Antibiotic-associated drug-related problems and pharmacist interventions during the Hajj pilgrimage in Saudi Arabia: insights from a retrospective analysis

Background: <br/>The Hajj pilgrimage offers a unique clinical setting because of the increased risk of infectious diseases, the larger number of elderly patients, and polypharmacy. Numerous factors contribute to the rise in drug-related problems (DRPs), particularly those involving antibiotics. Data on antibiotic-associated DRPs and pharmacists’ interventions during Hajj are lacking. This study aimed to characterize DRPs related to antibiotic use among individuals who attended the 2024 Hajj pilgrimage.<br/><br/>Methods:<br/>A retrospective cohort study was conducted across five hospitals in the Al-Mashair region (Mina, Arafat, and Muzdalifah) during the Hajj season (June 12–July 6, 2024). The Hospital Information System and Google Drive were employed to acquire data using a custom form. The form recorded patient demographics, drug-related issues, pharmacist interventions, and patient outcomes. Clinical pharmacists identified DRPs by assessing improper drug selection, dosage problems, adverse responses, and drug interactions. Outcomes were clinical improvement, worsening, or stability, confirmed by laboratory values and infection status.<br/><br/>Results: <br/>A total of 411 patients with DRPs were identified, with most being male (74.9%) and older adults (mean age 55.01 years). Respiratory conditions (44.0%) and infections (20.7%) were the most common diagnoses. The most frequent DRPs included improper drug selection (43.3%), inappropriate dosing (25.5%), and dose administration issues (25.1%). Penicillin-beta-lactamase inhibitor combinations were the most implicated drug class. DRPs occurred most often in non-intensive care unit inpatient wards (38.4%), with East Arafat Hospital reporting the highest number of cases (46%). Pharmacist interventions such as dose modifications and alternative therapies were widely accepted (86.79% and 98.94%, respectively). Patient outcomes were assessed based on clinical improvement, deterioration, or stability,<br/>along with changes in laboratory values and infection status. Older patients were significantly more likely to experience clinical improvement following pharmacist interventions (odds ratio =2.12, 95% confidence interval: 1.358–3.311, P=0.001).<br/><br/>Conclusions: <br/>This research emphasizes the significant role of pharmacists in detecting and addressing antibiotic-associated DRPs during the 2024 Hajj season. Pharmacist-led interventions, particularly dose modifications and alternative therapy recommendations, were associated with high physician acceptance and improved patient outcomes, especially among older adults. These findings underscore the significance of pharmacist-led stewardship programs in high-risk environments, such as mass gatherings, underscoring the<br/>necessity of ongoing monitoring and intervention to ensure patient safety and optimize antibiotic utilization.