Pharmacy Magazine_ Dec 2024 / Jan 2025 by New Media B2B

ACNE SCARRING GOES DEEPER THAN THE SKIN

Probiotics & mental health: The gut-brain connection

Breaking the silence: accurate info on MHT Monthly crossword WIN!

BONE HEALTH SIMPLIFIED

Calcium For strong bones and teeth

Vitamin D3 Promotes calcium absorption

Magnesium

Regulates calcium levels and helps prevent muscle cramps

Vitamin K2

Directs calcium to bones and helps prevent arterial calcification

Vitamin C Promotes collagen formation

EDITOR’S

a patient-centric

EDUCATION

EDITOR: Nicky Belseck

Email: nicky.belseck@newmedia.co.za

LAYOUT AND DESIGN: Beku Mbotoli

ADVERTISING

KEY ACCOUNT MANAGER:

Angela Latimer

Cell: 083 999 3123

Email: angela.latimer@newmedia.co.za

DATABASE ADMINISTRATOR

felicity.garbers@newmedia.co.za

PUBLISHING TEAM

GENERAL MANAGER: Dev Naidoo

GROUP ACCOUNT DIRECTOR:

Johann Gerber

Email: johann.gerber@newmedia.co.za

PRODUCTION MANAGER: Angela Silver

PRODUCTION CO-ORDINATOR:

Mbali Maseko

Email: mbali.maseko@newmedia.co.za

CUT OUT

KEEP:

Nicotine addiction: practical tips on addressing the disorder Nicotine, found in tobacco products and e-cigarettes, quickly stimulates dopamine release, fostering addiction.

29 Essential tips for relieving eye strain

Understanding and addressing eye strain is essential for guiding patients toward effective relief methods and promoting eye health.

30 Acute rheumatic fever decoded

31 Phentermine and diabetes: implications for weight loss and glycaemic control

In addition to promoting weight loss, phentermine may also help to improve glycaemic control in people with diabetes.

33 Tetanus vaccination can be a lifesaver

Understanding obesity management with Saxenda

ART DIRECTOR: David Kyslinger

Tetanus has an incubation period of 7-10 days. disorders, and the unique challenges men face in seeking mental healthcare.

COMMERCIAL

STRATEGY

Scan the QR code to sign up to receive a digital copy of the latest issue of Pharmacy Magazine every month

Stepping into with purpose

As we say goodbye to 2024, it's time to reflect on a year filled with significant strides and challenges in the field of pharmacy and health education. This past year has seen advancements in pharmaceutical sciences, innovative practices in patient care, and a strengthened commitment to wellbeing – all testaments to the dedicated efforts of pharmacists across the globe.

As we welcome 2025, let's carry forward the insights and resilience that have characterised our journey. The new year offers a fresh canvas to explore emerging technologies, continue professional growth, and further enhance patient care. It is our aim at Pharmacy Magazine to support you with insightful articles, the latest research, and opinions from the pharmacy community.

Thank you for your dedication and contributions to the SA healthcare landscape. Together, let's make 2025 a year of impactful progress and innovation.

Wishing you all a prosperous and enlightening new year.

INTERESTING TOPICS IN THIS MONTH’S ISSUE INCLUDE:

• Collaboration key to SA’s fatal, diabeteslinked CVD burden (page 7)

• The scary stats around hypertension (page 13)

• Probiotics & mental health: The gut-brain connection (page 21)

• Essential tips for relieving eye strain (page 29)

• Acute rheumatic fever decoded (page 30)

CROSSWORD CHALLENGE

Congratulations to the winner of Crossword #68 Karin van der Westhuizen

For your chance to win a R500 Woolworths voucher don’t miss this month’s crossword puzzle on page 34 .

WORDS TO LIVE BY

“We all get the exact same 365 days. The only difference is what we do with them.” – Hillary Depiano

EPIGENETIC SKIN SCIENCE: REVERSE THE SKIN AGE CLOCK WITH EPICELLINE

Join Pharmacy Magazine in partnership with Eucerin for a one-hour webinar exploring the groundbreaking innovation behind Eucerin Epicelline Serum, a revolutionary advancement in skincare.

Discover how cutting-edge epigenetic research has unlocked the secrets to reversing age-related changes in the skin, offering new possibilities for targeted, science-backed skin rejuvenation.

This session will provide pharmacists and healthcare professionals with:

Insights into the science of epigenetics and its role in skin health

An understanding of Epicelline – the result of 15 years of research, 50 000 ingredients tested, and AI-driven age clock technology

1 2 3

Practical information on recommending this advanced serum to patients seeking effective solutions for aging skin.

DATE: Tuesday, 4 February 2025

TIME: 19h00

SPEAKER: Dr Mercedes Morrison Scan QR code to register

REGISTRATION: https://bit.ly/EucerinWebinar4Feb25

Dr Mercedes Morrison is an experienced dermatologist based in Johannesburg. Her professional practice is centred at two private facilities, Netcare Milpark Hospital and Busamed Modderfontein Private Hospital. Her academic journey commenced at the Wits University, where she obtained her undergraduate MBBCh degree, followed by her postgraduate FCDerm (cum laude) qualification. Notably, she was honoured with the prestigious Peter-Gordon-Smith award, recognising her outstanding performance in the fellowship examination. She has international work experience having worked in both

the Republic of Ireland as well as New Zealand. Throughout her career, she has remained steadfast in her belief that every patient deserves nothing short of excellent medical care and she is deeply committed to fostering an environment of respect and understanding, ensuring these values are integral to the patient care. She has a keen interest in skin cancer, dermoscopy, inflammatory dermatoses, and medical dermatological conditions. She enjoys mentoring medical students during their elective periods as well as sharing knowledge with other colleagues.

Collaboration key to SA’s fatal, diabetes-linked CVD burden

Globally, CVD takes more lives than TB, HIV, and malaria combined, while 215 South Africans are killed by CVD every day – with 80% of CVD and strokes being preventable

Only concerted multidisciplinary collaboration and research will stem the tide of diabetes and diabetes-linked cardiovascular disease (CVD), the latter currently the leading cause of death locally and worldwide, claiming 17.9 million lives annually. This was the consensus among some of the world’s leading cardiologists and researchers gathered at the SA Heart Association’s annual congress aptly themed: The Cardiac Collaboration.

The prevalence of diabetes has also increased in SA, from 4.5% in 2010 to 12.7% in 2019. Of the 4.58 million people aged 20-79 years who were estimated to have diabetes in 2019, 52.4% were undiagnosed.

Dr Zaheer Bayat, chairperson of the Society for Endocrinology, Metabolism, and Diabetes of SA (SEMDSA), told delegates that endocrinologists and cardiologists would have to work together to improve outcomes for diabetic patients, 30% of whom suffered cardiovascular events.

He warned that a 134% increase of people living with diabetes was predicted over the next two decades, translating into a dramatic surge in chronic kidney disease, cardiovascular disease, blindness, and amputations.

Dr Bayat said he intends appealing for mass diabetes screening to find the 52% of people who researchers estimate are undiagnosed. Ideally, this should be followed by access to cheaply acquired, effective new glucose-lowering drugs.

“The reality is this country cannot afford all the new treatments for everyone – not private funders, not government. So, drugs are not really a solution – the best solution is to change lifestyle and prevent disease in the first place,” said Dr Bayat.

“We’re here to fight for our patients, not our pockets. Can we afford to have 52% of our patients not knowing they’re diabetic? People who should be contributing to our economy are living with diabetes and eventually dying,” he asserted.

Dr Bayat also said that globally, First World countries such as the USA and Sweden are reducing myocardial infarctions, strokes, and amputations, because they’re doing all the right things together. This included adopting a healthy lifestyle, effective management of sugar, blood pressure, and cholesterol, and smoking cessation.

“However, here in SA with private healthcare representing 15% of healthcare delivery but consuming 50% of the spend and the public sector representing 85% of the population and consuming the other half – we’re not doing nearly as well. With only 200 cardiologists in the country (one per 190 000 population), and even less nephrologists, we need to come together and change the trajectory of diabetes. We must work together to reduce morbidity and mortality,” said Dr Bayat.

Researchers estimate that 52% of people with diabetes are undiagnosed

*As demonstrated in cardiovascular outcomes trials

† Results apply to Ozempic® 0,5 mg and 1 mg plus standard of care vs. placebo plus standard of care in adults with T2D and established ASCVD.

‡ Ozempic® is not indicated for weight loss.6

CV=cardiovascular; T2D=type 2 diabetes; ASCVD=atherosclerotic cardiovascular disease.

References: 1. OzempicR Approved Professional Information, 17 February 2023. 2. Rodbard HW, Lingvay I, Reed J, et al. Semaglutide Added to Basal Insulin in Type 2 Diabetes (SUSTAIN 5): A Randomized, Controlled Trial. J Clin Endocrinol Metab 2018;103(6):2291-2301.

3. Lingvay I, Catarig AM, Frías JP, et al. Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes (SUSTAIN 8): a double-blind, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol 2019;7(11):834-844. 4. Capehorn MS, Catarig AM, Furberg JK, et al. Efficacy and safety of once-weekly semaglutide 1.0 mg vs once-daily liraglutide 1.2 mg as add-on to 1-3 oral antidiabetic drugs in subjects with type 2 diabetes (SUSTAIN 10). Diabetes Metab 2020;46(2):100-109. 5. Marso SP, Bain SC, Consoli A, et al. SUSTAIN-6 Investigators. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375(19):1834-1844. 6. Davies MJ, Aroda VR, Collins BS, etal. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022;45(11):2753-2786.

Abbreviated Professional Information

Scheduling status: S4 Name of the medicine: Ozempic® Qualitative and quantitative composition: Semaglutide 1,34 mg/ml. Therapeutic indication: Ozempic® is indicated: a) for the treatment of adults with insufficiently controlled type 2 diabetes mellitus as an adjunct to diet and exercise • as monotherapy when metformin is considered inappropriate due to intolerance or contraindications. • as combination therapy with oral anti-diabetic medicines (metformin, thiazolidinediones, sulphonylurea), basal insulin with or without metformin and pre-mix insulin. b) to reduce the risk of major adverse cardiovascular events (cardiovascular death, non-fatal myocardial infarction or non-fatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease. Posology and method of administration: Ozempic® starting dose is 0,25 mg once weekly. After 4 weeks, the dose should be increased to 0,5 mg once weekly. After at least 4 weeks with a dose of 0,5 mg once weekly, the dose can be increased to 1 mg once weekly to further improve glycaemic control. Ozempic® is to be administered once weekly at any time of the day, with or without meals. Ozempic® is to be injected subcutaneously in the abdomen, in the thigh or in the upper arm. The injection site can be changed without dose adjustment. Ozempic® should not be administered intravenously or intramuscularly. The day of weekly administration can be changed if necessary as long as the time between two doses is at least 2 days (>48 hours). When Ozempic® is added to existing sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy, the current dose of SGLT2 inhibitor can be continued unchanged. Contraindications: Hypersensitivity to semaglutide or to any of the excipients, a

personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2), pregnancy and lactation. Special warnings and precautions for use: Ozempic® should not be used in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. Ozempic® is not a substitute for insulin. Acute pancreatitis has been observed with the use of Ozempic®. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, Ozempic® should be discontinued; if confirmed, Ozempic® should not be restarted. Patients treated with Ozempic® in combination with a sulfonylurea or insulin may have an increased risk of hypoglycaemia. The risk of hypoglycaemia can be lowered by reducing the dose of sulfonylurea or insulin when initiating treatment with Ozempic®. Risk of Thyroid C-cell Tumours: Cases of MTC in patients treated with liraglutide, another GLP-1 receptor agonist have been reported in the post marketing period; the data in these reports are insufficient to establish or exclude a causal relationship between MTC and GLP-1 receptor agonist use in humans. Interaction with other medicines and other forms of interaction: In vitro studies have shown very low potential for Ozempic® to inhibit or induce CYP enzymes and to inhibit drug transporters. The delay of gastric emptying with Ozempic® may influence the absorption of concomitantly administered oral medicines. The potential effect of Ozempic® on the absorption of co-administered oral medicines was studied in trials at Ozempic® 1 mg steady state exposure. Fertility, pregnancy and lactation: Ozempic® is contraindicated during pregnancy and lactation. Undesirable effects: The most frequently reported adverse reactions with Ozempic® in clinical trials were gastrointestinal disorders, including nausea, diarrhoea and vomiting. Adverse reactions by system organ class and absolute frequencies identified in all phase 3a trials listed here as Very common (≥1/10): Hypoglycaemia when used with insulin or sulfonylurea, nausea, diarrhoea; Common (≥1/100 to <1/10): Hypoglycaemia when used with other OADs, decreased appetite, dizziness, diabetic retinopathy complications, vomiting, abdominal pain, abdominal distension, constipation, dyspepsia, gastritis, gastrooesophageal reflux disease, eructation, flatulence, cholelithiasis, fatigue, increased lipase, increased amylase, weight decreased; Uncommon (≥1/1,000 to <1/100): hypersensitivity, dysgeusia, increased heart rate, injection site reactions, hypersensitivity, acute pancreatitis; Rare (≥1/10,000 to <1/1,000): anaphylactic reaction.Frequency unknown: angioedema. Overdose: There is no specific antidote for overdose with Ozempic®. In the event of overdose, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. A prolonged period of observation and treatment for these symptoms may be necessary, taking into account the long half-life of Ozempic® of approximately 1 week. Reg. No.: 53/21.13/0497. For full prescribing information, refer to the Professional Information approved by the Medicines Regulatory Authority.

Novo Nordisk (Pty) Ltd. Reg. No.: 1959/000833/07. 150 Rivonia Road, 10 Marion Street Office Park, Building C1, Sandton, Johannesburg, 2196, South Africa. Tel: (011) 202 0500. Fax: (011) 807 7989. www.novonordisk.com.24910T. ZA24RZG00044 August 2024.

infection control Innovation

Addressing antimicrobial resistance and FIPs roadmaps for 2024-2028

Antimicrobial resistance (AMR) poses a significant global health threat, with a pronounced impact in Africa. The FIP Roadmaps for 2024-2028 provide a comprehensive strategy for pharmacists to actively combat AMR through targeted actions and policies.

KEY POINTS OF THE FIP ROADMAPS 2024-2028

P Global health commitment: Establishing robust national action plans on AMR is imperative. WHO recommendations stress that at least 70% of antibiotics used should be from the WHO Access Group Antibiotics, emphasising minimal side effects and low potential to cause resistance.

P Pharmacists’ role in AMS: Pharmacists play a critical role in antimicrobial stewardship (AMS). The FIP Development Goal 17 highlights the need for pharmacists to engage in educational and training programmes aimed at reducing AMR.

P Multifaceted approach: Strategies include integrating AWaRe categorisation into national treatment guidelines, advocating for economic models to support antimicrobial R&D, and developing public health education campaigns.

MAJOR CONCERNS IN THE AFRICAN REGION

P Regulatory enforcement: Strengthening legislative and regulatory controls concerning the lifecycle of antimicrobial medicines is crucial.

P Surveillance: Implementing robust surveillance programmes to monitor and report antimicrobial use and resistance patterns is necessary.

P Education and public health campaigns: Educating healthcare providers and the public about AMR and running public health campaigns to promote responsible antimicrobial usage.

STRATEGIES FOR AFRICA

P Authorised procurement: Ensuring antimicrobials are procured through authorised channels to maintain quality and safety.

P AMS implementation: Encouraging the implementation of AMS programmes at all levels, including local, regional, and national.

P Involvement in immunisation programmes: Pharmacists should collaborate with competent authorities to support national immunisation programmes, crucial for preventing infections and curbing AMR.

P Point-of-care diagnostics: Promoting the use of diagnostic tools to differentiate between bacterial and viral infections, thereby informing effective antimicrobial therapy.

P Public and professional education: Providing updated information on AMR, antimicrobial use, and AMS to prescribers, healthcare professionals, and the public.

P Proper disposal of antimicrobials: Developing return and disposal programmes for unused or expired antimicrobials to prevent environmental contamination.

ROLES FOR PHARMACISTS

F Stewardship programmes: Engaging in AMS programmes to optimise antimicrobial use and discourage misuse.

F Counselling: Offering appropriate counselling to patients on the use of antimicrobial medicines, ensuring adherence and monitoring for effectiveness.

F Regulatory compliance: Enforcing and adhering to regulations that prevent the sale of antimicrobials without a prescription.

OVERARCHING THEMES

The FIP Roadmaps call for a coordinated effort involving pharmacists, healthcare professionals, governments, and international organisations. Key themes include enhancing awareness and education on AMR, strengthening global and national action plans, fostering interprofessional collaboration, and adopting environmentally conscious practices. Pharmacists, as frontline healthcare providers, have a pivotal role in mitigating AMR through education, stewardship, and advocacy.

The fight against AMR requires consolidated and sustained efforts

AUTHOR: Bada Pharasi, Innovative Pharmaceutical Association of South Africa CEO

Opinion

Building a patient-centric healthcare ecosystem in SA: A bold new vision

Imagine a healthcare system which ensures that every patient’s voice helps shape their treatment, where barriers to life-saving care are dismantled, and where innovation is driven by meaningful collaboration writes

Bada Pharasi, CEO at the Innovative Pharmaceutical Association of South Africa

(IPASA)

SA’s healthcare system stands at a critical crossroads. Despite remarkable medical advancements, countless patients remain on the sidelines, hindered by financial, regulatory, and logistical barriers. Today, there’s an opportunity to reshape this reality by building a patient-centred healthcare model that expands access, amplifies patient voices, and creates strategic partnerships.

EMPOWERING PATIENT VOICES

In a truly inclusive healthcare system, patients aren’t just recipients of care; they are active contributors. By integrating patient perspectives into decision-making, healthcare becomes more responsive to those it serves.

Through collaborations with patient advocacy groups, educational campaigns, and year-round initiatives, there’s a growing movement to create an environment in which patients feel heard and empowered to influence the care they receive.

Key prerequisites for achieving this are efficient regulatory frameworks, impactful public-private partnerships, rare disease management, and a true commitment to innovation.

STREAMLINED REGULATORY PARTNERSHIPS

Timely access to groundbreaking treatments depends on efficient regulatory frameworks. Collaborating closely with regulatory authorities such as the South African Health Products Regulatory Authority (Sahpra) is pivotal in expediting access to new therapies.

PUBLIC-PRIVATE PARTNERSHIPS: CATALYSTS FOR INNOVATION

Expanding access to quality healthcare in SA demands strong public-private partnerships (PPPs) that leverage both public resources and private sector innovation.

BREAKING DOWN BARRIERS TO INNOVATION

The drive for a more accessible healthcare system also requires addressing policy barriers. Streamlined processes, simpler registration pathways for new drugs, and patient-centred reimbursement policies ensure that patients receive the right treatment at the right time. Working alongside policymakers, healthcare providers, and civil society, a concerted effort is being made to create a system in which innovation and equity go hand-in-hand to provide better outcomes and quality of life for all South Africans.

SHAPING THE FUTURE OF HEALTHCARE

The future of SA’s healthcare lies in a system that prioritises patients, breaks down barriers, and capitalises on partnerships to make innovation accessible.

The call to action is clear: build a healthcare ecosystem that is dynamic, inclusive, and adaptable to ensure that every South African has access to the care they need. By promoting patient voices and ensuring collaboration across sectors, we can transform SA’s healthcare system to be more responsive, resilient, and equitable – a system that truly serves its people.

The call to action is clear: build a healthcare ecosystem that is dynamic, inclusive, and adaptable to ensure that every South African has access to the care they need

Education cardiology

More than 11 million people die from hypertension every year1

The scary stats around hypertension

50% of South Africans with hypertension are undiagnosed and untreated

More people die from Hypertension – more commonly known as high blood pressure (BP) – than from any other illness1 and all signs point to this global pandemic getting worse.

Worldwide, more than 11 million people die from this chronic illness every year 1 , and in SA the picture is equally concerning. An estimated 53 men and 78 women over 30 die from the impact of hypertension every day. 2 A BP test is the fastest way to detect and help diagnose the illness and in so doing, prevent avoidable deaths.

Hypertension is acknowledged as the ‘silent killer’ because it’s just that; there are no symptoms, and you don’t feel ill until you have a cardiac event like a heart attack. Despite there being no indications or symptoms of ill health, this invisible illness can potentially, if left unchecked, lead to serious heart disease, stroke and even death. Proof of that – every three seconds someone dies from hypertension’s consequences.3 Other complications can include heart

failure, peripheral vascular disease, kidney damage, retinal haemorrhage, and visual impairment. With relatively few people making the connection between raised BP and the devastating consequences of the illness – awareness levels need urgent attention to curb the exponential growth of the disease in SA.

Hypertension is affecting more and more young adults. In SA, nearly 50% of people over age 15 have high BP. 4 Even more alarming is only 50% know they have it.5

Dr Martin Mpe a Gauteng-based Cardiologist and past-president of the South African Hypertension Society said, “If you don’t have your BP measured you won’t know you have the condition until it strikes. Detecting hypertension early also helps minimise the risks. A BP test is the only way to find out if your BP levels are elevated – a non-invasive and really quick measure that will immediately determine if levels are unacceptably high. A BP reading of 120-129/70-79 is considered normal. Patients with a BP higher than 140/90

cardiology

More than a third of people diagnosed and treated for hypertension, stop their treatment after only six months while 50% of people with hypertension stop their treatment completely after one year 6

should immediately seek further medical intervention.” Dr Mpe explained that with this kind of diagnosis, your doctor is likely to prescribe antihypertensive medication that’s taken every day. This is the only way to ensure that the treatment will effectively control blood pressure in the long-term and protect against the risk of cardiovascular events.

Concerningly, more than a third of people diagnosed and treated for hypertension, stop their treatment after only six months while 50% of people with hypertension stop their treatment completely after one year.6 Dr Mpe cautioned that this lack of adherence prevents BP from returning to normal and has very important and severe consequences, including an increased risk of a heart attack or stroke.7

Reinforcing this, Prof Brian Rayner, nephrologist and past director of the Hypertension Institute at the University of Cape Town said, “Elevated BP is subject to the rule of halves – 50% of the population is unaware of their condition, 50% of those who are aware do not take treatment, and 50% of those who take treatment are not controlled, leaving only 12.5% of the total population who are controlled.”

to correct a BP of 130-140/80-90. This includes daily exercise, reducing salt intake, following a good diet high in fruit and veg, no excessive alcohol consumption, maintaining an ideal weight, managing stress and no smoking.”

The frightening truth of the hypertension disease burden is the number of people with raised BP is on an upward trajectory, particularly in low and middle-income countries in Africa, with no signs of slowing down. Globally, adults with raised BP grew from 594-million to 1.13-billion between 1975 and 2015.8 Of great concern is that over these four decades research has shown that the highest worldwide BP levels shifted from high-income countries to low-income, developing countries, and by 2015, sub-Saharan Africa joined central and Eastern Europe and south Asia as the regions with the highest global BP levels.8 SA’s hypertension figures support this and the country has the highest rate of high blood pressure reported among people aged 50 and over for any country in the world, at any time in history, with almost 8 out of 10 people in this age group being diagnosed with high blood pressure.9

From this it’s clear that BP management is all about the numbers and these figures indicate that treatment goals are not being met and it’s time to retool.

Hypertension is most often caused by a combination of hereditary influences and poor lifestyle. Prof Rayner said, “You can do little about your parents or your age, but you can choose to live a healthy life and lifestyle changes should be sufficient

Dr Mpe said, “When one considers that 28 000 people die every day from the consequences of hypertension – that’s the equivalent of 70 jumbo jets crashing and killing everyone on board, it clarifies the importance of collaborative public information campaigns. A simple BP test can be instrumental in avoiding these preventable deaths, and why we need to bolster awareness levels as a matter of urgency. Mobilising South Africans to get their BP screened has never been more important.”

*References available on request

Role of fusidic acid in skin infections

Skin infections are common occurrences that can result from various types of injuries, such as scratches, scrapes, bites, and puncture wounds. These injuries may lead to bacterial infections characterised by pain, swelling, and the potential for further complications if not appropriately treated

Among the topical antibiotics available for managing skin infections, fusidic acid emerges as a first-choice option due to its unique properties and effectiveness against key bacterial pathogens.

Fusidic acid, a steroidal antibiotic, is particularly effective against Staphylococcus aureus, including methicillin-resistant strains (MRSA). It functions by inhibiting bacterial protein synthesis, thereby preventing the replication and spread of bacteria. This mechanism is crucial for tackling infections caused by bacteria that have developed resistance to other antibiotic classes. Unlike some antibiotics that indiscriminately target a broad range of bacteria, fusidic acid offers a more targeted approach, minimising disruption to the beneficial skin microbiota.

Pharmacists play a vital role in advising patients on the appropriate use of fusidic acid. It is commonly formulated in creams or ointments, which should be applied directly to the infected area. The typical course of treatment spans one to two weeks, depending on the severity and nature of the infection. It’s important to educate patients on adhering strictly to the prescribed duration of therapy to prevent resistance development.

One of the major advantages of fusidic

acid is its safety profile. Adverse effects are relatively rare, with contact dermatitis being the most commonly reported. However, this is generally mild and resolves upon discontinuation. You should nonetheless be vigilant in monitoring for side effects and advise patients to report any unexpected skin reactions.

Moreover, fusidic acid's effectiveness is not diminished by the presence of pus or debris at the infection site, making it suitable for a variety of superficial skin infections. This characteristic differentiates it from some other topical antibiotics that may become less effective in such conditions.

In summary, fusidic acid is a preferred topical antibiotic for treating skin infections owing to its targeted action against resistant bacteria, excellent safety profile, and potency even in varied environmental conditions. For pharmacists, understanding the nuances of fusidic acid application ensures patients receive effective, informed care in managing skin infections, optimising therapeutic outcomes, and contributing to the broader antimicrobial stewardship efforts by reducing the likelihood of resistance development through improper antibiotic use.

*References available on request

Fusidic acid is a preferred topical antibiotic for treating skin infections owing to its targeted action against resistant bacteria, excellent safety profile, and potency even in varied environmental conditions

Experience the freedom* with a 2-in-1 insulin co-formulation providing basal and mealtime control1-5

Targets both FPG and PPG for HbA1c control1,3,6,7

Ryzodeg® offers lower rates of nocturnal hypoglycaemia3,6,7

Once- or twice-daily dosing with main meal(s)1

# Image is for illustrative purposes only.

* with flexibility in dose timing when dosed with main meal(s). FPG: fasting plasma glucose; PPG: post-prandial plasma glucose; HbA1c: glycated haemoglobin.

References: 1 Ryzodeg® Professional Information August 2022. 2. Vijan S, et al. J Gen Intern Med. 2005;20(5):479–482. 3. Fulcher G, et al. Comparison of InsulinDegludec/Insulin Aspart and Biphasic Insulin Aspart 30 in Uncontrolled, Insulin-Treated Type 2 Diabetes: A Phase 3a, Randomized, Treatto-Target Trial. Diabetes Care. 2014;37:2085-89. 4. Haahr H, et al. Clin Pharmacokinet. 2017;56(4):339–354. 5. IQVIA MIDASR data. January 2020. 6. Onishi Y, et al. Superior glycaemic control with once-daily insulin degludec/insulin aspart versus insulin glargine in Japanese adults with type 2 diabetes inadequately controlled with oral drugs: a randomized, controlled phase 3 trial. Diabetes, Obesity and Metabolism. 2013; 15:826-832. 7. Philis Tsimikas A, et al. Similar glycaemic control with less nocturnal hypoglycaemia in a 38 week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin- treated subjects with type 2 diabetes mellitus. Diabetes Research and clinical practice. 2018;147:157-165.

S3 Name of the medicine: Ryzodeg® Composition: Each ml contains insulin degludec/insulin aspart (70 % soluble insulin degludec and 30 % soluble insulin aspart) 100 units/ml Therapeutic Indications: Treatment of adult diabetes mellitus patients, as basal add on to co-medication in patients who are inadequately controlled: - In type 1 diabetes mellitus, Ryzodeg® should be used with short-acting soluble insulin for use at the mealtimes when Ryzodeg® is not used. - In type 2 diabetes mellitus, Ryzodeg® should be used as an add on to oral antidiabetic medicines. Treatment of diabetes mellitus in adults, adolescents and children from the age of 2 years. Contra-Indications: Hypersensitivity to the active substances or to any of the excipients. Pregnancy. Special warnings and precautions for use: Hypoglycaemia: Too high insulin dose, omission of a meal or unplanned strenuous physical exercise may lead to hypoglycaemia. Patients whose blood-glucose control is greatly improved may experience a change in their usual warning symptoms of hypoglycaemia and must be advised accordingly. Usual warning symptoms of hypoglycaemia may be altered in patients with long-standing diabetes. The patient’s ability to concentrate and react may be impaired as a result of hypoglycaemia. Patients must be advised to take precautions to avoid hypoglycaemia while driving or operating machinery. Hyperglycaemia: Ryzodeg® should not be used to treat severe hyperglycaemia. Inadequate dosing and/or discontinuation of treatment in patients requiring insulin may lead to hyperglycaemia and potentially to diabetic ketoacidosis, which is potentially lethal. Concomitant illness, especially infections, may lead to hyperglycaemia and thereby cause an increased insulin requirement. Transferring to a new type, brand, or manufacturer of insulin must be done under strict medical supervision. Interactions: When using Ryzodeg® in combination with thiazolidinediones, patients should be observed for signs and symptoms of congestive heart failure, weight gain and oedema. Thiazolidinediones should be discontinued if any deterioration in cardiac function occurs. The following substances may reduce the insulin requirement: Oral antidiabetic medicines, glucagon-like peptide-1 (GLP-1) receptor agonists, monoamine oxidase inhibitors (MAOI), beta-blockers, angiotensin converting enzyme (ACE) inhibitors, salicylates, anabolic steroids and sulphonamides. The following substances may increase the insulin requirement: oral contraceptive, thiazides, glucocorticoids, thyroid hormones, sympathomimetics, growth hormones and danazol. Beta-blocking medicines may mask the symptoms of hypoglycaemia and may reduce the body’s response to hypoglycaemia. Octreotide and lanreotide may either increase or decrease the insulin requirement. Alcohol may intensify or reduce the hypoglycaemic effect of insulin. Insulin antibodies: Ryzodeg® administration may cause insulin antibodies to form. In rare cases, the presence of such insulin antibodies may necessitate adjustment of the insulin dose to correct a tendency to hyper- or hypoglycaemia. Immediate-type allergic reactions to either insulin itself or the excipients may potentially be life threatening. Skin and subcutaneous tissue disorders: Injection site reactions may occur. Patients must be instructed to perform continuous rotation of the injection site to reduce the risk of developing lipodystrophy (including lipohypertrophy, lipoatrophy) and cutaneous amyloidosis. There is a potential risk of delayed insulin absorption and worsened glycaemic control following insulin injections at sites with these reactions. A sudden change in the injection site to an unaffected area has been reported to result in hypoglycaemia. Blood glucose monitoring is recommended after the change in the injection site from an affected to an unaffected area, and dose adjustment of antidiabetic medications may be considered. In children, extra care should be taken to match insulin doses with food intake and physical activities to minimise the risk of hypoglycaemia. Paediatric population: Ryzodeg® may be associated with higher occurrence of severe hypoglycaemia compared to a basal-bolus regimen in the paediatric population, particularly in children 2 to 5 years old. For this age group, Ryzodeg® should be considered on an individual basis. Insulin initiation and glucose control intensification: Intensification or rapid improvement in glucose control has been associated with transitory, reversible ophthalmologic refraction disorder, worsening of diabetic retinopathy, and acute painful peripheral neuropathy. However, long-term glycaemic control decreases the risk of diabetic retinopathy and neuropathy. Fertility, pregnancy and lactation: Safety has not been established in pregnancy and lactation and Ryzodeg® should not be recommended for use during pregnancy. Posology and administration: Ryzodeg® can be administered once- or twice-daily with the main meal(s). When needed, the patient can change the time of administration, if Ryzodeg® is dosed with a main meal. The potency of insulin analogues, including Ryzodeg®, is expressed in units (U). 1 unit (U) Ryzodeg® corresponds to 1 international unit (IU) of human insulin and one unit of all other insulin analogues. In patients with type 2 diabetes mellitus, Ryzodeg® can be combined with oral anti-diabetic products approved for use with insulin, with or without bolus insulin. When using Ryzodeg® once-daily, it is recommended to consider changing to twice-daily when reaching 60 units. Split the dose based on individual patient’s needs and administer with main meals. In type 1 diabetes mellitus, Ryzodeg® is combined with short-/rapid-acting insulin at the remaining meals. Ryzodeg® is to be dosed in accordance with individual patients’ needs. Dose-adjustments are recommended to be primarily based on pre-breakfast glucose measurements. An adjustment of dose may be necessary if patients undertake increased physical activity, change their usual diet or during concomitant illness. Initiation: For patients with type 2 diabetes mellitus, the recommended total daily starting dose of Ryzodeg® is 10 units once daily with meal(s) followed by individual dosage adjustments. For patients with type 1 diabetes mellitus, Ryzodeg® is to be used once-daily at a mealtime and a short-/rapid-acting insulin should be used at the remaining meals with individual dosage adjustments. The recommended starting dose of Ryzodeg® is 60 - 70 % of the total daily insulin requirements. Transfer from other insulin medicines: Close glucose monitoring is recommended during transfer and in the following weeks. Patients with type 2 diabetes: Patients switching from once-daily basal or premix insulin therapy can be converted unit-tounit to once- or twice-daily Ryzodeg® at the same total insulin dose as the patient’s previous total daily insulin dose. Patients switching from more than once-daily basal or premix insulin therapy can be converted unit-to-unit to once- or twice-daily Ryzodeg® at the same total insulin dose as the patient’s previous total daily insulin dose. Patients switching from basal/bolus insulin therapy to Ryzodeg® will need to convert their dose based on individual needs. In general, patients are initiated on the same number of basal units. Doses and timing of concomitant antidiabetic treatment may need to be adjusted. Patients with type 1 diabetes: For patients with type 1 diabetes mellitus, the recommended starting dose of Ryzodeg® is 60 - 70 % of the total daily insulin requirements in combination with short-/rapid-acting insulin at the remaining meals followed by individual dosage adjustments. Doses and timing of concurrent short-/rapid-acting insulin products may need to be adjusted. Flexibility: Ryzodeg® allows for flexibility in the timing of insulin administration if it is dosed with the main meal(s). If a dose of Ryzodeg® is missed, the patient can take the next dose with the next main meal of that day, and thereafter resume the usual dosing schedule. Patients should not take an extra dose to make up for a missed dose. Ryzodeg® should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Undesirable effects: Very common (≥1/10); common (≥1/100 to < 1/10); uncommon (≥1/1 000 to < 1/100); rare (≥ 1/10 000 to < 1/1 000); very rare (< 1/10 000); not known (cannot be estimated from the available data). Very common: Hypoglycaemia. Common: Injection site reactions. Uncommon: Peripheral oedema and rare: Hypersensitivity and urticaria. Adverse Reactions from post-marketing experience: cutaneous amyloidosis (frequency unknown). Pharmacological classification: A 21.1 Insulin Preparations ATC code: A10AD06 Reg. No.: 47/21.1/0165. For full prescribing details, please refer to the Professional Information approved by the SAHPRA (South African Health Products Regulatory Authority).

NICOTINE ADDICTION:

practical tips on addressing the disorder

NICOTINE, FOUND IN TOBACCO PRODUCTS AND E-CIGARETTES, QUICKLY STIMULATES DOPAMINE RELEASE, FOSTERING ADDICTION

HEALTH IMPACTS OF NICOTINE ADDICTION

CARDIOVASCULAR ISSUES: Increased risk of heart disease and stroke

RESPIRATORY PROBLEMS:

Associated with COPD and chronic bronchitis through smoking

ADDICTION COMPLICATIONS: Hard to quit despite known health risks

BRAIN DEVELOPMENT IN YOUTH: Affects attention and impulse control

REPRODUCTIVE EFFECTS: Harmful during pregnancy, leading to low birth weight

CANCER RISKS: Tobacco products contain carcinogens, heightening cancer risks.

REFERENCE: Van Zyl-Smit R. Grebe AM. Nicotine Addiction – Practical Tips on Addressing the Disorder. Medical Academic. Available from: https://www.medicalacademic.co.za/ courses/nicotine-addiction-practical-tips-on-addressing-the-disorder/.

PRACTICAL TIPS FOR ADDRESSING NICOTINE ADDICTION

SET GOALS: Establish and adhere to a quit date

RECOGNISE TRIGGERS: Identify and manage triggers for cravings

SEEK SUPPORT: Utilise support networks and cessation programmes

EXPLORE THERAPIES: Use NRTs or prescribed medications to manage withdrawal

FOSTER HEALTHY HABITS: Engage in exercise, balanced eating, and stress-reduction techniques

STAY BUSY AND POSITIVE: Distract from cravings and celebrate milestones

AVOID ALCOHOL AND TRIGGERS: Especially important in early quitting stages.

STRATEGIES FOR PHARMACISTS

F Medication counselling: Clear guidance on medication use

F Patient education: Enhance understanding using simple language

F Adherence support: Utilise reminders and organisational tools

F Screenings and immunisations: Offer health screenings and antigen services

F Build relationships: Foster trust for open communication

F Cultural competence: Address cultural sensitivities in healthcare practices.

Reduces body blemishes & post-acne marks

NEW BODY CREAM

dermatology Education

Acne scarring goes deeper than the skin

Acne scarring carries a significant psychological burden on patients, with a profound impact on their quality of life

There’s no shortage of studies delving into the far-reaching impact that acne scarring has on patients of all ages.

PHYSICAL AND PSYCHOLOGICAL EFFECTS

Acne scarring leads to permanent skin changes, resulting in atrophic (depressed) and hypertrophic (raised) scars. These physical alterations contribute significantly to feelings of embarrassment and a negative self-image. Emotionally, individuals with acne scars often experience heightened anxiety, depression, and social withdrawal. They also report diminished self-esteem and a negative body image, affecting their overall quality of life. This is particularly acute among adolescents, who may be more sensitive to appearance-related issues.1

QUALITY OF LIFE (QOL) AND SOCIAL WITHDRAWAL

Studies emphasise that the severity and location of acne lesions are critical factors impacting individuals' quality of life. Those with both facial and truncal acne report a greater impairment in health-related quality of life compared to facial acne alone. This is especially true regarding self-esteem, where visible scars can lead to social avoidance and reluctance to engage in activities like sports or swimming. The psychological distress extends beyond physical appearances, affecting emotional health and social interactions.1,2

INFLUENCE OF SOCIAL MEDIA

In today's digital age, social media plays a significant role in shaping perceptions of acne. With the increasing influence of the internet and social media, patients are turning to online platforms for health-related information.3 A study focusing on French women highlighted the profound influence social media has on self-image and dating. Over 90% of women in the study believed that acne affected their profile pictures on social media, impacting their likes and matches on dating apps. The prevalent use of filters further signifies the attempt to conform to idealised beauty standards. 4

BROADER PSYCHOLOGICAL IMPACT

Kluger et al outlined how acne affects social media behaviour and dating app profiles. The embarrassment associated with acne can lead to avoidance in sharing unfiltered images online, leading individuals to use filters frequently. This need for validation through online interactions exacerbates insecurities and can reinforce feelings of isolation and jealousy toward those with clear skin. 4 Acne scarring is not just a dermatological issue but also a significant psychological one. Its impact on self-perception, quality of life, and social behaviour underscores the need for effective management strategies that address both physical and psychological aspects. Support systems promoting self-acceptance and awareness programmes can aid in mitigating the psychosocial consequences, ultimately enhancing the overall well-being of those affected.

*References available on request

Acne impairs patients' quality of life and negatively impacts selfperceptions, emotional well-being, and social functioning 3

QuatroFlora KEEPS THE COLON HEALTHY

QuatroFlora

KE E PS TH E C O L O N HEA LTH Y

ALL PROBIOTICS ARE NOT THE SAME

A L L P R O B I OT I C S AR E N OT TH E SAM E

ALL PROBIOTICS ARE NOT THE SAME

Gastro-intestinal problems a ffect all of usat some time or another. Diarrhea, constipation, bloating andthe like are often causedby over-indulgence or e ating somethingath t doesn’t agree with us , and quick ly clear up of their own accord.

Gastro-intestinal problems a ect all of us at some time or another Diarrhoea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord

Gastro-intestinal problems affect all of us at some time or another. Diarrhea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord.

Gastro-intestinal problems a ffect all of usat some time or another Diarrhea, constipation, bloating andthe like are often causedby over-indulgence or e ating somethingath t doesn’t agree with us , and quick ly clear up of their own accord.

❖ Beneﬁcial bacteria in the gut are known to:

Beneﬁcial bacteria in the gut are known to:

ALL PROBIOTICS ARE NOT THE SAME

Beneﬁcial bacteria in the gut are known to:

Gastro-intestinal problems a ect all of us at some time or another. Diarrhoea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord.

One of the greatest challenges for human wellbeing in the 21st centur y will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where

• prevent and stop diarrhoea or constipation

One of the greatest challenges for human wellbeing in the 21st centur y will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where

Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines.

One of the greatest challenges for human wellbeing in the 21st century will be to focus on the advantage of having a healthy colon and therefore a good immune system – this is where probiotics can play a significant role.

Distressing and unpleasant conditions such as these can however become chronic – and that can be caused by a bacterial imbalance in the intestines.

• Prevent and stop diarrhea or constipation

Beneﬁcial bacteria in the gut are known to:

• Prevent and stop diarrhea or constip ation

Beneﬁcial bacteria in the gut are known to:

• prevent and stop diarrhoea or constipation

• aid digestion and break down toxins

• Aid digestion and break down toxins

• Prevent and stop diarrhea or constip ation

• prevent and stop diarrhoea or constipation

• produce vitamins B12 and K

• produce vitamins B 12 and K

Distressing and unpleasant conditions such as these can however become chronic – and th at can be causedby a bacterial imbalance in the intestines.

Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines

• aid digestion and break down toxins

• Produce vitamins B12 and K

following ailments:

A good probiotic can be beneficial in the following ailments:

• Aid digestion and break down toxins

• produce vitamins B 12 and K

• stimulate the immune system.

Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines.

Distressing and unpleasant conditions such as these can however become chronic – and th at can be causedby a bacterial imbalance in the intestines.

Some groups of bacteria can cause acute or chronic illness, but another group of bacteria offers protective and nutritive properties Imbalances between the two can lead to a number of unpleasant conditions such as diarrhea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption In laborator y investigations, some strains of of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic effects thought to be due to their ability to bind with heterocyclic amines, which are carcinogenic substances formed in burnt red meat.

Probiotics are critical for normal digestion and for defence against infec tion.

Probiotics are critical for normal digestion and for defence against infection.

Bac teria in the gut are k nown to:

Bacteria in the gut are known to:

Some groups of bacteria can cause acute or chronic illness, but another group of bacteria offers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhoea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption. In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic effects thought to be due to their ability to bind with heterocylic amines, which are carcinogenic substances formed in burnt red meat.

• Stimulate the immune system

Bac teria in the gut are k nown to:

• Enhance the mucosal barrier

• Stimulate the immune system

• Enhance the mucosal barrier

• Aid and break down toxins

• Aid digestion and break down toxins

• Inhibit adherence of pathogens

• Aid digestion and break down toxins

• Inhibit adherence of pathogens

Somegroups of bacteria can cause acute or chronic illness , but anothergroup of bacteria o ffers protective and nutritive properties . Imbalances between the two can lead to a number of unpleasant conditions such as diarrhea , constipation , bloating , IBS, allergies, poor digestion and poor nutrientabsorption . In laboratory investigations , some strains of of LAB (Lactobacillus bulgaricus) h ave demonstrated anti-mutagenic effects thought to be due to theirability to bind with heterocyclic amines , which are carcinogenic substancesformed in burnt red ame t.

Tel: 041 3781189

Tel: 084 561 1144

• Stimulate the immune system

• Diarrhoea or constipation

• stimulate the immune system

• Diarrhoea or constipation

• Produce vitamins B12 and K

following ailments:

• Stimulate the immune system

• Diarrhoea or constipation

• stimulate the immune system.

• Stimulate the immune system

• Bad breath, gas & bloating

• Allergies, rhinitis, lac tose intolerance

Some groups of bacteria can cause acute or chronic illness, but another group of bacteria o ers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhoea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption. In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic e ects thought to be due to their ability to bind with heterocylic amines, which are carcinogenic substances formed in burnt red meat.

• Allergies, rhinitis, lactose intolerance

• Allergies, rhinitis, lac tose intolerance

Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora®, with clinical documentation available on the health beneﬁts of the strains it contains.

Probiotics are critical for normal digestion and for defence against infec tion.

Some groups of bacteria can cause acute or chronic illness, but another group of bacteria o ers protective and nutritive properties. Imbalances between the two can lead to a number of unpleasant conditions such as diarrhoea, constipation, bloating, IBS, allergies, poor digestion and poor nutrient absorption In laboratory investigations, some strains of LAB (Lactobacillus bulgaricus) have demonstrated anti-mutagenic e ects thought to be due to their ability to bind with heterocylic amines, which are carcinogenic substances formed in burnt red meat

The two most important groups of friendly intestinal ﬂora, or probiotics, are Lactobacilli – found mainly in the small intestine, and Biﬁdobacteria – found mainly in the colon.

sales@betapharm.co.za www.betapharm.co.za

The two most importantgroups of friend ly intestinal ﬂora , or probiotics , are Lactobacilli – found main ly in the small intestine , andBiﬁdobacteria – found main ly in the colon.

The two most important groups of friendly intestinal ﬂora, or probiotics, are Lactobacilli – found mainly in the small intestine, and Biﬁdobacteria – found mainly in the colon.

Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health beneﬁts.

Probiotics are live micro-organisms ,which when consumed in adequate amounts , have strong health beneﬁts . Beneﬁcial bacteria in the gut are known to:

Just as all humans are not the same , all probiotics are not the sameInsist on QuatroFlora ® with clinical documentation available on the health beneﬁts of the strains it contains.

Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora® with clinical documentation available on the health beneﬁts of the strains it contains.

Just as all humans are not the same, all probiotics are not the same Insist on QuatroFlora®, with clinical documentation available on the health beneﬁts of the strains it contains

Somegroups of bacteria can cause acute or chronic illness , but anothergroup of bacteria o ffers protective and nutritive properties . Imbalances between the two can lead to a number of unpleasant conditions such as diarrhea , constipation , bloating , IBS, allergies, poor digestion and poor nutrientabsorptionIn laboratory investigations , some strains of of LAB (Lactobacillus bulgaricus) h ave demonstrated anti-mutagenic effects thought to be due to theirability to bind with heterocyclic amines , which are carcinogenic substancesformed in burnt red ame t.

The two most important groups of friendly intestinal ﬂora, or probiotics, areLactobacilli– found mainly in the small intestine, andBiﬁdobacteria– found mainly in the colon.

The two most importantgroups of friend ly intestinal ﬂora , or probiotics , are Lactobacilli – found main ly in the small intestine , andBiﬁdobacteria – found main ly in the colon.

Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health beneﬁts.

Probiotics are live micro-organisms which, when consumed in adequate amounts, have strong health beneﬁts

Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora®, with clinical documentation available on the health beneﬁts of the strains it contains.

Just as all humans are not the same , all probiotics are not the same . Insist on QuatroFlora ® with clinical documentation available on the health beneﬁts of the strains it contains.

• Gastroenteritis and playschool diseases in young children

The two most important groups of friendly intestinal ﬂora, or probiotics, areLactobacilli– found mainly in the small intestine, andBiﬁdobacteria– found mainly in the colon

Probiotics are live micro-organisms ,which when consumed in adequate amounts , have strong health beneﬁts .

QuatroFlora™ capsules contain the following strains of probiotic bacteria for improving gastro-intestinal health and well-being: Biﬁdobacterium,

Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health beneﬁts

QuatroFlora ™ capsules contain thefollowing strains of probiotic bacteriafor improving gastro-intestinal health and well-being: Biﬁdobacterium, BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27, Streptococcus thermophilus, STY-31

™ capsules contain thefollowing strains of probiotic bacteriafor improving gastro-intestinal health and well-being: Biﬁdobacterium,

BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27, Streptococcus

QuatroFlora

BB-12®, Lactobacillus acidophilus, LA-5®, Lactobacillus bulgaricus, LBY-27, Streptococcus thermophilus, STY-31

nutrition & supplements Education

Probiotics and mental health: the gut-brain connection

oFlorarQuat PSEKE ETH

NOLOC YTHLHEA

Unlock the secrets of the microbiota-gut-brain axis and discover how probiotics could transform mental health care by alleviating anxiety and depression

Emerging research on the gutbrain connection is unveiling the potential role of probiotics in managing mental health conditions such as anxiety and depression. This connection, often referred to as the microbiota-gut-brain axis, encompasses complex interactions between gut microbiota, the central nervous system, and various physiological pathways involving the endocrine, neural, and immune systems.1,2,3,4

MECHANISMS OF ACTION

Probiotics may reduce inflammation by modulating circulating cytokines, which play a substantial role in the pathogenesis of mental health disorders. Additionally, gut microbiota influence the production of neurotransmitters such as serotonin and gamma-aminobutyric acid (GABA), crucial for mood regulation.1,2

DIET AND LIFESTYLE FACTORS

ALL PROBIOTICS ARE NOT THE SAME

GUT MICROBIOTA AND MENTAL HEALTH

ALL PROBIOTICS ARE NOT THE SAME

cialBeneﬁ bacteria in the gut are known to:

Dysbiosis, an imbalance of gut microbiota, has been linked to mental health disorders, including anxiety and depression. Studies indicate that those suffering from these conditions often display altered gut microbiota compositions compared to healthy individuals. The microbiota-gut-brain axis enables bidirectional communication between the gut and the brain, mediated by hormones, neurotransmitters, and immune factors that can influence brain function and behaviour.1,2,3

A good probiotic can be beneficial in the

❖ Beneﬁcial bacteria in the gut are known to: Prevent and stop diarrhea or tionaconstip Aid digestion and break down toxins

• prevent and stop diarrhoea or constipation

• aid digestion and break down toxins

• produce vitamins B

Diarrhoea or constipation Bad breath, gas & bloating

• stimulate the immune system.

Allergies, rhinitis, lactose intolerance

Just as all humans are not the same all probiotics are not the same with clinical tionadocument vaila ble on the health beneﬁts of the strains it contains.

Just as all humans are not the same, all probiotics are not the same. Insist on QuatroFlora®, with clinical documentation available on the health tsbeneﬁ of the strains it contains.

Gastroenteritis and playschool diseases in

Diet plays a pivotal role in gut health. Diets enriched with fermented foods, dietary fibres, and other prebiotics can boost beneficial gut microbiota while suppressing harmful ones, potentially offering protective effects against mental disorders.1,2,3 Given significant individual differences in gut microbiota composition, personalised approaches to diet and probiotic supplementation might be necessary for effective treatment. 2,3

PROBIOTICS AS A THERAPEUTIC INTERVENTION

Probiotics, particularly strains like Lactobacillus and Bifidobacterium, have shown promise in alleviating symptoms of anxiety and depression.1,2 Clinical studies, such as one involving participants with mild to moderate depression, have demonstrated significant mood improvements in those taking a multispecies probiotic compared to a placebo group. However, this study did not observe changes in anxiety levels. 4

™troFloraaQu psulesac contain the ollowingf strains of probiotic bacteria orf improving gastro-intestinal health and well-being: ,acteriumbBiﬁdo ,®2BB-1 actobacillusL ,ophilusdaci ,®5-AL suillcaobtcaL ,usciragulb ,27-YBL uscococtptreS ,ilushpomreht 13-YTS

Gastro-intestinal problems a fect all of us ta some time or otan ,n tingaobl and eht elik era neoft caused -indulgence or tingae something tath doesn’t reega with us y clear up of their own accord.

Gastro-intestinal problems affect all of us at some time or another. Diarrhoea, constipation, bloating and the like are often caused by over-indulgence or eating something that doesn’t agree with us, and quickly clear up of their own accord. Distressing and unpleasant conditions such as these can, however, become chronic – and that can be caused by a bacterial imbalance in the intestines.

Probiotics are critical for normal digestion and for defence against infection. Bacteria in the gut are known to:

CHALLENGES AND FUTURE DIRECTIONS

• Stimulate the immune system

• Enhance the mucosal barrier

• Aid digestion and break down toxins

While preliminary findings are promising, the field calls for more high-quality, large-sample clinical trials to establish the efficacy and mechanisms of probiotics in treating mental health disorders. Focus should also include the species level of gut microbiota to understand specific roles in mental health.1,2,4 Emerging research underscores the potential of probiotics as a complementary approach to traditional psychiatric medications for managing anxiety and depression. Although the field is still unfolding, future advancements could lead to more effective and accessible treatments for mental health conditions.1,2,4

*References available on request

Distressing and unpleasant conditions such as these can however become chronic – and tath can be caused yb a bacterial imbalance in the intestines. Some roups of bacteria can cause acute or chronic illness roup of bacteria fersfo protective and nutritive properties Imbalances between the two can lead to a number of unpleasant conditions such as ,diarrhea ,tionaconstip ,tingablo ,IBS ,iesgaller poor digestion and poor nutrient bsorptiona In rtoaboral y ,tionsainvestig some strains of of LAB (Lactobacillus bulgaricus) veah tedademonstr genicaanti-mut fectsfe thought to be due to their bilitya to bind with heterocyclic ,amines which are carcinogenic substances ormedf in burnt red t.ame

• Inhibit adherence of pathogens

Tel: 041 3781189

The two most important groups of friendly intestinal ora,ﬂ or probiotics, are Lactobacilli – found mainly in the small intestine, and Biﬁdobacteria – found mainly in the colon.

sales@betapharm.co.za www.betapharm.co.za

The two most important roupsg of ylfriend intestinal ,flora or ,probiotics are Lactobacilli – oundf ylmain in the small ,intestine and Bifidobacteria – oundf ylmain in the colon. Probiotics are live micro-organisms ,which when -con sumed in teaadequ ,amounts veah strong health benefits

Probiotics are live micro-organisms that, when consumed in adequate amounts, have strong health ts.beneﬁ

Studies support the idea that the gut-brain-axis (GBA) extends even beyond these two systems into the endocrine, neural, and immune pathways1

Breaking the silence: accurate info on MHT

Among many women, there is still uncertainty about Menopause Hormone Therapy (MHT), resulting in confusion and missed opportunities for effective treatment

According to Johannesburg-based Obstetrician and Gynaecologist Dr Trudy Smith, “Menopause is a natural transition, but it often brings symptoms that disrupt daily life. It is therefore critical that women are empowered to seek support and have access to the treatment they require.”

UNDERSTANDING MENOPAUSE AND MHT

Menopause marks the absence of menstrual periods for 12 consecutive months. Symptoms such as hot flushes, night sweats, and mood changes often start during perimenopause and can continue long after menopause. These symptoms can have a profound impact on a woman’s well-being.

Menopause Hormone Therapy (MHT) is the most effective way to control menopausal symptoms while also providing other health benefits. Oestrogen, the primary hormone used in MHT, helps alleviate hot flushes, night sweats, and vaginal dryness. For women with a uterus, progesterone must be included in an MHT regimen to protect the lining of the womb from excessive growth caused by oestrogen.

“MHT remains the most effective option for managing hot flushes and night sweats,” explained Dr Smith. “It can also reduce long-term

It’s important to equip women with accurate information to help them make empowered health choices during menopause

health risks like osteoporosis and heart disease. However, a personalised approach is essential, with professional guidance to evaluate the potential risks and benefits.”

NAVIGATING THE CONTROVERSIES

The safety of MHT has been well debated, especially around breast cancer and cardiovascular risks. The International Menopause Society’s latest White Paper clarifies that for most healthy women starting MHT within ten years of menopause, the benefits outweigh the risks.

Women with certain health histories –such as breast cancer or clotting conditions –may need to explore non-hormonal alternatives. Dr Smith emphasised, “It is crucial that each woman discusses her individual circumstances with her healthcare provider to determine the best course of action.”

TACKLING MISINFORMATION

The spread of misinformation has led many women to avoid evidence-based treatments or opt for unproven remedies. “The South African Menopause Society’s goal is to ensure that every woman feels empowered to make informed decisions about her health and receives the support she needs to navigate this life stage with confidence and comfort,” concluded Dr Smith.

BACTERIAL SKIN INFECTION EMERGENCY?

NEW SUPIROBAN CREAM TO THE RESCUE!

SUPIROBAN™, SA’s #1 topical antibacterial treatment, is now available in a CREAM formulation.1

SUPIROBAN™ CREAM is as EFFECTIVE compared to other oral and topical antibacterial agents commonly used for skin infections.2

SUPIROBAN™ CREAM promotes PATIENT COMPLIANCE. Creams are perceived as easier to apply than ointments: No greasy mess! No stained clothing!2

The MOST AFFORDABLE mupirocin cream available.3

TWO size options: 15 g tube for cuts, grazes, small areas. 30 g tube for bed sores, burn wounds, post-operative home use.4

The ONLY mupirocin cream in a 30 g tube size.3

ONE 30 g tube is 25 % more affordable than TWO originator 15 g tubes!3

Greenstone Place, Greenstone, Edenvale, Gauteng, 1609, Tel: +27 (0)11 564 3900. www.glenmarkpharma.com. 475/10/2024. New vehicle. Same tried and trusted efficacy.

dermatology Webinar Report

Spotlight on bacterial skin infections

Pharmacy Magazine recently hosted a webinar in partnership with Glenmark during which dermatologist Dr Hitesh Pitambar delved into the complexities of bacterial skin infections and highlighted practical approaches for pharmacists. The session aimed to equip pharmacists with essential knowledge to enhance patient care in treating these infections.

KEY PATHOGENS & INFECTIONS

Dr Pitambar provided a detailed exploration of two major bacterial culprits: Staphylococcus aureus and Group A Streptococci. These pathogens are known to breach the skin's defenses, leading to various infections. The webinar identified common conditions caused by these bacteria, including:

P Impetigo: A highly contagious infection mainly affecting children. Mupirocin cream is recommended for treatment, with oral antibiotics as a secondary option if necessary.

P Ecthyma and folliculitis: These involve deeper skin layers and hair follicles, respectively, requiring topical antibiotics for management.

P Furunculosis (boils): These deeper infections may require both topical and oral antibiotics for effective resolution.

TREATMENT STRATEGIES &

ANTIBIOTIC STEWARDSHIP

A focal point of the discussion was the use of mupirocin, a topical antibiotic notable for

its efficacy against gram-positive bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Attendees were reminded of the importance of conducting susceptibility tests to guide treatment decisions and maintain antibiotic efficacy.

MUPIROCIN'S EFFICACY & PATIENT COMPLIANCE

Mupirocin was positively compared to other treatment options due to its formulation, which enhances patient compliance. Studies cited during the webinar confirmed its effectiveness and safety in managing skin infections, reinforcing its role as a first-line treatment. The session underscored the critical role of pharmacists in advising on and dispensing this medication, along with educating patients about adhering to prescribed treatments.

CONCLUSION & RECOMMENDATIONS

The webinar concluded by urging pharmacists to practice intelligent antibiotic stewardship. This includes advising on the sparing use of antibiotics and recognising when the body's natural healing processes can prevail without intervention. Emphasis was placed on continually monitoring resistance patterns and potentially adapting treatment protocols accordingly.

Overall, the webinar provided pharmacists with comprehensive insights into diagnosing and managing bacterial skin infections, ensuring they are well-prepared to assist patients effectively in combating these common yet challenging conditions.

For those who missed the live session, a replay and additional resources are available to ensure all pharmacy professionals can benefit from the shared knowledge. Visit www.pharmacymagazine.co.za to watch the replay.

Watch the webinar replay for a full breakdown of the complexities of bacterial skin infections and practical approaches for pharmacists

Dr Hitesh Pitambar

Body mass index 30 kg/m2

Posology and method of administration: The starting dose is 0,6 mg once daily. The dose should be increased to 3,0 mg once daily in increments of 0,6 mg with at least one week intervals to improve gastro-intestinal tolerability. If escalation to the next dose step is not tolerated for two consecutive weeks, consider discontinuing treatment. Daily doses higher than 3,0 mg are not recommended. Saxenda® is for subcutaneous use only. It must not be administered intravenously or intramuscularly. Saxenda® is administered once daily at any time, independent of meals. However, it is preferable that Saxenda® is injected around the same time of the day. It should be injected in the abdomen, thigh or upper arm. Patients must be instructed to perform continuous rotation of the injection site to reduce the risk of developing cutaneous amyloidosis. There may be a potential risk of change in Saxenda® absorption or effect following Saxenda® injections at sites with cutaneous amyloidosis. Saxenda® should not be used in combination with another GLP-1 receptor agonist. When initiating Saxenda®, consider reducing the dose of concomitantly administered insulin or insulin secretagogues (such as sulfonylureas) to reduce the risk of hypoglycaemia. Saxenda® is not recommended for use in children below 12 years of age or in adolescents with a body weight below or equal to 60 kg due to lack of data. Contraindication: • Hypersensitivity to liraglutide or to any of the excipients listed under Composition. • Pregnancy and lactation. Special warnings and precautions for use: Saxenda® must not be used as a substitute for insulin. There is no clinical experience in patients with congestive heart failure New York Heart Association (NYHA) class IV and Saxenda® is therefore not recommended for use in these patients. The safety and efficacy of Saxenda® have not been established in the following patients, viz: • Treated with other products for weight management, • With obesity secondary to endocrinological or eating disorders or to treatment with medicinal products that may cause weight gain, • With severe renal impairment, • With severe hepatic impairment, • With inflammatory bowel disease and diabetic gastroparesis. Use in these patients is not recommended. Acute pancreatitis has been observed with the use of GLP-1 receptor agonists. Patients should be informed of the characteristic symptoms of acute pancreatitis. If pancreatitis is suspected, Saxenda® should be discontinued; if acute pancreatitis is confirmed, Saxenda® should not be restarted. In the absence of other signs and symptoms of acute pancreatitis, elevations in pancreatic enzymes alone are not predictive of acute pancreatitis. In clinical trials, a higher rate of cholelithiasis and cholecystitis was observed in patients treated with Saxenda® than in patients on placebo. Patients should be informed of the characteristic symptoms of cholelithiasis and cholecystitis. In clinical trials in type 2 diabetes, thyroid adverse events, such as goitre have been reported in patients with pre-existing thyroid disease. Saxenda® should therefore be used with caution in patients with thyroid disease. An increase in heart rate was observed in clinical trials. Heart rate should be monitored at regular intervals consistent with usual clinical practice. Patients should be informed of the symptoms of increased heart rate (palpitations or feelings of a racing heartbeat while at rest). For patients who experience a clinically relevant sustained increase in resting heart rate, treatment with Saxenda® should be discontinued. Patients treated with Saxenda® should be advised of the potential risk of dehydration in relation to gastrointestinal side effects and take precautions to avoid fluid depletion. Patients with type 2 diabetes receiving Saxenda® in combination with insulin and/or sulphonylurea have an increased risk of hypoglycaemia. Fertility, pregnancy and lactation: Saxenda® should not be used during pregnancy and lactation. Undesirable effects: Gastrointestinal reactions were the most frequently reported adverse reactions during treatment with Saxenda®. Very common side effects are nausea, vomiting diarrhoea, constipation, headache. Common side effects include: Hypoglycaemia, insomnia, dizziness, dysgeusia, dry mouth, dyspepsia, gastritis, gastro-oesophageal reflux disease, abdominal pain upper, flatulence, eructation, abdominal distension, cholelithiasis, injection site reactions, cutaneous amyloidosis, asthenia & fatigue, increased lipase/increased amylase. Uncommon side effects include: dehydration, tachycardia, pancreatitis, cholecystitis, urticaria & malaise. Rare side effects include: anaphylactic reaction, acute renal failure & renal impairment. Overdose: With overdose, the patients reported severe nausea, vomiting and diarrhoea, but recovered without complications. Severe hypoglycaemia has also been observed. In the event of overdosage, appropriate supportive treatment should be initiated according to the patient’s clinical signs and symptoms. The patient should be observed for clinical signs of dehydration and blood glucose should be monitored. Reg. No.: 50/21.13/1091. For full prescribing information, refer to the Professional Information approved by the Regulatory Authority. Ver. 12/09/2022.

endocrinology Webinar Report

Understanding obesity management with Saxenda

Pharmacy Magazine recently hosted a webinar in partnership with Novo Nordisk on Understanding obesity management with Saxenda which provided pharmacists with comprehensive insights into the management and treatment of obesity. This is a summary of the key points covered.

Recognising obesity as a chronic disease

Obesity is acknowledged as a chronic, relapsing, and progressive disease that necessitates immediate action for effective prevention and control. It is associated with multiple health complications, including diabetes, cardiovascular diseases, and certain cancers.

The role of the brain in appetite regulation

The brain's unique three-layer appetite system regulates eating behaviour through homeostatic (hunger-driven) and hedonic (pleasure-driven) eating, influenced by endocrine signals and the brain's reward system.

Obesity management guidelines

The webinar provided guidelines on managing obesity, classifying it based on BMI and waist circumference. Pharmacotherapy options like Saxenda (liraglutide), Naltrexone/bupropion, and Orlistat were discussed for their efficacy and safety.

Global trends and screening

Global trends indicate increasing obesity prevalence. The importance of waist circumference and other measurements like DEXA, CT, and MRI in assessing health risks was emphasised.

Behavioural interventions

Behavioural interventions, including cognitive behavioural therapy and counselling, were highlighted as effective for sustainable weight management. Surgical and endoscopic interventions also offer significant weight loss.

Structured approach to obesity management

A structured approach involves asking for permission to discuss weight, assessing patient history, agreeing on

treatment plans and goals, advising on treatment options, and assisting with long-term management.

Canadian clinical practice guidelines

The guidelines recommend an empathetic approach in discussing weight, assessing patient stories, advising on management options, and agreeing on realistic goals.

Comprehensive history and screening

A detailed history to identify root causes of weight gain, blood pressure measurement, fasting glucose or HbA1c levels, lipid profile, and screening for non-alcoholic fatty liver disease (NAFLD) were recommended.

Edmonton obesity staging system (eoss)

EOSS helps determine obesity severity and guide clinical decision-making. The American Association of Clinical Endocrinologists (AACE) guidelines recommend lifestyle therapy, pharmacotherapy, and bariatric surgery based on BMI and complications.

Glp-1 and Saxenda

GLP-1 and its receptor agonists (GLP-1RAs) were discussed for appetite regulation. Saxenda (liraglutide), a GLP-1 analogue, showed significant weight loss in clinical trials and improved health outcomes.

Trials and findings

The webinar reviewed clinical trials showing Saxenda's effectiveness in achieving weight loss. The ACTION IO study indicated that sustained long-term weight loss is challenging due to adaptive biological responses.

Comprehensive care approach

Pharmacotherapy, combined with lifestyle interventions, can effectively manage obesity. Proper obesity care in clinical settings helps achieve sustained weight loss and improves quality of life.

The summary reflects critical takeaways for pharmacists managing obesity, emphasising the integration of behavioural, pharmacological, and clinical strategies for effective patient care.

Be sure to watch the webinar replay to learn about pharmacotherapy intervention and the role of Saxenda in managing obesity as a chronic disease

KuraFlo® – so much more than Seasonal

Hay fever, allergies, dry coughs, asthma… these are the conditions that are most experienced during Spring and Summer seasons. Because of the heat and humidity, there is a lack of air movement which can cause pollutants like dust and pollen to be trapped in the airways. And although flu is prevalent in cold weather, we are also still susceptible to flu because of sudden temperature changes in Summer when we move from air-conditioned rooms to outdoor heat, or sudden rainstorms.

With a higher salt quantity in the product than that of the body, hypertonic saline draws fluid from the inflamed, swollen lining of the nose, sinuses, larynx and bronchi to help open the airways. This then helps wash out those trapped particles.

In addition, we have also launched our new anti-inflammatory, antibacterial, antiseptic Skin Healing Cream to help for those skin irritations, rashes, mosquito bites, cuts and sunburn.

Helping you Breathe Better & now Feel Better too!

Essential tips for relieving eye strain

Eye strain, medically known as asthenopia, is a common condition characterised by tired, uncomfortable eyes, often occurring after prolonged focus on tasks like reading or using digital devices. As pharmacists, understanding and addressing eye strain is essential for guiding patients toward effective relief methods and promoting eye health.

UNDERSTANDING EYE STRAIN AND ITS SYMPTOMS

Asthenopia is essentially fatigue of the eyes, resulting from intense use over extended periods. It's prevalent among individuals engaged in activities requiring considerable visual concentration, such as staring at computer screens, reading for long hours, or driving long distances. Common symptoms include headaches, blurred vision, dry or watery eyes, sore or burning sensations, light sensitivity, and, in some cases, difficulty focusing.1

EFFECTIVE REMEDIES AND LIFESTYLE ADJUSTMENTS

prevent the eyes from straining; lighting should be placed to avoid glare on screens and reading material.3

• Digital device adjustments: Advise on the importance of adjusting screen brightness and contrast to match ambient light levels, which significantly reduces strain on the eyes.1,3,4

• Use of artificial tears: Consider recommending over-the-counter lubricating eye drops to alleviate dryness and keep eyes moist, especially for individuals in environments with low humidity.1,3

THE ROLE OF PHARMACISTS IN MANAGING EYE STRAIN

There are several methods to relieve and prevent eye strain, primarily involving changes in daily habits. Pharmacists can recommend the following strategies:

• 20-20-20 rule: Encourage the practice of this rule, which involves taking a 20-second break to view something 20 feet away every 20 minutes spent on digital devices. This simple technique helps relax the eyes.1,2,3

• Eye exercises: Suggest exercises such as focusing on a nearby object before shifting to a distant one. This practice helps reduce fatigue by varying the focal length of the eyes.1,4

• Proper lighting: Ensure that reading or working environments are well-lit to

Pharmacists serve as accessible healthcare professionals capable of providing valuable advice and solutions for eye strain: F Education: Educate patients about the importance of regular breaks from screens and the potential for long-term damage if eye strain is ignored, emphasising the 20-20-20 rule.1,2,3 Product recommendations: Guide patients towards appropriate products, such as blue light filtering glasses or prescribed computer glasses for those regularly using screens 4 and OTC artificial tears to help keep eyes lubricated.1,3,4

F Diagnostics and referral: Identify symptoms indicative of deeper issues requiring professional eye examinations. Referral to optometrists for vision problems detected through preliminary screening can be vital.2

Through these strategies and patient education, pharmacists can significantly alleviate the discomfort associated with eye strain, contributing to enhanced patient wellbeing and overall eye health.

*References available on request

Understanding and addressing eye strain is essential for guiding patients toward effective relief methods and promoting eye health

Acute rheumatic fever decoded

Acute Rheumatic Fever (ARF) is a significant illness resulting from an autoimmune response to infection with Group A Streptococcus (GAS), particularly following a throat infection like pharyngitis or skin infections like impetigo. It primarily affects children between the ages of five and 15 and can lead to severe complications if not managed appropriately. Pharmacists play a crucial role in the prevention, identification, and management of this condition.

ETIOLOGY AND PATHOPHYSIOLOGY

ARF occurs when the immune system mounts an aberrant response to GAS infection. The antibodies generated to fight the streptococcus bacteria also target the body’s tissues, including the heart, joints, skin, and brain. This cross-reactivity can lead to inflammation and tissue damage, particularly affecting the heart valves, a condition known as rheumatic heart disease (RHD).

DIAGNOSIS

The diagnosis of ARF relies on the revised Jones Criteria, which requires evidence of preceding GAS infection and the presence of major and minor clinical features. Supporting evidence for recent GAS infection includes a positive throat culture or rapid antigen test, or elevated streptococcal antibody titres.

MANAGEMENT

The management of ARF consists of eradicating the GAS infection, symptom relief, and preventing recurrence. Here’s what pharmacists need to know:

P Antibiotic therapy

V Primary prophylaxis: Penicillin remains the treatment of choice for eradicating GAS. For penicillin-allergic patients, alternatives include cephalosporins, clindamycin, or macrolides.

Carditis is the major cardiac manifestation of acute rheumatic fever. It occurs in 50% to 70% of first episodes and is associated with valvulitis

CLINICAL PRESENTATION

It's important to be aware of the varied clinical manifestations of ARF, which can appear weeks after the initial GAS infection. The major clinical features include:

P Carditis: Inflammation of the heart, which can present as murmurs, pericarditis, or heart failure.

P Polyarthritis: Migratory inflammation of large joints, which is often the most common first symptom.

P Chorea: Also known as Sydenham's chorea or St Vitus' dance, characterised by involuntary movements, muscle weakness, and emotional instability.

P Erythema marginatum: A non-itchy rash with a distinctive ring-like appearance.

P Subcutaneous nodules: Painless lumps under the skin.

Minor manifestations include fever, arthralgia (joint pain), increased acute phase reactants (like ESR and CRP), and a prolonged PR interval on electrocardiogram.

V Secondary prophylaxis: Continuous antibiotic prophylaxis is essential to prevent recurrent ARF and subsequent RHD. Benzathine penicillin G administered intramuscularly every three to four weeks is preferred.

P Anti-inflammatory treatment

V Aspirin or naproxen is often used to reduce joint inflammation.

V In severe cases, corticosteroids may be indicated to manage carditis.

P Heart failure management

V For patients with heart involvement, managing cardiac failure via standard heart failure protocols may be required.

ROLE OF PHARMACISTS

Pharmacists should ensure adherence to antibiotic prophylaxis schedules and educate patients and caregivers about the importance of preventing recurrent GAS infections. They should be vigilant about potential drug interactions and side effects of long-term antibiotics and antiinflammatory medications.

Reference: Centers for Disease Control and Prevention. Acute Rheumatic Fever (ARF) and Rheumatic Heart Disease (RHD). 1 March 2024. Available from: https://www.cdc.gov/group-a-strep/ hcp/clinical-guidance/acute-rheumatic-fever.html

Phentermine and diabetes: implications for weight loss and glycaemic control

Phentermine is a prescription weight loss medication that works by suppressing appetite and increasing metabolism. It is commonly used in combination with lifestyle modifications, such as diet and exercise, to help people achieve and maintain weight loss. Diabetes is a chronic metabolic disease that is characterised by high blood sugar levels. It can lead to several serious health complications, including heart disease, stroke, blindness, and kidney failure.

PHENTERMINE AND WEIGHT LOSS

Phentermine has been shown to be effective for weight loss in both people with and without diabetes. In a clinical trial of 130 patients with type 2 diabetes, those randomised to phentermine-topiramate ER lost 9.4% of baseline weight, compared to 2.7% weight loss in those assigned to placebo.

PHENTERMINE AND GLYCEMIC CONTROL

In addition to promoting weight loss, phentermine may also help to improve glycaemic control in people with diabetes. In the same clinical trial mentioned above, patients randomised to phenterminetopiramate ER had a greater reduction in HbA1c (a measure of long-term blood sugar control) than those assigned to placebo.

Phentermine is generally not recommended for people with uncontrolled high blood pressure, heart disease, or glaucoma. It should also be used with caution in people with diabetes who are taking insulin or other medications that can lower blood sugar levels.

CONCLUSION

Phentermine is an effective weight loss medication that may also help to improve glycaemic control in people with diabetes. However, it is important for patients to talk to their doctor to see if phentermine is right for them and to discuss any potential risks or side effects.

ADDITIONAL CONSIDERATIONS FOR PHARMACISTS

• When counselling patients with diabetes who are considering phentermine, it is important to emphasise the importance of close monitoring of blood sugar levels. Patients should be instructed to check their blood sugar levels more frequently than usual, especially when they first start taking phentermine.

SAFETY CONSIDERATIONS

Phentermine is generally safe for most people, but it can cause some side effects, such as dry mouth, insomnia, and constipation. It is important to note that phentermine can interact with other medications, so it is important for patients to talk to their doctor before starting treatment.

• Pharmacists should also be aware that phentermine can interact with several other medications, including insulin and other diabetes medications. It is important to review the patient's medication list carefully before starting phentermine treatment.

• Pharmacists should also educate patients about the potential side effects of phentermine and advise them to contact their doctor if they experience any unusual symptoms. Overall, phentermine can be a safe and effective weight loss medication for people with diabetes, but it is important to use it under the supervision of a healthcare professional.

*References available on request

In addition to promoting weight loss, phentermine may also help to improve glycaemic control in people with diabetes

Tetanus vaccination can be a lifesaver

It’s important that parents, home gardeners, and those who work with soil and animals should be aware of the need to stay up to date with regular tetanus vaccinations. “The speed of onset of tetanus was recently highlighted when a keen home gardener developed symptoms just five days after working with compost with their bare hands,” said Dr Pete Vincent of Netcare Medicross Tokai.

TETANUS FREQUENTLY ASKED QUESTIONS

WHEN SHOULD PATIENTS CONSULT A MEDICAL PROFESSIONAL IF THEY HURT THEMSELF?

Dr Vincent stressed that patients who haven’t had a tetanus inoculation within the past ten years or can’t remember when last they had one, should seek medical attention straight away. Particularly if the wound is dirty, deep, has foreign objects in it, or was caused by contact with an animal. “This also applies if there has been any contact with soil or anything potentially contaminated with animal or human faeces, rust, or saliva. A contaminated wound will require a consultation with a doctor even if your tetanus shot is up to date,” said Dr Vincent. “If you’re diabetic or immunocompromised, these would also be reasons to go to your doctor as soon as possible to be safe.”

WHERE ARE THE BACTERIA THAT CAUSE TETANUS FOUND?

Tetanus is caused by a bacterium called Clostridium tetani. Its spores live in soil and

faeces, often in a dormant state, until they find a suitable place to grow. They can enter the body through a break in the skin, from even the smallest wound, cut, or burn. “The bacterium is found in compost, manure, and dust and can be present in the blood and body fluids of infected animals,” Dr Vincent added.

HOW SERIOUS IS TETANUS?

“Tetanus has an incubation period of seven to ten days. It releases a toxin which affects the nerves associated with muscles.” Dr Vincent stressed that tetanus can be potentially fatal. “Don’t take a chance on it. It can result in death, even in healthy people.”

WHY IS TETANUS ALSO CALLED LOCKJAW?

Tetanus often begins with slight spasms in the jaw and face muscles, which can cause the jaw to lock in place.

WHAT OTHER SEVERE SYMPTOMS OF TETANUS DO SUFFERERS EXPERIENCE?

Dr Vincent explained that during the resulting muscle spasms, a person with tetanus can experience severe breathing problems. “The spasms can be so severe that they even have the potential to cause broken bones. A person with tetanus can develop pneumonia or a pulmonary embolism, which can lead to death. Tetanus can also be fatal when the spasms damage the nerves that control breathing, the heart or other organs.”

Tetanus has an incubation period of 7-10 days

CROSSWORD #70

WIN:R500 WOOLWORTHS VOUCHER

TO ENTER

Use the letters in the highlighted blocks to find the final answer for this month’s crossword puzzle. Email the answer with your name, surname, and cell phone number to PharmacyMagazine@newmedia.co.za. Competition closes 20 February 2025. Winners will be contacted directly. Visit www.pharmacymagazine.co.za for full terms and conditions.

ACROSS

6. Menopause marks the absence of periods for 12 consecutive months. (PAGE 23)

9. Pharmacy Magazine recently hosted a webinar that delved into the complexities of skin infections. (PAGE 25)

13. Eye strain is medically known as . (PAGE 29)

14. Pharmacy Magazine recently hosted a webinar on Understanding obesity with Saxenda. (PAGE 27)

15. resistance poses a significant global health threat. (PAGE 9)

16. is a prescription weight loss medication that works by suppressing appetite and increasing metabolism. (PAGE 31)

DOWN

1. Vitamin D3 promotes absorption. (PAGE 2)

2. Acute Fever is a significant illness resulting from an autoimmune response to infection with Group A Streptococcus. (PAGE 30)

3. A person with tetanus can develop pneumonia or a embolism. (PAGE 33)

4. Acne scarring carries a significant burden on patients, with a profound impact on their quality-of-life. (PAGE 19)

5. Emerging research on the gut-brain connection is unveiling the potential role of probiotics in managing mental health conditions such as and depression. (PAGE 21)

7. Despite remarkable medical advancements, countless patients remain on the sidelines, hindered by , regulatory, and logistical barriers. (PAGE 11)

8. More people die from than from any other illness. (PAGE 12 & 13)

10. Fusidic acid is a topical for managing skin infections. (PAGE 15)

11. When tackling nicotine addiction, use NRTs or prescribed medications to manage . (PAGE 17)

12. Pharmacy Magazine will be hosting a webinar on skin science on 4 February 2025. (PAGE 6)

To enter scan QR code

CROSSWORD #68 WINNER

KARIN VAN DER WESTHUIZEN

CROSSWORD #69

IMMUNE SUPPORT that offers you MORE!*

South Africa’s No.1 Children’s Multivitamin & Mineral Supplement1 , Créche Guard Immune is specifically formulated to help give children the daily nutrients they need to support healthy growth and development. Créche Guard’s Immune supplements are ideal for fussy eaters who might not be getting all the important vitamins and minerals from their diet.

Créche Guard Immune is available in two convenient dosage forms - both provide a combination of vitamins and minerals essential for growing bodies and developing minds; and include zinc, vitamin D and vitamin C for immune support.

immune multivit syrup

Alcohol and tartrazine free

Suitable from 12 months +

Tasty cherry flavoured syrup

Available in 100 ml, 200 ml & 500 ml

immune multivit gummies

Alcohol, tartrazine and gelatine free

Suitable from 3 years +

Tasty strawberry flavoured gummy

Available in 30 individually wrapped gummies