E-DRUG: Absence of pharmaceutical policies in Sudan
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We conducted a pilot study for 3 weeks in Khartoum Teaching hospital the biggest and oldest hospital in Sudan (1904). The objectives of this study are to test the applicability of data collection tool and to explore obstacles that may face the process of data collection and to train nurses who will collect data.
Our main aim is to develop new policy for the prescribing and administration of antibiotics used for surgical prophylaxis.
This pilot revealed very interesting points and showed general unawareness with the principles of surgical prophylaxis among health care providers. Cefuroxime is the predominant antibiotic prescribed as preoperative agent given in many cases as sub-dose of 750mg. The patient may receive cefuroxime in the post operative period for more than 24 hours - one up to four days according to the type of operation.
In most cases the patients received the prophylactic dose in time window range from 0-10 min before the incision, which is not sufficient for the drug to attain a concentration that is needed to inhibit the anticipated organisms at the operated site.
The most interesting observation is the prolong period of prophylaxis as in some cases it was 10 days range between 6-7 days. For example for cesarean section the patient may received 2- days cefuroxime + metronidazole as injectable followed by oral co-amoxiclav as 1g b.d for 5 days + metronidazole. Co-amoxiclav is the predominant antibiotic it has been prescribed for almost 70% of the patients. For some clean surgery like hernia and breast surgery the patient may receive cefuroxime for 48 hours followed by co-amoxiclav for 5-7 days.
Our study stared in March and will continue for 6-9 month as baseline and our plan to introduce a multiple type of interventions (clinical guidelines guarded by clinical pharmacists, Use of standardized preoperative antibiotic prescribing forms and concurrent feedback).
Pharmaceutical policies in our country to regulate the use of antibiotic are absent. Absence of clinical guidelines in hospitals and absence of policies to regulate the activities of pharmaceutical promotion as this irrationality in prescribing is the result of high pressure exerted by the pharmaceutical companies. This is exemplified by the excess use of co-amoxiclav in the postoperative period in this pilot. Absence of policies in registration of antibiotics and other medicines may also help in the finding of such situation.
Abubaker Elbur
PhD Student
University of Gezira
Sudan
bakarelbu@yahoo.co.uk