Uma comparação crítica entre a Lista de Medicamentos Essenciais para Crianças da Organização Mundial de Saúde e a Relação Nacional de Medicamentos Essenciais (Rename) / A critical comparison between the World Health Organization list of essential medicines for children and the Brazilian list of essential medicines (Rename)

OBJECTIVE: To perform a critical comparison between the Brazilian national essential medicines list (Rename, 2012) with the list of essential medicines for children (LEMC, 2011) of the World Health Organization (WHO), regarding the differences among drugs and formulations listed for children. METHODS: The LEMC drugs were classified into four categories: 1) absent in Rename; 2) included in Rename but without any formulation suitable for children; 3) listed in Rename only in some formulations; 4) present in Rename in all formulations. The missing formulations were analyzed by therapeutic group. Alternatives present in Rename were searched. RESULTS: From the 261 drugs of interest on the LEMC, 30.3% are absent from Rename, 11.1% are in Rename but without any pediatric formulation, and 32.2% are present in some but not all formulations listed in LEMC. Considering all formulations items listed in the LEMC (n = 577), 349 are missing from Rename, of these 19.6% due to their strength, and 18.5% due to the the dosage form. Useful formulations specific for neonatal care, respiratory tract, central nervous system, and anti-infectives, among other groups, are missing. CONCLUSIONS: The lack of age-appropriate formulations of essential medicines for children in Brazil includes important therapeutic groups and indispensable drugs for severe clinical conditions. Some of these products exist in the Brazilian pharmaceutical market, but not in public facilities; others could be produced by national laboratories with commercial interest or stimulated by a specific governmental policy, as in other countries.

OBJETIVO: Realizar uma comparação crítica entre a Relação Nacional de Medicamentos Essenciais (Rename, 2012) e a Lista de Medicamentos Essenciais para Crianças (LMEC, 2011) da Organização Mundial de Saúde (OMS), com relação às diferenças entre os medicamentos e as formulações listadas para crianças. MÉTODOS: Os medicamentos da LMEC foram classificados em quatro grupos: 1) não constam na Rename; 2) constam na Rename, porém sem qualquer formulação adequada para crianças; 3) listados na Rename apenas com algumas formulações; 4) constam na Rename em todas as formulações. As formulações que faltam foram analisadas por grupos terapêuticos. As alternativas presentes na Rename foram pesquisadas. RESULTADOS: Dos 261 medicamentos de interesse listados na LMEC, 30,3% não estão presentes na Rename, 11,1% estão na Rename, mas sem qualquer formulação pediátrica, e 32,3% estão presentes em algumas, mas não todas as formulações listadas na LMEC. Considerando todos os itens de formulações listados na LMEC (n = 577), 349 não constam na Rename, desses, 19,6% devido à intensidade de dosagem, e 18,5% devido à forma farmacêutica. Faltam formulações úteis específicas para cuidado neonatal, trato respiratório e sistema nervoso central, anti-infecciosos, entre outros grupos. CONCLUSÃO: A ausência de formulações adequadas à idade de medicamentos essenciais para crianças no Brasil inclui importantes grupos terapêuticos e medicamentos indispensáveis para quadros clínicos graves. Alguns desses produtos são encontrados no mercado farmacêutico brasileiro, porém não existem em unidades públicas; outros poderiam ser produzidos por laboratórios nacionais com interesse comercial ou estimulados por uma política governamental específica, como é feito em outros países.

Oseltamivir compounding in the hospital pharmacy during the (H1N1) influenza pandemic

AIMS: Pandemics impose large demands on the health care system. The supply of appropriate chemotherapeutic agents, namely oseltamivir solution, presented a serious challenge in the recent influenza pandemic. This study reports on the rational series of pharmacotechnical steps that were followed to appropriately handle bulk oseltamivir powder to meet the increased demand. METHODS: During a six-week period in August and September of 2009, a task force was created in the Central Pharmacy of Hospital das Clínicas to convert imported oseltamivir phosphate into ready-to-use solution for utilization by physicians and public health authorities. The protocol included dissolution, physico-chemical tests and the bottling of a liquid microdose formulation for emergency room and outpatient dispensing with adequate quality control during all phases. RESULTS: The successful production routine was based on a specially designed flowchart according to which a batch of 33210 g of oseltamivir powder was converted into 32175 solution units during the aforementioned period with a net loss of only 2.6 percent. The end products were bottles containing 50 ml of 15 mg/mL oseltamivir solution. The measured concentration was stable and accurate (97.5 percent - 102.0 percent of the nominal value). The drug was prescribed as both a prophylactic and therapeutic agent. DISCUSSION: Hospital pharmacies are conventionally engaged in the manipulation of medical prescriptions and specialty drugs. They are generally responsible for only small-scale equipment used for manufacturing and quality-control procedures. The compounding of oseltamivir was a unique effort dictated by exceptional circumstances. CONCLUSION: The shortage of oseltamivir solution for clinical use was solved by emergency operationalization of a semi-industrial process in which bulk powder was converted into practical vials for prompt delivery.

Preventing avian influenza in humans: the role of simple public health interventions.

An influenza pandemic due to influenza virus A H5N1 subtype is considered highly likely. Strategies for prevention and control of a pandemic include actions that need to be taken by the national authorities and communities. The availability of a vaccine and antiviral drugs in sufficient quantities for billions of people in the developing world is doubtful. Simple cost effective public health interventions can significantly reduce the risk of contracting infection. These interventions include precautions that will prevent people from contracting infection from sick or dying poultry and their products, human cases and a contaminated environment. Specific measures are based on principles of cutting short the transmission of infection in humans and inactivating the virus at its source. The paper describes context specific actions that can be implemented in both rural and urban settings by the communities themselves.

Antiretroviraux et milieu associatif au Senegal: outils et methodes pour renforcer les capacites des associations et ameliorer le role des communautes dans l'Initiative senegalaise d'acces aux antiretroviraux (ISAAR)

Ce document resulte d'un atelier de sensibilisation sur les ARV et le role potentiel susceptible d'etre joue par les associations dans l'Initiative senegalaise d'acces aux antiretroviraux (ISAARV) tenu a Dakar en mars 2004. Les differents modules de formation utilises durant l'atelier y sont presentes; avec les elements relatifs aux objectifs de la session; la liste du materiel pedagogique utilise; le resume de la methodologie de la session; les informations donnees en reponse aux questions des participants; les posters presentes

Drug Resistance to AIDS; Tuberculosis and Malaria in the African Region

With just 10of the world population; sub-Saharan Africa has the highest burden of HIV/AIDS; tuberculosis and malaria in the world. Both access to and adequate utilization of eff ective treatment with quality-assured medicines are crucial for reducing the disease burden. However; eff orts to improve access to treatment are hampered by the development of HIV; TB and malaria drug resistance. This is a result of genetic mutations and is a major threat to control of HIV/AIDS; TB and malaria. HIV drug resistance can be minimized by good antiretroviral treatment (ART) programmes; removal of barriers to continuous access to ART and reduction of HIVtransmission. Recent surveys conducted at antenatal clinics in several countries in the African Region estimated that HIV resistance to all drug classes is less than 5. A global HIV drug resistance network established in 2001 supports countries in capacity building and guidance on standard procedures for monitoring HIV drug resistance. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are principally a result of inadequate or poorly administered treatment regimens. The new WHO Stop TB Strategy launched in 2006 identifies management of MDR-TB as a core component of TB control. The magnitude of MDR-TB in the African Region is still unknown. In 2007; 27 countries notifi ed MDR-TB cases; and six reported at least one case of XDR-TB. Following widespread resistance to chloroquine and sulphadoxine-pyrimethamine all malaria-endemic countries except two in the Region have changed the treatment policy to artemisinin-based combination therapy (ACT). The main method of monitoring antimalarial drug resistance is through therapeutic efficacy testing. Todate there has been no confi rmed resistance to ACTs in the African Region. Given the emergence and spread of resistance to HIV; TB and malaria drugs; the purpose of this paper is to describe the issues and challenges and propose a way forward with regard to the prevention and control of such resistance

Access to treatment for HIV/AIDS: report of a meeting of international experts; 12-13 June 2001; Washington; DC; USA

This publication is a report of an international experts meeting held in 12-13 June 2003 at Washington (USA); which aims to explore and prioritise operations research questions about access to treatment for HIV/AIDS. Even if the discussions focused on treatment with ARVs; many of the issues raised and the research questions identified also pertain to treatment of opportunistic infections and the provision of palliative and end-of-life care

Prise en charge medicale des patients vivant avec le VIH/sida au Senegal

Ce guide constitue un outil de formation des formateurs au niveau decentralise sur la prise en charge de l'infection par le VIH chez l'enfant et chez l'adulte.Il traite des aspects relatifs a l'organisation du systeme de sante et de soins au Senegal; aux paquets minimum d'activites VIH/sida selon le niveau de la pyramide sanitaire; au depistage de l'infection par le VIH; a la prise en charge medicale de l'enfant et de l'adulte vivant avec le VIH; a la prevention de la transmission mere-enfant du VIH; a la prise en charge des accidents avec exposition au sang; aux procedures standardisees par la prevention des accidents avec exposition au sang; aux soins palliatifs et de fin de vie au cours de l'infection par le VIH