Edition 8/December 2024 YEAR END MESSAGE CHAIRMAN, PSSA SOUTHERN GAUTENG BRANCH Tshifhiwa Rabali It is with great sadness that I write this year-end message for the Golden Mortar following the passing of our beloved pharmacist, Chairman of the Golden Mortar board, mentor, colleague, and friend—affectionately known as "Uncle Dave" among our young pharmacists. His absence leaves a profound void in our branch and in our hearts. As a branch, we have had an incredibly busy and productive year, with many of our envisioned projects coming to fruition. One of the highlights of the year was the 2024 FIP Congress, hosted by PSSA National in Cape Town - the first of its kind in sub-Saharan Africa. As a branch, we financially supported deserving colleagues to attend this historic event, and all our branch committee members were also sponsored to participate. It was a momentous success, with over 3,500 delegates from around the world in attendance. The congress provided an invaluable platform for us, as leaders of the society, to engage meaningfully with government representatives and other key stakeholders in the pharmacy profession. Another notable event was our September Symposium, held on September 30th at the Wits Medical School as a hybrid gathering. It was heartening to see so many pharmacists attend, both in person and virtually. Our invited speakers delivered highly informative and professional presentations, enriching the knowledge of all attendees. My sincere thanks go to the chairpersons of our sub-committees, who demonstrated remarkable dedication: • Mrs. Valerie Beaumont, Chairperson of PMS, and the Business Sub-Committee. • Dr. Stephanie De Rapper, Vice-Chairperson and Chairperson of the CPD Sub-Committee. • Mr. James Meakings, Honorary Treasurer and Chairperson of Pharmacy Mutual. • Mrs. Lynette Terblanche, our representative at the Pharmacy Museum. The teamwork and commitment shown by the branch committee members this year have been nothing short of exceptional. To each of you, I extend my heartfelt thanks for your tireless efforts and dedication to the success of our branch. I would like to also extend my gratitude to our Executive Director, Mrs. Lailaa Cajee, and her dedicated staff, Ms. Cecile Ramonyane and Mr. Rooiklip Swafo, for their unwavering support throughout the year. As we close this chapter of the year, I hope you all enjoy a well-deserved festive season and enter the new year with renewed energy and purpose. For those traveling, I wish you safe journeys until we meet again. Lastly, I would like to thank my wife and children for their unwavering support and understanding, as my responsibilities often took me away from home. Your love and patience have been my cornerstone. I thank you all. Tshifhiwa Rabali Chairman, PSSA SG Branch The Golden Mortar 8/2024 1
1 Year End Message from the Branch Chairman 3 Museum Artefacts Book Department 9 Professional Indemnity 12 SG Branch AGM - Save the Date 14 - 15 SG Branch Committee Year End Function 4 Year End Message from the Branch Chairman 6 Web Information 12 AGM Notice Agenda 5-6 Tributes to David Sieff 7 Year End Message from the Branch Chairperson 8-9 Antibiotics: Complete the Course 10 - 11 2024 Wits Achievements 13 Year End Message From the Chairperson HAPPY HOLIDAYS The Golden Mortar 8/2024 2
R165 R325 R95 To start your very own collection please contact: Cecile @ 011 442 3615 ceciler@pssasg.co.za R360 THE PSSA BOOK DEPARTMENT Do you know that the Book Department has a range of essential publications for pharmacists at preferential prices for members of the PSSA? From overseas publications such as Martindale, Merck Manual and Dorland’s Illustrated Medical Dictionary to local publications such as the South African Medicines Formulary (SAMF) and the Scheduled Substance Register. Ordering is this simple: Go to the PSSA website, www.pssa.org.za, click on the Hello, sign in button to order books at the discounted fee for members. Choose Book Store and complete online. Or Contact Dinette at PSSA National Office on (012) 470-9559 or at dinette@pssa.org.za The Golden Mortar 8/2024 3
2024 A message of gratitude and encouragement to the South African Association of Community Pharmacists Southern Gauteng Branch, SARCDA Trade Exhibitions (Pty) Ltd, Staff, Branch Administrator Ella Edelstein and fellow pharmacists at large. Frans Landman As we approach the conclusion of another remarkable year, I wanted to take a moment to express my heartfelt gratitude and extend my warmest wishes to each one of you. Your unwavering commitment to promoting the well-being of our community, along with your dedication to the field of pharmacy, has been very inspiring. Throughout the year I have had the honour of witnessing your enthusiasm, your passion, and your tireless efforts in advancing the practice of pharmacy in our region. Your presence at our events and meetings has truly made a difference. The knowledge, insights, and expertise that you have generously shared with one another have undoubtedly contributed to the growth and success of our association. I would like to extend a special word of appreciation to our senior members. This year, we faced the profound loss of our esteemed colleague Mr. David Seiff whose wisdom, experience, and continuous support played a significant role in shaping the foundation upon which our branch stands. His dedication to pharmacy and unwavering commitment to mentoring our younger members have served as an exceptional example and source of encouragement for all. To all our members, I commend you for the energy and enthusiasm you have brought to our association throughout the year. Your contributions, whether big or small, have made a profound impact on our collective goals. Your active participation in our initiatives and your willingness to engage with one another have fostered an environment of collaboration and growth. Together, we have achieved milestones and crossed new frontiers in the field of community pharmacy. As we reflect on the past year, I want to thank colleagues for attending the FIP congress in Cape Town, let us carry forward the invaluable lessons we have learned, the friendships we have formed and the accomplishments we have achieved. Let us continue to support one another, celebrate our achievements, and inspire future generations of community pharmacists, and here I am referring to especially the YPG grouping. On behalf of the South African Association of Community Pharmacists, Southern Gauteng Branch, I wish each one of you a joyous holiday season filled with love, peace, and relaxation. May the coming year bring an abundance of opportunities, professional growth, and personal fulfilment. To my better half Christine, thank you for allowing me to take up time for chairing this branch! Together, we will continue to strive for excellence and make a positive impact on the health and well-being of our community. Gratefully Frans Landman Chairman, SAACP SG Branch. The Golden Mortar 8/2024 4
Dave for 74 years. From student days. We have kept in touch with each other on a regular basis. Please let me add. Dave was deeply religious. He had a prayer life. He met his beautiful wife Rita whilst we were mere students. Rita is a qualified pharmacist. He fell in love and married Rita. A solid family man. All his children professionals. We were deeply active in student affairs, never realising how significant this would be in later years. He appeared before Pharmacy Council, and understood the mechanisms of council. Dave and Rita were regular guests at our community functions. He was deeply dedicated to Continuing pharmacy education, and never missed lectures throughout his life. He challenged the lecturers, and displayed a deep insight into medicine. He was an outstanding businessman , and ran a successful Community Pharmacy. He trained Ivan Saltzman, founder of DisChem. Later to work for Ivan as a Pharmacist. He was a member of PDC…..eventually became CLICKS. And UPD. He had stints in industry and I think hospital Pharmacy. His pharmacy name was Libra meaning free. He gave his services free. The angels must welcome him in the heavens. With tears in my eyes. Kenneth Anthony Hanna. Pharmacist. TRIBUTE TO DAVID SIEFF 23 September 1936 – 30 October 2024 This tribute relates to the very sad loss of my colleague and friend David Sieff. David always had a great passion for the pharmacy profession giving his time and life unselfishly to his profession which set an expressive example to his colleagues. He qualified at the Witwatersrand Technikon in 1967 attaining the Diploma in Pharmacy. He worked in all sectors of the pharmacy profession - as a detail representative, community pharmacist, hospital pharmacist and a hospice pharmacist. He was the owner of Libra Pharmacy in Berea, Johannesburg from 1974 to 1990. He was very involved with the Golden Mortar since 1974 and was appointed as Editor in 1985. He ensured that the profession was always well informed with pharmacy news and education. He was a regular attendee at Annual General Meetings of the PSSA and SAACP and rarely missed AGMs, conferences, committee meetings and continuing education sessions. He regularly scrutinized the minutes of the meetings he attended for correctness. Photography was one of his hobbies. In the early days David became famous for taking photos with his camera at conferences and of presenters at pharmacy gatherings and was often challenged with the remark 'have you got a film in your camera David?' ...continued on page 6 The Golden Mortar 8/2024 5
David’s many awards and recognitions within the pharmacy profession bear testament that his was a distinguished career of considerable importance: • Honorary Life Membership of the National Association of Community Pharmacists • Honorary Life Membership Southern Gauteng Branch of the Pharmaceutical Society. • Honorary Life Membership of the Southern Gauteng Branch of the South African Association of Community Pharmacists • Jack Bloom Award • Fellow of the Pharmaceutical Society of South Africa I was honoured when in 2023 I moved a Motion to award David with the prestigious Julius Israelsohn Award for dedicated, unstinting and exemplary service to the Pharmacy profession, in particular the South African Association of Community Pharmacy (SAACP). David Sieff and Bernard Lapidus were instrumental in nominating and seconding me as Chairman of the SAACP Branch Committee - by this action David initiated my involvement with the SAACP and PSSA which initiated my own involvement within organised pharmacy. In addition to his passion for his work and the various Committees he served on, Dave was a devoted and caring family man. He is survived by his wife Rita, two daughters, Michelle and Robyn, sons-in-law and grandchildren, who he adored. Heartfelt condolences are extended to his family. Even to the very end when his health was failing, and he was growing weak in mind and body his focus was on the profession and the Golden Mortar. . I salute you my friend in your passing, the time we spent and shared together and what you have contributed to your profession. May you rest in peace my friend - you will be sadly missed by all. Gary M Köhn The Golden Mortar 8/2024 6
Rashmi Gosai Dear esteemed colleagues and members of the Pharmaceutical Society of South Africa SG Branch As we approach the end of the year, I would like to take this opportunity to reflect on the accomplishments and challenges faced by our community of pharmacists. On behalf of the South African Association of Hospital and Institutional Pharmacists (SAAHIP) - Southern Gauteng branch, I extend my sincerest gratitude to each of you for your tireless dedication, expertise, and compassion in serving our patients and communities. This year has seen significant advancements in healthcare, and we've played a vital role in shaping the landscape of pharmacy practice. Your commitment to delivering exceptional patient care, ongoing professional development, and advocacy for the profession has been truly inspiring. Sadly, we also bid farewell to our dear colleague and friend, David Sieff, whose passing leaves an immense void in our community. David's unwavering commitment to SAAHIP and PSSA spanned many years, and his contributions have had a lasting impact on our organizations. His dedication, wisdom, and kindness will be deeply missed. We honor his legacy and extend our heartfelt condolences to his family, friends, and loved ones. As we look to the new year, let's continue to: • Enhance patient-centered care • Foster collaborative healthcare practices • Advance pharmaceutical sciences • Strengthen our professional community May David's selflessness, expertise, and passion for pharmacy inspire us to continue striving for excellence. Wishing you and your loved ones a joyous holiday season, rejuvenating break, and a prosperous new year. Warm regards, Rashmi Gosai Chairperson, South African Association of Hospital and Institutional Pharmacists - SG The Golden Mortar 8/2024 7
by Lynda Steyn - BPharm Amayeza Info Services INTRODUCTION Antibiotic overuse and misuse in all spheres of life has led to the antimicrobial resistance crisis that the world is now facing. Exposing the human microbiome to antibiotics, even with short courses, increases the risk of antimicrobial resistance (AMR). Reducing the unnecessary exposure to, and the overuse of antibiotics, requires educating both healthcare professionals as well as the public. COMPLETE THE COURSE? As healthcare professionals, pharmacists have always understood the importance of completing a course of antibiotics, or risking the emergence of resistance from the remaining bacteria. The patient is then counselled and a “Complete the Course” is typed on the prescription label, with a sticker as reinforcement. Is this an outdated way of thinking and likely to be a contributing factor to antimicrobial resistance (AMR)? Interesting and thought-provoking articles suggest that completing a course of antibiotics may not always be appropriate. TARGET VERSUS COLLATERAL SELECTION Target selected resistance occurs with certain pathogens when there is inadequate antimicrobial dosing, or where monotherapy gives rise to spontaneous resistant mutations. This occurs with certain diseases such as tuberculosis, HIV, malaria and gonorrhoea, caused by what are known as “professional” pathogens. While professional pathogens, such as these, require adequate treatment strategies with antibiotics to prevent resistant strains and a “complete the course” in this case is appropriate, this approach not always appropriate for all infections. The biggest concern, and the way AMR is more likely to occur, is through the “collateral selection.” This involves commensal bacteria being exposed (incidentally) to an antibiotic, and pressured into selecting for antibiotic resistance, enabling them to cause infection in the future. The commensal bacteria (found in the gut, the skin, the urinary tract, upper and lower respiratory tract and abdomen) are not the target of the antibiotic therapy, and the longer they are exposed to the antibiotic, the greater their potential for developing resistance. These resistance genes may be transferred by asymptomatic carriers and can pass between the same species, or to different species of bacteria. The commensal bacteria at risk of resistance include, Escherichia coli, as well as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter spp, Pseudomonas spp, and Enterobacter spp (ESKAPE organisms). Ways in which the exposure to antibiotics may be reduced is through shortening courses of antibiotics, or having the patient discontinue the course when they feel better. There is evidence that, in most cases, shorter courses of appropriate dose antibiotics are non-inferior to longer courses of antibiotics. However, even the shorter antibiotic durations prescribed are not always evidence-based. The “course” is still standardised, based on averages, and does not take into account the patient’s immune system and complex ecosystem. It makes sense, therefore, that there should be no reason not to discontinue a course of antibiotics where the antibiotic was started empirically, and then deemed to be unnecessary upon review, or where the infection is self -limiting (e.g. conjunctivitis or bronchitis) and the patient’s symptoms have improved. …/continued on page 9 The Golden Mortar 8/2024 8
Endogenous bacterial flora that cause infections persist even after the infection is cleared. These microorganisms (ESKAPE microorganisms) are responsible for most skin infections, urinary tract infections, upper and lower respiratory tract and abdominal infections. While the antibiotic may be able to eradicate the microorganism causing the infection, the endogenous flora are also exposed to the antibiotic and are vulnerable to resistance. Continuing with the course of antibiotics in these infections is more likely to contribute to resistance, than stopping the course early when symptom improvement has been achieved. EDUCATING HCPs Before any antibiotic is prescribed, the following should be taken into account: • Is the use of the antibiotic appropriate? • Is the infection likely to resolve without treatment? • Does the benefit of using the antibiotic outweigh its risks? • Is a laboratory confirmation of bacterial infection indicated? • Can antibiotic therapy be delayed while waiting for results? If an antibiotic is prescribed for a particular infection which has a scientifically determined minimum duration, the patient should be counselled to complete the course. However, where there is no certain optimal duration of an antibiotic, a decision to stop the antibiotic when symptoms improve may be acceptable. This decision to stop should be taken in consultation with the prescriber and the patient should be counselled to discard the remaining antibiotic safely. CONCLUSION The rate at which antibiotic-resistant human pathogens are emerging is overtaking the rate of discovery of new antibiotics, to the extent that antimicrobial resistance (AMR) has been declared a global public health threat by the World Health Organization (WHO). There is no supporting evidence to suggest that stopping an antibiotic course early is likely to lead to antibiotic resistance, whereas there is evidence to support AMR developing when antibiotic courses are taken longer than necessary. The outdated advice to “complete the course” should be replaced by the term “take exactly as prescribed.” REFERENCE IS AVAILABLE UPON REQUEST The Golden Mortar 8/2024 9
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