Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3 percent males and 48.7 percent females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5 percent reported self-medicating; 29.4 percent used a homemade preparation (13.9 percent referred to an industrialized product like boric acid as a homemade preparation), and 11.1 percent used a manufactured product. The most frequently used products included a boric acid solution (53.3 percent), a normal saline solution (35.7 percent), herbal infusions (6.1 percent) and breast milk (4.8 percent). Viral conjunctivitis was the most frequent diagnosis (24.4 percent), followed by the presence of a corneal foreign body (7.4 percent). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Medicamentos de venta libre en el Brasil / Over-the-counter drugs in Brazil

En el presente estudio se analizaron los 100 productos del mercado farmacéutico popular (de venta libre) más vendidos en el Brasil, en el período comprendido entre junio de 1992 y junio de 1993. Se excluyeron 23 productos alimentarios clasificados como medicamentos. La muestra, formada por 77 medicamentos, representaba aproximadamente 67 por ciento del consumo en valores y 76,8 por ciento del consumo en unidades de las especialidades vendidas en el mercado popular. Para la clasificación de los medicamentos, se utilizó el sistema anatómico-terapéutico-químico (ATC). Las especialidades también se clasificaron con la metodología del valor intrínseco, que considera la eficacia y los riesgos de las mismas. La mayoría de las especialidades (91 por ciento) mostraron "poco valor intrínseco" (dudoso/nulo, relativo, inaceptable), y 70 por ciento correspondieron a combinaciones en dosis fijas. Solo 10 especialidades pertenecían a la Relación Nacional de Medicamentos, producida por el Ministerio de Salud, y cuatro a la lista de medicamentos esenciales de la OMS. Los grupos terapéuticos a los que pertenecían las especialidades fueron, en orden de mayor a menor frecuencia, el aparato digestivo, la piel, el aparato genitourinario, el aparato musculosquelético, el sistema nervioso central, los antiparasitarios, el aparato respiratorio y los órganos de los sentidos. El subgrupo terapéutico de mayor venta fue el de preparaciones para la garganta, mientras que el que representó el mayor valor en ventas fue el de los analgésicos no opiáceos y antipiréticos. Los resultados que confirman la hipótesis planteada de que los medicamentos de venta libre en el Brasil presentan mala calidad terapéutica y de que el consumo de muchas de estas especialidades farmacéuticas representa gastos innecesarios para la población. Se puede afirmar también que algunos de esos medicamentos no deberían estar disponibles para una población que no está al corriente de las complicaciones asociadas con su utilización, puesto que 25 por ciento de las intoxicaciones registradas en el país se deben a la automedicación. Una estrategia para mejorar la utilización de medicamentos a largo plazo es modificar la percepción que tiene la población en general con respecto a la necesidad y uso de los medicamentos para curar sus dolencias

In this study we examined the 100 over-the-counter drugs that were most widely sold in Brazil from June 1992 to June 1993. We excluded 23 food products that were classified as medicinal. The sample, which included 77 drugs, was representative of about 67% of all sales in monetary value, and 76.8% of all units sold of the different classes of over-the-counter drugs. The anatomical-therapeutic-chemical (ATC) system was used to classify the various drugs; each class of drugs was also graded according to a scale of its intrinsic value, taking into account effectiveness and risks. Most classes of drugs (91%) showed "little intrinsic value" (that is, were of questionable or no value, of relative value, or unacceptable), and 70% were fixed-dose combinations. Only 10 classes of drugs were included in the Ministry of Health's National Drug List, and four appeared in WHO's list of essential drugs. The therapeutic classes to which the drugs belonged were, in descending order of frequency, for the digestive tract, skin, genitourinary system, musculo-skeletal system, central nervous system, parasitic diseases, respiratory tract, and sensory system. The therapeutic subgroup that commanded the highest sales was that of the non-opiate analgesics and antipyretics. Our results confirm the hypothesis that over-the-counter drugs in Brazil are of poor therapeutic quality and that the use of many such drugs is a source of unnecessary expense for the population. Some of them should not be accessible to individuals who lack current knowledge of their side effects, since 25% of all cases of poisoning in the country are related to self-medication. Modifying the public's perception of the need for taking drugs to relieve their ailments is one approach that may improve their use of medications in the long term.