Drug pooling: A cost-saving strategy to enhance antibiotics availability for pediatric in-patient in Nigeria.

BACKGROUND: Antibiotic use is common but has a lot of challenges. Implementation of an efficient and cost-effective policy, which can improve the availability and sustainability of pediatric antibiotic use, is required. In this study, we explore the concept of antibiotic drug pooling (DP) as a means to overcome challenges often associated with antibiotic use. MATERIALS AND METHODS: The study was undertaken in three public tertiary hospitals in Southeast Nigeria using a mixed-methods approach. Three focus group discussions with caregivers of in-patient children and 16 in-depth interviews with physicians, nurses, and pharmacists provided the data for the study. In addition, the medical records of patients on admission were examined. Information collected centered mainly on antibiotic use and challenges, participants' perception of antibiotics pooling, as well as possible ways to improve on antibiotic availability and sustainability. RESULTS: Out of 53 children on admission, antibiotics were prescribed for 45 (84.2%) of them children. Seventeen (37.8%) of the 45 on antibiotics had their initial antibiotics changed. The major challenges encountered by all the caregivers interviewed were the cost of the antibiotics (85%). None of the caregivers was willing to submit their purchased drugs for pooled use by other in-patients. Health-care providers, however, lauded the concept of DP and made the following suggestions on ways the proposed concept could be improved: harmonized prescription, billing, and unit-dose dispensing for the first 72 h antibiotic treatment. CONCLUSION: The adoption of a harmonized prescription pattern and billing as well as unit-dose dispensing for the first 72 h antibiotic treatment will provide a cost-effective means of ensuring antibiotic availability and sustainability. The drug-pooling concept will not only enhance prompt commencement and discontinuation of antibiotic treatment but will also reduce waste and improve time-out policy.

Colonic cancer in adolescents. A report of three cases.

Colorectal cancer is a common malignant neoplasm in adults, with a peak incidence of 60-79 years. About 1 million cases of the disease and half a million deaths associated with it are reported world-wide each year. Colorectal cancer, however, is very uncommon in children and adolescents. This is a presentation of 3 cases of colon cancer in Nigerians aged 17 and 19 years. Two of them were adenocarcinoma and the other leiomyosarcoma. The pathogenesis and aspects of management are discussed.