ORCID Profile
0000-0002-2510-4397
Current Organisation
The University of Auckland
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Publisher: Springer Science and Business Media LLC
Date: 24-08-2014
DOI: 10.1007/S00455-014-9558-1
Abstract: Citric acid is used in cough reflex testing in clinical and research settings to assess reflexive cough in patients at risk of swallowing disorders. To address a lack of knowledge in this area, this study investigated the stability and sterility of citric acid solutions. Triplicate solutions of citric acid (0.8 M) in isotonic saline were stored at 4 ± 2 °C for up to 28 days and analysed by high-performance liquid chromatography. Microbiological sterility of freshly prepared s les and bulk s les previously used for 2 weeks within the hospital was determined using a pour plate technique. Microbial survival in citric acid was determined by inoculating Staphylococcus aureus, Escherichia coli, or Candida albicans into citric acid solution and monitoring the number of colony-forming units/mL over 40 min. Citric acid solutions remained stable at 4 °C for 28 days (98.4 ± 1.8 % remained). The freshly prepared and clinical s les tested were sterile. However, viability studies revealed that citric acid solution allows for the survival of C. albicans but not for S. aureus or E. coli. The microbial survival study showed that citric acid kills S. aureus and E. coli but has no marked effect on C. albicans after 40 min. Citric acid s les at 0.8 M remained stable over the 4-week testing period, with viable microbial cells absent from s les tested. However, C. albicans has the ability to survive in citric acid solution if inadvertently introduced in practice. For this reason, in clinical and research practice it is suggested to use single-use aliquots prepared aseptically which can be stored for up to 28 days at 4 °C.
Publisher: Bentham Science Publishers Ltd.
Date: 2007
DOI: 10.2174/157488607779315471
Abstract: Suitable dosage forms are not always available for specific patient populations and must be extemporaneously compounded. Extemporaneous preparation is the manipulation of drugs and excipients for a particular patient using traditional compounding techniques these are referred to as 'off-label' and 'unlicensed' medicines. Off-label use can include altered doses, dosage forms or indications for use. Registered medicines are produced to internationally recognized standards of Good Manufacturing Practices. Within the pharmaceutical manufacturing industry, quality, safety and efficacy are enforced by regulatory legislations. In contrast, the responsibility for acceptable standards for the compounding of 'off-label' medicines falls on the prescriber, pharmacist or hospital nurse. Studies have been conducted by researchers from Australia and throughout Europe, highlighting the frequency of off-label use for paediatrics, with one study reporting that most extemporaneous preparations (29.6%) were for drugs required to treat metabolic diseases. Risks include compounding errors, adverse reactions to ingredients and excipients, and non-validated stability of the product. Sterile compounded products, including products for ophthalmic and palliative care, carry additional risks in these vulnerable patients. This paper provides an overview of off-label medicines highlighting biopharmaceutical, quality, safety and efficacy issues important to medical and allied health professionals.
Publisher: Informa UK Limited
Date: 11-2013
DOI: 10.1080/00480169.2013.773853
Abstract: The aims of this study were to explore the extent of extemporaneous compounding in veterinary centres throughout New Zealand and to determine whether pharmacists could collaborate with veterinarians to improve this service in New Zealand. Questionnaires were sent to 200 randomly selected veterinarians in New Zealand. Semi-structured interviews were also conducted with selected participants from four animal facilities (zoos, research facilities and animal shelters) and two compounding pharmacies. Of the 200 veterinarian questionnaire recipients, 99 responded. Ten replies were withdrawn from the study giving a response rate of 44.5%. Of these 89, 33 (37%) compounded in their practice. Of the 33 compounding professionals, 3 (9%) compounded daily for animals under their care 11 (34%) weekly, 18 (54%) monthly and 1 (3%) compounded yearly. Compounding was done by 29/33 (88%) veterinarians, 16/33 (48%) veterinary nurses or 6/33 (18%) others. It was carried out due to the unavailability of commercial products, or the need for dose adjustment to ease administration or improve compliance. The animals most commonly requiring veterinary compounding were dogs (21/33 64%), cats (19/33 58%) or cattle (15/33 46%). Products which were commonly compounded included cyclosporin eye drops, methimazole gels and potassium bromide solutions. Issues commonly faced when compounding included unavailability of dosage forms (18/33 55%) or appropriate ingredients (14/33 42%), stability (12/33 36%), time constraints (10/33 30%) or unavailability of equipment (9/33 27%). Reasons given for not compounding included medicines being commercially available (38/56 68%), pharmacy compounding for those particular practices (24/56 43%), lack of training (21/56 38%), ingredients (16/56 29%) or equipment (15/56 11%). All participants who worked with a pharmacist (11/33 33%) described this relationship as beneficial and indicated they would continue to do so in the future. Veterinary extemporaneous compounding exists in New Zealand. As pharmacists have extensive knowledge in formulating medications and compounding they could be of greater value to veterinarians and their patients. Educating both professions on the opportunities available to them from this collaboration could be an important step forward. This study provides new information regarding extemporaneous compounding for veterinary patients in New Zealand.
No related grants have been discovered for Derryn Gargiulo.