Post on 08-Mar-2016
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Just and compassionate quality pharmaceutical services for all
Interventions and innovations to
improve antibiotic use:
Stories from EPN
Global Forum on
Bacterial Infections
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EPN- A network aimed at PSS
o EPN is a worldwide network with members from across Africa and beyond including:
n India
n Australia
n the United States
n Europe
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Working mainly with church health systems
o Up to 40% of health services in the rural areas of most African countries are provided by church health facilities. This contribution is critical for the attainment of the MDGs on health.
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Access to and rational use of medicines
o The objectives of this programme are to
n facilitate increased access to affordable quality medicines and
n ensure rational use of medicines
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Strategies to improve use of antibiotics
o Address availability n Promoting intra Africa trade in medicines supply
from Kenya to Malawi, Chad and Zimbabwe …..has also addressed
quality and cost n Advocating for the use of the in country pharmaceutical suppliers n Campaign against informal sources and channels
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Strategies to improve use of antibiotics
o Improve pricing n Pooled procurement initiatives n Share price information
o Provide information and promote its use to improve practice n Collect data on local resistance patterns
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Strategies to improve use of antibiotics
o Building quality systems n Pooled QC testing n Sharing information – manufacturers, regulators….
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Medicine listed n P/F Manufacturer Ciprofloxacin 10 P = all JB Chemicals, Cosmos, Kopran, Phat kin -‐ DRC; BDH, Micro labs, Cipla
– India, Pharma quick – Benin Amoxicillin 9 P= all Addis Pharma -‐ Ethiopia, SAI PH – Tunisia, Zenufa Shellys Tanzania,
Caisa Pharma -‐ DRC, Medivet – Kenya, Doxycycline 9 P=8, F=1 Flamingo Meditab Rayat Pharmachem – India; others Phenoxymethyl Penicillin (Pen V)
8 P=7, F= 1 M & G -‐ Ghana, Shellys – Tanzania, Elys – Kenya, Regal – Kenya, North China group – China, Sparsh Biotech – India
SMX/TMP 11 P = 8, F =
3
Microlabs – India, Elys – Kenya, ZT Pharma – China, Caisa Pharma – DRC, Regal – Kenya, Medopharm – India
Astra life care – India, Cipla – India, Ethiopia Pharma -‐ Ethiopia
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Strategies to improve use of antibiotics
o Investing in Human Resources o Courses for health professionals
n Rational management of antibiotics has been developed and run in Uganda
n Essentials of pharmacy practice is targeting pharmacy assistants in hospital
o Training methodology n Simple clear messages n Interactive & participatory learning
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Investigating antibiotic use (1)
Surveys on practices influence prescribing of antibiotics
o 63.6% of 22 hospitals in a study in Kenya reported having a functional medicines and therapeutics committee (MTC)
o Only 20% of the hospitals reported having certain antibiotics whose prescribing was limited to selected groups of prescribers
o 42.9% of clinicians felt that locally developed treatment guidelines would be more useful than national guidelines
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Investigating antibiotic use (2)
o Retrospective data of culture and sensitivity of two laboratories of the CBC Health Board n Banso Baptist Hospital n Mbingo Baptist Hospital
o Compilations of pharmacy Interventions at point of dispensing
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Investigating antibiotic use (3)
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Antibiotic-related interventions (59% of all Interventions)
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20.0
Perc
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Inappropriate Dose 19.0
Wrong Drug/Omission 17.2
Duplicate Therapy w current drug 15.5
Drug-disease (pregnancy) interaction 15.5
Inappropriate route of administration 12.1
Allergies to Ingredients 6.9
Dosing schedule not consistent 5.1
Contraindication 5.1
Possible drug-drug interaction 3.4
Percentage
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Public education on antibiotic use
Addressing: o Incomplete doses with
antibiotics o Dangers of poor quality
medicines o Importance of laboratory
testing o Buying medicines from
licensed outlets
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Public education on antibiotic use
Tailored to the needs of the community
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Public education on antibiotic use
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Practice Improvements
o Promoting use of available tools e.g. MSH ICAT tool was used in St. Martin Hospital Cameroon to give an insight into the state of selected practices »»»» basis for intervention
o Investing in MTCs »»» 6 hospitals in Arusha: clear TOR, supported by hospital management
o Development of local treatment guidelines for infectious diseases
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Challenges
o Effectiveness of interventions – how to reach as many countries (communities) as possible
o Inadequate documentation of interventions and mechanisms to demonstrate that antibiotic use practice has improved
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Acknowledgements
University of Nairobi
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Thank you
Ecumenical Pharmaceutical Network (EPN) CHAK Complex - Musa Gitau road, Off Waiyaki Way, Lavington
P. O. Box 749 - 00606 Sarit Centre Nairobi, Kenya
Tel: +254 20 4444832/4445020 Mob: +254 724 301755 Fax: +254 20 2678147 E-mail: info@epnetwork.org
Web site: www.epnetwork.org