Colistin is considered a last treatment option for multi-drug and extensively resistant Gram-negative infections. We aimed to assess the available data on the dosing strategy of colistin. A systematic review was performed to identify all published studies on the dose optimization of colistin. Grey literature and electronic databases were searched. Data were collected in a specified form and the quality of the included articles was then assessed using the Newcastle-Ottawa scale for cohort studies, the Cochrane bias tool for randomized clinical trials (RCT), and the Joanna Briggs Institute (JBI) critical checklist for case reports. A total of 19 studies were included, of which 16 were cohort studies, one was a RCT, and two were case reports. A total of 18 studies proposed a dosing regimen for adults, while only one study proposed a dosing schedule for pediatric populations. As per the available evidence, a loading dose of 9 million international units (MIU) of colistin followed by a maintenance dose of 4.5 MIU every 12 h was considered the most appropriate dosing strategy to optimize the safety and efficacy of treatment and improve clinical outcomes. This review supports the administration of a loading dose followed by a maintenance dose of colistin in severe and life-threatening multi-drug Gram-negative bacterial infections.

Drug shortages continue to pose a significant threat to public health and safety. Drug shortages not only worsen patient outcomes, but also significantly burden healthcare systems with additional costs. This study aimed to assess community pharmacy staff knowledge, opinion, and practice toward drug shortages in Saudi Arabia from November 2019 to March 2020. This was a cross-sectional study carried out among 1,008 community pharmacists from Saudi Arabia using a validated, self-administered and Internet-based survey. Analysis was done using chi square and fisher exact tests. Most participants were males (97.2%), less than 30 years old (48.1%), and non-Saudi citizens (94.4%), and 72.0% had good knowledge of drug shortages (score = 4–5). Around 36.0% reported that it takes 1–3 days to receive a response to the shortage report. There was a statistically significant association between the professional level of the community pharmacists and their opinion about reporting drug shortages (P < .05). Most community pharmacies (56.2%) did not receive any notification about drug shortages. In conclusion, most community pharmacists are knowledgeable and have good practice regarding drug shortages, but their opinions about drug shortages differ according to each pharmacy reporting policy.

Background: Clinical trials are essential tools for advancing cancer treatment, improving survival rates, and introducing innovative therapies. However, patient participation in clinical trials remains low in the Middle East, including Saudi Arabia. This study explores Saudi cancer patients’ awareness, perceptions, and willingness to participate in clinical trials while identifying key barriers to enrollment. Methods: A cross-sectional survey was conducted using a self-administered questionnaire distributed via email and social media. Saudi cancer patients aged 14 and older, fluent in Arabic or English, and with a confirmed cancer diagnosis were eligible. Ethical approval was obtained, and participation was voluntary with ensured data confidentiality. The survey assessed awareness of clinical trials, perceived benefits, willingness to enroll, and barriers to participation. Data were analyzed using SPSS version 23, with chi-square tests used to examine associations. Results: A total of 201 participants completed the survey. Most were female (69.2%), with a mean age of 39.5 years. Awareness of clinical trials was moderate (51.2%), with social media and healthcare providers being primary information sources. While 57.2% recognized the benefits of clinical trials, 44.8% expressed concerns about risks. Trust in healthcare providers influenced willingness to participate, with 49.8% confident in their physician’s recommendations. The most common barriers were fear of side effects (82.6%) and lack of information (42.8%). Only 5.5% had prior experience with clinical trials, but 35.3% expressed willingness to enroll if recommended by a healthcare provider. Gender and income were significantly associated with perceptions and willingness to participate. Conclusions: Findings highlight the need for targeted educational initiatives to improve awareness and trust in clinical trials among Saudi cancer patients. Addressing key barriers, particularly concerns about side effects and limited information, could enhance participation, ultimately advancing cancer research and treatment in the region.

Background: The clinical significance of utilizing a vancomycin loading dose in critically ill patients remains unclear. Objective: The main aim of this systematic review is to evaluate the clinical safety and efficacy of the vancomycin loading dose in critically ill patients. Methods: We performed a systematic review using PRISMA guidelines. PubMed, the Web of Science, MEDLINE, Scopus, Google Scholar, the Saudi Digital Library and other databases were searched. Studies that reported clinical outcomes among patients receiving the vancomycin LD were considered eligible. Data for this study were collected using PubMed, the Web of Science, MEDLINE, Scopus, Google Scholar and the Saudi Digital Library using the following terms: “vancomycin”, “safety”, “efficacy” and “loading dose” combined with the Boolean operator “AND” or “OR”. Results: A total of 17 articles, including 2 RCTs, 11 retrospective cohorts and 4 other studies, met the inclusion/exclusion criteria out of a total 1189 studies. Patients had different clinical characteristics representing a heterogenous group, including patients in critical condition, with renal impairment, sepsis, MRSA infection and hospitalized patients for hemodialysis or in the emergency department. Conclusions: The study shows that the target therapeutic level is achieved more easily among patients receiving a weight-based LD as compared to patients received the usual dose without an increased risk of new-onset adverse drug reactions.

Background: In Saudi Arabia, the government has implemented compulsory premarital screening and consultations for high-risk and positive sickle cell results (traits = AS gene and disease = SS gene). However, despite these measures being in place since 2004, there are still cases of children being born with sickle cell disease. This study aims to evaluate the costs associated with the government’s mandatory premarital screening for sickle cell anemia, compare these expenses with those incurred due to high-risk marriages and analyze the government’s healthcare spending on sickle cell anemia management. Method: A decision tree model was conceptualized for the purpose of this study to identify the possible paths from the premarital screening (PMS) procedure. A total of 300,000 cases were processed through this decision tree model. Results: The annual management costs for children with the probability of having sickle cell disease are estimated to be USD 10,746,450 in the screening arm and USD 40,488,000 in the no-screening arm. These costs vary depending on the genetic combination of the parents. For individuals with the SS/SS gene combination, the estimated cost is USD 8,137,800 per year. When parents have the SS/AS gene combination, the estimated cost is USD 2,071,950 annually. For those with the sickle cell trait combination (AS/AS), the cost is estimated to be USD 536,700 per year. A direct comparison shows a modeled PMS incremental cost is estimated at USD 29,741,550, which is approximately a 73% reduction in healthcare costs. Conclusions: The premarital screening for sickle cell disease is not only cost-saving but also shows the potential for significantly reducing healthcare spending related to sickle cell disease in the future.