 prescriptions (26.1%) contained at least one prescribing error. Across these prescriptions, a total of 145 individual prescribing errors were identified. Dose-related errors were the most common (68.3%), followed by inaccuracies in dosing frequency (11.0%) and inappropriate drug selection (9.0%). The occurrence of prescribing errors was significantly associated with patient weight (p = 0.016), the number of medications per prescription (p < 0.001), and the recorded diagnosis (p = 0.018). The majority of errors were intercepted prior to medication dispensing (93.0%), and no cases of patient harm were identified. Qualitative analysis revealed that errors were predominantly detected through cross-checking with authoritative drug references, recalculation of weight-based doses, and application of clinical judgement, and were most often resolved through direct communication with the prescribing clinician. Conclusions: Prescribing errors occur frequently in paediatric outpatient settings; however, most are preventable with appropriate safeguards. Pharmacists play a critical role in identifying and resolving these errors before they result in patient harm. Enhancing paediatric prescribing support systems and strengthening interprofessional collaboration may further advance medication safety within primary health-care services. Full article

Background/Objectives: For patients diagnosed with chronic kidney disease (CKD), it is important to follow guidelines addressing dose-adjustments for renally eliminated drugs to avoid complications related to toxicity and subtherapeutic effects. In Saudi Arabia, limited data are available regarding appropriate medication doses for CKD. In this study, we investigated the prevalence of inappropriately administered drugs in patients with CKD and examined factors associated with unadjusted renal dosing. Methods: A retrospective, cross-sectional, observational analysis (2023–2025) was conducted via a systematic electronic medical record review of hospitalized patients diagnosed with CKD and cardiovascular diseases (CVDs) in the Al-Baha region, Saudi Arabia. Medications were selected and evaluated for appropriate dosing based on creatinine clearance (CrCl). Medications were categorized as appropriately adjusted, inappropriately adjusted, unadjusted, or contraindicated. Results: A total of 440 patients (787 prescriptions) were included. At the patient level, 85% had at least one appropriately adjusted medication, 13% had at least one inappropriately adjusted medication, 30% had at least one medication that was not adjusted despite indication, 34% had at least one medication requiring no adjustment, and 17% had at least one contraindicated medication (categories are not mutually exclusive). At the prescription level, which was the primary analytic unit (N = 787), 48% of prescriptions were appropriately adjusted, 7% were inappropriately adjusted, 17% were not adjusted despite indication, 19% required no adjustment, and 10% were contraindicated. Antibiotics accounted for the largest share of inappropriate adjustments, representing 77% (43/56) of all inappropriate dose-adjustment events. In exploratory bivariate analyses, age was not statistically significantly associated with dosing outcomes (Holm-adjusted p = 0.145). Polypharmacy was highly prevalent (91% of patients) but was not significantly associated with any dosing outcome in these exploratory analyses, likely due to limited statistical power. Conclusions: Our results showed that several regularly prescribed drugs, including metformin, sitagliptin, ceftazidime, ciprofloxacin, and spironolactone, were inappropriately prescribed to patients with CKD. These dosing errors can be avoided by increasing clinicians’ and pharmacists’ awareness of appropriate dosage modifications essential for patients with CKD. Full article

Antimicrobial resistance (AMR) is a growing global health threat with important implications for pediatric populations. Children are frequently exposed to antibiotics in both hospital and community settings, where inappropriate prescribing, suboptimal dosing, and excessive use of broad-spectrum agents remain common. These practices contribute to the emergence of resistant pathogens, increase adverse drug events, and may negatively affect the developing immune system and microbiota. This narrative review summarizes current evidence on pediatric antimicrobial stewardship (AMS), highlighting recent trends in antimicrobial use and key stewardship strategies across inpatient and outpatient care. Core interventions, including prospective audit and feedback, preauthorization, guideline implementation, AWaRe-based prescribing, therapeutic drug monitoring, and early intravenous-to-oral switch, are discussed. The review also examines the expanding role of diagnostic stewardship, focusing on rapid molecular diagnostics, point-of-care testing, and host-response biomarkers to improve differentiation between bacterial and viral infections and support targeted therapy. Despite progress, pediatric AMS faces persistent challenges, such as regional variability in prescribing practices, limited pediatric-specific data for new antimicrobials and diagnostics, and organizational and behavioral barriers. Emerging tools, particularly artificial intelligence, may enhance decision-making and optimize antimicrobial use, although further validation in pediatric settings is needed. Strengthening pediatric AMS is essential to improving care quality and mitigating the impact of AMR. Full article

Background: Human serum albumin (HSA), the most abundant plasma protein, is essential for oncotic pressure, endothelial protection, drug binding, and immune modulation. Despite its widespread clinical use since the 1940s, its therapeutic benefit in critically ill patients remains debated. This narrative review summarizes current evidence on HSA use in common intensive care scenarios. Clinical Applications: In hepatorenal syndrome (HRS), albumin combined with vasoconstrictors like terlipressin improves renal function and survival. In spontaneous bacterial peritonitis (SBP), albumin lowers the risk of acute kidney injury and mortality, particularly in high-risk cirrhotic patients. Post-paracentesis albumin reduces circulatory dysfunction and may enhance survival in cirrhosis. For septic shock, trials show no overall mortality benefit over crystalloids, though albumin may offer hemodynamic advantages in specific subgroups. In acute respiratory distress syndrome (ARDS), albumin improves oxygenation in hypoalbuminemic patients, without survival benefits. During major cardiac or abdominal surgery, albumin reduces fluid needs and postoperative complications, especially in hypoalbuminemic individuals. In acute brain injury, albumin’s role is controversial: it may aid recovery after cerebral hemorrhage, but can worsen outcomes in traumatic brain injury. In trauma and ECMO patients, albumin may stabilize hemodynamics and improve outcomes in selected cases. Conclusions: Inappropriate albumin use remains common, and evidence on its optimal concentration, dose, timing, and patient selection is limited. HSA is safe and beneficial in specific situations. Routine use should follow evidence-based guidelines. Future research must identify patients who are most likely to benefit and clarify optimal dosing strategies, concentrations, and therapeutic goals. Full article

Antimicrobial Stewardship Programs (ASPs) are a cornerstone strategy to mitigate the global threat of antimicrobial resistance (AMR), primarily driven by inappropriate antimicrobial use. ASPs aim to optimize antimicrobial therapy by ensuring appropriate indication, agent selection, dosing, route of administration, and duration of treatment. Through these interventions, ASPs improve clinical outcomes, reduce adverse drug events, decrease selective pressure for resistant organisms, and contribute to healthcare cost containment. Effective implementation requires a multidisciplinary approach involving physicians, pharmacists, microbiologists, nurses, and information technology specialists, and must be tailored to local epidemiology and healthcare system capacity in accordance with World Health Organization (WHO) recommendations. This narrative review describes the development and evolution of the national antimicrobial stewardship policy in Chile, based on a review of publications indexed in SciELO, official documents from the Ministry of Health (MINSAL), and relevant national legislation. In Chile, antimicrobial stewardship initiatives began in the late 1990s with regulatory measures mandating prescription-only dispensing of antimicrobials and the introduction of national technical standards for rational antimicrobial use. After that, Chile adopted a comprehensive One Health approach and implemented national AMR action plans aligned with WHO strategies. Substantial progress has been achieved across hospital, primary care, veterinary, and aquaculture settings, including expanded ASP coverage, strengthened regulatory frameworks, national surveillance systems for antimicrobial consumption and resistance, and incorporation of stewardship indicators into institutional performance metrics. Despite these advances, challenges related to workforce capacity, technological infrastructure, and long-term monitoring persist and must be addressed to further consolidate national ASP implementation. Full article

Background: Glucagon-like peptide-1 receptor agonists are increasingly prescribed for weight loss, but concerns remain regarding adverse events beyond gastrointestinal, renal, and pancreatic effects. Understanding these risks is essential to guide safe clinical application and public health policy. The study aims to characterize psychiatric risks, administration-related adverse events, and patterns of inappropriate use associated with semaglutide, liraglutide, and tirzepatide for weight management. Methods: Disproportionality analysis using proportional reporting ratios and reporting odds ratios was conducted to detect significant signals in adverse event reports within the U.S. Food and Drug Administration Adverse Event Reporting System, identifying semaglutide, liraglutide, or tirzepatide as drugs used for weight loss while excluding gastrointestinal, renal, and pancreatic adverse events. Results: Among 40,253 adverse event reports (68.6% female; median ages: semaglutide, 62 years; liraglutide, 59 years; tirzepatide, 53 years), semaglutide demonstrated the strongest disproportionality signal for psychiatric adverse events, notably anxiety (PRR 1.34, 95% CI 1.18–1.51), depression (PRR 1.83, 95% CI 1.62–2.07), and suicidal ideation (PRR 3.44, 95% CI 2.98–3.97). Tirzepatide showed markedly higher signals for injection-site reactions (PRR 7.98, 95% CI 7.8–8.18) and inappropriate use, including incorrect dosing and off-label administration (PRR 5.98, 95% CI 5.9–6.06). Conclusions: In real-world use, semaglutide is disproportionately associated with psychiatric adverse events, whereas tirzepatide demonstrates higher rates of injection-site complications and misuse. Liraglutide presents a comparatively lower risk profile. These findings underscore the need for vigilant psychiatric monitoring, patient education on injection technique and dosing, and stronger regulatory oversight to reduce misuse of GLP-1 receptor agonists for weight loss. Full article

Background/Objectives: Digoxin is a cardiotonic agent with a narrow therapeutic window and a high risk of toxicity. The current clinical use is based on an empirically FDA-recommended regimen which has wide dosing ranges, introducing the risk of inappropriate dosing and related adverse events. This study aims to develop a physiologically based pharmacokinetic (PBPK) model to characterize digoxin pharmacokinetics in adult and pediatric patients with heart failure, and then to evaluate the FDA-recommended regimen. Methods: The PBPK model was initially developed in healthy adults using PK-Sim^®. Then, it was translated to adults with heart failure by incorporating disease factors. Next, it was further translated to pediatrics by scaling age-related parameters. Finally, through two-step translations, the model was used to evaluate current dosing regimens to inform safety and effectiveness based on observing predicted trough concentrations at a steady state. Results: This PBPK model has strong predicting ability, where observed concentrations and key PK metrics (C_max, AUC_0-t) were within 0.5–2.0-fold of predictions in healthy adults, adults with heart failure, neonates, and infants. The model prediction work on the evaluation of recommended dosing regimens from the FDA shows that the current regimen may not achieve the lowest boundary of the therapeutic window (0.5–2 ng/mL) in neonates (0–30 days), whereas infants (1–2 months) and children (<18 years) are generally good within it. Conclusions: This PBPK model explained major physiological and pathological contributors to differences in digoxin pharmacokinetics across populations and showed good performance in pediatric extrapolation. It also pointed out the shortage of empirical dosing regimens for such a drug with a narrow therapeutic window. The model may assist in optimizing the pediatric dosing strategies of digoxin, and suggests that current neonatal dosing regimens need refinement. Full article

Invasive Candida infections in the neonatal intensive care unit (NICU) are associated with significant morbidity and mortality, particularly among extremely preterm neonates. Early treatment with antifungals is critical to improve survival rates and avoid long-term adverse outcomes. Prevention with antifungal prophylaxis in high-risk neonates has been shown to reduce the prevalence of invasive Candida infections effectively. However, the irrational and/or inappropriate use of antifungals has been documented. This narrative review aims to provide an overview of the rationales for the inappropriate use of antifungals in the NICU, the consequences that ensue, and the promising strategy of antifungal stewardship programs to optimize antifungal use. The nonspecific clinical presentation of systemic Candida infections and the lack of rapid, accurate diagnostic techniques for Candida identification and specification in most settings lead to a high rate of empirical treatment in neonates without a proven infection. Moreover, evidence on the optimal dosing of antifungal agents and the treatment duration in the neonatal population is lacking, which may result in excessive or subtherapeutic drug exposure. Antifungal misuse is associated with microbiological consequences, including the emergence of antifungal-resistant Candida strains, and clinical consequences, such as drug toxicities and alterations in the intestinal mycobiome. It is therefore imperative to optimize antifungal use in the NICU. The implementation of antifungal stewardship programs, which, through a multidisciplinary approach, aim to improve diagnosis and guide clinicians on antifungal selection, dosing, and duration for both prevention and treatment according to the local epidemiology, represents a promising strategy for antifungal optimization in the NICU. Full article

Antimicrobial resistance (AMR) is a growing global health concern with profound implications for ophthalmology, where it compromises the management of ocular infections such as bacterial keratitis, conjunctivitis, endophthalmitis, and postoperative complications. Resistance in common ocular pathogens, including Staphylococcus aureus (S. aureus), Streptococcus pneumoniae (S. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa), and coagulase-negative staphylococci (CoNS) emerge through genetic mutations, horizontal gene transfer, and biochemical mechanisms such as enzymatic degradation, target modification, efflux pumps, and reduced membrane permeability. Biofilm formation further complicates eradication on the ocular surface and interior. The key drivers of resistance include inappropriate or prolonged topical antibiotic use, routine prophylaxis in ocular surgery, subtherapeutic dosing, and cross-resistance with systemic antimicrobials. The rise in multidrug-resistant strains, particularly methicillin-resistant S. aureus, fluoroquinolone-resistant P. aeruginosa, and drug-resistant S. pneumoniae has been linked to delayed treatment response, increased healthcare costs, and sight-threatening outcomes. Recent advances in rapid diagnostics, molecular assays, and point-of-care testing support earlier and more precise detection of resistance, enabling timely therapeutic decisions. Promising strategies to address AMR in ophthalmology include antimicrobial stewardship, novel drug delivery platforms, and alternative approaches such as bacteriophage therapy and antimicrobial peptides. Emerging tools, including genomic surveillance, artificial intelligence (AI)-driven resistance prediction, and personalized antimicrobial regimens, further expand opportunities for innovation. Collectively, this review synthesizes current evidence on AMR in ocular disease, summarizing patterns of resistance, underlying mechanisms, and clinical consequences, while highlighting strategies for mitigation and underscoring the need for global awareness and collaboration among clinicians, researchers, and policymakers to safeguard vision. Full article

Polycystic ovary syndrome (PCOS) is an endocrine disorder prevalent in women of reproductive age, often requiring complex pharmacological management. The heterogeneity of the syndrome and the use of on- and off-label therapeutic agents—ranging from insulin sensitizers and ovulation inducers to oral contraceptives and herbal supplements—pose significant challenges, including adverse effects, drug interactions, and poor adherence. This narrative review explores the role of pharmacists in identifying and mitigating drug-related problems (DRPs) associated with PCOS therapy. Through thematic synthesis of the current literature, the study highlights common DRPs such as suboptimal drug selection, inappropriate dosing, prolonged therapy duration, and treatment-related safety concerns. It underscores the value of pharmacists’ interventions in enhancing medication adherence, optimizing therapeutic regimens, providing patient education, and monitoring adverse events. A structured, patient-level pharmaceutical care model is proposed, emphasizing personalized assessment, interdisciplinary collaboration, and continuous follow-up. The integration of clinical pharmacists into PCOS care teams has the potential to improve treatment effectiveness, patient satisfaction, and long-term health outcomes. Pharmacists’ contributions are especially critical given the widespread use of off-label therapies and supplements with variable evidence of benefit. Tailored pharmaceutical care can thus bridge the existing gaps in PCOS management and enhance the quality of life for the affected individuals. Full article

Background: There is limited published evidence on the prevalence of potentially inappropriate prescribing of medicines in relation to kidney function in older Australians, particularly those with dementia. Objectives: To examine the prevalence, temporal trends and factors associated with potentially inappropriate prescribing of renally-dependent medicines in patients with dementia, using Australian general practice data. Methods: This comparative study was reported in accordance with the STROBE guidelines for cohort studies. Retrospective analyses of the National Prescribing Service (NPS) MedicineInsight dataset were performed to determine the proportion of patients aged ≥ 65 years with a recorded diagnosis of dementia, along with matched controls, who had potentially inappropriate prescribing based on their estimated glomerular filtration rate (eGFR) during the study period (2011–2020). Each patient was included only once throughout the study. Potentially inappropriate prescribing was evaluated for 33 commonly used medicines, using the Cockcroft-Gault equation for estimated creatinine clearance or eGFR, in accordance with the guidelines from the Australian Medicines Handbook (AMH). Each patient’s medicines were included if they were prescribed within 180 days after the most recent recorded lowest eGFR value for the patient. Medicines having prescribed doses exceeding those recommended for an individual’s renal function were classified as ‘inappropriate dosage’, while those whose use was advised against were labelled ‘contraindicated’. Both categories were regarded as inappropriate prescriptions. Descriptive statistics were used to summarise patient characteristics and medication use. Temporal trends were displayed in graphs, with statistical significance determined using the Cochran-Armitage test. Binary logistic regression models were used to examine the associations between sociodemographic and clinical factors and the prescribing of medicines inconsistent with AMH guidelines. Results: The unmatched cohorts included 33,101 patients, comprising 4092 with dementia and 29,009 without. Among them, 58.4% were female, and the overall median age was 82 years [interquartile range (IQR): 77–87]. After propensity score matching, there were 4041 patients with dementia and 8031 without dementia. Over the study period, potentially inappropriate prescribing increased slightly, but insignificantly, in both groups of patients; the prevalence of inappropriate use of at least one of the 33 drugs of interest rose from 6.5% (95% CI 4.5–9.1%) in 2011 to 8.9% (95% CI 6.0–12.7%; p for trend: 0.966) in 2020 in the dementia group, and 9.2% (95% CI 8.0–10.5%) to 11.1% (95% CI 10.3–12.0%; p for trend: 0.224) in the matched controls. Over the ten-year period, approximately 9.3% (377) of patients with dementia in the matched cohort received at least one potentially inappropriate prescription. Among these, 154 (40.8%) were for contraindicated medicines, and 223 (59.1%) were for inappropriate doses based on renal function. Among patients with dementia in the matched cohort, fenofibrate, nitrofurantoin, and moxonidine were the most frequently prescribed medicines at doses inconsistent with AMH guidelines. In the unmatched dementia cohort, potentially inappropriate prescribing was not significantly associated with demographic characteristics or most comorbidities; however, it occurred more frequently in patients with an eGFR below 30 mL/min/1.73 m² or those with concomitant diabetes. Conclusions: Positively, the prevalence of potentially inappropriate prescribing of renally-dependent medicines in primary care patients with dementia in Australia was similar to their matched controls. However, there was room for improvement in the prescribing of these drugs in both patients with and without dementia. Full article

Inappropriate prescription patterns and polypharmacy are critical challenges facing the optimal management of schizophrenia patients, especially in regard to patient safety. Background/Objectives: The purpose of this study was to examine the relationship between patient safety and the existence of incorrect prescription patterns and/or polypharmacy in the medications prescribed to individuals with schizophrenia. This issue is addressed in a broad context, highlighting the purpose of this study. Methods: A cross-sectional study was adopted, involving a prospective analysis of the prescriptions of schizophrenia patients receiving treatment. Prescription patterns deemed inappropriate were evaluated based on evidence-based guidelines. Antipsychotic maximum allowable daily doses were calculated using the British National Formulary Maximum Daily Dose (BNFmax), an online tool. Patient safety outcomes were assessed using the Glasgow Antipsychotic Side-effect Scale (GASS). Results: A total of 198 patients diagnosed with schizophrenia and receiving treatment consented to participate in the GASS survey. A total of 116 (58.6%) males participated. The mean age of patients was 40.1 (±12.7). Thirty-one (66.2%) reported mild side effects, while 67 (33.8%) reported moderate side effects. Polypharmacy was detected in 103 (52%) patients’ prescriptions. The correlation between GASS and BNFmax was positive and statistically significant (p < 0.001). The elevation in GASS score was associated with polypharmacy prescriptions (OR 3.21; 95% CI 1.64–6.29), the presence of first-generation antipsychotics (FGAP) (OR 2.79; 95% CI 0.236–5.951), any combination of antipsychotics containing haloperidol (OR 3.22; 95% CI 1.11–9.32), and olanzapine (OR 3.46; 95% CI 1.36–8.79). Conclusions: The safety of patients with schizophrenia has been proven to be impacted by the improper use of psychotropic drugs. Following evidence-based guidelines is a cornerstone to ensuring optimal, effective, and safe patient treatment plans. Full article