Saudi Journal of Clinical Pharmacy

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Background: Hepatorenal syndrome (HRS) is a functional form of acute kidney injury (AKI) that develops in patients with advanced liver disease. The use of octreotide (OCT) and midodrine (MID) along with albumin is commonly used in practice despite lack of strong evidence. Objective: The purpose of the study is to evaluate the efficacy of combining octreotide and midodrine in HRS patients. Materials and Methods: This is a retrospective, single center study. All patients who received both OCT/MID from January 2005 to April 2013 were identified from the electronic pharmacy system at a major tertiary care center in Riyadh, Saudi Arabia. The aim of the study is to evaluate the safety and efficacy and predictors to response of the combination of OCT/MID in patients with decompensated liver cirrhosis with type I HRS receiving standard of care therapy. The primary endpoint was the change in estimated glomerular filtration rate (eGFR) within 30 days of starting therapy compared to baseline. Results: There was no significant improvement in eGFR using Cockcroft-Gault (CG) from baseline until the end of treatment (P = 0.311). Conclusion: Combination therapy of octreotide and midodrine along with albumin did not improve the eGFR in patients with type 1 HRS.

Case Report: In this paper we discuss the clinical course of a 25-week gestational age preterm neonate who suffered with multiple comorbidities atop of an E. meningoseptica infection causing meningitis and hydrocephalus. A multitude of antibiotics were administered to the child, such as vancomycin, ciprofloxacin, trimethoprim-sulfamethoxazole, and rifampicin. However, the pathogen either had prior resistance to the agents or newly developed resistance along the disease course. After many trials of antibiotics, the usage of ceftazidime/avibactam and moxifloxacin dual therapy induced clinical and microbiological eradication of the pathogen. Objective: This case report aims to discuss the multidrug approach used to treat a preterm neonates Elizabethkingia Meningoseptica infection in a Tertiary Care Hospital in Saudi Arabia. Conclusion: E. meningoseptica is an uncommon infectious agent which can cause meningitis and even sepsis that is difficult to treat due to its multidrug resistance phenotype. Continuous reviews of new case reports on successful attempts of treating E. meningoseptica are paramount to maintaining updated therapy options for newly encountered cases in day-to-day practice in the neonatal intensive care unit (NICU).

Online since 26^th July 2021