Background: The inappropriate use of antimicrobials in outpatient and inpatient settings has led to the spread of microbial resistance, reduced clinical effectiveness of antimicrobial drugs, and significant direct and indirect costs. Various programs have been implemented to improve antimicrobial usage patterns. The study examined how the Health Transformation Plan (HTP) affected prescribing injectable antibiotics and costs at a referral teaching hospital. Methods:  A retrospective observational study was conducted covering the periods 2011 to 2014 (pre-HTP period) and 2014 -2017 (post-HTP period) at Namazi Hospital in Shiraz, Iran. Forty-four injectable antimicrobial drugs were categorized into antifungals, antibacterials, and antivirals based on their Anatomical, Therapeutic, and Chemical codes.  Changes in prescribing practices were assessed annually based on total consumption rate, per capita consumption, total cost, and per capita cost. Required data were extracted from the hospital pharmacy database. Results:   Following the implementation of HTP, there were increases in total consumption (13.31%), numerical per capita consumption (1.39%), total cost (142.63%), and per capita cost (146%) of injectable antimicrobial drugs. The increases in per capita consumption, total cost, and per capita cost were statistically significant (P <0.05). Conclusion:  In conclusion, changes in antimicrobial consumption patterns following the implementation of HTP may be partially attributed to increased demand facilitated by easier and faster access to requested antibiotics by pharmacists and physicians in hospitals.

Background: This study aims to examine the cost variations of oral antidiabetic agents in India, highlighting the financial barriers that may impact patient adherence and treatment efficacy. Methods: This analytical study was performed by analysing the prices of 18 oral antidiabetic drugs with 42 formulations. Data was collected from the National Pharmaceutical Pricing Authority (NPPA) platform, focusing on single-drug tablet formulations. Price variations were assessed using cost ratios and percentage cost variations. Compliance with the Drug Price Control Order (DPCO) ceiling prices were also analysed. Results: The study revealed significant price variations among different brands of the same drug, with voglibose 0.3 mg exhibiting the highest cost ratio (1:139.92) and percentage variation (13892.30%). Additionally, a notable proportion of brands exceeded the DPCO ceiling prices, particularly metformin 1000 mg, where 9 out of 15 brands were non-compliant to the ceiling price. Conclusion: Despite the presence of a regulatory authority, substantial price variability among oral antidiabetic agents persists in India, potentially affecting patient adherence and health outcomes. The violations of DPCO pricing regulations indicate a need for stricter enforcement and expansion of price controls to ensure the affordability of essential medications and improve overall patient care.

Background: Nimesulide, a widely used non-steroidal anti-inflammatory drug (NSAID), is prescribed for pain relief, osteoarthritis, and dysmenorrhea. Variations in manufacturing processes can result in quality differences across brands, potentially affecting efficacy and safety. This study aims to assess the pharmacopeial quality control parameters and price variation of ten brands of Nimesulide tablets available in the Nepalese market. Methods:  Ten different brands of Nimesulide 100 mg tablets (five Nepalese and five Indian) were randomly selected. Quality control tests, including weight variation, hardness, friability, disintegration, dissolution, and drug content assay, were performed following British Pharmacopoeia standards. Price variation was also assessed. Results: All brands met the pharmacopeial standards for weight variation, hardness, friability, disintegration, dissolution, and drug content. Minor variations were observed in disintegration time and dissolution rates. Indian brands were relatively more expensive than Nepalese brands. Conclusion:  meropenem and cephalosporins/siderophore cephalosporins have similar effectiveness as therapy for gram-negative infections in HAP .

Background:   Pharmaceutical science is one of the most dynamic scientific fields in the production of new science and technology due to its tremendous impact on improving health. Techniques such as DEA (data envelopment analysis) and BSC (balanced scorecard) are tools that cannot be considered alternative techniques. The main purpose of this study is to evaluate the efficiency of pharmaceutical companies introduced in the Tehran Stock Exchange based on the model Balanced Scorecard, and using data envelopment analysis. Methods:    In the beginning, performance evaluation indicators from four perspectives: financial, customer, internal processes, and learning and growth; then the efficiency of these companies is considered based on the indicators considered in the model (BSC), measured using (DEA). The statistical population of this study consisted of 13 pharmaceutical companies operating in Iran and listed on the Tehran Stock Exchange. After collecting data, the efficiency rating of pharmaceutical companies was calculated using the output-driven CCR model. This model has been implemented using DEA-Solver software. Results:   The results of the model implementation include efficiency scores for each decision unit. As a result, companies that have a rating of 1 are effective. Others are considered ineffective. The results show that out of the 13 pharmaceutical companies surveyed, 9 companies are effective and the rest are ineffective. Conclusion:  As a result, companies that have a score of 1 are efficient and compared to other units, they have relatively better used their resources and obtained better results.

Background: Hospital Acquired Pneumonia (HAP) or nosocomial pneumonia is an infection caused mainly by gram-negative bacteria. Carbapenems and cephalosporins/cephalosporin siderophores are effective for infections caused by gram-negative bacteria. Objective: To compare the effectiveness of antibiotics from the Carbapenem group (meropenem) compared to the cephalosporin/cephalosporin siderophore group in HAP infections caused by gram-negative bacteria. Methods:  Sources of article searches used Cochrane and PubMed, which were then selected by the PICO method with a population of adult HAP patients, with comparator cephalosporins/cephalosporin siderophores that have clinical improvement outcomes with parameters of microbiological response and death, the flow chart PRISMA described it. Results: A total of 7 articles comprehensively discussed the effectiveness of cephalosporins/siderophore cephalosporins and meropenem against Klebsiella pneumonia, Pseudomonas aeruginosa, and Escherichia coli. The clinical recovery of patients after administering these two antibiotics showed high therapeutic effectiveness and could reduce mortality. Ceftazidime-avibactam, ceftolozane-tazobactam, and cefiderocol are new antibiotics that are effective for HAP. Meropenem at high doses can offset the efficacy of the three antibiotic combinations and minimize antibiotic resistance. Conclusion:  meropenem and cephalosporins/siderophore cephalosporins have similar effectiveness as therapy for gram-negative infections in HAP.

Background:  Chronic Kidney Disease (CKD) represents a substantial global health and economic challenge, affecting millions of individuals and placing a heavy burden on healthcare systems. This review delves into the major risk factors contributing to CKD, with a focus on diabetes, hypertension, cardiovascular diseases, age, gender, genetic factors, family history, socioeconomic status, chronic use of certain medications, high protein diet, auto-immune diseases, urinary tract obstruction, recurrent kidney infections, and some additional factors. Methods:   This review provides a comprehensive analysis of the impact of these risk factors on both healthcare costs and patient out-of-pocket expenses, highlighting the direct and indirect financial burdens associated with CKD. Results:  It critically examines how these factors not only accelerate CKD progression but also compound the financial strain on patients. Diabetes, characterized by persistent hyperglycaemia, leads to kidney damage and necessitates extensive medical management, while hypertension exacerbates kidney deterioration through increased vascular pressure. Socioeconomic status further complicates CKD management, as lower income and limited access to healthcare services hinder effective treatment and exacerbate health disparities. Conclusion:  This article offers insights into potential interventions and policy measures designed to mitigate the economic impact on affected individuals, emphasizing the need for integrated strategies to address both the health and financial aspects of CKD.