Antimicrobial Medicines Research Articles

Phytochemical Activities of Artemissia vulgaris and Acacia nilotica Plant Extracts

With the growing era, there is tremendous need to produce high potential antimicrobial drugs and medicines from various herbaceous plants and natural resources has been increasing due to increasing multiple drug resistance in pathogens. An experiment was performed to know about antimicrobial activities of various plant extracts. These activities were tested by using agar diffusion method. The bacterial as well as fungal strains were collected and were cultured on agar plates. After that these plates were left in incubator for 24 hours at 37°C to develop zones clearly all round the plant extracts. The activities of bacteria and fungi were determined by using inhibition diameter zones. The clear inhibition zones were found against bacterial strains in study. Antimicrobial activity of acetone, n-hexane and water extracts viz. Acacia nilotica and Artemissia vulgaris tested against Pseudomonas aeruginosa, Bacillus subtils and E. coli as well as Aspergillus niger and Fusarium oxysporum. Acetone extracts were found to be more effective as compared with n-hexane while water extracts show no activity.

Optimising the use of antimicrobial medicines in Sudan

Antimicrobial resistance (AMR) has been a priority area identified by the Government of Sudan and development partners. This paper is part of a study in Sudan using the available documents covering relevant fields pertaining to AMR and interviews with key informants from World Health Organization (WHO) office Sudan, Federal Ministry of Health and other relevant entities. Documents were obtained from related websites for policies, strategies, guidelines, reports, and plans as well relevant international and government agencies in Khartoum. The study was guided by the WHO’s five strategic objectives of Global Action Plan on Antimicrobial Resistance. This paper focuses on the fourth objective on optimising the use of antimicrobial medicines in human health and animal health. The study revealed the presence of numerous policies and guidelines on antibiotic use and generic prescribing at different levels with little evidence of their implementation. There were a lack of supervisory or monitoring systems to ensure proper and rational prescribing, and appropriate dispensing of antimicrobials in both public and private sectors. The system is weakened due to low capacity for monitoring and checking as a result of limited resources both in terms of human resources, skills, tools and quality checks to ensure the quality of medicines post-marketing. There is a need to set up a quality management system within the existing structures for the distribution, prescription and dispensing of antibiotics in both public and private institutions. The system should clearly define the processes and provide adequate resources to ensure appropriate monitoring and control of antibiotic distribution, prescription and dispensing

Сравнительная оценка поведения гелей на основе поливинилпирролидона в условиях in vitro и in vivo

A series of experiments aimed at studying antimicrobial properties of gel experimental samples has been carried out, and their prolonged action in vivo and in vitro has been compared. The gel under study is a processed composition based on polyvinylpyrrolidone (PVP) and antimicrobial drugs; it is intended for the prevention and treatment of implant-associated infection in traumatology and orthopedics. Two methods were used to process the composition: ionizing radiation and heating. PVP treated in this way is a matrix for drug delivery to the structures of the articular cavity, which allows using antimicrobial medicines, in particular gentamicin and fosfomycin, for targeted influence on infectious agents. All gel samples, regardless of the method for their preparation, exhibited antimicrobial activity against Staphylococcus aureus, the main causative agent of postoperative infectious processes. The antimicrobial properties of the gel were long-lasting; they were observed for 14 days. No pathological changes were found in the tissues adjacent to the gel. Key words: implant-associated infection, surgery, traumatology, biofilm, polymer hydrogel, gentamicin, fosfomycin

The Antibiotic Resistance Crisis - An Indian Perspective

This research study reiterates the optimal usage of antimicrobial medicines in humans and animals to lessen antibiotic resistance. A primary survey was conducted to study an individual’s role in prevention and control of antibiotic resistance. It was found that antibiotics are being irrationally used and the efficacy of antibiotics, as previously transforming the medical sciences and saving lives of many is in danger due to the quick emergence of bacterial resistance. Extensive efforts are therefore required to manage crisis by implementing new policies and renewing research efforts. Additionally, there exists a dire need to educate patients and public regarding antibiotic resistance crisis.

Effect of Distreptaza® Distrept on the antibiofilm activity of clindamycin against Staphylococcus spp.

This article highlights one of the most important medical and social problems – an increase in the number of diseases of the female reproductive system caused by microorganisms and the insufficient effectiveness of modern antimicrobial medicines, absence of medicine with antibiofilm action. This prompts the authors to search for products that increase the effectiveness of antibiotic therapy, as well as medicines that can suppress film formation and disrupt the biofilm structure. The article presents the results of studying the biofilms sensitivity formed by Staphylococcus spp. to the action of the enzyme preparation Distreptaza® Distrept and its effect on the specific antibacterial activity of clindamycin.Purpose of the study: to evaluate the Distreptaza® Distrept impact on the specific effect of clindamycin against the biofilms of Staphylococcus aureus and Staphylococcus epidermidis.Materials and methods: one-day cultures of S. aureus 222 and S. epidermidis 297 were used in the experiments. Solutions of drugs and microorganisms were added simultaneously, with the action on the formed biofilms – 24 hours after the introduction of the bacterial inoculum to study the effect of medicines on film formation. Experiments were carried out according to the generally accepted technique based on the sorption of gentian violet by biofilm structures with subsequent desorption of the dye into an organic solvent.Results: the experiments showed that Distreptaza® Distrept interferes with the film formation of Staphylococcus spp. (S. aureus inhibition in 85.4%, S. epidermidis in 20.3%). Distreptaza® Distrept affects the biofilms formed by S. aureus, the biomass of S. aureus decreases by 59.5%. It was found that Distreptaza® Distrept enhances the specific activity of clindamycin, both at the stage of film formation, and on the formed biofilms.Conclusions: the medicine Distreptaza® Distrept has antibiofilm activity, increases the specific antibacterial effect of clindomycin against biofilms of gram-positive microorganisms. This allows us to talk about the prospects for this drug use as monotherapy in chronic recurrent diseases of the genital tract, as well as in combination with antimicrobial drugs.

Developing Protein-Antitumoral Drug Nanoconjugates as Bifunctional Antimicrobial Agents.

A novel concept about bifunctional antimicrobial drugs, based on self-assembling protein nanoparticles, has been evaluated here over two biofilm-forming pathogens, namely Pseudomonas aeruginosa and Staphylococcus aureus. Two structurally different antimicrobial peptides (GWH1 and PaDBS1R1) were engineered to form regular nanoparticles of around 35 nm, to which the small molecular weight drug Floxuridine was covalently conjugated. Both the assembled peptides and the chemical, a conventional cytotoxic drug used in oncotherapy, showed potent antimicrobial activities that were enhanced by the combination of both molecules in single pharmacological entities. Therefore, the resulting prototypes show promises as innovative nanomedicines, being potential alternatives to conventional antibiotics. The biological performance and easy fabrication of these materials fully support the design of protein-based hybrid constructs for combined molecular therapies, expected to have broad applicability beyond antimicrobial medicines. In addition, the approach taken here validates the functional exploration and repurposing of antitumoral drugs, which at low concentrations perform well as unexpected biofilm-inhibiting agents.

Sources of variation of antimicrobial use in Charolaise and Limousine beef breeds in Veneto region (Italy)

Sources of variation of antimicrobial use in Charolaise and Limousine beef breeds in Veneto region (Italy)

Social, cultural and economic aspects of antimicrobial resistance

COVID-19 pandemic has taught us the terrible cost of being unprepared for global health emergencies. The lack of treatments, vaccines, and sufficiently coordinated responses resulted in many unprecedented challenges that must now be analyzed and tackled rapidly. The crisis has raised awareness of the urgent need to improve the design of health systems, as well as the practical implementation of new strategies and technical to better prepare for future pandemics. These preparations must also consider harms secondary to the pandemic, including the resulting effects on antimicrobial resistance (AMR). While drug-resistant infections pose a well-known and severe threat to human and animal health, the COVID-19 pandemic is compounding this already problematic situation. Although often considered only a medical problem, antimicrobial resistance is an evolutionary challenge accelerated by social, cultural and economic factors that lead to the misuse, overuse and abuse of life-saving antimicrobial medicines. The antimicrobial resistance challenge is compounded by inadequate attention to disease prevention and response, global circulation of people and products, differences in industry and market regulations across countries, and a fragile pipeline of new antibiotics and their alternatives. While the discovery of new antimicrobials will provide temporary solutions, sustainable success requires rigorous social science research that explores the drivers of antimicrobial resistance. These should promote balance between equitable access to, conservation of, and innovation for antimicrobials, adapted to local conditions across the globe. To encourage collaboration and to address this challenge, we have created the International Network for Antimicrobial Resistance Social Science (INAMRSS).12 The network is an open consortium of social science researchers focused on addressing the global challenge of antimicrobial resistance. We believe antimicrobial resistance is only surmountable through efforts that consider social, political and economic factors. We intend to champion social science as part of a broadly defined One Health perspective to inform global initiatives. INAMRSS is a member of the Global AMR R&D Hub stakeholder group, which has built a system to track antimicrobial resistance research investment, but has not yet started monitoring relevant social science research funding. We endorse the recommendation of the United Nations Interagency Coordination Group on Antimicrobial Resistance for creating an Independent Panel on Evidence for Action against such resistance, with appropriate expertise across disciplines including the social sciences, and with a focus on the ways that humans are driving this problem and can contribute to solutions (Less)

Veterinary Diagnostic Practice and the Use of Rapid Tests in Antimicrobial Stewardship on UK Livestock Farms.

In this paper we consider the shifting role, practice and context of veterinary diagnosis in addressing concerns over what is, in the context of the growing threat of antimicrobial resistance, considered unnecessary or excessive antimicrobial medicine use in UK livestock farms. With increasing policy and regulatory interest in diagnostic practices and technologies, coupled with an expanding focus on the development and deployment of new rapid and point-of-care on-farm diagnostic testing, this paper investigates current diagnostic practices amongst veterinarians working on dairy, pig and poultry farms in Great Britain (England, Wales, and Scotland) and, more specifically, veterinarians' use and perceptions of new and emerging rapid and point-of-care diagnostic tests. Drawing on a series of 30 semi-structured interviews with farm animal veterinary professionals across the three sectors, this paper examines the manner in which such tests are both used and anticipated in clinical farm animal veterinary practice and the possible impact rapid test technologies might have on broader farm animal health management and disease control. Analysis of the transcribed interviews reveals a number of complexities around the use of rapid and point-of-care diagnostic tests. The relative rapidity and simplification of such tests, facilitating immediate treatment responses, is held in balance against both the accuracy and the more detailed and documented procedures of established laboratory testing routes. In situations of multifaceted on-farm etiologies, respondents maintained that rapid tests may offer restricted diagnostic capabilities, though in other situations they were found to offer ready confirmation of disease presence. A third complexity arising from the growth of rapid and point-of-care testing and revealed in this study relates to the shifting distribution of responsibilities in animal health care within contemporary food chains. The growing availability of rapid and point-of-care tests effectively diversifies the range of diagnostic actors with consequences for the flow of diagnostic and disease information. The veterinarians in this study identified areas where new rapid and point-of-care tests would be of particular value to them in their clinical practice particularly in addressing concerns over inappropriate antimicrobial use in animal treatment. However, despite the considerable policy advocacy on rapid and point-of-care tests as key tools in shifting diagnostic practice and reducing unnecessary antimicrobial use, veterinarians in this study, while recognizing the potential future role of such tools and technologies, nonetheless viewed diagnostic practice as a far more complex process for which rapid tests might constitute only a part.

Analysis of sodium hypochlorite effect on dentin structural components

The aim of this review article is detailed analyzation of the effect of sodium hypochlorite on the structural components of dentin. This compound is one of the strongest antimicrobial medicines for root canal treatment. However, sodium hypochlorite in certain concentrations has a detrimental effect on dentin, which leads to the loss of its physicochemical properties.Materials and methods. The study of publications was produced in the electronic databases such as Google Scholar, PubMed and ScienceDirect in the course of a systematic review of the literature. Included articles contain information about the on the effect of sodium hypochlorite on the structural components of dentin and the harmful effects of medicines for root canal treatment on organic elements.Results. 67 articles were viewed during the rview. After analyzing the literature for inclusion criteria, the total number of publications has become 43.Conclusions. According to the literature, it can be assumed that an increase in sodium hypochlorite concentration and its exposure time can lead to depletion of dentin organic matrix, which in turn, is responsible for the root fracture.

Knowledge, attitude and perception on antimicrobial use and antimicrobial resistance among final year medical students in the College of Medicine, Malawi.

Medical curricula need to provide adequate knowledge on antimicrobial medicine use and antimicrobial resistance (AMR). Such knowledge is critical in shaping correct attitudes and perceptions among future prescribers. However, the extent of preparation provided by medical curricula remains unknown. The current study sought to determine knowledge, attitude and perception on antimicrobial use and AMR among final year medical students in Malawi. A descriptive cross-sectional study was undertaken among all final year medical students at the College of Medicine, University of Malawi in 2016. Total population sampling and self-administered questionnaires were used. Data were entered using Microsoft Excel and analysed with Epi info. Descriptive analysis for categorical data was done using frequencies and proportions, and for continuous data using measures of central tendency. The response rate in this study was 95%. The mean and median aggregated scores were 7.2 and 7, respectively, for the 11 knowledge questions. Over 88% of the respondents answered more than half of the knowledge questions correctly. Respondents agreed that antimicrobials are overused both at national (50; 69%) and at hospital (52; 72%) levels. This study reports high aggregated knowledge scores on antimicrobial use and resistance with wide variations on correct knowledge scores per question. The study further shows varying level in attitudes and perceptions among medical students. Overall, there were gaps on antimicrobial use and knowledge of AMR which the medical curriculum should addresses.

Practice of dispensing antimicrobial medicines from community pharmacies

Abstract Background Inappropriate use of antimicrobial medicines is one of the main causes of antimicrobial resistance (AMR). The objective of this work was to study the situation on dispensing antimicrobials from pharmacy outlets in Armenia. Methods The study was implemented in 30 community pharmacies from different regions of Yerevan. Medicines dispensed to 900 patients/caregivers (30 visitors in each pharmacy outlet) were analyzed. The following indicators were calculated: the percentage of antimicrobials prescribed by physicians, the percentage of visitors, who got antimicrobials without providing a prescription and so on. Results Antimicribials (n = 171) consisted 11.3% of all the dispensed medicines (N = 1513). Only 25 (14.6%) antimicrobials were dispensed to visitors who had prescriptions. Only 19 (12.6%) of 151 medicines provided without prescription were OTC-medicines, other 132 (87.4%) were prescription only medicines. According to information received from visitors, 58.5% of all dispensed antimicrobials were selected by physicians, 10.5% of antimicrobials were advised by pharmacists and almost one third was selected by patients, family members, etc. More than 90% of the total number of visitors, whom antimicrobials were dispensed, got them without providing a prescription. 13 patients received 2 and more antimicrobials. Conclusions Many prescription only antimicrobials are dispensed from community pharmacies without prescription and some medicines are not prescribed by physicians. That means many antimicrobials are used inappropriately. There is need in strategy that could prevent dispensing antimicrobials without prescription. Key messages Dispensing prescription only antimicrobials without prescription can compromise rational use of medicines. Professional knowledge and public awareness about AMR should be improved.

Antimicrobial and immunomodulatory responses of photodynamic therapy in Galleria mellonella model

BackgroundNew therapeutics are urgently needed for infectious diseases, especially for the fungal infection like Fonsecaea monophora. Photodynamic therapy has been showing antimicrobial activity on some pathogens. The combination of antimicrobial medicines and photodynamic therapy (PDT) might be a practical approach. However, whether the treatment of PDT could do benefits to the host immunity remains poorly documented.ResultsIn this study, Galleria mellonella larvae were employed as a model organism to evaluate the activity of PDT, and also to investigate the regulation of humoral immunity by PDT. Photosensitizer 5-aminolevulinic acid (ALA) was applied to the G. mellonella infection model. It was found that ALA-mediated PDT was non-toxic to G. mellonella, and could extend the median survival of infected larvae from 3 days to 5.5 days. We observed that larval hemocytes inhibited the growth of Candida albicans and Staphylococcus aureus, without any contribution by ALA-PDT. Furthermore, the application of ALA-PDT demonstrated the immunomodulation of larval innate immunity as increased hemocyte density counting, cell morphological transformation, and sensitivity to pathogens.ConclusionsG. mellonella could be considered as a useful model to study the immunoregulation of PDT. This model revealed that ALA-PDT positively defense against infections through inducing humoral immune responses of larvae.

Antimicrobial resistance is a global problem – a UK perspective

Increasingly we are reaching a situation where current antimicrobial medicines are no longer effective for common infections, and antimicrobial resistance (AMR) is now a global public health crisis. The reliance on antimicrobials such as antibiotics has become a major issue for both medicine and agriculture, particularly given the slow development of new medicines and pharmaceutical industry investment. The UK government has been working with other international bodies in the search for solutions to the many challenges AMR poses. Herbal medicines may provide a useful modality in the fight against AMR and can work solely or in tandem with current antimicrobial approaches. Recommendations for herbal medicine use during the COVID-19 viral pandemic have featured in Chinese national guidelines and policies, but UK strategies have no such guidance on herbal treatment for any infectious disease. More research is urgently needed to explore the biological plausibility and safety of herbal medicines to manage AMR. AMR is universal, affecting anyone and everyone, at any age and in any country. Investigating how such approaches can be integrated into western medicine will be important to elucidate.

Antimicrobial resistance: An emerging threat for one health - solutions and way forward

The spread of infections that are resistant to antimicrobial medicines has emerged as a threat to public health globally. This is promoted by human actions such as inappropriate prescribing and use of antibiotics prescribing and use of antimicrobials, insufficient hospital hygiene, inappropriate use of antibiotics in livestock sector, misuse of antibiotics in agriculture and humans, irresponsible manufacturing of antibiotics including uncontrolled release of active antibiotics into the environment. Antibiotics resistance can be more prevalent where antibiotic consumption is found to be higher. Lack of monitoring and control in using antibiotics is prominent and need to be targeted at country level. India is at the greatest risk looking to low process of antibiotics, easy availability and unnecessary use of antibiotics. For containing antimicrobial resistance there is a need to promote and protect human health within the framework of a One health approach through coherent, comprehensive and integrated multi- sectoral cooperation and actions as human, animal and environment health are interconnected. In India, various actions have been taken including setting up of a National Task Force on AMR Containment (2010), “Chennai Declaration” by a consortium of the Indian Medical Societies (2012), Setting of Indian Council of Medical Research national surveillance network of laboratories, “Redline” campaign for educating public and National Action Plan on AMR 2017. There is a need integrating AMR education in medical education. `

Identification and Characterization of Two Defensins from Capsicum annuum Fruits that Exhibit Antimicrobial Activity.

Scientific advances have not been enough to combat the growing resistance to antimicrobial medicines. Antimicrobial peptides (AMPs) are effector molecules of the innate immune defense system in plants and could provide an important source of new antimicrobial drugs. The aim of this work was to extract, purify, characterize, and evaluate the antifungal activities present in fractions obtained from Capsicum annum fruits through reversed-phase chromatography. The fractions named F2 and F3 presented the highest inhibitory activity against Candida and Mycobacterium tuberculosis species. In addition, we identified two sequences of AMPs in the F2 and F3 fractions through mass spectrometry that showed similarity to an already well-characterized family of plant defensins. A plasma membrane permeabilization assay demonstrated that the peptides present in F2, F3, and F4 fractions induced changes in the membrane of some yeast strains, culminating in permeabilization. The production of reactive oxygen species was induced by the fractions in some yeast strains. Fractions F2, F3, and F4 also did not show toxicity in macrophage or monocyte cultures. In conclusion, the obtained data demonstrate that the AMPs, especially those present in the fractions F2 and F3, are promising antimicrobial agents that may be useful to enhance the development of new therapeutic agents for the treatment of diseases.

Book Review Nanofiber Membranes for Medical, Environmental, and Energy Applications 1st Edition

The book gathered latest discovery solutions from experts all over the globe who specialize in nanofiber membrane technology. The effort and knowledge sharing by the experts on the recent development of nanofiber membrane’s fabrication, characterization, and performance for medical, environment and energy applications are greatly appreciated. This book provides readers with a holistic cycle of nanofiber membrane development, which comprehensively deliberates on how nanofibers incorporation affects the membrane formation, enhance the properties and performance of membranes and ultimately lead to different kinds of applications. There are thirteen chapters in the book, covering topics comprise of polymer, inorganic and composite-form of nanofiber membrane materials for a wide range of applications (e.g., liquid, gas and energy). Each chapter starts with a brief introduction on the particular topic, followed by the nanofiber membrane’s production, characterization, performance and potential application of the nanofiber membranes. Challenges and future prospect are also well discussed in most of the chapters, providing rational perspective for the use of advanced nanofiber membranes in real world. The book comes with comprehensive discussion on nanofiber membranes form various applications such as medical (e.g. antimicrobial, biomedical, tissue engineering and regenerative medicine), water and wastewater treatment (e.g. membrane distillation, heavy metal, and toxic removal), and energy (e.g. fuel cell and ion exchange membranes). This could also give a clear picture on the trend of advanced materials as the way forward for the mentioned applications. Interestingly, this book shares a structured overview on recent achievements of nanofiber membranes in medical application, particularly on the electrospun as regenerative medicine for potential use in wound, vascular, nervous, bone, and dental applications. Besides that, it also discusses on fabrication of nanoscale fibrous scaffolds that mimic the natural extracellular matrix (ECM) of our body and enhance cell attachment, drug loading, and mass transfer that able to potentially improve care for millions of patients who suffered from inadequate medical treatments. This book also highlighted on the potential use of modified nanofiber membranes for wastewater treatments including superhydrophobic/superoleophilic nanofiber membranes and superhydrophilic/superoleophobic nanofiber membranes as type of superwetting materials. Detail discussion on conventional and latest development of membrane distillation for desalination and water treatment process, including fundamental concepts, operating principles and the future perspectives are also included in the book. There are three chapters in the book that discussed on the application of nanofiber membrane fabrication for energy generation. These include discussion on lithium-ion batteries, solar cells, dye-sensitized solar cells, supercapacitors, hydrogen storage and pressure-retarded osmosis, fabrication of nanocomposite polymer electrolyte membrane for fuel cell applications and also nanofibers ion exchange membranes. One of the highlight of this book is a chapter on fabrication of advanced mesoporous nanofiber networks by phase separation‑based methods, which employing flash-freezing nanocrystallization technique, and this technique is getting more attention in recent research literatures. Most importantly, this book does come along with intensive explanation on the working mechanism of separation and purification of the nanofiber membranes. Overall, this book is well written, and it serves as a platform for knowledge sharing, and I extremely recommend this book to students, academicians, researchers and industrial players. It is suggested that in future edition, every chapter in this book will be substantially enhanced and updated to reflect the latest developments in the fields. Besides that, wide range of research scopes pertaining nanofiber membrane fabrication for medical, environmental, and energy applications is also recommended to be further highlighted and reviewed.

Zein/MCM-41 Nanocomposite Film Incorporated with Cinnamon Essential Oil Loaded by Modified Supercritical CO2 Impregnation for Long-Term Antibacterial Packaging.

Antimicrobial medicine and food packages based on bio-based film containing essential oils have attracted great attention worldwide. However, the controlled release of essential oils from these film nanocomposites is still a big challenge. In this study, a long-term antibacterial film nanocomposite composed of zein film and cinnamon essential oil (CEO) loaded MCM-41 silica nanoparticles was prepared. The CEO was loaded into MCM-41 particles via modified supercritical impregnation efficiently with a high drug load (>40 wt%). The morphologies of the prepared nanoparticles and film nanocomposite were characterized by a scanning electron microscope. The release behaviors of CEO under different temperatures, high humidity, continuous illumination and in phosphate buffer solution (PBS) solution were investigated. The results showed that the film nanocomposite had an outstanding release-control effect. The addition of MCM-41 nanoparticles also improved the mechanical properties of zein films. The antibacterial effect of CEO was significantly prolonged by the film nanocomposite; indicating the CEO film nanocomposite fabricated via modified supercritical CO2 impregnation was a potential long-term antibacterial medicine or food package material.

Self-medication with antibiotics in Maputo, Mozambique: practices, rationales and relationships

Self-medication, as a form of self-care, is a common practice worldwide, and often involves the use of both over-the-counter and prescription-only medicines, including antibiotics, anti-malarials and others. Increasing concerns over the global emergence and spread of antimicrobial resistance point to the need to reduce and optimise the use of antimicrobial medicines, both in human and animal health. Over the past few decades, numerous studies on self-medication with antibiotics have sought to determine the prevalence, risks and/or factors related to ‘inappropriate’ use in different parts of the world. Yet much of this literature tends to follow a rather normative approach, which regards such practices as problematic and often irrational, frequently overlooking structural aspects, situated circumstances and individuals’ own reasoning. Based on a mixed methods social science research project in Maputo, which included a household survey, observations in pharmacies and interviews with users and healthcare providers, this paper aims to discuss self-medication in light of local users’ everyday practical reasoning. While situating self-medication within local contextual contingencies, the analysis highlights the ways in which personal and socially shared experiences, articulated with forms of knowledge and information provided by different sources, shape and inform practices of and attitudes towards self-medication with antibiotics. By looking at self-medication beyond (non-)prescription use, and by examining individuals’ decisions within their socioeconomic and therapeutic landscapes in Maputo, this study sheds light on the structural and relational factors that contribute to certain consumption practices that do not always follow biomedical recommendations of ‘rational’ or ‘appropriate’ use, helping to deconstruct and further problematise the various legitimate meanings and understandings of ‘responsible’ use.

Drug utilization, rationality, and cost analysis of antimicrobial medicines in a tertiary care teaching hospital of Northern India: A prospective, observational study.

BACKGROUND:The burden of bacterial infections is huge and grossly under-represented in the current health-care system. Inappropriate use of antimicrobial medicines (AMMs) poses a potential hazard to patients by causing antibiotic resistance. This study was conducted to assess the: (i) AMM consumption and use patterns in patients attending the outpatients and inpatients of Medicine and Surgery departments of the hospital. (ii) Appropriateness of the AMM in the treatment prescribed, and (iii) cost incurred on their use in admitted patients.MATERIALS AND METHODS:An observational, prospective study was conducted among inpatients and outpatients of the Medicine and Surgery departments of a tertiary care hospital of northern India. Analysis of 2128 prescriptions and 200 inpatient records was performed using a predesigned format. The use of AMMs was reviewed using anatomical therapeutic chemical classification and defined daily doses (DDDs). To evaluate the expenditure incurred on AMMs, ABC analysis was performed.RESULTS:AMMs were prescribed to 37.9% outpatients and 73% of admitted patients. The percentage encounters with AMMs was 40.6% (medicine) and 25.6% (surgery) outpatients. The total DDDs/100 patient days of AMMs in medicine and surgery were 3369 and 2247. Bacteriological evidence of infection and AMM sensitivity was present in only 8.5% of cases. Over 90% of AMMs were prescribed from the hospital essential medicines list. Most of the AMMs were administered parenterally (64.9%). Multiple AMMs were prescribed more to inpatients (84.2% vs. 4.2% outpatients). Overall, expenditure on AMM was 33% of the total cost of treatment on medicine. ABC analysis showed that 74% of the expenditure was due to newer, expensive AMM, which constituted only 9% of the AMM used. The AMM therapy was found to be appropriate in 88% of cases as per Kunin's criteria for rationality.CONCLUSION:AMMs are being commonly prescribed without confirmation of AMM sensitivity in the hospital. A large proportion of expenditure is being incurred on expensive AMM used in a few number of patients. There is a need for developing a policy for rational use of AMM in the health facility.