Browsing by Author "Eljaaly, Khalid"

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    Antibiotics in the pipeline: a literature review (2017–2020)
    (Springer, 2021-10-04) Al-Tawfiq, Jaffar A.; Momattin, Hisham; Al-Ali, Anfal Y.; Eljaaly, Khalid; Tirupathi, Raghavendra; Haradwala, Mohamed Bilal; Areti, Swetha; Alhumaid, Saad; Rabaan, Ali A.; Al Mutair, Abbas; Schlagenhauf, Patricia; Medicine, School of Medicine
    Introduction Antimicrobial resistance (AMR) is an emerging global threat. It increases mortality and morbidity and strains healthcare systems. Health care professionals can counter the rising AMR by promoting antibiotic stewardship and facilitating new drug development. Even with the economic and scientific challenges, it is reassuring that new agents continue to be developed. Methods This review addresses new antibiotics in the pipeline. We conducted a review of the literature including Medline, Clinicaltrials.org, and relevant pharmaceutical companies for approved and in pipeline antibiotics in phase 3 or new drug application (NDA). Results We found a number of new antibiotics and reviewed their current development status, mode of action, spectra of activity, and indications for which they have been approved. The included studies from phase 3 clinical trials were mainly utilized for the treatment of acute bacterial skin and skin structure infections, community-acquired bacterial pneumonia, and pneumonia acquired in the healthcare settings. The number of these agents is limited against high priority organisms. The identified antibiotics were based mainly on previously known molecules or pre-existing antimicrobial agents. Conclusion There are a limited number of antibiotics against high priority organisms such as multi-drug-resistant Pseudomonas aeruginosa, and carbapenem-resistant Enterobacteriaceae. New antimicrobial agents directed against the top priority organisms as classified by the World Health Organization are urgently needed.
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    Contraindicated drug–drug interactions associated with oral antimicrobial agents prescribed in the ambulatory care setting in the United States
    (Elsevier, 2018) Eljaaly, Khalid; Alshehri, Samah; Bhattacharjee, Sandipan; Al-Tawfiq, Jaffar A.; Patanwala, Asad E.; Medicine, School of Medicine
    Objectives Antimicrobial agents are commonly used in ambulatory care settings. Our objective was to examine national-level patterns of contraindications between oral antibacterial or antifungal agents and patients' other oral medications in the US ambulatory care setting. Methods This cross-sectional study included multiple year pooled data (2003–2011) from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey (NHAMCS Outpatient Department). Visits by adults (age ≥18 years) in ambulatory settings in the United States who were prescribed oral antibacterial or antifungal agents were evaluated for potential drug–drug interaction (DDI) contraindications. Findings with relative standard error >30% or unweighted sample size <30 were not reported because these were deemed unreliable estimates. Results From 2003 to 2011, there were 1 235 000 outpatient visits (proportion = 0.52%; 95% confidence interval (CI), 0.29–0.74) in which a patient was prescribed an antimicrobial agent associated with a contraindicated DDI. The most prevalent antimicrobials with contraindicated combination among outpatients were simultaneous use of macrolide-containing products (erythromycin or clarithromycin) with statin medication–containing products (simvastatin or lovastatin) (841 864 visits, proportion = 1.91%; 95% CI, 0.96–2.86). The next most common combination was use of fluoroquinolones with antiarrhythmic agents (amiodarone, sotalol, quinidine or procainamide) (365 622 visits, proportion = 0.19%; 95% CI, 0.06–0.32). Conclusions Providers should be aware of potential contraindicated DDIs when prescribing antibiotics, especially macrolides and fluoroquinolones.
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    Description and Analysis of Cytokine Storm in Registered COVID-19 Clinical Trials: A Systematic Review
    (MDPI, 2021-06) Eljaaly, Khalid; Malibary, Husam; Alsulami, Shaimaa; Albanji, Muradi; Badawi, Mazen; Al-Tawfiq, Jaffar A.; Medicine, School of Medicine
    The purpose of this systematic review was to describe the characteristics of clinical trials that focused on COVID-19 patients with cytokine release syndrome (CRS) and the variability in CRS definitions. Two authors independently searched three clinical trial registries and included interventional clinical trials on COVID-19 hospitalized patients that required at least one elevated inflammatory biomarker. Relevant data, including the type and cutoff of the measured biomarker, oxygen/respiratory criteria, fever, radiologic criteria, and medications, were summarized. A total of 47 clinical trials were included. The included studies considered the following criteria: oxygen/respiratory criteria in 42 trials (89%), radiologic criteria in 29 trials (62%), and fever in 6 trials (18%). Serum ferritin was measured in 35 trials (74%), CRP in 34 trials (72%), D-dimer in 26 trials (55%), LDH in 24 trials (51%), lymphocyte count in 14 trials (30%), and IL-6 in 8 trials (17%). The cutoff values were variable for the included biomarkers. The most commonly used medications were tocilizumab, in 15 trials (32%), and anakinra in 10 trials (24.4%). This systematic review found high variability in CRS definitions and associated biomarker cutoff values in COVID-19 clinical trials. We call for a standardized definition of CRS, especially in COVID-19 patients.
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    Histamine release theory and roles of antihistamine in the treatment of cytokines storm of COVID-19
    (Elsevier, 2020-09-03) Eldanasory, Omar Abdelhay; Eljaaly, Khalid; Memish, Ziad A.; Al-Tawfiq, Jaffar A.; Medicine, School of Medicine
    Histamine initiates abnormal immune response leading to cytokine storm and multi-organs failure. Thus, the use of antihistaminic medications could result in a significant immune modulation which may help in the treatment of cytokine storm of COVID-19. Future studies could compare H2R antagonists with those of steroid therapy in addition to the effect of combination therapy in relation to standard therapy.
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    Hydroxychloroquine safety: A meta-analysis of randomized controlled trials
    (Elsevier, 2020-07-06) Eljaaly, Khalid; Alireza, Kasim Huseein; Alshehri, Samah; Al-Tawfiq, Jaffar A.; Medicine, School of Medicine
    Background: Hydroxychloroquine (HCQ) is currently being examined for COVID-19. No previous meta-analysis has evaluated its side effects versus placebo. We conducted this meta-analysis to compare the safety of HCQ versus placebo. Methods: Two authors independently searched PubMed and EMBASE databases for randomized controlled trials (RCTs) of adults comparing the adverse events (AEs) of HCQ versus placebo for any indication. Peto odds ratios (Peto ORs) and 95% confidence intervals (CIs) were calculated based on random-effects models. The heterogeneity (I2) was assessed using Cochran's Q test. Results: Nine RCTs (eight were double-blind) with a total of 916 patients were included. HCQ caused significantly more skin pigmentation than placebo (Peto OR, 4.64; 95% CI, 1.13 to 19.00; P-value = 0.033; I2 = 0%). The increase in other AEs did not reach statistical significance: rash (Peto OR, 1.11; 95% CI, 0.3 to 3.77; P-value = 0.03; I2 = 0%); gastrointestinal AEs (Peto OR, 1.43; 95% CI, 0.55 to 3.72; P-value = 0.46; I2 = 15.17%); headache (Peto OR, 1.94; 95% CI, 0.65 to 5.78; P-value = 0.23; I2 = 9.99%); dizziness (Peto OR, 1.32; 95% CI, 0.49 to 3.52; P-value = 0.58; I2 = 0%); fatigue (Peto OR, 2.13; 95% CI, 0.76 to 5.98; P-value = 0.15; I2 = 0%); and visual AEs (Peto OR, 1.61; 95% CI, 0.76 to 3.41; P-value = 0.22; I2 = 0%). Cardiac toxicity was not reported. Conclusions: This meta-analysis of RCTs found a significantly higher risk of skin pigmentation in HCQ users versus placebo. More data are needed to evaluate HCQ in the context of COVID-19 treatment.
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    The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section
    (Elsevier, 2021-10) Alhazzani, Waleed; Alshahrani, Mohammed; Alshamsi, Fayez; Aljuhani, Ohoud; Eljaaly, Khalid; Hashim, Samaher; Alqahtani, Rakan; Alsaleh, Doaa; Al Duhailib, Zainab; Algethamy, Haifa; Al-Musawi, Tariq; Alshammari, Thamir; Alqarni, Abdullah; Khoujah, Danya; Tashkandi, Wail; Dahhan, Talal; Almutairi, Najla; Alserehi, Haleema A.; Al-Yahya, Maytha; Al-Judaibi, Bandar; Arabi, Yaseen M.; Abualenain, Jameel; Alotaibi, Jawaher M.; Al Bshabshe, Ali; Alharbi, Reham; Al-Hameed, Fahad; Elhazmi, Alyaa; Almaghrabi, Reem S.; Almaghlouth, Fatma; Abedalthagafi, Malak; Al Khathlan, Noor; Al-Suwaidan, Faisal A.; Bunyan, Reem F.; Baw, Bandar; Alghamdi, Ghassan; Al Hazmi, Manal; Mandourah, Yasser; Assiri, Abdullah; Enani, Mushira; Alawi, Maha; Aljindan, Reem; Aljabbary, Ahmed; Alrbiaan, Abdullah; Algurashi, Fahd; Alsaawi, Abdulmohsen; Alenazi, Thamer H.; Alsultan, Mohammed A.; Alqahtani, Saleh A.; Memish, Ziad; Al-Tawfiq, Jaffar A.; Al-Jedai, Ahmed; Medicine, School of Medicine
    BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.