[e-drug] antibiotics still a problem

e-drug
1

E-drug:

I worked at one of goverment secondary level hospital last year, and control of antibiotics raimend an existing problem till date, though I have moved to a district hospital the problem with prescribing antibitotics remained unresolved. The health department in SA have made things easy by listing all the available antibiotics in public sector on Essential Drug List (EDL), and there is also a policy on prescribing restrictions (i.e who should prescribe what and up to which level).

The problem I and other pharmacists have often exprienced is doctors prescribing antibiotics unneccessary e.g., a patient will be prescribed antibiotic for dry cough or chest pain and headache, and often this result in a huge conflict between pharmasists and doctors.

Then there is a problem with precribing antibiotics that are expensive with a concept of "the high the price the better the pharmacological effect".

The problem with peadiatric dosing is even worse, most peads doses are calculated according to body mass, however there is no chance of this happening, doctors and nurses are busy to calculate doses and even busier to phone dispensary and ask for assistance.

There is also a gap between antibiotics found in different categories of hospital, however you will find presciption of tertiary hospital antibiotic at distric hopital.

I have realised that some of prescribers are not aware of the importance of prescribing patterns and drug utilization hence this problem. Personally I have reached a saturation point re this matter and are tired of preaching one thing every day. I must mention though that there are those doctors who will pick-up the phone and call dispensary re what is available and discuss the medication with the pharmasist and believe me, in cases like this it is rare to see the patient coming back to the hospitall with the same illness.

If you have exprienced the same problem at your hopitals please let me know how you dealt with it.

Pinkoane Mamiki
Pharmacist -community service
South Africa
swartsp@doh.ofs.gov.za

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E-DRUG: Antibiotics still a problem (2)
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Dear Pinkoane,

I understand your frustration but please don't get discouraged in preaching
doctors. Being one from a developing country, I know that it takes not only
huge consistent efforts from person like you over time, but also government
interventions with an effective drug policy and regulatory process and a
drug and therapeutic committee who can provide the expertise and guidance to
them. More importantly, it takes continuing medical education for
prescribers to achieve judicious prescribing and learn the antimicrobial
susceptibility profiles (at least of key pathogens) from the country, from
the region, from the hospital and possibly community and even at the ward
level (for instance ICUs).

You are experiencing lack of consistent prescribing behavior from doctors
seen even in industrialized countries. Remember that in the USA, 50% of
antimicrobials are not justified. We have lot to do!

It is my experience that antimicrobial susceptibility testing and quality
control in developing countries needs standard protocols, better equipment,
well trained laboratory staff, a drug and therapeutic committee and the
production of antimicrobial profiles distributed to doctors and in remote
area where is not a doctor to nurses, and health care workers. They need to
get acquainted with this information to empirically justified their choice
of an antibiotic/antimicrobial.

In Latin America and Caribbean, Pan American Health Organization (PAHO) has
developed in most of the affiliated countries an antimicrobial resistance
surveillance network, quality control training for laboratory staff,
production and dissemination of antimicrobial resistance profiles for key
pathogens, supported an annual antibiotic training in Buenos Aires,
Argentina at the Malbran Institute and have established coalition with
national and international organizations such as the Alliance for the
Prudent Use of Antibiotics (APUA).

The Pan American Infectious Disease Society through their members has an
antimicrobial resistance and antibiotic committee that pays attention to
prescribing issues. Some of their members are advisors for the National
Committee for Clinical Laboratory Standards (NCCLS).

Since 1981, APUA (www.apua.org ) has developed chapters in 52 countries.
These chapters are local grassroots groups composed by professionals from
different disciplines including the industry and consumers. They are the
local experts who can advocate and provide guidance to policy makers and
prescribers. APUA headquarters provides technical assistance to countries
and individuals.

I believe we can do better! Interventions like the ones described above
should be culturally competent and tailored to the country and appropriate
settings and targeted from different angles.

Thank you,

Anibal

Anibal Sosa, MD
Director, International Program & Clinical Advisor
Alliance for the Prudent Use of Antibiotics (APUA)
75 Kneeland Street
Boston, MA 02111, USA

Tel: (617) 636-2709
Fax: (617) 636-3999
E-mail: anibal.sosa@tufts.edu
www.apua.org