6/24/2019 Welcome We Products in the pharmacy for preparing the Traveller. Derek Evans Chair ‐ elect of the Pharmacy Professional Group PPG PPG Pre Pre ‐ con confer erenc ence pr presen entatio tion ‐ CI CIST STM16 1 2 Nat Natural medicines medicines ‐ availab ailable Fi First Ai Aid ki kits ts ‐ wha what to to put put in in them them products pr oducts an an evi evidence ence of of eff effica cacy Sheila Seed Derek Evans PPG Council member PPG Chair elect 3 4 Pre and Pre and Pro Probiotics ‐ ev evidence ence Nat Natural medicines medicines ‐ availab ailable • Differences between pre and probiotics products pr oducts an an evi evidence ence of of eff effica cacy • Quick review of some of the key data for each group Derek Ev Der Evans, FRPh FRPhS, FR FRGS GS, MF MFTM TM RC RCPS (Gla (Glasg) • Use in travel medicine. Travel Me Tr Medici dicine Spec Specia iali list and and Consult Consultant Adjunct Clinic Adj linical Pr Prof ofesso essor in in Pha Pharmacy Pr Pract actice, ce, Keck Gr Ke Gradua aduate Institut itute, School School of of Pha Pharmacy and and He Health alth Sciences Scien 5 6 1
6/24/2019 Pro Probiotics Pre Prebiotics • Defined as live organisms that can confer a health benefit • Non ‐ digestible food ingredient on the host • Selectively stimulates the growth, activity or both • Differ from prebiotics by colonising the bowel to displace • Of a limited number of species resident in the gut. dangerous bacteria. • Second generation using bifidobacterial ‐ galacto ‐ oligosaccharides (B ‐ • Early studies concluded that probiotics reduced the risk of GOS) better functionality and selectivity. acute diarrhoea by 26% in adults. • Non ‐ digestible substance that act as food for the gut microbiota WHO. Health and Nutritional Properties in food with live Lactic Acid bacteria) Mason. Differences between pre and probiotics. Pharmaceutical Journal 2001 Mason. Probiotics: are they worth taking? Pharmaceutical Journal 2007 Blackwood. A Proactive Management Approach to travellers diarrhoea in vulnerable travellers. J BGTHA 2013; XXII: 5 ‐ 10 Sazawal. Efficacy of probiotics in prevention of acute diarrhoea. Lancet Inf Diseases 2006, 6: 374 ‐ 82 Hutkins. Prebiotics: why definitions matter. Curr Opin Biotechnology 2016; 37:1 7 8 Data ana Da analysis is PREBIO PREBIOTICS TICS Feedback eedback on on PR PROBIO OBIOTICS TICS • 8 literature references between 2005 ‐ 2018 on PREBIOTICS • 2007 meta ‐ analysis of PROBIOTICS may offer a safe and effective method to prevent TD • All using standardised B ‐ GOS (41171) • 6 reports of providing protection bacterial infections (S typhii) • 2014 meta ‐ analysis of PROBIOTICS did not have a significant effect on TD • 1 study highlighted 39% reduction in risk of TD symptoms. VARIABILITY IN SETTING, STRAINS USED, CAUSES OF TD UNABLE TO PERFORM A META ‐ ANALYSIS REVIEW INDUSTRY NEEDING TO ADDRESS DEFICITS IN LISTING OF STRAIN INSUFFICIENT DATA FOR EXPERT REVIEW PANEL TO CONFIRM USE IN SPECIFIC ORGANISMS TD REDUCTION. Riddle. Guidelines for the prevention and treatment of travelers diarrhea: a graded expert panel report. Journal of Travel Medicine, 2017, vol Riddle. Guidelines for the prevention and treatment of travelers diarrhea: a graded expert panel report. Journal of Travel Medicine, 2017, vol 24, suppl 1, S2 ‐ S19 24, suppl 1, S2 ‐ S19 Evans. Non ‐ pharmacotherapeutic interventions in travellers diarrhoea. Journal of Travel Medicine, 2018, vol 25, suppl 1, S38 ‐ S45 Evans. Non ‐ pharmacotherapeutic interventions in travellers diarrhoea. Journal of Travel Medicine, 2018, vol 25, suppl 1, S38 ‐ S45 9 10 Results of Re of Sw Swedish tria trial ‐ sin single le st study udy Pre Pre and and Pro Probiotic use use in in tr travel medi medici cine B ‐ GOS reduces the risk of diarrhoea after 7 days • Travellers diarrhoea prevention, reduction or treatment continues to be a major problem in travel related disease Confirmed that this was to be interpreted as starting 7 days before travel to be effective • Question of antibiotic use and stewardship continues to be debated on the value and risks • Ruling of the use/abuse of loperamide and FDA ruling on use. Hasle. Can a gala to ‐ oligosaccharide reduce the risk of travelers diarrhoea? A placebo ‐ controlled, randomised, double ‐ blinded study 2017. Journal of Travel Medicine, 2017, 24: 5 Connor. Letter to editor. 2018. Journal of Travel medicine doi: 10.1093/jtm/tax076 11 12 2
6/24/2019 Di Discussion cussion Curr Current under erst standi ding ng • With the answers regarding the use of antibiotics in TD • Prebiotics: having a standardised preparation, have being unresolved insufficient studies published for a meta ‐ analysis review to • An alternative approach would be to consider the natural support use in TD alternatives and consider the efficacy of these groups • Single study data indicates potential use for reduction in TD • Prebiotics produced from a combination of bacteria and long chain saccharides have studies that claim reduction in • Probiotics: suffer from having poor standardisation of test TD organisms and bias in trial studies. • Probiotics produced from natural non ‐ pathogenic material • Meta ‐ analysis data cannot support claims for use in have a WHO definition and conflicting reports of the reduction of TD benefits in TD 13 14 Conc Conclu lusio sions • Confusion and mixing of reviews together for pre and probiotics ‐ should be considered independently. • Addressing of the reasons for poor study data with Questions ? probiotics by the pharma industry • Requires separate studies for prebiotics 15 16 Nat Natural Medi dicines: cines: Sel Select cted ed Av Avoiding in insect bi bites Products oducts and and Effecti ctiveness eness Larry Goodyer Karl Hess PPG Council member PPG Council member 17 18 3
6/24/2019 An An in inter pr prof ofessi essional onal co collaborat ation From Fr om EH EH to to Zi Zika. The The sc scope ope of of betw between een a co community and and a pr practice actice and and evi evidence ence re relate ted to to tr travel el clin clinic ic in in a Swi Swiss uni university ity Canadian pharm Canadian pharmacis acists ts as as tr travel el pri primar ary ca care re and and publ public health health health ca health care re pr provider oviders cen center er Sherilyn Houle Marie Jose Barbalat PPG Council member Switzerland 19 20 Questions to speakers Close and Reception 21 22 4
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