Research Articles (Pharmacology)

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Catha edulis and Datura stramonium mitigate oxidative stress, mitochondrial dysfunction, and cell death in an SH-SY5Y model of Parkinson's disease
Mogale, Tidimalo; De Beer, Andries Daniël; Rudolph, Willem Johannes; Steenkamp, Vanessa (Elsevier, 2026-04-06)
INTRODUCTION : Parkinson's disease (PD), the second most common neurological disorder, is often managed with medications targeting specific symptoms. Complementing conventional therapies, medicinal plants are frequently used for neurological disorders, including PD. This study evaluated the effects of crude extracts and fractions of Catha edulis (Vahl) Forssk. ex Endl. and Datura stramonium L.—psychoactive plants—on PD-related mechanisms using SH-SY5Y human neuroblastoma cells. METHOD : Crude extracts of C. edulis (leaves) and D. stramonium (leaf/root mixture) were prepared using dichloromethane/methanol (50/50). Fractionation was performed via C8 solid-phase extraction. Cytotoxicity and cytoprotective effects of the crude extracts and fractions against 6-hydroxydopamine-induced cytotoxicity were assessed using the sulforhodamine B assay. Mechanistic studies included reactive oxygen species (ROS) generation, mitochondrial integrity, and apoptosis assays. In silico analysis was used to assess the binding of biomarkers to dopamine receptors. RESULTS : Both plant extracts exhibited minimal cytotoxicity. Crude extracts and fractions (F1–F7) displayed cytoprotective effects (5.8–34.28 %). The highest ROS reduction was observed for F1 of C. edulis (1.72-fold) and F2 of D. stramonium (1.33-fold). Both extracts reduced caspase 3/7 activation and maintained mitochondrial integrity. Atropine and scopolamine showed cytoprotection with IC50 values of 49.48 μM and 48.26 μM, respectively. In silico analysis indicated strong binding affinities of norephedrine and noradrenaline to dopamine D1 and D2 receptors. CONCLUSION : Both plant extracts preserved cell viability, reduced ROS levels, and maintained mitochondrial integrity, highlighting their potential as therapeutic agents for PD.
The evolution of obesity pharmacotherapy from sympathomimetics to incretin-based therapies
Ncube, Keith Ntokozo; Moloi, Neo L.; Malange, T. D. (Medpharm Publications, 2026-01)
Obesity is a chronic metabolic disorder that has reached epidemic proportions globally and in South Africa, contributing to the increasing burden of cardiometabolic diseases. Although lifestyle modifications remain a fundamental approach, long-term weight loss is often limited, necessitating the use of pharmacotherapy. Historically, centrally acting sympathomimetics, such as phentermine, have been predominant in South African treatments, albeit with restrictions concerning their safety and duration. This review examines the evolution of obesity pharmacotherapy from traditional agents, including phentermine and orlistat, to contemporary incretin-based therapies. Particular emphasis is placed on glucagon-like peptide-1 receptor agonists and dual incretin agonists, such as semaglutide and tirzepatide, which have demonstrated unprecedented efficacy in clinical trials involving patients with obesity. Emerging multi-hormonal and non-injectable agents are also discussed. This article underscores the transition from short-term appetite suppression to sustained pharmacological management of obesity and its comorbidities.
Estimated extent of purchasing of antibiotics without a prescription from community pharmacies in a rural provincein South Africa and the implications
Maluleke , Tiyani Milta; Maluleke, MorganTiyiselani; Jelić, Ana Golić; Campbell, StephenM.; Marković-Peković, Vanda; Schellack, Natalie; Chigome, Audrey; Cook, Aislinn; Godman, Brian; Meyer, Johanna C. (Frontiers Media, 2025-08-28)
BACKGROUND : Antimicrobial resistance is a considerable global health threat especially among low- and middle-income countries, exacerbated by considerable inappropriate dispensing of antibiotics. There have though been concerns with variable levels of dispensing of antibiotics without a prescription in South Africa. Consequently, a need to comprehensively estimate current levels of dispensing of antibiotics without a prescription, which was the aim of this study. METHODS : Administer a previously piloted questionnaire to all currently operating community pharmacies in a rural province, where dispensing of antibiotics without a prescription is likely to be greatest. The questionnaire included data on the estimated prevalence of antibiotics dispensed, their class and indication, and whether dispensed without a prescription. Community pharmacies were categorized into three: Independent, Chain and Franchise. RESULTS : 128/169 (75.7%) operational pharmacies participated, with independent pharmacies representing the majority (60.9%). There was a 78.3% response rate from 400 distributed questionnaires, including 106 pharmacists (33.9%) and 207 pharmacist assistants (66.1%) from 128 pharmacies. Antibiotics accounted for 47.9% (95% CI: 47.2%-48.6%) of all medicines dispensed. Penicillins were the most prevalent antibiotic dispensed (41.1%). Almost half (47.2%) of the antibiotics dispensed included macrolides, fluoroquinolones and cephalosporins, which are typically antibiotics from the Watch group. Sexually transmitted infections (33.5%) and upper respiratory tract infections (25.8%) were the most frequent indications for antibiotic dispensing. Overall, 69.3% of 128 participating pharmacies in this rural province in South Africa admitted to dispensing antibiotics without a prescription in the past 14 days, principally among independent pharmacies (98.7%). However, estimates suggest only 8.6% of the total volume of antibiotics being dispensed were dispensed without a prescription among the 88 community pharmacies admitting to this practice in the past 3 days. Encouragingly, 98.1% of community pharmacists and 97.6% of pharmacist assistants indicated they always or mostly offered symptomatic relief before dispensing antibiotics without a prescription to patients with self-limiting conditions. CONCLUSION : There were considerable concerns regarding the prescribing and dispensing of antibiotics in this rural province including Watch antibiotics. This included the number of community pharmacies, especially independent pharmacies, where patients could purchase antibiotics without a prescription. Multiple strategies involving all key stakeholder groups are need to improve future antibiotic use across South Africa and reduce AMR.
Current knowledge and attitudes toward antibiotic use among community pharmacy personnel in a rural province in South Africa and the implications
Maluleke , Tiyani Milta; Maluleke, Morgan Tiyiselani; Jelić, Ana Golić; Campbell, Stephen M.; Marković-Peković, Vanda; Schellack, Natalie; Ramdas , Nishana; Godman, Brian; Meyer, Johanna C. (Frontiers Media, 2025-10-02)
BACKGROUND : Antimicrobial resistance (AMR) is an appreciable threat to public health, especially among low- and middle-income countries (LMICs), exacerbated by high levels of inappropriate prescribing and dispensing of antibiotics in these countries. There have been variable levels of dispensing of antibiotics without a prescription among community pharmacies in South Africa. Given the importance of community pharmacies, especially in rural South Africa, there is a need to assess their knowledge and attitudes towards antibiotics, AMR, and antibiotic stewardship. This was the aim of this study. METHODS : A previously piloted questionnaire was administered to pharmacy personnel currently operating community pharmacies in a rural province in South Africa, where dispensing of antibiotics without a prescription is likely to be greatest. The questionnaire included key knowledge questions regarding antibiotics and AMR, as well as ways to reduce AMR. Community pharmacies were divided into three categories: Independent, chain, and franchise pharmacies. RESULTS : A total of 128 pharmacies participated (75.7%), with independent pharmacies representing the majority (60.9%). A total of 313 completed questionnaires were returned (78.3% response rate), including responses from 106 pharmacists (33.9%) and 207 pharmacist assistants (66.1%). Overall, there was very good knowledge among both community pharmacists and pharmacist assistants concerning antibiotics and AMR. However, there was a significant misconception regarding the potential role of antibiotics in relieving pain. Encouragingly, attitudes regarding the risks associated with obtaining antibiotics without a prescription among both community pharmacists and pharmacist assistants were high. There was also strong agreement among both community pharmacists and pharmacist assistants for potential solutions to AMR. CONCLUSION : Overall, the findings showed that most pharmacists and pharmacist assistants in this rural province demonstrated a strong understanding of the effectiveness of antibiotics in bacterial infections and their lack of effectiveness to treat viral infections. They also demonstrated considerable knowledge regarding the risks associated with the inappropriate dispensing of antibiotics without a prescription, as well as ways to address rising AMR rates.
Women trailblazers shaping the global future of antimicrobial stewardship and antimicrobial resistance
Goff, Debra A.; Amir, Afreenish; Ashiru-Oredope, Diane; Balasa, Ella; Carter, Vanessa; Dramowski, Angela; Flayhart, Diane; Kanj, Souha; Rossi, Flavia; Schellack, Natalie; Shader Smith, Diane; Thursky, Karin; Van den Bergh, Dena; Villegas, Maria Virginia (Taylor and Francis, 2026)
No abstract available.
Beyond prescriptions : chronic medication adherence predicts mortality risk in a large-scale cohort study
Blanco, Jessica Hamuy; Janse van Rensburg, Dina Christina; Jansen van Rensburg, Audrey; Uys, Corrie; Schellack, Natalie (Frontiers Media, 2025-11-25)
OBJECTIVES : The Medication Adherence Risk Score (MARS) is a calculated score using pharmacy transactional data spanning 50% of the South African private pharmacy market. This study aims to demonstrate that the existing MARS model enhances risk stratification by identifying individuals at increased risk of mortality related to non-adherence to chronic medication. METHODS : This was a retrospective cohort study in which an analysis of the relative mortality experience was compared to a standard fully underwritten base was performed for each of the MARS categories (low, medium, high and very high). The actual-to-expected ratio (AER) and relative risk (RR) for each category were compared across age groups and gender. The least absolute shrinkage and selection operator (LASSO) regression analysis method was applied to determine the most important variables within the dataset, providing insight into whether MARS offered more benefit than traditional risk rating factors. A time-to-event analysis by MARS categories was performed using the Cox proportional hazards model. RESULTS : The mortality experience of the study population was higher than the expected fully underwritten base (AER = 175%). For the overall sample, increasing AER and RR did not correlate with increasing MARS categories. However, use of the MARS in addition to age band allowed for differentiation of risk within the 25 to 55 age bands, with a higher MARS score indicating a higher AER and RR. The time-to-event analysis showed a statistically significant difference in the mean number of months before death occurred between the different MARS categories (low = 26.53; medium = 8.93; high = 7.02; very high = 6.92; p < 0.001). CONCLUSION : The MARS is not generalisable across all groups, as evidenced by the absence of a monotonic trend in the overall sample. However, when combined with age, it effectively differentiated mortality risk for individuals aged 25–55. The standard fully underwritten model underestimated the number of deaths within this pharmacy population. The time-to-event analysis showed a significant inverse relationship between MARS category and survival time.
Hypertension pharmacogenetics and limitations in Africa - a focus on the ACE, AGTR1 and CYP2C9 genes
Gomera, Rejoice T.; Van Hougenhouck-Tulleken, Wesley; Brand, Sarel J.; Van Niekerk, Chantal; Outhoff, Kim (Springer, 2026)
Hypertension affects approximately a billion people worldwide and is a major risk for adverse cardiovascular and renal outcomes, particularly in the sub-Saharan African population. Only a small number of treated hypertensive patients achieve blood pressure control. Apart from factors such as poor medication adherence, the limited efficacy of some therapies could be attributed to inter-individual genetic variability. Thus, identifying genetic markers linked to antihypertensive drug response could assist in individualizing hypertension treatment and optimizing antihypertensive regimens to provide the greatest efficacy with the lowest risk for adverse effects. The Angiotensin-converting enzyme (ACE), Angiotensin II type I receptor (AGTR1) and Cytochrome P450 family 2 subtype C member 9 (CYP2C9) genes play pivotal roles in hypertension, and several key single-nucleotide variations (SNV) in these genes are known to have substantial effects on drug response in non-African populations. Numerous research findings corroborate that genotype-targeted antihypertension treatment regimens are more successful and can reduce costs by mitigating the likelihood of serious side effects. However, these findings may not be directly applicable to African populations due to the limited number of studies conducted and increased genomic variability within African populations. Two interconnected but distinct challenges impede translation of these benefits to African populations, namely limited implementation of pharmacogenetic testing for actionable drug-gene pairs across African healthcare systems, and the underrepresentation of African genetic ancestry in global genomic datasets, which hinders the identification and validation of population-specific variants. This review explores these dual challenges by examining the pharmacogenetic landscape of hypertension, with a focus on three clinically relevant genes: ACE, AGTR1, and CYP2C9. We highlight known gene-drug interactions, population-specific data gaps, and the need for research and infrastructure development to advance precision medicine in Africa.
Psychometric validation of the community antimicrobial use scale (CAMUS) in primary healthcare and the implications for future use
Ramdas, Nishana; Schellack, Natalie; Uys, Corrie; Godman, Brian; Campbell, Stephen M.; Meyer, Johanna C. (MDPI, 2026-01)
BACKGROUND/OBJECTIVES : Patient-level factors strongly influence antimicrobial resistance (AMR) through the pressure applied to healthcare professionals to prescribe antibiotics even for self-limiting viral infections, enhanced by knowledge and attitude concerns. This includes Africa, with high levels of AMR. However, validated measurement tools for African primary healthcare (PHC) are scarce. This study evaluated the reliability, structural validity, and interpretability of the Community Antimicrobial Use Scale (CAMUS) in South Africa. METHODS : A cross-sectional survey was conducted with 1283 adults across 25 diverse public PHC facilities across two provinces. The 30-item theory-based tool underwent exploratory and confirmatory factor analysis (EFA/CFA), reliability, and validity testing. RESULTS : EFA identified a coherent five-factor structure: (F1) Understanding antibiotics; (F2) Social and behavioural norms; (F3) Non-prescribed use; (F4) Understanding of AMR; and (F5) Attitudes. Internal consistency was strongest for knowledge and misuse domains (alpha approximation 0.80). Test–retest reliability was good-to-excellent (ICC: 0.72–0.89). CFA confirmed acceptable composite reliability (CR ≥ 0.63). Although average variance extracted (AVE) was low for broader behavioural constructs, indicating conceptual breadth, it was high for AMR knowledge (0.737). Construct validity was supported by positive correlations with health literacy (r = 0.48) and appropriate use intentions (r = 0.42). Measurement error metrics (SEM = 1.59; SDC = 4.40) indicated good precision for group-level comparisons. CONCLUSIONS : CAMUS demonstrated a theoretically grounded structure with robust performance in knowledge and misuse domains. While social and attitudinal domains require refinement, we believe the tool is psychometrically suitable for group-level antimicrobial use surveillance and programme evaluation in South African PHC settings and wider to help with targeting future educational programmes among patients.
Actions speak louder than words : are we role modelling what we hope for?
Cordier, Werner (South African Medical Association, 2025-12)
Role modelling in academic settings represents a powerful force that shapes the next generation of scholars, professionals and citizens. When we, as role models, demonstrate factors such as intellectual curiosity, ethical rigour and respectful communication, we create a platform for further professional development of our students. The implicit messages we send through our actions – what constitutes professional behaviour, what it means to be an academic, and what drives scholarship – often speak louder than our explicit teachings. Care should therefore be taken to ensure these messages are translated appropriately. Role modelling is a powerful learning device that bridges formal academic content related to such matters and highlights its authenticity. It is particularly well-suited for behavioural learning, especially when we consider the vast array of contextual factors, such as sociodynamic interactions, that are not easy to translate in a text or lecture.
Facing up to reality : over-the-counter access to antibiotics in low-income and middle-income countries needs a paradigm shift in thinking
Mendelson, Marc; Afari-Asiedu, Samuel; Schellack, Natalie; Wertheim, Heiman; Mpundu, Mirfin; Gautham, Meenakshi (Elsevier, 2025-12)
Almost half of the global population do not have access to universal health coverage and the current shortfall of health-care professionals (including doctors and nurses) is estimated to reach a deficit of 11 million by 2030, disproportionately affecting low-income and middle-income countries (LMICs). Against this backdrop, of the 8 million deaths per year from bacterial sepsis worldwide, over 3 million are from treatable antibiotic-sensitive infections. This number suggests that access to antibiotics under the current model is insufficient. In many LMICs, over-the-counter antibiotic sellers that range from informal drug procurers to small-sized and medium-sized private pharmacies are the primary and most accessible care providers. Yet global health narratives, often shaped by the traditional doctor-led prescribing model, portray them as drivers of misuse rather than recognising them as politically and economically embedded actors that meet unmet health and antibiotic needs. In this Viewpoint, we argue that over-the-counter antibiotic sellers need to be integrated into a solution for antibiotic misuse and overuse, rather than being seen as part of the problem. Furthermore, we provide a framework with which to achieve integration, so that the concept of global health care for all becomes a reality.
A systematic review of medication adherence and mortality in chronic disease : implications for clinical guidelines and policy
Hamuy Blanco, Jessica; Janse van Rensburg, Dina Christina; Jansen van Rensburg, Audrey; Uys, Corrie; Schellack, Natalie (Wiley, 2026-02)
OBJECTIVES : This systematic review aims to investigate whether good medication adherence in adults with chronic conditions is associated with a lower mortality risk compared to poor adherence within published literature, and the extent to which this relationship is represented within South African policy and legislation. METHODS : A systematic search of three electronic databases-PubMed, MEDLINE (Ovid) and Scopus-was conducted. Only primary research articles published in English after March 2004 and with study populations >18 years of age were considered. South African health legislation and professional guidelines from 2014 onwards were sourced using search terms aligned with the systematic review strategy and systematically analysed. RESULTS : Twenty-six articles were included in the systematic review. Effect measures included hazard ratios (HR), incidence rate ratios (IRRs) and odds ratios (OR), where values greater than 1 indicate a higher risk of mortality. The effect measures from individual studies were categorized according to adherence levels: good, intermediate, poor and non-adherent. A total of 17 effect measures were reported for good adherence, only one of which was greater than 1. There were 44 effect measures reported for intermediate, poor and non-adherence categories, all of which were greater than 1. Pooled estimates for poor adherence and non-adherence had the highest HRs (HR = 1.63; 95% confidence interval [CI]: 1.36-1.96 and HR = 2.77; 95% CI: 2.3-3.34 respectively). Review of South African health legislation and professional guidelines showed a dominance of mortality-related terms (1.323 and 2.98 matches per 1000 words for 'mortality' and 'death', respectively) compared with adherence-related terms (0.053-2.98 matches per 1000 words). Co-occurrence between medication adherence-related search terms (MARS, adherence, medication adherence, adhere, non-adherence and medication compliance) and mortality-related search terms (death, mortality and survival) was low within all documents analysed. CONCLUSION : The systematic review demonstrates a clear relationship between good adherence to chronic medication and a lower mortality risk. However, the review of legislative and policy documents suggests that government efforts are focused primarily on surveillance, rather than strategy or preventative measures. This strong evidence should motivate incorporating adherence-based risk assessments into clinical and legal frameworks.
Identification of multiple cardiotonic steroids in faecal material of untreated humans and rat strains
Masso, Zelie Flavienne; Mullah, Ebrahim; Bint, Hannah; Thiba, Anza; Dinat, Sarhana; Nweke, Ekene Emmanuel; Norton, Gavin R.; Woodiwiss, Angela Jill; Cromarty, Allan Duncan; Candy, Geoffrey Patrick (Elsevier, 2026-03)
Endogenous cardiotonic steroid (CTS) concentrations are raised in cardiovascular diseases. CTSs undergo gastro-hepatobiliary recirculation, with the gut being an important route of elimination, yet the presence of CTSs in faecal material is seldom reported. This study investigated methods to extract and identify the presence of CTSs in faecal material of rats and humans without prior treatment. METHODS : Freeze-dried faecal material from different untreated rat strains was extracted using various solvents, with separation and identification of CTSs using HPLC/MS. Preliminary results were obtained from human faecal material. RESULTS : Multiple CTSs were identified in faecal material, with marinobufagenin (MBG) predominant. Telocinobufagin was only detected in certain rat strains, whereas the extraction methods used did not recover ouabain. MBG and digoxin were elevated in Dahl salt sensitive rats fed supplementary salt. Bufalin was present in most spontaneously hypertensive rats (SHRs) but was not detectable in Wistar Kyoto rats (WKY). Conversely, digitoxin was detected in most WKYs but only few SHRs. Levels of digitoxin and bufalin remained relatively constant over 24 days in untreated rats. Solvent selection was critical in determining the CTSs extracted from human faecal material. CONCLUSIONS : Multiple CTSs were detected in faecal material of untreated rats and humans. Steroids varied between rat strains and aligned with phenotype. Extraction requires further solvent optimisation and the use of tandem MS/MS is essential to reliably detect the profile of CTSs present. Analysis of CTSs present in readily available faecal material will enable studies to determine relationships between CTSs, the microbiome and disease progression. HIGHLIGHTS • Extraction of cardiotonic steroids from faecal material is critically dependent on the solvent. • Multiple cardiotonic steroids were identified in the faecal material of untreated rats and humans. • Steroids varied with rat strains with marinobufagin being most abundant. • Bufalin and digitoxin were predominant in SHR and WKY rat faeces respectively. • Identified steroids isolated aligned with the phenotype of the rat strain.
Prevalence and associated factors for purchasing antibiotics without a prescription among patients in rural South Africa : implications for addressing antimicrobial resistance
Maluleke , Tiyani Milta; Maluleke, Morgan Tiyiselani; Ramdas, Nishana; Jelic, Ana Golic; Kurdi, Amanj; Chigome, Audrey; Campbell, Stephen M.; Markovic-Pekovic, Vanda; Schellack, Natalie; Godman, Brian; Meyer, Johanna C. (MDPI, 2025-12-16)
BACKGROUND : Antimicrobial resistance (AMR) is now a critical issue in South Africa, enhanced by considerable inappropriate prescribing of antibiotics. There is currently variable dispensing of antibiotics without a prescription. Where this occurs, it is principally for urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to comprehensively evaluate antibiotic dispensing patterns and factors influencing this to reduce AMR. METHODS : A previously piloted questionnaire was administered to patients exiting three different categories of community pharmacies in a rural province. The questionnaire included data on the prevalence of antibiotics dispensed, whether without a prescription, and the rationale for this. RESULTS : A total of 465 patients leaving community pharmacies with a medicine were interviewed. 54.4% of interviewed patients were dispensed at least one antibiotic, with 78.7% dispensed these without a prescription from either independent or franchise pharmacies. Metronidazole (36.1%) and azithromycin (32.7%) were the most dispensed antibiotics. STIs were the most common infectious disease for which an antibiotic was dispensed (60.1%), with 99.6% dispensed without a prescription. Upper respiratory tract infections (URTIs) were the most common infection where antibiotics were dispensed with a prescription (60.0%), with little dispensing without a prescription (7.1%). The most frequently cited reasons for obtaining antibiotics without a prescription were prior use (56.8%), long waiting times at PHC clinics (15.6%), and financial constraints (6.0%). CONCLUSIONS : There is an urgent need to review community pharmacists’ scope of practice, including allowing them to prescribe antibiotics for infectious diseases such as UTIs, similar to other countries. Concomitantly, utilise trained community pharmacists to engage with prescribers to improve future antibiotic use, especially for URTIs.
Tackling migraines head-on : insights into pathophysiology, management and treatment
Balmith, Marissa; Mare, M.; Basson, Charlize; Nyane, N.; Ditshego, Rebotile; Flepisi, B. (Medpharm Publications, 2025-10)
Migraines are complex neurological disorders characterised by recurrent episodes of moderate-to-severe headaches, often accompanied by sensory disturbances. Globally, migraine is one of the leading causes of disability and is classified into various subtypes based on individual characteristics and symptoms. Clinical presentation and diagnosis rely on the identification of specific symptoms and stages of migraine attacks, distinguishing them from other types of headache disorders. The pathophysiology of migraine involves a complex interplay between neurological, vascular, and biochemical factors, with the trigeminovascular system playing a central role. Migraine management includes both non-pharmacological and pharmacological approaches. Non-pharmacological strategies involve lifestyle modifications, dietary adjustments, and sleep and stress management. Pharmacological treatment involves therapies such as triptans, nonsteroidal anti-inflammatory drugs (NSAIDs), and calcitonin gene-related peptide (CGRP) antagonists, as well as preventive medications such as antihypertensives, antidepressants, antiepileptics, and newer biological therapies. Key challenges in migraine treatment include the accessibility of advanced therapies, the role of pharmacogenomics in personalised treatment, and the development of emerging therapies through clinical trials. Further research is needed to better understand the complex pathophysiology of migraine for the development of more effective and targeted treatment strategies.
Overview and management of colds and flu
Dlamini, Z.; Kupa, K.; Schellack, Natalie (Medpharm Publications, 2025-04)
In South Africa deaths related to colds and flu are at least three times higher when compared to the USA. The burden of HIV and tuberculosis in our country heightens the risk of severe flu-related illness. The common cold and flu are caused by very different viruses that share very similar symptoms. The common cold is a self-limiting upper respiratory tract viral infection and it is caused by the rhinovirus, coronavirus or the adenovirus. It usually resolves within 7–10 days. Flu is caused by the influenza virus and usually presents with headaches, myalgia, fever and body aches. There is no place for antibiotic usage in colds and flu management, and there is no clinical evidence which suggests that using antibiotics alters the course of the disease or prevents secondary infection. Treatment is mainly symptomatic and includes many over the counter-medicines, specific antiviral agents and herbal treatment.
Atrial fibrillation in South Africa : anti-arrhythmic and anticoagulation therapy-clinical considerations for pharmacists
Jordaan, Beatrice; Bronkhorst, E. (Medpharm Publications, 2025-10)
BACKGROUND d: Atrial fibrillation (AF) represents the most prevalent persistent cardiac rhythm disorder encountered in routine clinical care and is a leading contributor to stroke, systemic embolic events, and heart failure. In South Africa, the occurrence of AF is currently lower than anticipated, though it is showing an upward trend, driven in part by the substantial prevalence of hypertension, obesity, and valvular heart disease, frequently linked to rheumatic heart disease (RHD). Furthermore, the risk for arrhythmias is increased with structural heart disease due to fibrotic scar formation caused by myocardial infarction. Pharmacological and non-pharmacological treatments are used to limit the effect of arrhythmias on morbidity and potential mortality. The therapeutic approach to AF typically includes strategies for rhythm or rate regulation using anti-arrhythmic agents, in combination with anticoagulation agents to reduce the risk of thromboembolic events. In the public healthcare sector, warfarin continues to be the predominant anticoagulant, whereas direct oral anticoagulants (DOACs) are being adopted with increasing frequency in private healthcare settings. OBJECTIVES : This review summarises current epidemiology of AF in South Africa, outlines anti-arrhythmic and anticoagulation strategies, and highlights key considerations for pharmacists, including drug interactions, adverse effects, and patient counselling. RESULTS : While beta-blockers, calcium channel blockers, amiodarone, and sotalol remain mainstays for rate/rhythm control, newer agents have improved tolerability profiles. Anticoagulation decisions should be guided by the CHA₂DS₂-VA and HAS-BLED scores, in line with the 2024 ESC guideline, balancing stroke prevention with bleeding risk. DOACs offer practical advantages but cost, accessibility, and reversal agent availability remain limiting factors in public healthcare. CONCLUSION : Pharmacists play a critical role in AF management through patient education, adherence support, adverse effect monitoring, and optimisation of therapy in line with national and international guidelines.
SGLT2 inhibitors in type 2 diabetes mellitus : a pharmacist’s guide to optimised care
Jordaan, Beatrice; Outhoff, Kim (Medpharm Publications, 2025-09)
OBJECTIVES : To review current evidence on sodium–glucose co-transporter-2 (SGLT2) inhibitors in the management of type 2 diabetes mellitus (T2DM), highlighting their mechanisms, efficacy, safety, and relevance to the growing burden of diabetes mellitus within the South African healthcare context, where high rates of undiagnosed disease and limited specialist access amplify the importance of pharmacist-led interventions. This review underscores the vital role of pharmacists as frontline diabetes care providers – facilitating optimal use of SGLT2 inhibitors such as empagliflozin and dapagliflozin through patient counselling, safety monitoring, and therapeutic guidance. METHODS : A narrative literature review was conducted by searching PubMed, Google Scholar, and local databases. Key articles on SGLT2 inhibitors, their effects on cardiovascular and renal outcomes, and prevalence data on T2DM in South Africa were included. Relevant clinical trials and meta-analyses published in English were appraised, with a focus on recent developments and guidelines. RESULTS : Burden of diabetes in South Africa: T2DM prevalence can reach 12.9% or higher in certain urban black populations, exceeding the overall International Diabetes Federation (IDF) estimate of 10.8%. Nearly half (45.4%) of those affected remain undiagnosed. Mechanism and benefits: SGLT2 inhibitors lower blood glucose by enhancing urinary excretion of glucose, providing insulin-independent glycaemic control. They induce weight loss and mild blood pressure reductions. Cardiorenal protection: Large-scale trials conducted in T2DM patients with either established chronic kidney disease or cardiovascular disease or high cardiovascular risk demonstrate meaningful reductions in cardiovascular events, hospitalisation for heart failure, and progression of chronic kidney disease. Safety profile: While generally well tolerated, key adverse effects include genitourinary infections and rare euglycaemic ketoacidosis, especially during acute illness or low-carbohydrate intake. CONCLUSION : SGLT2 inhibitors address both the escalating rates of T2DM in South Africa and its serious complications. Their robust cardiorenal benefits, combined with modest weight loss and minimal hypoglycaemia risk, make them an essential component of contemporary diabetes pharmacotherapy. Pharmacists play a central role in identifying appropriate candidates, advising on safety precautions, and improving patient outcomes in an increasingly burdened healthcare landscape.
Hypertension in South Africa : a growing epidemic and evolving treatment paradigms
Jordaan, Beatrice; Theron, B.; Owusu, E.; Bronkhorst, E. (Medpharm Publications, 2025-06)
BACKGROUND : Hypertension is a major public health concern in South Africa, affecting 40–50% of adults, with control rates below 50% despite available treatments. It is a key driver of cardiovascular morbidity and mortality, particularly in populations with limited healthcare access, poor medication adherence, and high rates of comorbidities such as diabetes and obesity. This review examines the epidemiology, pathophysiology, diagnosis, treatment strategies, and public health approaches to hypertension in South Africa, highlighting gaps in care and opportunities for intervention. RESULTS : Pharmacological interventions such as fixed-dose combinations (FDCs) improve adherence but remain underutilised in public healthcare due to cost constraints. Community-based screening programmes (e.g. HealthRise South Africa) have successfully identified high-risk individuals, yet less than 30% of screened patients attend follow-ups due to referral challenges. Primary healthcare (PHC) infrastructure is overburdened, with workforce shortages, inconsistent medication availability, and weak referral systems limiting hypertension management. Public health policies targeting salt and sugar reduction have been implemented, but enforcement remains weak, and public awareness is insufficient. CONCLUSION AND POLICY IMPLICATIONS : Addressing hypertension in South Africa requires a multi-pronged strategy focusing on: 1. Expanding access to cost-effective FDCs in public clinics to improve adherence and BP control. 2. Strengthening PHC capacity through workforce training, task-shifting, and improved referral pathways. 3. Scaling up community-based screening and linkage-to-care programmes for early detection. 4. Enhancing enforcement of dietary policies and launching nationwide awareness campaigns on lifestyle modifications. 5. Implementing national BP monitoring registries to track trends and guide policy adjustments. A patient-centred, equity-driven approach that integrates pharmacological advances with robust public health interventions is critical to reversing the current trends of uncontrolled hypertension in South Africa.
Haemoglobin A1c (HbA1c) : clinical relevance, history, and role in diabetes mellitus management – a South African perspective
Jordaan, Beatrice; Outhoff, Kim (Medpharm Publications, 2025-06)
BACKGROUND : Diabetes mellitus (DM) is a growing health challenge in South Africa, with an increasing prevalence driven largely by urbanisation and lifestyle changes. Haemoglobin A1c (HbA1c) has emerged as a pivotal biomarker for diagnosing and monitoring diabetes. Its clinical utility is well established globally, yet its optimal use in the South African healthcare landscape remains an area of interest. This article provides a comprehensive review of HbA1c, outlining its historical discovery, biochemical basis, clinical applications, and interpretation challenges. Emphasis is placed on its role in South Africa, where access to laboratory testing and point-of-care diagnostics influences diabetes care. METHODS : A literature review was conducted using PubMed, Google Scholar, and local healthcare databases to evaluate HbA1c’s effectiveness in DM diagnosis and monitoring. International and South African guidelines were analysed to assess the standardisation and applicability of HbA1c testing in diverse populations. RESULTS : HbA1c is vital in diabetes management, though its accuracy may be affected by haemoglobinopathies, ethnicity, age, and medical conditions. Technological advances, such as point-of-care testing (POCT), have improved accessibility, particularly in underserved areas. Personalised HbA1c targets are increasingly recommended to enhance patient-centred care. CONCLUSION : While HbA1c is a valuable diagnostic and monitoring tool, healthcare professionals (HCPs) must be aware of its limitations in specific populations. Expanding access to HbA1c testing and integrating individualised glycaemic targets can improve diabetes management outcomes in South Africa.
Depression unveiled : a comprehensive review of pathophysiology and treatment advances
Skosana, P.; Naidoo, Mivasha; Nabyoma, J.; Mushipe, T. (Medpharm Publications, 2025-09)
Depression is one of the most commonly diagnosed mental health disorders among adults and is currently the third leading cause of disease worldwide. Depression, also referred to as major depressive disorder (MDD), poses a significant global health challenge, affecting over 300 million individuals worldwide. In sub-Saharan Africa, neuropsychiatric conditions account for nearly 10% of the disease burden, with depression being the most frequently diagnosed disorder. Clinically, depression manifests through symptoms such as feelings of worthlessness, cognitive and sleep disturbances, and suicidal ideation, with major depression representing the predominant subtype. Its complex pathogenesis has been extensively investigated, incorporating hypotheses related to genetic predisposition, neurotransmitter dysregulation, and hypothalamic-pituitary-adrenal (HPA) dysfunction, among others. While both pharmacological and non-pharmacological interventions demonstrate efficacy, antidepressant medications remain the cornerstone of treatment. Untreated depression can lead to widespread emotional, behavioural, and physical health complications, significantly impairing quality of life. This review reports current hypotheses regarding the underlying pathophysiology of depression and evaluates therapeutic strategies with an emphasis on the pharmacological profile of the classes used to treat depression.

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