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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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Just and compassionate quality pharmaceutical services for all
Interventions and innovations to
improve antibiotic use:
Stories from EPN
Global Forum on
Bacterial Infections
www.epnetwork.org Just and compassionate quality pharmaceutical services for all 2
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
www.epnetwork.org Just and compassionate quality pharmaceutical services for all 3
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
Just and compassionate quality pharmaceutical services for all 5
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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
Just and compassionate quality pharmaceutical services for all 6
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Strategies to improve use of antibiotics
o Building quality systems n Pooled QC testing n Sharing information – manufacturers, regulators….
Just and compassionate quality pharmaceutical services for all 7
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
Just and compassionate quality pharmaceutical services for all
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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
Just and compassionate quality pharmaceutical services for all
www.epnetwork.org
Investigating antibiotic use (3)
Just and compassionate quality pharmaceutical services for all
Antibiotic-related interventions (59% of all Interventions)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Perc
enta
ge
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
www.epnetwork.org Just and compassionate quality pharmaceutical services for all 13
Public education on antibiotic use
Tailored to the needs of the community
www.epnetwork.org Just and compassionate quality pharmaceutical services for all
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
Just and compassionate quality pharmaceutical services for all
15
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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
Just and compassionate quality pharmaceutical services for all 16
www.epnetwork.org Just and compassionate quality pharmaceutical services for all
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: [email protected]
Web site: www.epnetwork.org
