A cross-sectional analysis of the association between age and gender and prescribed minimum benefit chronic disease list conditions among South Africans with concomitant hypertension, diabetes and dyslipidaemia.

BACKGROUND: Prescribed Minimum Benefit Chronic Disease List (PMB CDL) conditions are a regulated list of conditions most common to South Africa. OBJECTIVES: To investigate the prevalence and association between PMB CDL conditions and age and gender among patients with concomitant hypertension, diabetes and dyslipidaemia. METHODS: The study population consisted of patients (n = 17 866) with a prescription containing at least one co-prescribed antilipemics, antihypertensive and antidiabetic (identified using the MIMS Desk Reference). ICD-10 codes on claims for PMB CDL conditions were counted. RESULTS: 39.5% of patients had a PMB CDL condition. Women had higher odds for hypothyroidism (OR 6.30, 95% CI; 5.52, 7.19, p < 0.001) and lower odds for coronary artery disease (CAD) (OR 0.63, 95% CI; 0.55, 0.72, p < 0.001) than men. In combination with hypothyroidism the odds for CAD were reversed and strongly increased; 3.54 (95% CI; 2.38, 5.25, p < 0.001). The odds for females having cardiac failure (CF) was insignificant and low (OR 0.87, 95% CI; 0.75, 1.01, p = 0.063); however combined with hypothyroidism, the odds increased to 5.35 (95% CI; 3.52, 8.13, p < 0.001). CONCLUSION: Hypothyroidism was an important discriminating factor for co-morbidity in women with concomitant hypertension, diabetes and dyslipidaemia, in particular with cardiovascular disease.

Assessment of the Appropriateness of Antibiotic Prescriptions in Lesotho Public Hospitals: A Novel Methodology Based on Principles of Antibiotic Prescribing.

The study primarily aimed at assessing the appropriateness of antibiotic prescriptions in a section of public health institutions in Lesotho using an assessment tool formulated from principles of antibiotic prescribing. Relevant data on procedures of infection diagnosis and prescribed antibiotics were collected from both inpatient and outpatient case reports for a one-month period in five public hospitals in Lesotho. These were analyzed for the appropriateness of the prescribed antibiotics. Prescription appropriateness assessment was based on conformities of prescribed antibiotics to criteria developed from pertinent principles of antibiotic prescribing. Assessed prescriptions, 307 inpatient and 865 outpatient prescriptions in total, were classified into categories of appropriateness based on extents to which they satisfied conditions defined by combinations of criteria in the assessment tool. Antibiotic prescriptions from inpatient and outpatient departments of study site hospitals were categorized into groups of different degrees of appropriateness. A total of 32.2% inpatient prescriptions and 78.4% outpatient prescriptions assessed were appropriately written for the empiric treatment of infections for which bacterial pathogens were considered absolute or possible etiologies. The use of prescription assessment tools based on principles of antibiotic prescribing is a feasible option of assessing the appropriateness of antibiotic prescriptions, particularly in low-income countries where expert panels cannot be formed.

The Impact of Appropriate Antibiotic Prescribing on Treatment Evaluation Parameters.

The therapeutic impact of inappropriate prescribing of antibiotics is debatable, particularly in situations where infections are treated empirically with multiply prescribed antibiotics. Prescribers may remain under the illusion that such prescriptions are appropriate on the basis of any observed positive treatment outcomes, even though an antibiotic prescribed in such combination therapy may actually be infective against infecting pathogens. This, inevitably, promotes inappropriate antibiotic prescribing. Prescribers may be motivated to make more conscious attempts to prescribe antibiotics appropriately if it is proven that judicious prescribing of antibiotics has positive impacts on treatment outcomes. The objective of this study was to determine the impact of appropriate prescribing of antibiotics on treatment outcomes, days of patient hospitalization and costs related to antibiotic treatment. Observational data on antibiotic treatment were collected for a one-month period from case notes of all inpatients (n=307) and outpatients (n=865) at five government and mission hospitals in Lesotho. Prescriptions were classified into categories of appropriateness based on extents to which antibiotics were prescribed according to principles. Treatment success rates, mean days of hospitalization and costs of antibiotic treatments of inpatients treated with specified prescription categories were determined. Appropriate prescribing of antibiotics for inpatients had positive impacts on treatment outcomes, patients' days of hospitalization for infections and costs of antibiotic treatments. In outpatient settings, appropriate prescribing of antibiotics failed to show any significant impact on costs of antibiotics. Appropriate prescribing of antibiotics had a positive impact on patients' recovery and costs of antibiotic treatments in inpatient settings.

Analysis of possible drug-drug interactions between ritonavir and other antiretrovirals in a section of the private health care sector in South Africa

Background: The introduction of human immunodeficiency virus (HIV) protease inhibitors (PIs) has led to a dramatic decline in the morbidity and mortality associated with HIV infection. However; the concomitant use of PIs and other antiretrovirals (ARVs) can be complicated by drug-drug interactions (DDIs); adversely affecting levels of PIs. Methods: A quantitative; retrospective drug utilisation study was performed using data obtained from the medicine claims database of a pharmacy benefit management company during 2004; 2005 and 2006. The possible DDIs found among ARVS themselves were identified using the classification by Tatro.Results: The percentage of ARV prescriptions claimed of the total number of medicine items increased from 1.68(n = 43 482) during 2004 to 3.18(n = 51 613) during 2005; then to 4.74(n = 47 085) during 2006. A total of 1 326; 1 863 and 960 possible DDIs were identified among ARVs themselves for 2004; 2005 and 2006 respectively. Of these; ritonavir (unboosted or boosted) presented with the most possible DDIs; accounting for 74.28(n = 985) for 2004; 67.90(n = 1 265) for 2005; and 27.50(n = 264) for 2006. The highest prevalence of DDIs identified was between ritonavir (unboosted) and saquinavir (n = 974; 5) for 2005 and 2006; followed by indinavir (n = 490; 129; 155) for 2004 to 2006; and efavirenz (n = 274) for only 2004; then ritonavir (boosted); co-formulated as lopinavir/ritonavir; and efavirenz (n = 118; 88; 34) for 2004 to 2006; nevirapine (n = 49; 37) for 2004 and 2005; indinavir (n = 9) for 2004; and saquinavir (n = 22) for 2006.Conclusion: These findings indicate that concomitant use of PIs such as ritonavir; a potent cytochrome P450(CYP)3A4 enzyme inhibitor; and other ARVs is complicated by possible DDIs and therefore further studies need to be done on the ARV combinations and management of these DDIs. How to cite this article: Katende-Kyenda; N.L.; Lubbe; M.S.; Serfontein; J.H.P.; Truter; I. 2009. Analysis of possible drug-drug interactions between ritonavir and other antiretrovirals in a section of the private health care sector in South Africa. African Journal of Primary Health Care et Family Medicine; 1(1); Art. #21; 6 pages. DOI: 10.4102/ phcfm.v1i1.21