Antibiotics Consumption in the Eastern Region of Libya 2012-2013

Background: Drug utilization studies conducted in Libya during the period 1991-2013, have pointed out that there is an irrational use of antibiotics as a common practice that costs the health system more than 7.7 million Libyan Dinars / year. The aim of this study is to assess the trend of antimicrobial consumption in the Eastern region of Libya during 2012 ­ 2013.Methods: Antimicrobial consumption data from the years 2012 and 2013 were obtained mainly from Benghazi office, Medical Supply Organization (MSO; the only official drug-importing body in Libya). This study is concerned with antibiotics imported only to the Eastern region of Libya, population of which representing approximately 35% of total Libyan population. The WHO, Anatomical-Therapeutic-Chemical (ATC) classification and the Defined Daily Dose (DDD) methodology were used to calculate antibiotic consumption. The total antimicrobial consumption data were calculated as DDD/1000 inhabitants/day.Results: Total utilization of antibiotics decreased dramatically from 15.47 DDD/1000 inhabitants/day in 2012 to 4.30 DDD/1000 inhabitants/day in 2013 which in turn shows a significant decline compared to 41.72 DDD/1000 inhabitants/day during the period 1991-1993. Consumption of penicillins decreased from 19.902 DDD/1000 inhabitants/day during 1991-1993 to 1.896 DDD/1000 inhabitants/day during 2012-2013 with pattern of amoxicillin/clavulanic acid consumption which equals 3 times ampicillin consumption and is the highest compared to all penicillins. This was accompanied by a prominent increase in consumption of amphenicols and fusidic acid during 2012-2013, noting that fusidic acid consumption was the highest among all antibiotics. Conclusion: MSO since 2011 (post 17th February, 2011 revolution) lost its control over importing medicine due to receiving many drugs, as donations from different international sources without acceptable levels of coordination. This has been reflected on drug purchasing policy of MSO during 2013, which failed to regain the previously accepted level of DDD/1000 inhabitants/day for antibiotics consumption. The decreased consumption of penicillins together with increased consumption of amphenicols and fusidic acid complies with the pattern of antibiotic resistance reported previously in Libya. Similar studies should be conducted to evaluate national drug consumption under normal conditions, to be compared with regional and international data

Peptic ulcer Disease drugs usage patterns and its economic burden in a tertiary health institution in Niger Delta, Nigeria

Background: Drug utilization evaluation for peptic ulcer disease and its cost implication are rare in Niger Delta. The objective of the study was to evaluate drug usage pattern in peptic ulcer diseases as well as its cost implications.Methods: The cross sectional drug use evaluation study involving the use of questionnaire and patient case notes was carried out in a tertiary health institution. The validated pretested questionnaire was interviewer administered to 300 patients sampled consecutively followed by a retrospective review of their respective case notes between April to November 2013. Information collected include risk factors, prescribed drugs, Helicobacter pylori assay test results among others. Cost of each drug and therapy were then computed appropriately. Data was analyzed using Statistical package for Social Sciences (SPSS) version 20, Microsoft Excel and Graph Pad Prism for windows Instat Version 3.Results: Out of the 300 patients, H. pylori test was conducted in 262 (87.3%) while the presence or absence of the organisms could not be confirmed in the remaining 38 subjects. Out of the 262 patients with H. pylori test results, only 166 representing 63.4% were positive. History of non-steroidal anti-inflammatory drugs (NSAID) usage was very high among the subjects (250; 83.3%) and highest for ibuprofen 146 (48.7%). The most prescribed drugs were antacids (268; 89.3%), amoxicillin (165; 55.0%), and a combined formulation of omeprazole, tinidazole, and clarithromycin in 140 (46.7%) subjects, followed by omeprazole alone (125; 41.7%).The national direct cost implication for the estimated 17.6 million is in the range of NGN186,849,000,000.00 ($958,200,000.00), out which NGN109,867,000,000.00($563,420,513.00) was for PUD drugs (50.9%) and NGN32,698,575,000.00 ($167,685,000.00) for H. pylori tests (17.5%), while the remaining 31.7% valued at NGN59,231,133,000.00 ($303,749,400.00) was for non-ulcer drugs, personnel and transportation.Conclusion: The pattern of drugs usage is consistent with standard treatment guidelines. Peptic ulcer drugs for the 300 subjects constituted NGN1,618,641 ($8300.72) which represents 73.0% of the total amount spent on drugs. The national direct cost of PUD is close to NGN200 billion ($1.04 billion). Updated information on drug usage and their costs is needed for improved usage and system efficiency

Lessons from the Kaduna sustainable drug supply intervention initiative

Background : The Sustainable Drug Supply System (SDSS) is a strategy for ensuring uninterrupted drug supply for sustained and affordable health care delivery in all health care institutions in some States in Nigeria. Drug distribution network in Nigeria is in a state of chaos because it consists of multitude of illegal markets, patent medicine stores, pharmacies, private and public hospitals, wholesalers/importers and pharmaceutical manufacturers operating in an uncoordinated manner.Objectives : To examine the distribution channels of the Kaduna State SDSS; evaluate it within the framework provided in the Nigerian Drug Distribution Guidelines (NDDG) and assess the challenges militating against the scheme.Methods : The study was a cross sectional survey of stakeholders managing the scheme and patients patronizing the health care facilities using semi ­ structured questionnaires. Data obtained were analysed using descriptive and inferential statistics.Results : The result of the study indicated that the Kaduna State SDSS distribution channels are consistent with the provisions of the NDDG. Drug availability in facilities was widely reported to have improved following the SDSS intervention; however 41.2% of the respondent believed the drugs are expensive.Conclusion : If the provisions of the Kaduna State SDSS are properly implemented and enforced, the model is capable of addressing the uncoordinated drug distribution system and curbing the supply chain vulnerability to infiltration by unauthorized and corrupt participants in the state

Evaluation of Drug Use and Patient Care Practices in a Referral Health Facility in Yenagoa; Bayelsa State; Nigeria

Background: Evaluation of drug use and patient care practice is a very vital aspect of patient care. It also measures the quality of care provided by health practitioners for patients. Data from this study is very essential in healthcare management and planning. Objectives: To assess drug use and patient care practices at the outpatient section of a referral hospital in Yenagoa; south-south; Nigeria; using WHO drug use indictors. Methods: The study was conducted at Federal Medical Centre; Yenagoa; Bayelsa State. A total of 2450 prescriptions from the outpatient pharmacy were selected by systematic sampling and retrospectively studied. A prospective study of the patient care practices and health facility indicators; which include consultation and dispensing times; revenue time; Patient's knowledge of their medications and availability of key essential drugs; was also undertaken. Data collected was analyzed using WHO guideline for assessment of drug use in healthy facilities. Results: The average number of drugs prescribed per encounter was 3.4; Percentage of encounters with at least an antibiotic prescribed was 35.5. Injections were prescribed in 22of encounters. 62of drugs were prescribed by generic name while 87of drugs prescribed were from the essential drug list. The mean consultation and dispensing times were 11.5 and 3.5 minutes respectively. Two out of every three patients interviewed knew both the names and the duration of their medications while four out of every five knew the correct dosage of their medications. Conclusion: Many of the prescribing and patient care indicators assessed were found to be inappropriate and need to be improved upon. . There was high tendency of poly- pharmacy and over prescription of antibiotics. The patients' knowledge of vital aspects of medication management was found to be inadequate. The overall picture of drug use suggests that the indicators at this facility are not yet at the optimal level

Pharmacists and Nurses Perception of Medication Errors in a Nigerian University Teaching Hospital

Purpose: To investigate the type and frequency of all medication dispensing and administration errors as perceived by pharmacists and nurses respectively; and the factors associated with such errors in a Nigerian university teaching hospital. Methods: The study was conducted at the Obafemi Awolowo University Teaching Hospitals; Ile-Ife and Ilesa; Nigeria. Data was collected by the use of pre-tested questionnaire administered to 35 pharmacists and a stratified sample of 130 nurses over a period of 2 weeks. The questionnaires were sorted and analysed. Results: The pharmacists that responded (80) cited incorrect drug; incorrect strength of drug (70) and wrong dose of drug (60) as the most common dispensing errors. Fifty percent of pharmacists put the estimated frequency of occurrence of these dispensing errors at 1 per 100 prescriptions dispensed. Most of the nurses (65) identified administration of wrong drug; administration of wrong dose (63) and wrong time of drug administration (57) as the most frequently occurring medication administration errors in the teaching hospital. All the pharmacists and 78of nurses identified excess workload as the most important factor contributing to errors in medication dispensing and administration respectively. Conclusion: The fundamental factor perceived to be contributing to errors in medication dispensing and administration was excess workload resulting from insufficient members of staff

The Pattern of Sale and Use of Non-Steroidal Anti-Inflammatory Drugs in Rural and Urban Centres in Nigeria

Purpose: The widespread use of non-steroidal anti-inflammatory drugs (NSAID) has meant that the adverse effects of these relatively safe drugs have become increasingly prevalent. This work examines the pattern of sale and use of NSAIDs as to call for caution in cases of misuse that may lead to renal; gastrointestinal and cardiac damage in users. Methods: 56 drug outfit managers in patent medicine store; pharmacy; hospital drug unit and market centre visited in their outlets; were evaluated with respect to years of experience; educational level and registration status. 180 NSAIDs users were also assessed based on their perception and pattern of use of the drugs in view of their personally declared previously and diagnosed ailments. Results: 86of the drug outfit managers had less than tertiary education with 59of the sampled outfits being unregistered and unlicensed. 74of the sample population procured their NSAIDs from sources where adequate pharmaceutical care is unlikely to be available in an observed situation where 79have clinical conditions likely to be worsened by NSAID misuse.11.1of the respondents who are categorized as geriatrics ingest NSAIDs daily while over 23of this class require more than two different NSAIDs at a time. Conclusion: Restriction in the sale; by way of reviewing the sale status; of NSAIDs will drastically reduce the rate at which the drugs are ingested. The possible gastrointestinal; renal and cardiac damage due to NSAID misuse requires evaluation so that the required level of caution can be exercised in the handling of the drugs

Antimicrobial Prescribing Patterns in a Group of Private Primary Health Care Clinics in South Africa

The aim of this study was to investigate the prescribing of antimicrobials in private primary health care in South Africa. A retrospective drug utilisation study was conducted on data obtained from the database of nine private primary health care clinics for the year 2001. Antimicrobials were classified pharmacologically and their usage analysed according to number of patients and consultations; age groups; gender; diagnoses and cost. Of the 83 655 patients; 49 772 (59.50) were female and 33 650 (40.22) males. No gender was indicated in 233 (0.28) of the cases. Medicine items (n = 515 976) were prescribed costing R1 716 319. Of these; 18.69 (n = 96 421) were antimicrobials costing R1 045 108 (60.89). Antimicrobials were prescribed in 72 of the consultations. The antimicrobials that were the most often prescribed were penicillins (38.17); sulphonamides (22.49); antiprotozoals (9.88) and tetracyclines (9.34) for diagnoses such as viral-influenza; upper-respiratory infections; acute-bronchitis and acute-sinusitis. Antibiotics prescribed for viral diseases indicated inappropriate use because these infections are caused by non-bacterial agents; and thus are self-limiting. Therefore antibiotics were neither necessary nor appropriate. Further investigations should be done on standard antimicrobial treatment-guidelines in private primary health care settings in South Africa

Prevenir les risques de lesions oesophagiennes causees par les formes orales de medicaments

N.A.

Review: Strategies for the Prevention and Containment of Antibiotic Resistance

Antibiotic resistance may emerge by antibiotic selection pressure but is perpetuated by diverse risk factors and maintained within environments as a result of poor infection control. Population-specific drug pharmacokinetics and pharmacodynamics also play a role. The WHO; US; UK and EU have initiated strategies for the containment of resistance; with surveillance and delineation of the cause(s) cited as essential. Surveillance of antibiotic efficacy should be disease-based; establishing sensitivity profiles of common causative organisms to inform the development of or amendment to standard treatment guidelines and essential drugs lists adopted within the national drug policy. The manner of antimicrobial use (overuse; underuse; inadequate dosing) associated with resistance should be established for appropriate intervention in terms of rational drug use; a reduction in use and dosing regimens based on population-specific pharmacokinetics and pharmacodynamics. Risk factors unique to South African communities (poverty; HIV) and hospitals (duration of hospitalisation; location within the hospital; intensive care unit stay; surgery; wounds; previous and current antimicrobial therapy; mechanical ventilation; urinary catherterisation; nasogastric intubation; central venous and peripheral catheters; previous hospitalisation and transfer from another unit or hospital) must be determined and due vigilance exercised in patients exhibiting classical risk factors for the acquisition of or colonisation with resistant pathogens. Hygiene and sanitation (in communities) and infection control (in hospitals) status must be determined and interventions initiated to prevent the spread of resistance. Pharmacokinetics and pharmacodynamics specific to diverse populations must be devised to optimise antimicrobial therapy. South Africa has unique needs in the antimicrobial resistance arena; needs to be addressed in the context of severe financial; human resources and technological challenges

Prescribing Patterns of Methylphenidate in a South African Patient Population who are Members of a Private Medical Aid

Methylphenidate is primarily used for attention deficit hyperactivity disorder (ADHD) in children. The primary aim of the study was to investigate the prescribing patterns of methylphenidate of a medical aid patient population in a private sector and to compare the results with previous studies. An exposure cohort drug utilisation study was conducted. Data were obtained from a South African medical aid administrator. Prescription records for 115 patients who received methylphenidate during 2002 were retrospectively analysed. Nearly three-quarters (73.0) of the patients were males and 79.1of patients were 18 years or younger. The average age of patients was 15.6 (SD=10.8) years. Seventeen patients were 30 years or older. Two-thirds of prescriptions (67.3) were for methylphenidate 10 mg (the innovator product); 20.7were for the 20 mg slow-release innovator product and the rest were prescriptions for the recently introduced 10 mg generic equivalent tablet. Patients received on average 4.0 (SD=3.3) prescriptions for methylphenidate during the year. The average Prescribed Daily Dose (PDD) for methylphenidate was 15.4 (SD=7.6) mg. Further studies are recommended; especially into the quality of life of patients before and after receiving methylphenidate. The impact of methylphenidate on the academic performance of patients should also be quantified

Prescribing of Drugs for the Treatment of Migraine with Specific Emphasis on Sumatriptan

Migraine affects between 5.15of males and 13;5-31of females in South Africa. Little is known about the prescribing patterns of anti-migraine drugs in South Africa. The aim of the study was to investigate the prescribing of drugs for the treatment of migraine (ATC Group NOZC); with specific emphasis on sumatriptan; in a primary care patient population in South Africa; making use of a computerised prescription database. A total of 3 01 1 products for the treatment of migraine at a cost of R451559 were prescribed to 578 patients in the study over a period of one year (1996) since sumatriptan was the onlytriptan available in South Africa in 1996. The average age of patients was 48;40 (SD = 14;19) years; with 74;57ofpatients between 20 and 59 years of age. Approximately 80of patients were females. Female patients were prescribed 81;53of the products. Most drugs (67;55) were for the prophylaxis of migraine; of which clonidine andflunarizine were the most frequentlyprescribed. Of the drugs prescribedspecifically for the management of migraine; sumatriptan (575prescriptions to 103 patients) was the most frequently prescribed; followed by 400 prescriptions for ergotamine. Tablets were the preferred dosage form. Since migraine affects primarily the economically active sector of the community and its treatment is relatively expensive; pharmacists have an important role to play in managing and counselling migraine sufferers

Les raisons associées à la non prescription des antirétroviraux chez les patients approchant l'initiative ONUSIDA : cas de la Côte d'Ivoire

Objectif identifier les raisons de la non-prescription du traitement antiretroviral chez les patients vivant avec le VIH-SIDA; et suivis dans les centres accredites dans l'initiative ONUSIDA /Ministere de la Sante Publique de Cote d'ivoire. Methode : les donnees ont ete recueillies a partir des dossiers des patients qui avaient approche les centres accredites; entre le 31 Aout 1998 et le 1er Aout 2000. L'analyse apporte sur les caracteristiques sociodemographiques; cliniques; biologiques immunologiques (le taux de lymphocytes CD4) des patients. Resultats: un collectif de 1729 patients majoritairement ivoiriens (97pour cent); ages de 2 a 75 ans (moyenne a 35 ans); repartis entre 50pour cent d'hommes et 50pour cent de femmes (sexe-ratio egal a 1). Environ 46pour cent de ces patients residaient a Abidjan. Il y avait 1577 patients naifs (91pour cent) et 152 pretraites (9pour cent). Environ 42pour cent provenaient du CAT d'Adjame; 21pour cent des maladies infectieuses. Dans cette population il y avait 864 patients traites et 865 non traites. L'analyse a permis de noter une relation significative entre la decision de traiter le sexe feminin; le statut celibataire ou veuf et le revenu mensuel des patients (p0;000); de meme que l'assurance maladie (p0;00 et OR

Etude de la consommation medicamenteuse ambulatoire : analyse de 1400 delivrances a Abidjan

Notre travail est une etude prospective sur une periode de huit mois. Elle a permis d'evaluer le profil de la consommation medicamenteuse ambulatoire; de situer la place des medicaments generiques. Il ressort de cette etude que : l'ordonnance medicale represente 49 pour cent; le conseil en pharmacie 13 pour cent et l'automedication 38 pour cent des delivrances ; la ligne de prescription moyenne par ordonnance est de 2;98 ; 2 060 medicaments ont ete prescrits et appartiennent a 20 classes therapeutiques ; quatre classes therapeutiques couvrent 65;66 pour cent des LP; ce sont: les anti-infectieux; les antalgiques et antispasmodiques; les medicaments du metabolisme et nutrition; les anti-inflammatoires ; 2;89 pour cent de prescriptions redondantes; 2;74 pour cent de prescriptions comportant des interactions medicamenteuses ; le cout moyen de l'ordonnance est de 9 976 F CFA ; les medicaments generiques representent 14;48 pour cent des medicaments delivres ; la substitution represente 0;24 pour cent ; la rationalisation des prescriptions; l'information des prescripteurs et des dispensateurs sont des elements indispensables pour un bon usage des medicaments

Drug utilization patterns for under five children

In this descriptive study; conducted in an outpatient clinic of a Teaching Hospital in Ibadan; drug utilization patterns for underfive children treated between 1984 and 1987 were evaluated. The results of the study showed that over the four year period; a range of 27.8 per cent in 1984; to 32.2 percent in 1987 of children were treated with antimalarial drugs even though only 7 percent to 19 per cent of them were clinically diagnosed as having malaria