Distribuição e custo de antimicrobianos na Atenção Primária / Distribución y costo de antimicrobianos en la Atención Primaria / Antimicrobial distribution and costs in primary care

Resumo Objetivo: Analisar a distribuição e custos de antimicrobianos na Atenção Primária de uma capital da Região Nordeste do Brasil. Método: Estudo transversal, analítico, desenvolvido em Teresina, Piauí, Brasil. Os dados contemplam o período de junho de 2015 a julho de 2016. Calculou-se estatísticas descritivas e o Teste de Kruskal-Wallis para comparar as medianas das distribuições de dados independentes. Resultados: Foram distribuídos 1.651.516 antimicrobianos de 15 tipos diferentes dos quais a amoxicilina (500mg) foi o mais distribuído (75%) nos Centros de Atenção Psicossocial e nas Unidades Básicas de Saúde (47%). O custo total no período foi de 98.705,00 reais. Não houve diferenças estatisticamente significante entre as medianas dos custos em cada zona do município estudado. Conclusão: A distribuição desses medicamentos é realizada de forma irregular entre as unidades, de acordo com a demanda. O fornecimento não segue protocolo específico, e não se investiga um possível aumento na demanda ou redução.

Resumen Objetivo: Analizar la distribución y costos de antimicrobianos en Atención Primaria de una capital del Noreste de Brasil. Método: Estudio transversal, analítico, desarrollado en Teresina, Piauí, Brasil. Datos obtenidos entre junio de 2015 y julio de 2016. Se aplicó estadística descriptiva y el Test de Kruskal-Wallis para comparar las medianas de las distribuciones de datos independientes. Resultados: Fueron distribuidos 1.651.516 antimicrobianos de 15 tipos diferentes, de los cuales la amoxicilina (500mg) fue el más entregado (75%) en Centros de Atención Psicosocial y en Unidades Básicas de Salud (47%). El costo total durante el período fue de 98.705,00 Reales. No hubo diferencia estadísticamente significativa entre las medianas de costos en cada zona del municipio estudiado. Conclusión: La distribución de estos medicamentos se realiza de manera irregular entre las unidades, de acuerdo a la demanda. La provisión no cumple protocolos específicos, y no se investiga un posible aumento o reducción de demanda.

Abstract Objective: To analyze antimicrobial distribution and costs in primary care of a capital city in the Northeast region of Brazil. Methods: Cross-sectional, analytical study, developed in the city of Teresina, in the state of Piauí, Brazil. Data cover the period from June 2015 to July 2016. Descriptive statistics and the Kruskal-Wallis test were calculated to compare the medians of the independent data distributions. Results: A total of 1,651,516 antimicrobials were distributed in 15 different types, with amoxicillin (500mg) being the most distributed (75%) in psychosocial care centers, and in the basic health units (47%). The total cost for the period was 98,705.00 BRL. There were no statistically significant differences among the costs medians in each zone of the studied municipality. Conclusion: These drugs are irregularly distributed among the units, according to the demand. The supply does not follow a specific protocol, and a possible increase or reduction in demand is not investigated.

Costo de las neumonías asociadas a la ventilación mecánica en pacientes adultos en un hospital general en Chile / Cost evaluation of ventilator-associated pneumonia in adult patients in a general hospital in Chile

Resumen Introducción: La neumonía asociada a la ventilación mecánica (NAVM) es un evento adverso que aumenta la morbi-mortalidad y costos. Genera días adicionales de hospitalización y de procedimientos diagnósticos y terapéuticos para su tratamiento. No existen datos actualizados nacionales respecto al exceso de costos por NAVM. Objetivo: Dimensionar el costo de las NAVM en un hospital general de la Región Metropolitana. Pacientes y Métodos: Aplicación del protocolo caso-control de costos de infecciones intrahospitalarias de la Organización Panamericana de la Salud (OPS) y cálculo directo de gasto en exceso por evento de NAVM. Se comparó el exceso de días de hospitalización, de antimicrobianos en dosis diaria definida (DDD) y de cultivos. Resultados: Se recolectaron 18 casos de NAVM entre los años 2012 y 2015 en pacientes adultos. Se seleccionaron 18 controles pareados por edad y género. Se observó una mayor estadía promedio de 6,1 días en los casos (p < 0,05), una mayor prescripción de antimicrobianos (diferencia promedio de 11,7 DDD, sin significancia estadística) y un exceso de solicitud de cultivos con una diferencia promedio de 3,2 (p < 0,05). El costo unitario por NAVM fue de 4.475 USD. Conclusiones: Los eventos de NAVM generan una mayor estadía hospitalaria, consumo de recursos diagnósticos y terapéuticos.

Background: Ventilator-associated pneumonia (VAP) is an adverse event that increases morbidity, mortality and costs due to a prolonged stay and requirement of microbiological studies and antimicrobial therapy. There is not recent data of VAP costs in Chile. Aim: To evaluate additional costs in adult patients with VAP compared to controls in a general hospital in the Metropolitan Area. Patients and Methods: Use of the PAHO paired casecontrol protocol for cost evaluation associated to nosocomial infections and estimation of cost in excess per VAP event. Length of stay (LOS) in excess, antimicrobial consumption in daily-defined doses (DDD), and number of microbiological studies were compared between both groups. Results: From 2012 to 2015, 18 patients with VAP events were identified with their respective controls. LOS exceeded 6.1 days on average among patients with VAP respect to controls (p < 0.05). DDD was higher among patients with VAP (difference 11.7 DDD) as well as number of cultures (3.2 higher on average, p < 0.05). Cost in excess per VAP event reached 4,475 USD. Conclusions: In our Centre, VAP events are associated to a higher LOS, antimicrobial consumption and microbiological studies.

Voluntary exercise prior to traumatic brain injury alters miRNA expression in the injured mouse cerebral cortex

MicroRNAs (miRNAs) may be important mediators of the profound molecular and cellular changes that occur after traumatic brain injury (TBI). However, the changes and possible roles of miRNAs induced by voluntary exercise prior to TBI are still not known. In this report, the microarray method was used to demonstrate alterations in miRNA expression levels in the cerebral cortex of TBI mice that were pretrained on a running wheel (RW). Voluntary RW exercise prior to TBI: i) significantly decreased the mortality rate and improved the recovery of the righting reflex in TBI mice, and ii) differentially changed the levels of several miRNAs, upregulating some and downregulating others. Furthermore, we revealed global upregulation of miR-21, miR-92a, and miR-874 and downregulation of miR-138, let-7c, and miR-124 expression among the sham-non-runner, TBI-non-runner, and TBI-runner groups. Quantitative reverse transcription polymerase chain reaction data (RT-qPCR) indicated good consistency with the microarray results. Our microarray-based analysis of miRNA expression in mice cerebral cortex after TBI revealed that some miRNAs such as miR-21, miR-92a, miR-874, miR-138, let-7c, and miR-124 could be involved in the prevention and protection afforded by voluntary exercise in a TBI model.

Comparative pathogenicity of Coxsackievirus A16 circulating and noncirculating strains in vitro and in a neonatal mouse model

An enterovirus 71 (EV71) vaccine for the prevention of hand, foot, and mouth disease (HMFD) is available, but it is not known whether the EV71 vaccine cross-protects against Coxsackievirus (CV) infection. Furthermore, although an inactivated circulating CVA16 Changchun 024 (CC024) strain vaccine candidate is effective in newborn mice, the CC024 strain causes severe lesions in muscle and lung tissues. Therefore, an effective CV vaccine with improved pathogenic safety is needed. The aim of this study was to evaluate the in vivo safety and in vitro replication capability of a noncirculating CVA16 SHZH05 strain. The replication capacity of circulating CVA16 strains CC024, CC045, CC090 and CC163 and the noncirculating SHZH05 strain was evaluated by cytopathic effect in different cell lines. The replication capacity and pathogenicity of the CC024 and SHZH05 strains were also evaluated in a neonatal mouse model. Histopathological and viral load analyses demonstrated that the SHZH05 strain had an in vitro replication capacity comparable to the four CC strains. The CC024, but not the SHZH05 strain, became distributed in a variety of tissues and caused severe lesions and mortality in neonatal mice. The differences in replication capacity and in vivo pathogenicity of the CC024 and SHZH05 strains may result from differences in the nucleotide and amino acid sequences of viral functional polyproteins P1, P2 and P3. Our findings suggest that the noncirculating SHZH05 strain may be a safer CV vaccine candidate than the CC024 strain.

In-Vitro Study of Antimicrobial Activities of Five Different Commercial Fixed Dose Combination Drugs in Indian Market.

Objective: In-vitro determination of antimicrobial activities of five different fixed dose combination drugs (FDC). Material and methods: Five antibiotic combination tablets [Cefadroxil plus Clavulanic acid (500:125 mg), Cefuroxime plus Clavulanic acid (500 : 125 mg), Cefixime plus Clavulanic acid (200 : 125 mg), Cefixime plus Ofloxacin (200 : 200 mg) and Cefixime plus Azithromycin (200 : 500 mg)] were tested for antimicrobial action against different microorganisms after their successful incubation for 18 hours at 37°C. Broth dilution or agar dilution methods were used to evaluate susceptibility of microorganisms. Results: 􀁺 Minimum inhibitory concentration (MIC) of Cefadroxil in combination with clavulanic acid reduced by 25%, 29%, 85% and 50%, against S. aureus, K. pneumonia, H. influenzae and S. pneumoniae respectively. 􀁺 No reduction was seen in MIC of Cefuroxime against S. aureus, K. pneumonia, H. influenzae, E. coli or S. pneumoniae after addition of Clavulanic acid. 􀁺 MIC of Cefixime against S. pneumoniae reduced from 0.2 to 0.14 when combined with Clavulanic acid. 􀁺 MIC of Ofloxacin against K. pneumoniae, E.coli and S. pneumoniae reduced by 82%, 50% and 85% respectively in combination with Cefixime. 􀁺 MIC of Cefixime against E.coli, S. typhi and S. pneumoniae reduced by 95%, 90% and 40% respectively in combination with Ofloxacin. 􀁺 MIC of Cefixime against S. typhi and S. pneumoniae reduced by 33.33% and 60% respectively with addition of Azithromycin. 􀁺 MIC of Azithromycin against S. typhi reduced by 70% after addition of Cefixime. Conclusion: Combination of Cefixime and Ofloxacin improves susceptibility of E. coli and S. pneumoniae. Addition of Azithromycin or Ofloxacin improves susceptibility of S. typhi against Cefixime. MIC of Azithromycin also improves with addition of Cefixime. Addition of Clavulanic acid improves antimicrobial action of Cefixime against S. pneumoniae and Cefadroxil against S. aureus, K. pneumonia, H influenza and S. pneumonia.

Impacto de la infección nosocomial en un hospital de Bogotá (Colombia): efectos en mortalidad y costos / Nosocomial infections impact in a hospital in Bogota (Colombia): effects on mortality and hospital costs

Background: Nosocomial infections (NI) are events associated with high impact on hospital costs and mortality. Aim: To evaluate from the health provider's perspective the costs and mortality attributable to NI. Methods: We selected a sample of patients with and without NI matched by age and diagnosis at admission. Costs were calculated and converted from Colombian pesos to US dollars using the average exchange rate of 2008. We evaluated the mortality rate in both groups. Results: We collected data on 187 patients with NI and 276 without NI. Median total hospitalization cost was US$ 6,329 (95% CI US$5,527-7,934) in NI patients, while in non-infected patients this median was US$1,207 (95% CI US$ 974-1,495). Mortality was higher in the NI group (31.6% versus 5.1%). Patients with NI had longer hospital stays (median 21 days, 95% CI 18-24 days) than non-infected patients (median 5 days, 95% CI 5-6 days). Mortality was also markedly higher in the NI group than in the non-infected group (31.6% versus 5.1%). Conclusion: NI are adverse and costly events related to patient attention that affect adversely the quality of attention.

Introducción: Las infecciones asociadas a la atención en salud (IAAS) están relacionadas con un incremento en los costos de hospitalización y un mayor riesgo de mortalidad. Objetivo: Establecer los costos y la mortalidad asociados a la presentación IAAS en una institución de cuarto nivel. Métodos: Se hizo una selección pareada de pacientes con IAAS y sin IAAS para calcular el costo por medio de costeo directo y emparejamiento. Los costos fueron calculados en pesos colombianos y convertidos a dólares estadounidenses según la tasa de cambio de 2008. Resultados: Se incluyeron 187 pacientes con IAAS y 276 pacientes sin IAAS. La tasa de IAAS fue de 1,8% La mediana del costo de hospitalización en los pacientes con IAAS fue US$ 6.329 (95% CI US$ 5.527-7.934) y en los no infectados de US$1,207 (95% CI US$ 974-1.495). Los pacientes con IAAS presentaron mayor tiempo de estancia hospitalaria, con una diferencia de 16 días respecto a los no infectados (21 días (IC 95% 18-24) vs 5 días (IC 95% 5-6)). Se encontró una mortalidad atribuible de 26,4%. Conclusiones: Las IAAS son eventos adversos a la atención, que se asocian con mayor mortalidad y generación de costos extra.

Impacto económico del uso secuencial de los antimicrobianos en los niños con apendicitis aguda complicada / Economic impact of the sequential use of antimicrobials in children with complicated acute appendicitis

FUNDAMENTO: el presente estudio mostró el resultado económico conseguido con la aplicación secuencial de los antimicrobianos en los niños tratados por apendicitis aguda complicada en el servicio de cirugía pediátrica de Camagüey. MÉTODO: se realizó un estudio cuasi-experimental transversal en todos los casos de niños tratados por apendicitis aguda complicada entre enero de 2010 y diciembre de 2013, en el servicio de cirugía pediátrica del Hospital Pediátrico Universitario Eduardo Agramonte Piña de Camagüey. Los resultados económicos fueron comparados con los enfermos tratados por la misma enfermedad entre enero de 2006 y diciembre de 2009. RESULTADOS: se incluyeron en el estudio 401 enfermos. Entre los años 2006-2009 la estadía hospitalaria fue de 7, 03 días/enfermo, en tanto entre el 2010-2013 fue de 4, 2 días. La media de los costos por pacientes fue $ 578, 8 para los casos y de $ 953, 6 para los controles. El consumo de los antimicrobianos entre el 2006-2009 fue de 3 755 bulbos de ceftriaxona, 2 253 bulbos de amikacina y de 4 506 frascos de metronidazol; entre el 2010-2013 solo fueron utilizados 1 965 bulbos de ceftriaxona, 1 179 bulbos de amikacina y 2 358 frascos de metronidazol. CONCLUSIONES: el estudio demostró una notable reducción en la estancia, los costos hospitalarios y en la utilización de antimicrobianos costosos.

BACKGROUND: the present study demonstrates the economic results achieved with the sequential application of antimicrobials in children treated because of complicated acute appendicitis in the pediatric surgery department of Camagüey. METHOD: a transversal quasi-experimental study was conducted in all the cases of children treated because of complicated acute appendicitis between January, 2010 and December, 2013 in the pediatric surgery department of the Eduardo Agramonte Piña Pediatric Teaching Hospital of Camagüey. The economic results were compared to those obtained from the patients treated because of the same disease between January, 2006 and December, 2009. RESULTS: four hundred and one patients were included in the study. Between the years 2006-2009 the hospital stay was of 7, 03 days/ patient; on the other hand, between the years 2010-2013 it was of 4, 02 days/patient. On average, the cost per patient was $ 578, 8 for the cases and $ 953, 6 for the controls. The consumption of antimicrobials, between 2006 and 2009, was of 3 755 ampoules of ceftriaxone, 2 253 ampoules of amikacin and 4 506 bottles of metronidazole; between 2010 and 2013 only 1 965 ampules of ceftriaxone, 1 179 ampoules of amikacine and 2 358 bottles of metronidazole were used. CONCLUSIONS: the study demonstrated a notable reduction in hospital stay and costs and in the use of expensive antimicrobials.

The cost of excessive postoperative use of antimicrobials: the context of a public hospital / Consequências do uso excessivo de antimicrobianos no pós-operatório: o contexto de um hospital público

OBJECTIVE: To evaluate the improper use of antimicrobials during the postoperative period and its economic impact. METHODS: We conducted a prospective cohort study by collecting data from medical records of 237 patients operated on between 01/11/08 and 31/12/08. RESULTS: from the 237 patients with the information collected, 217 (91.56%) received antimicrobials. During the postoperative period, 125 (57.7%) patients received more than two antimicrobials. On average, 1.7 ± 0.6 antimicrobials were prescribed to patients, the most commonly prescribed antibiotic being cephalothin, in 41.5% (154) of cases. The direct cost of antimicrobial therapy accounted for 63.78% of all drug therapy, this large percentage being attributed in part to the extended antimicrobial prophylaxis. In the case of clean operations, where there was a mean duration of 5.2 days of antibiotics, antimicrobials represented 44.3% of the total therapy cost. CONCLUSION: The data illustrate the impact of overuse of antimicrobials, with questionable indications, creating situations that compromise patient safety and increasing costs in the assessed hospital. .

OBJETIVO: avaliar o emprego de antimicrobianos relacionado ao seu uso inadequado e impacto econômico durante o período pós-operatório. MÉTODOS: foi desenvolvido um estudo de coorte prospectivo por meio da coleta de dados de 237 prontuários de pacientes operados entre 01/11/08 e 31/12/08. RESULTADOS: dos 237 pacientes com informações coletadas no estudo 217 (91,56%) fizeram uso de antimicrobianos. Durante o pós-operatório, 125 (57,7%) pacientes utilizaram mais de dois antimicrobianos. Foi prescrito, em média, 1,7 ± 0,6 antimicrobianos por paciente, sendo o antimicrobiano mais prescrito a cefalotina, em 41,5% (154) dos casos. O custo direto da terapia antimicrobiana representou 63,78% de toda a terapia farmacológica, sendo esta grande porcentagem atribuída em parte ao prolongamento da profilaxia antimicrobiana. No caso das operações limpas, onde houve um tempo médio de uso de antimicrobianos de 5,2 dias, os gastos com antimicrobianos representaram 44,3% do custo total da terapia. . CONCLUSÃO: os dados exemplificam o impacto do uso excessivo de antimicrobianos, com indicações questionáveis e criando situações que comprometem a segurança dos pacientes e aumento os custos no hospital avaliado. .

Cost of antimicrobial treatment in patients infected with multidrug-resistant organisms in the Intensive Care Unit / Costo de la terapia antimicrobiana en pacientes infectados con microorganismos multirresistentes en la Unidad de Cuidados Intensivos

This study aims to compare the costs of antimicrobial drugs used in the treatment of patients infected with multidrug-resistant organisms (MDRO) or those not infected with this type of organisms in an intensive care unit (ICU). It is a retrospective comparative case-control study, performed in a public hospital in the capital city of Brazil, comprising the years 2007, 2008 and 2009. Information on age, sex, length of hospitalization, clinical outcome, antimicrobial drugs, microorganisms and microbial sensitivity to antibiotics was collected. Spearman and Mann-Whitney tests were used for statistical analysis. The level of significance was set at p < 0.05. The sample consisted of 401 patients with a mean age of 51.36 years (± 19.68) being 226 (56.4%) male. As for the length of stay, 32.9% of the patients remained more than 20 days, with 195 discharged and 206 deaths. Global cost of antimicrobial treatment was US$ 1113 221.55 during the three year period. Treatment cost for patients with MDRO was higher than for those without (p = 0.010). At least one MDR strain was isolated in 54.6% of the patients. According to these results, nosocomial infections due to MDRO and the high costs involved may endanger the effectiveness of antimicrobial therapy in ICU and Health Centers.

El presente estudio tuvo como objetivo comparar los costos del tratamiento con fármacos antimicrobianos para las infecciones debidas a organismos multirresistentes (OMDR) versus aquellas debidas a gérmenes no multirresistentes, en la Unidad de Cuidados Intensivos (UCI) de un hospital público de Brasilia, Distrito Federal. Fue un estudio retrospectivo, de casos y controles y abarcó un período de tres años (2007, 2008, 2009). Se recolectó información sobre edad, sexo, tiempo de internación, resultados clínicos, antimicrobianos usados, microorganismos aislados y su sensibilidad a los antibióticos. Se utilizaron en el análisis estadístico las pruebas de Spearman y de Mann-Whitney, con p < 0.05. La muestra consistió en 401 pacientes con media de edad de 51.36 años (± 19.68), siendo 226 varones (56.4%). En cuanto al tiempo de internación, un 32.9% de los pacientes permanecieron más de 20 días, con 195 altas y 206 óbitos. El tratamiento antimicrobiano costó US$ 1113 221.55 en los tres años, siendo éste mayor para los que presentaron OMDR que para los que no los presentaron (p = 0.01). Se comprobó la presencia de, por lo menos, un microorganismo multirresistente en el 54.6% de los pacientes. La infección intrahospitalaria con OMDR y el elevado costo del tratamiento de los pacientes infectados con estos microorganismos puede comprometer la efectividad de la terapia antimicrobiana en estas Unidades y Centros de Salud.

Use of antimicrobial agents and granulocyte colony stimulating factors for febrile neutropenia in cancer patients in a tertiary care hospital in India.

Background: Use of antimicrobials (AM) and granulocyte colony stimulating factors (G-CSF) affect the outcome and cost of treatment of febrile neutropenia (FN). There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. Materials and Methods: A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. Results: A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1%) were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE) was Rs 4694.45 ± 296.35 (113.95 ± 7.19$). G-CSF accounted for 76.14 - 97.58% of the total costs. Conclusion: Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.

Measuring medicine prices in Peru: validation of key aspects of WHO/HAI survey methodology / Determinación de los precios de los medicamentos en Perú: validación de aspectos fundamentales del método de encuesta de la OMS/HAI

Objectives: To assess the possibility of bias due to the limited target list and geographic sampling of the World Health Organization (WHO)/Health Action International (HAI) Medicine Prices and Availability survey used in more than 70 rapid sample surveys since 2001. Methods: A survey was conducted in Peru in 2005 using an expanded sample of medicine outlets, including remote areas. Comprehensive data were gathered on medicines in three therapeutic classes to assess the adequacy of WHO/HAI's target medicines list and the focus on only two product versions. WHO/HAI median retail prices were compared with average wholesale prices from global pharmaceutical sales data supplier IMS Health. Results: No significant differences were found in overall availability or prices of target list medicines by retail location. The comprehensive survey of angiotensin-converting enzyme inhibitor, anti-diabetic, and anti-ulcer products revealed that some treatments not on the target list were costlier for patients and more likely to be unavailable, particularly in remote areas. WHO/HAI retail prices and IMS wholesale prices were strongly correlated for higher priced products, and weakly correlated for lower priced products (which had higher estimated retailer markups). Conclusions: The WHO/HAI survey approach strikes an appropriate balance between modest research costs and optimal information for policy. Focusing on commonly used medicines yields sufficient and valid results. Surveyors elsewhere should consider the limits of the survey data as well as any local circumstances, such as scarcity, that may call for extra field efforts.

Objetivos: Evaluar la posibilidad de sesgo debido a la limitación de la lista de referencia y del muestreo geográfico de la encuesta de precios y disponibilidad de medicamentos de la Organización Mundial de la Salud/Health Action International (OMS/HAI) usada en más de 70 muestras de encuestas rápidas desde el 2001. Métodos: En el año 2005, se realizó una encuesta en Perú, con una muestra ampliada de puntos de venta de medicamento, incluso en zonas remotas. Se recogieron datos integrales acerca de los medicamentos de tres clases terapéuticas, con el fin de evaluar la idoneidad de la lista de referencia de medicamentos de la OMS/HAI y el énfasis únicamente en dos versiones del producto. Las medianas de los precios al por menor de la OMS/HAI se compararon con el promedio de precios al por mayor del proveedor de datos mundiales de ventas farmacéuticas IMS Health. Resultados: No se observó ninguna diferencia significativa en la disponibilidad general ni en los precios de los medicamentos de la lista de referencia por localización de venta al por menor. La encuesta integral de los inhibidores de la enzima convertidora de la angiotensina, los antidiabéticos y los productos antiulcerosos reveló que algunos tratamientos que no están en la lista destinataria eran más caros para los pacientes y era más probable que no estuvieran a la venta, sobre todo en las regiones remotas. Los precios al por menor de la OMS/HAI y los precios al por mayor de IMS presentaron una correlación intensa en el caso de los productos de precio más alto, y la correlación fue débil en el caso de los productos de precio más bajo (que tuvieron márgenes de beneficio calculados más altos para el minorista). Conclusiones: El método de la encuesta de la OMS/HAI logra un equilibrio adecuado entre los costos de investigación moderados y la información óptima para la política. El énfasis en los medicamentos de uso frecuente produce unos resultados válidos y suficientes. Los encuestadores de otros...

Fundo Estratégico da Organização Pan-Americana da Saúde: mecanismo facilitador para melhorar o acesso aos medicamentos / The PAHO Strategic Fund: a mechanism to facilitate access to medicines

OBJETIVO: Descrever o funcionamento do Fundo Estratégico para medicamentos da Organização Pan-Americana da Saúde (OPAS). MÉTODO: Estudo retrospectivo, com recorte temporal de 2004 a 2007, fundamentado em levantamento bibliográfico e documental em arquivos dos escritórios da OPAS nos Estados Unidos, El Salvador, Guatemala, Honduras e Brasil. Foram levantados o volume total de recursos e os tipos de medicamentos movimentados por meio do Fundo Estratégico nos anos de 2004, 2005, 2006 e nos meses de janeiro a setembro de 2007. RESULTADOS: O levantamento revelou um fundo bem estruturado que movimentou recursos crescentes, de US$ 3 475 043,00 em 2004 a US$ 19 646 634,00 em 2007 (de janeiro a setembro). Houve um crescimento na participação dos antirretrovirais nesse dispêndio, de pouco menos de 8 por cento do total em 2004 a 57,89 por cento em 2007. Ainda em 2007, 66,63 por cento da movimentação financeira do Fundo Estratégico foram destinados à compra de antirretrovirais para nove países (Brasil, Guatemala, El Salvador, Equador, Honduras, Haiti, Belize, Nicarágua e Bolívia) de um total de 17 países participantes. O país que mais movimentou recursos financeiros por meio do Fundo Estratégico foi o Brasil, com 63 por cento dos gastos para compra de insumos estratégicos no período de janeiro a setembro de 2007. CONCLUSÃO: A proposta de unificar as compras de medicamentos de todos os países participantes para melhor negociação de preços e administração das compras permitirá economias de escala. O Fundo Estratégico pode contribuir para ampliar o acesso aos medicamentos e melhorar a gestão do sistema público de saúde da América Latina.

OBJECTIVE: To describe the medicine procurement activities of the PAHO Strategic Fund. METHOD: This is a retrospective study covering the period from 2004 to 2007, based on a bibliographic and document survey of Pan American Health Organization (PAHO) archives in the United States, El Salvador, Guatemala, Honduras, and Brazil. The volume of resources and the types of drugs procured by the fund were determined for the years 2004, 2005, and 2006 and for the period of January to September 2007. RESULTS: The survey revealed a well-structured fund handling increasing resources, from US$ 3 475 043.00 in 2004 to US$ 19 646 634.00 in 2007 (January to September). The participation of antiretroviral drugs in this expenditure has grown from less than 8 percent of the total in 2004 to 57.89 percent in 2007. Still, in 2007, 66.63 percent of the financial resources managed by the Strategic Fund were allocated to the purchase of antiretroviral drugs for nine countries (Brazil, Guatemala, El Salvador, Ecuador, Honduras, Haiti, Belize, Nicaragua, and Bolivia) out of a total of 17 participating countries. Brazil was the country using the most resources through the Strategic Fund, accounting for 63 percent of the expenditure for the purchase of strategic supplies between January and September 2007. CONCLUSION: The proposal to unify the purchase of medications for all participating countries to improve pricing and purchasing management will result in large-scale savings. The Strategic Fund can contribute to increasing access to medicines and improving the management of the public health care system in Latin America.

Antimicrobial price variation: conundrum of medical profession!

Pharmacoeconomics plays a pivotal role in clinical practice. High medicine prices can adversely affect a patient's finances and compliance. The Indian pharmaceutical industry has become a cornucopia of medicines with wide variation in prices for the same medicine marketed under different brand names. Price list of available antimicrobial brands was procured from a commercial drug directory. Average price of widely prescribed oral antimicrobials was found and price variation between different brands was calculated. The variation in medicine prices was found to be from 95% lower to more than 350% higher than the average price. Implications of price variation in clinical practice are discussed and remedial measures suggested.

Comparative efficacy of amoxicillin, cefuroxime and clarithromycin in the treament of community - acquired pneumonia in children

To compare the clinical response to amoxicillin, cefuroxime and clarithromycin in the treatment of community-acquired pneumonia in children and to see the cost effectiveness of each treatment. Design: Randomized clinical control trial. Place and Duration of Study: Department of Pediatrics, Khyber Teaching Hospital, Peshawar, from October 2001 to February 2002. Subjects and Patients between 3 to 72 months of age, admitted in the hospital with community acquired pneumonia, were randomly divided into three groups,1,2,3. They were started on amoxicillin, cefuroxime and clarithromycin respectively. The patients were assessed daily. If there was no clinical improvement at 48 hours the antibiotic was changed. ANOVA statistical test was applied to see the clinical response to the treatment in the three groups. Cost effectiveness of the treatment was compared. There was no statistical difference in the clinical response at 48 hours of initiating treatment and at discharge [p > 0.01 each]. The mean hospital stay in group 1 and 2 was 3.3 days and group 3 was 3.2 days respectively [p > 0.01]. Ninety-seven% patients in group 1 and 3, and 95% patients in group 2 showed clinical improvement. The cost of treatment of community acquired pneumonia for 8 days was Rs 496/-, 730/-, 1018/- for amoxicillin, clarithromycin and cefuroxime respectively. Amoxicillin was found the most cost effective followed by clarithromycin and cefuroxime respectively in the treatment of non-severe and severe community-acquired pneumonia

Costos de infecciones intrahospitalarias de un grupo de pacientes en un hospital de tercer nivel de atención / Cost of intrahospital infections in a group of patients at a tertiary care hospital

Objetivos. Conocer los costos que generan las infecciones intrahospitalarias (IIH). Material y métodos. Se estudiaron 131 infecciones intrahospitalarias en 82 pacientes en todos los servicios del Hospital de Pediatría del Centro Médico Nacional Siglo XXI, IMSS, de junio a agosto de 1995. Se analizaron: días de sobrestancia, tipo de infección, episodios por paciente, medicamentos, exámenes de laboratorio y gabinete utilizados para el tratamiento de dichas infecciones. Se calcularon los costos de cada rubro y el porcentaje invertido en IIH del presupuesto total otorgado a la unidad. Resultados: 970 días de sobreestancia (7.4 días promedio), 974 días de antimicrobianos, (11.9 días/IIH). Se utilizaron 410 estudios de laboratorio y 191 estudios de gabinete (1.4/IIH). El costo total de estas 131 IIH fue de $ 3'516,421.00. Conclusiones. El costo de las IIH depende de días de sobreestancia, medicamentos, y exámenes de laboratorio y gabinete que requiere cada una para su control. Las áreas de terapia intensiva fueron las más costosas, el 43.2 por ciento de los niños presentó más de una IIH. Del presupuesto total de la unidad fue utilizado 12.1 por ciento para el tratamiento de las IIH. Este análisis refuerza la necesidad de aplicar medidas para disminuir las IIH y los gastos que éstas generan

Antimicrobial prescribing pattern in an Indian tertiary hospital.

550 prescriptions of the indoor patients receiving antimicrobial drugs in the Departments of Internal Medicine, Surgery, Urology and Paediatrics were analysed for drug utilization studies. The prescribing frequency of one antimicrobial per prescription was maximum in Surgery and Urology (52.52%) and Internal Medicine (50.51%) whereas prescribing frequency of two antimicrobials was maximum in Paediatrics (59.9%). In all the departments, quinolones, aminoglycosides, cephalosporins and penicillins were frequently prescribed among which amikacin, ciprofloxacin, cefotaxime and cloxacillin were most preferred drugs, with a general tendency of prescribing newer antimicrobials. In majority of cases selection of antimicrobials was not based on microbiological confirmation. It is suggested that the use of newer and expensive antimicrobials should be kept reserved only for serious and life threatening situations.