Attitude and practice of doctors toward adverse drug reactions (adrs) reporting in a Nigerian tertiary health facility

Background : Adverse drug reactions; (ADRs); constitute an important cause of morbidity and mortality worldwide. Spontaneous adverse drug reaction (ADR) reporting is the bedrock of post-marketing surveillance but under-reporting remains its major drawback. Objectives : This study aimed at evaluating the attitude and practice of ADR among doctors in a tertiary health facility in Oyo State; Nigeria; with a view to improving ADRs reporting. Methods : This was a cross-sectional questionnaire based study involving medical doctors working at the Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital; Ogbomoso. Consenting doctors were evaluated on their attitude and practice of ADRs through self-administered questionnaire. Data obtained were entered and analyzed using SPSS version 17. Results : A total of 35 doctors responded to the questionnaires. Only about 57.1 considered ADR before prescribing; all of whom were also aware of the procedure for reporting. Awareness of the existence of National Pharmacovigilance Center (NPC) was 71.4. Thirty (85.7) of the respondents have encountered ADR; but only 2.9 have ever reported it with yellow form. Majority (85.7) of the respondents did not consider ADR reporting as a useful tool in the prevention of drug related morbidities and mortalities. Other factors that may hinder ADR reporting include: lack of awareness of the existence of yellow forms for reporting (68.6) and poor knowledge of procedure for reporting (48.6). Conclusion : ADR reporting rate was very low among the participants in this small study; large studies aimed at evaluating the determinants of ADR reporting should be considered. Should these findings be confirmed; training and re-retraining through Continuing Medical Education (CME); and establishment of pharmacovigilance committee would be required to ensure a national pharmaovigilance system

Comparative study of efficacy of artesunate plus cotrimoxazole and artesunate plus chloroquine in the treatment of malaria in Nigerian children: a preliminary report.

Background & objectives: The study was undertaken to evaluate the efficacy of cotrimoxazole plus artesunate and to compare the efficacy of this combination with that of artesunate plus chloroquine in the treatment of acute uncomplicated falciparum malaria in children. Methods: Children aged between 0.5 and 12 yr with clinical and parasitological evidence of Plasmodium falciparum malaria were randomized to receive either artesunate plus cotrimoxazole or artesunate plus chloroquine. They were followed-up with clinical and parasitological assessment for a period of 14 days. Results: In all, 57 out of 81 (31 in the artesunate plus cotrimoxazole group and 26 in artesunate plus chloroquine group) completed the study as per protocol and were evaluated. Pre-treatment clinical and parasitological parameters were similar in the two treatment groups. The time to clear fever and other symptoms were similar in the two groups 1.0 + 0 vs 1.14 + 0.38 (p > 0.05). Parasite clearance times were also similar; 1.65 + 0.49 days vs 1.58 + 0.67 days respectively for artesunate plus cotrimoxazole and artesunate plus chloroquine (p > 0.05). The cure rates on Day 14 were 100% for both artesunate plus cotrimoxazole and artesunate plus chloroquine groups. Both drug combinations were well-tolerated in the small population of children. Conclusion: These results indicate that artesunate plus cotrimoxazole has similar efficacy to artesunate plus chloroquine in the treatment of acute uncomplicated P. falciparum malaria in children resident in an endemic area of south-west Nigeria.

Use of Chloroquine in Uncomplicated Falciparum Malaria Chemotherapy: The Past; the Present and the Future

Chloroquine is a 4-aminoquinoline discovered over five decades ago for treatment of uncomplicated malaria. It was widely used as first line treatment and prophylaxis for individuals going into malaria endemic regions. It was initially highly effective against the four Plasmodium species (P. falciparum; P. malaria; P. ovale and P. vivax) infecting human. It is also effective against gametocytes except those of P. falciparum. Resistance of P. falciparum to chloroquine is widespread and led to discontinuation of chloroquine in malaria treatment by most countries. In recent times; evidences are emerging for chloroquine to probably secure its original place in treatment of acute uncomplicated falciparum malaria. This would be a welcome idea since chloroquine is readily available; relatively safer and cheaper than most currently use antimalarial drugs. Thus; researchers should intensify efforts on periodic in vitro monitoring of chloroquine efficacy; clinicians should further discourage use of chloroquine until efficacy is remarkably restored and pharmaceutical industries should look into potential chloroquine and chloroquine-resistance reversal fixed and non-fixed doses combinations

Pre-hospital and prescription use of antibacterial drugs at a secondary health centre in Ibadan, Nigeria

The overall goal of this study is to reduce morbidity and mortality ascribable to bacterial infections by encouraging rational use of antibiotics. Antibiotics use prior to and prescriptions of antibiotics by the attending physicians were evaluated in a group of patients attending a secondary health facility. A quasi-exit interview was conducted using a structured questionnaire. The major presenting symptoms were sought from patients and/or parents and/or guardians; drug history was taken and doctors' prescriptions were copied onto an already prepared format. All data were entered into EPI-INFO version 6 for analyses. The mean age of patients who were enrolled was 14 ±±±± 16.96 [range: 0.08-78 years] but males patients were statistically younger than females: respectively 9.94 ±±±± 15.48 years (0.08-78 years) and 18.43 ±±±±17.10 years (range: 0.08 ­ 70 years); F: 122 P< 0.00. Pre-hospital use of antibiotics was documented in about a third of all the patients and cotrimoxazole was the most commonly used antibiotics accounting for 68.5% of antibiotics use in this group patients. Antibiotics were contained in more than half of all the prescriptions and erythromycin and cephalosporin were antibiotics of choice. This is contrary to the previous findings in the same area of study but different health facility. There is need for formulation of appropriate drug policy and establishment of continuing medical education for doctors as well as public enlightenment programmes on rational use of antibiotics

Effects of antifolates - co-trimoxazole and pyrimethamine-sulfadoxine - on gametocytes in children with acute, symptomatic, uncomplicated, Plasmodium falciparum malaria

Antimalarial drugs including the antifolate, pyrimethamine-sulfadoxine (PS), can modulate the prevalence and intensities of gametocytaemia following treatment of acute malaria infections. They may also directly influence the transmission and spread of drug insensitivity. Little is known of the effects of co-trimoxazole (Co-T), another antifolate antimalarial, on gametocytes in children with acute malaria infections. We compared the effects of Co-T and PS on the prevalence and intensities of gametocytaemia and gametocyte sex ratios in 102 children aged 0.5-12 years presenting with acute and uncomplicated falciparum malaria. Compared to pre-treatment, both drugs significantly increased gametocyte carriage post-initiation of treatment. However, gametocyte carriage was significantly lower on day 14 in those treated with Co-T than PS. Significant increase in gametocytaemia with time occurred in PS - but not Co-T-treated children. Kaplan-Meier survival curve of the cumulative probability of remaining gametocyte-free in children who were agametocytaemic at enrolment showed that by day 7 of follow up, children treated with PS had a significantly higher propensity to have developed gametocytes than in Co-T-treated children (Log-rank statistic 5.35, df = 1, P = 0.02). Gametocyte sex ratio changes were similar following treatment with both drugs. PS and Co-T treatment of acute malaria infections in children from this endemic area is associated with significant increases in prevalence and intensities of gametocytaemia but these effects are more marked in those treated with PS than Co-T.

Profile of chloroquine - induced pruritus in Nigerian children resident in Ibadan, Nigeria

Chloroquine is still the first-line drug in the treatment of malaria in Nigeria and West- Africa sub-region. A major drawback to the use of chloroquine is pruritus. We studied a total of 175 children aged 1­15 years with a view to assessing some factors that may influence chloroquine induced pruritus and the possible impact on therapy with this drug. The mean age was 5.2+4.0 and there were 87 females and 88 males. Chloroquine-induced pruritus was found in 43/175 (24.6%). All the subjects experienced the itching within 24 hours of ingestion of the drug and median duration of the itching was 2 days. Majority of those who itched still used chloroquine to treat malaria for various reasons. There was positive family history in 34/43 (79%) of those who itched and 57/132 (43%) of those who did not itch to chloroquine. Those who had chloroquine-induced pruritus were relatively older (mean age 6.90+3.68 years versus 4.64+4.00; p< 0.05) and mean age onset of chloroquine-induced pruritus was positively associated with mean age of the children r = 0.91; 95% confidence limits: 0.71< r < 0.91. We concluded that chloroquine-induced pruritus in this group of children evolved with increasing age and was associated with positive family history