Monitoring medicines use to support national medicines policy development and implementation in the Asia Pacific region.

Critical to the successful implementation of a national medicines strategy is evaluation of the policy and ongoing monitoring of medicine use. Methods for monitoring medicines use within countries vary depending on the country and its stage of medicines policy development and implementation. In this paper, we provide four case studies on monitoring medicines use to support national medicines policy development and implementation. Cases come from Bhutan, Indonesia, Malaysia and the Republic of Korea.

Antibiotic use and resistance: perceptions and ethical challenges among doctors, pharmacists and the public in Vellore, South India.

Inappropriate antibiotic use and resistance are major public health challenges. Interventional strategies require ascertaining the perceptions of major stakeholders and documenting the challenge to changing practice. Towards this aim, a qualitative study was conducted in Vellore, South India, using focus group discussions among doctors, pharmacists and public. There were eight groups with six to eight participants each. The themes explored were: understanding of infections, antibiotics and resistance; practices and pressure driving antibiotic use; and strategies for appropriate use. Data were transcribed, analysed, verified and a summary prepared with salient features and quotations.

Methodology for surveillance of antimicrobials use among out-patients in Delhi.

Background & objectives: Determining antibiotic use in the population is problematic in India, as there are no population level databases on prescriptions and over-the-counter sales. This study attempts to establish a methodology for surveillance of antibiotic use in the community. Methods: Antibiotic use was monitored in fi ve municipal wards of Delhi, from January-December 2004. Thirty co-operative retail pharmacies were enrolled in Inderpuri (7), Karol Bagh (3), Patel Nagar (5), Rajinder Nagar (6) and Rajouri Garden (9); data on antibiotic use were collected in two ways. Firstly, bulk purchase data were collected by recording the quantities of all antibiotics purchased by these pharmacies every month over one year. Secondly, 15-25 ‘exit interviews’ were conducted with patients leaving the enrolled pharmacies every month. Antibiotic use from bulk purchase data was measured as defi ned daily dose (DDD)/1000 population and from exit interview data as DDD/1000 patients visiting the pharmacy during data collection and also as per cent patients receiving an antibiotic. Results: Bulk purchase and exit interview data showed some similar patterns of antibiotic use with a growing peak in the consumption of most antibiotics classes in the months of February and March. Use of the fl uoroquinolone group (J01MA) was much higher than other antibiotic classes by both methods. Exit interviews revealed that 21 per cent of persons who visited the pharmacies bought antibiotics. Both measures of use from exiting patient interviews showed the same trend over time. Interpretation & conclusions: Both drug use methods can be used to measure antibiotic use in the private retail pharmacies and outpatient department of public facilities. Surveillance of antimicrobial drug use from private retail pharmacies in a municipal zone in Delhi indicated overuse of antimicrobial drugs, particularly fluoroquinolines.