Essential Drug List Research Articles

Nephroprotection of Garcinia mangostana Pericarp Extract and α-Mangostin Against Oxidative Stress in Renal Manifestation of Ulcerative Colitis in Mice

Garcinia mangostana (GM) pericarp is an herbal medicine in the Thailand National Essential Drug List. GM pericarp and its major active constituent α-mangostin (MGS) exhibit several pharmacological properties, including anti-oxidative activity. Ulcerative colitis (UC) is the consequence of prolonged oxidative stress and inflammation in the large intestine and can result in extraintestinal manifestations (EIM) in other organs. This study evaluated the impact of GM pericarp extract and MGS on oxidant-antioxidant status in the kidneys of UC-induced mice. Six-week-old ICR mice were administered orally GM pericarp extract (40, 200, and 1,000 mg kg-1 ), MGS (30 mg kg-1 ), or sulfasalazine (100 mg kg-1 ) for 7 consecutive days. UC was induced by administering dextran sulfate sodium (40 kDa; 6 g kg-1) on days 4-7. Kidneys were collected to determine the activity and expression of the catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPx) antioxidant enzymes, lipid peroxidation levels, and glutathione stores. UC induction suppressed expression of Cat, CuZn-Sod, Mn-Sod, and Gpx mRNAs and reduced CAT, SOD, and GPx activities in the kidneys, which was followed by  an increase in lipid peroxidation. Total GSH and reduced GSH contents decreased, while oxidized GSSG content increased, reducing the GSH/GSSG ratio in the kidneys. GM and MGS improved the oxidative status of the kidneys similar to sulfasalazine by restoring the expression and activity of the antioxidant enzymes and balancing the glutathione stores. GM and MGS are promising nephroprotective antioxidant treatments and are worthy of development as alternative medicines for renal EIMs of UC.

Comparative prescription patterns of antipsychotics among schizophrenic patients attending two public health facilities in North-Eastern and North-Central Nigeria: a crosssectional study

In the care of patients, assessment of the use of drugs is very imperative as it shows the quality of care delivered to patients by the caregivers. The study aimed to compare the prescription patterns of antipsychotics in two public healthcare facilities in Nigeria using a standardized World Health Organization instrument. The studies were conducted at the General Hospital, Offa (GHO), Kwara State, and the Federal Neuropsychiatric Hospital, Maiduguri (FNPHMM), Borno State. Ethical approvals were obtained from the studied facilities. A total of 625 prescriptions in each of the facilities were selected by random sampling. Frequency distributions and student t-test were used. The average number of drugs prescribed per encounter was 3.9 in the GHO, while 1.2 was recorded in the FNPHMM. Injections were prescribed in 14.4% and 18.7% of encounters in the GHO and the FNPHMM, respectively. One hundred percent (100.0%) of the drugs were prescribed by generic name in the GHO and 98.2% in the FNPHMM. The percentage of drugs from the National Essential Drug List was 72% in the FNPHMM and 100% in the GHO. The prescribing indicators assessed were found to be below standard in the FNPHMM while the GHO showed polytherapy.

An Audit of Antibiotic Prescribing Pattern Among Children in Emergency Settings of a Tertiary Medical College and Hospital

Background: Resistance to antimicrobials is increasing, which leads to a significant increase in mortality, morbidity, and health care costs. In order to promote rational antibiotic uses, standard policies must be set and can be done only after the current antibiotic prescription has been audited. Objective: The aim of the study was to describe the antibiotic prescribing patterns in the pediatric emergency of a tertiary care hospital. Methods: The data were collected from the pediatric emergency over the period of 6 consecutive days from August 6, 2018 to August 11, 2018. The methodology recommended by the World Health Organization (WHO) for the investigation of drug use in a health facility was followed. The data were analyzed for the percentage of antibiotics prescribed by generic name, prescribed from essential medicine list of government, drugs with fixed-dose combination, and percentage of broad- and narrow-spectrum antibiotics used. Result: A total of 600 prescriptions were analyzed in the study. Most of the children were less than 1 year of age (30.8%). Combination of three antibiotics were prescribed in 8.8 % of patients. A 100% of antibiotics were prescribed from the essential drug list. Antimicrobials prescribed by generic name were 52%. Injection ceftriaxone was the commonest antibiotic prescribed (43.3%), followed by amikacin (25.2%). The broad- and narrow-spectrum antibiotics prescribed were 86.6% and 13.4 %, respectively. Conclusion: The antibiotics are used cautiously in the paediatrics emergency department of this institute. Among those who were prescribed antibiotics, all prescriptions were from the essential drug formulary. Our findings provide support for investigating antibiotic utilization in other settings and work toward developing a national rational prescribing strategy.

Evaluation of Drug Use Pattern in Pediatric Outpatient Clinics in a Tertiary Teaching Hospital Using WHO Drug-Prescribing Indicators.

PurposeThe main aim of the study is to assess physicians’ prescribing patterns using the World Health Organization (WHO) prescribing indicators among pediatric outpatient clinics, and to identify areas in need of intervention regarding the rational use of medicines among pediatric outpatients in Jordan.MethodsThis is a descriptive observational cross-sectional study that was conducted at the outpatient pediatric clinics at Jordan University Hospital (JUH). During the study period, prescriptions were collected over a period of two months. Prescribing patterns were assessed using the five WHO drug prescribing indicators.ResultsA total of 1011 prescriptions/encounters were assessed. More than half of the encounters were for male patients (n= 595, 58.9%), and the median age of patients was eight years (IQR = 7.9). The average number of drugs prescribed per encounter was 1.8 ± 1.3; however, a specific individual clinic, the respiratory clinic, witnessed an average of 2.1 drugs prescribed per encounter. All of the prescribed drugs were prescribed by generic name (100%). Only 47.7% of the drugs were from the essential drug list of the JUH. Overall, antibiotics were prescribed in 19.5% of the encounters, but at higher rates in some clinics such as respiratory clinics (50.8%). Injectables were prescribed in 9.5% of the 1011 encounters; however, they were prescribed at higher rates in endocrinology and neurology clinics, in 44.8% and 31.3% of encounters, respectively.ConclusionThis study revealed some adequate prescribing habits with an optimal prescribing pattern of generics and number of drugs per encounter among pediatric patients. However, the prescribing patterns of the essential drug list, antibiotics, and injectables, in specific clinics, failed to meet WHO standards. The findings of this study shed light on the need to establish national strategies to improve prescribing practices among the pediatric population.

Antibiotic Prescribing Pattern in Paediatric Emergency Department at Tertiary Care Teaching Hospital in Nepal

Background and Objectives: The indiscriminate use of antibiotics often results in an increased incidence of adverse drug reactions (ADR), suboptimal therapy, treatment failure, polypharmacy and most importantly, the emergence of antibiotic resistance. Thus, the objective of this study was to assess the paediatric emergency department, antibiotic prescribing pattern at a tertiary care teaching hospital, Universal College of Medical Sciences (UCMS), Bhairahawa, Rupandehi, Nepal.
 Material and methods: A prospective, cross-sectional, observational study was carried out on 152 paediatric patients of ages between 2 months to 12 years at the paediatric emergency department of UCMS. The data were collected by reviewing the prescription paper, and the required information was recorded using a structured data collection sheet prepared for study. The prescribing pattern was assessed through the World Health Organization (WHO) prescription indicators using the WHO Children Formulary 1993 AD.
 Results: This study revealed that out of 152 patients, average number of drugs prescribed was 5.13 and antibiotic per patient was 2.10±.540. Antibiotics were prescribed at least once for 93.4% of patients. Drugs prescribed from Essential drug list (EDL) was 46.46% and that encountered with injectable was 92.1%. There was a significant difference between the patients age group and the number of drugs prescribed (χ2 = 21.553, p = 0.010). The mean duration of antibiotic treatment was 6.95±3.145. Cephalosporin’s (36.6%) followed by aminoglycosides (28.8%) were most frequently prescribed antibiotics.
 Conclusion: Multiple courses of antibiotics are most frequently prescribed, which could increase antibiotic resistance in future. Continuous audits, training and new treatment protocols should be developed for prescribing and using antibiotics in paediatric patients.

CURRENT TRENDS IN PRESCRIBING PATTERN OF ANTI-MIGRAINE DRUGS IN PATIENTS OF MIGRAINE AT A TERTIARY CARE TEACHING HOSPITAL

Background. An inappropriate prescribing pattern of antimigraine drugs by doctors may often encourage inappropriate self-medication by patients because of the asymmetry of medical information. Objective. The study is aimed to assess the current trends in prescribing patterns of anti-migraine drugs, rationality of prescription, and pattern of migraine severity in patients of migraine. Methods. A cross sectional study was conducted at a tertiary care teaching hospital. All the prescribing details including patient’s demographic details, diagnosis, details of drug therapy (drug name, dose, duration, and frequency) were recorded. Rationality of prescription was assessed using the WHO core drug prescribing indicators and the pattern of severity of migraine was assessed using MIDAS scoring system. Results. Out of 85 patients, 71 were female (83.5%), mostly around 21-30 years of age, and 27 (31.7%) patients had other comorbidities. Naproxen was the most commonly used NSAID for termination of acute migraine attack (15.3 %). The most common drugs prescribed for prophylaxis included beta adrenergic blockers (Propranolol, 14.66%), antidepressants (Amitriptyline, 9.33% and Fluoxetine 3.33%), and antipsychotics (Prochlorperazine, 4.66%). Domperidone (17.30%) was the most commonly prescribed antiemetic. Prescription of triptans was low (2.66%) with Rizatriptan as the most commonly prescribed triptan. Conclusions. The current study revealed that further improvements are required in prescribing practices especially in average number of drugs per prescription, prescription of drugs with generic names, and prescription of drugs of the essential drugs list.

Study of methods for state regulation of prices and costs of the health care system for medicines in the United Kingdom

Objective: analysis of state regulation of prices and costs for the purchase of medicines (drugs) in the United Kingdom (UK), and proposal development to improve the processes of state regulation of manufacturers’ marginal registered prices of medicines included in the list of vital and essential drugs approved in the Russian Federation.Material and methods. Analysis of the structure of state regulation of prices and costs for the procurement of drugs was carried out based on information contained in the regulatory legal documents of the UK Government, health services and technical regulation, and data provided in systematic reviews and articles.Results. A key feature of regulation in the UK is maximizing the efficiency of health care costs based on the principles of digitization, long-term planning and health technology assessment in pricing. Government regulation of costs is focused on the patent-protected drug segment. Providers of such medicines fall under the Voluntary or Statutory Scheme and are required to make payments in the form of a fixed percentage of sales to the Department of Health and Social Care. Certain drug segments are exempt from payments to stimulate innovative development of the pharmaceutical industry and accelerate market access for new therapies. As practice shows, the Voluntary Scheme is more profitable for most companies. Regulation in the segment of reproduced drugs is carried out by free-market mechanisms and the antimonopoly service.Conclusion. The analysis revealed the mechanisms and key features of the methods of state regulation of prices and costs of the health care system for the procurement of drugs, identified best practices that are promising for adaptation to improve the state regulation of prices in the Russian Federation.

Safety of Using Traditional Chinese Medicine Injections in Primary Medical Institutions: Based on the Spontaneous Reporting System 2016–2020 in Henan Province, China

Objective: Traditional Chinese medicine (TCM) injection is widely used, but its adverse drug reaction (ADR) may be a serious public health concern in primary medical institutions. This research will explore the safety of TCM injections and provide clinical recommendations at the primary medical institutions. Method: ADR data were collected by the Henan Adverse Drug Reaction Monitoring Center from 2016 to 2020 were analized Descriptive statistics, chi-square analysis, binary logistic regression, and Mantel-haenszel hierarchical analysis were used to identify the risk factors associated with the rational use of TCM injections in primary medical institutions. Results: A total of 30,839 cases were collected in this study, 4905 cases (15.90%) were SADRs. Patients using TCM injections in primary medical institutions were more likely to cause SADRs (OR = 1.149, 95% CI: 1.061–1.245). Aged over 60 years (OR = 1.105, 95% CI: 1.007–1.212), non-essential drugs (OR = 1.292, 95% CI: 1.173–1.424), autumn (OR = 1.194, 95% CI: 1.075–1.326) and TCM injections with safflower (OR = 1.402, 95% CI: 1.152–1.706), danshen (OR = 1.456, 95% CI: 1.068–1.984) and medication reasons with chemotherapy (OR = 2.523, 95% CI: 1.182–5.386) and hypertension (OR = 1.495, 95% CI: 1.001–2.233) were more likely to suffer SADR in primary medical institutions. Conclusion: In general, the number of reported cases of TCM injection was declining over time, but the proportion of SADRs in primary medical institutions increased. In the future, it is necessary to continue to restrict TCM injections at the macro policy level, and vigorously promote the varieties in the essential drug list. At the micro level, it is necessary to intervene in specific populations, specific diseases and specific drugs, first start with them, step by step, and effectively prevent SADR occurrences in primary medical institutions.

Evaluation of Drug Prescribing Patterns in Dermatology Outpatient Department of Two Teaching Hospitals in Bangladesh

Background: Skin diseases are common and cause a huge burden globally. Bangladesh is known to have a high prevalence of skin diseases. Considering the economic burden of the skin diseases treatment and its high prevalence, it is important to study the drug prescribing patterns in skin diseases.
 Objective: To evaluate the prescribing pattern of drug according to World Health Organization (WHO) prescribing indicators among the patients attending Dermatology outpatient department in two teaching hospitals.
 Materials and method: A cross sectional descriptive study was conducted in outpatient department of Dermatology in Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College & Mitford Hospital (SSMC & MH) from July 2015 to June 2016. A total number of 600 prescriptions (300 from each hospital) were enrolled in the study. The general information and data were collected in the questionnaire and subjected to evaluation using WHO prescribing indicators.
 Results: The average number of drugs per prescription was 2.41 in DMCH and 2.38 in SSMC & MH. Only 23.72% drugs in DMCH and 27.79% drugs in SSMC & MH were prescribed by generic name. The percentage of prescriptions with antibiotics was 46% in DMCH and 45.66% in SSMC & MH. The percentage of prescriptions with an injection encountered was 0.67% and 0.33% in DMCH and SSMC & MH respectively. This study also revealed that, the percentage of drugs prescribed from the Essential Drug List (EDL) of Bangladesh was 56% in DMCH and 57.68% in SSMC & MH.
 Conclusion: There is need to emphasize to keep the average number of drugs as low as possible and encourage prescribing by generic name and from Essential Drug List (EDL).
 Delta Med Col J. Jul 2020 8(1): 9-14

АНАЛИЗ ЭКОНОМИЧЕСКОЙ ДОСТУПНОСТИ АССОРТИМЕНТА ОГРАНИЧИТЕЛЬНЫХ ПЕРЕЧНЕЙ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ, ПРИМЕНЯЕМЫХ ДЛЯ ЛЕЧЕНИЯ ЗАБОЛЕВАНИЙ КЛАССА «НОВООБРАЗОВАНИЯ»

This research covers the analysis of the economic affordability of the range of drugs for the treatment of neoplasms class diseases included in the restrictive lists of drugs. A positive dynamics of growth in the incidence of neoplasms was recorded, the leading position in the growth of the number of diseases is occupied by Oryol region, where average rate of increase (ΔRincr) is 9 %. The number of antineoplastic drugs used in the treatment of diseases of class C00-D48 CLASS II Neoplasms included in the list of vital and essential drugs in 2019 totalled to 781 drugs. When analyzing the price range of this array of drugs, it was revealed that 69.4 % of antineoplastic drugs are in the price range over 1,000 rubles. An analysis of economic availability of antineoplastic drugs showed that the best value of the integral indicator of the availability coefficients are for Cyclophosphan-LENS®, Fluorouracil-Teva, Rubomycin (ONOPB JSC), the least available were: Vargatef, Imbruvika, Tafinlar. The integral indicators of availability coefficients of the researched drugs range from 0.443 (Cyclophosphan-LENS®) to 6531.884 (Vargatef). The analysis of the economic affordability of the range of restrictive lists of drugs used for the treatment of neoplasm class diseases is an important aspect of the activity, which makes it possible to give an objective assessment of the work of executive authorities and entities in the sphere of drug circulation in the formation of an affordable range of restrictive lists of drugs.

Effectiveness of Supply Chain Planning in Ensuring Availability of CD/NCD Drugs in Non-Metropolitan and Rural Public Health System

Several studies have reported on the shortage of drugs with the changing demographic and disease profile, especially triggered by the growing burden of lifestyle diseases. However, very few have evaluated the demand-side challenges from the objective of universalisation of healthcare. Therefore, this study was designed to evaluate the factors that have impeded access to affordable generic and essential drugs in non-metropolitan urban and rural India. The study was conducted in six states and responses were elicited from a sample of doctors, pharmacists, nurses, accredited social health activist (ASHA) workers, state officials, warehouse managers and patients across the study states. The study reveals that while the acceptance of prescribing generic drugs has improved over the last decade, the use of branded drugs has been restricted only to complex cases or where generic drug efficacy has not been established. The centralised procurement efficiencies seem to have hit a plateau in terms of assuring drug availability to the last mile, thereby impacting local purchase, especially pandemic procurement. Most states have also established dedicated corporations for drug procurement, albeit at different levels of organisational maturity as far as adherence to the processes and systems are concerned. However, supply chain phenomena like the bullwhip effect gets accentuated given the levels of our public health system. Learnings from other consumer-facing sectors with similar challenges of increased variability and uncertainty are yet to be explored for the health sector to leapfrog towards achieving improved ‘drug availability’ or ‘zero stock-out’. Standardising drug categories, regular updating of the essential drug list (EDL) reflecting the demographic and disease profile, various practices like complete digitisation, rolling forecasts, stock-keeping unit rationalisation, flexible public procurement contracts, etc., have been explored as potential solutions in this paper. Creating a dedicated team of forecasters within the procurement organisations, well adept at using analytics, could be key to real-time demand estimation, paving the way for a quarterly rolling forecast to facilitate procurement using well-designed rate contracts with suppliers that captures variability in such rolling forecasts.

Prescriptions Audit for Antibiotics among Outpatients in the Department of Periodontics

Aims: The aim of this study was to audit prescriptions for antibiotics for cost optimization in outpatients undergoing periodontal treatment.
 Study Design: A prospective cross-sectional study.
 Place and Duration of Study: This study was done at a dental college in Himachal Pradesh from August 2020 to July 2021.
 Methodology: 849 patients agreed to share their data, 614 of whom received antibiotics. The demographic information, the name of the given antibiotic, dosage form, dose, strength, frequency, and the reason for prescribing were gathered. Antibiotic monotherapy and multitherapy prescriptions were evaluated. Antibiotics prescribed by the NLEM 2015 were calculated. For cost minimization evaluation, the price of prescribed antibiotics in branded and generic names was calculated in INR. The results were calculated using descriptive statistics and presented in frequency and percentage.
 Results: This finding shows irrationality and out-of-pocket expenses in antibiotic prescribing. The most common diagnosis was periodontitis. Only 74.5% of all antibiotics prescribed were from the NLEM 2015. The most often recommended antibiotic was a fixed-dose combination of Amoxicillin + Clavulanic acid (61.2%) and accounts for 87.80% of the total cost of 146669.82 INR. Only 9.7 % of antibiotics were prescribed with a generic name.
 Conclusion: Generic names and prescribing from essential drug lists play a critical role in the treatment and prevention of a wide variety of diseases on a worldwide scale by providing cost-effective healthcare coverage.

Pattern of utilization, disease presentation, and medication prescribing and dispensing at 51 primary healthcare centers during the Hajj mass gathering

BackgroundThe majority of pilgrims seeking healthcare during Hajj are seen at primary healthcare centers (PHCCs). Data on the utilization of these facilities during Hajj can aid in directing optimal health services delivery and allocation of resources during the pilgrimage.MethodWe investigated the pattern of disease presentation, caseload, and medication prescribing and dispensing at 51 PHCCs during the 2019 Hajj. Data on patients’ demographics, diagnoses, and prescribed medications were retrieved from each PHCC’s electronic records and analyzed. Data were also used to calculate six of the World Health Organization (WHO) indicators for drug use at these facilities.ResultsData were captured for 99,367 patients who were mostly Hajj pilgrims (95.4%), male (69.1%) from the Eastern Mediterranean (60.8%) and had a mean age of 46.6 years (SD = 14.9). Most patients (85.2%) were seen in Mina and towards the end of Hajj. The majority of patients (96.0%) had a single diagnosis; most commonly, respiratory (45.0%), musculoskeletal (17.2%), and skin (10.5%) diseases. Patients were prescribed 223,964 medications, mostly analgesics (25.1%), antibacterials for systemic use (16.5%), anti-inflammatory and antirheumatic products (16.4%), and cough and cold preparations (11.9%). On average, 2.25 (SD = 0.94) medications were prescribed per consultation, with low (1.3%) prevalence of polypharmacy. An antibiotic and an injectable were prescribed in 43.6 and 2.67% of patient encounters, respectively. Most (92.7%) of the prescribed drugs were actually dispensed, in an average time of 8.06 min (SD = 41.4). All PHCCs had a copy of the essential drugs list available, on which all the prescribed drugs appeared.ConclusionRespiratory illnesses are the main reason for PHCCs visits during Hajj, and analgesics and antibiotics are the most common medications prescribed to pilgrims. Our results, including the calculated WHO drug use indicators, contribute to evidence-based optimization of primary healthcare services during Hajj.

Inclusion of Potentially Inappropriate Medicines for the Older Adults in the Brazilian Consensus in Accordance with International Criteria.

AimThe use of potentially inappropriate medications (PIM) can impair the safety and effectiveness of pharmacotherapy in the older adults. Thus, several countries have lists and criteria to indicate these drugs, in order to promote the safety of prescription and the rational use of drugs in geriatric practice.ObjectiveThis study sought to contribute to the inclusion of PIM for the older adults in the Brazilian criterion (BCPIM/2016) – current list used in Brazil and reference in Latin American countries – through expert approval, comparing convergences with international AGS lists BEERS/2019, STOPP/START/2015, PRISCUS/2010 and EU (7)-PIM List/2015.MethodsThis is a critical analysis of potentially inappropriate medications for use in the older adults present in the list of Brazilian criteria, together with their absence of some drugs that are on international lists (BEERS/2019; Priscus/2010; Stopp/Start/2015; EU7-PIM list/2015). This study was subdivided in 6 stages: selection of national criteria, classification of drugs according to Anatomic Therapeutic Chemical, comparison between BCPIM/2016 with international lists, selection of drugs not included in the Brazilian list, selection of experts for evaluation and suggestions about drugs not included in the Brazilian list and the synthesis of the analysis carried out by the specialists.ResultsWe cataloged 66 drugs marketed in Brazil that are on international lists, but not in the Brazilian consensus, of which 24 were validated by experts as necessary for inclusion in this consensus, considering the risks and benefits in health care for the older adults. However, the lists have divergences and similarities between them. We observed that eight drugs were common to all criteria studied, mainly related to the nervous system.ConclusionThe results suggest the need for periodic validation of PIM against research clinics, new drugs and the inclusion of this agenda by the Ministry of Health in the revision of the National List of Essential Drugs and other Clinical Protocols and Therapeutic Prescription Guidelines for the older adults.

Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.

Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas.

Discovery, Development, Inventions and Patent Review of Fexinidazole: The First All-Oral Therapy for Human African Trypanosomiasis.

Human African trypanosomiasis (HAT or ‘sleeping sickness’) is a neglected tropical disease. If untreated, it is always fatal and leads to death. A few treatments are available for HAT, but most of them require a skilled professional, which increases the financial burden on the patient. Recently, fexinidazole (FEX) has been approved by the European Medicine Agency (EMA) and the United States Food and Drug Administration (USFDA) as the first all-oral therapy for the treatment of stage-1 (hemolymphatic) as well as stage-2 (meningoencephalitic) of HAT. Before the FEX approval, there were separate treatments for stage-1 and stage-2 of HAT. This study reviews the discovery, development timeline, inventions, and patent literature of FEX. It was first approved by EMA and USFDA in 2018 and 2021, respectively. FEX was also added to the World Health Organization’s list of essential drugs in 2019. The patent literature search revealed many types of patents/patent applications (compound, salt, process, method of treatment, drug combinations, and compositions) related to FEX, which have been summarized in this article. The authors foresee a great scope to develop more inventions based on FEX (novel salts, polymorphs, drug conjugates, cyclodextrin complex, etc.) for the treatment of many protozoal diseases (Leishmaniasis and Chagas disease), inflammatory diseases, and other microbial infections. New combinations of FEX with other treatments of HAT may also provide fruitful results. This review might be useful to the scientists working on the HAT and other neglected diseases to develop novel inventions and innovations of therapeutic relevance.

Pharmacoeconomic Analysis of Gilteritinib in the Therapy of Adult Patients with Relapsed/Refractory Acute Myeloid Leukemias with FLT3 Mutation

Background. The implementation of new FLT3-targeted drugs in clinical practice has changed the approaches to the management of patients with acute myeloid leukemias (AML) with FLT3 mutation. One of these drugs is gilteritinib, approved by FDA in 2018 as a drug of choice in the therapy of adult patients with relapsed/refractory AML with FLT3 mutation. Aim. To assess the economic feasibility of gilteritinib in the therapy of adult patients with relapsed/refractory AML with FLT3 mutation. Materials & Methods. Pharmacoeconomic modelling was based on Markov and decision-tree models. Incremental cost-effectiveness ratio (ICER) was calculated relative to the efficiency indicator “overall survival”. Its values were compared with those calculated for venetoclax as reference drug, which has been already included in Essential Drug List and used as a first-line drug in this population if high-dose chemotherapy therapy is contraindicated. A Budget Impact Analysis has been made. Results. Gilteritinib proved to be not only more effective in terms of overall survival (median 9.3 vs. 5.6 months), but also more cost-intensive (7,408,108 vs. 1,685,356 rubles a year) compared to the currently used polychemotherapy regimens. However, the difference of ICER with venetoclax was +4.89 % of total costs. The Budget Impact Analysis showed that the total economic load of implementing gilteritinib in clinical practice throughout 3 years will be 8,628,658,505 rubles. Conclusion. Gilteritinib therapy is economically feasible and viable for adult patients with relapsed/refractory AML with FLT3 mutation.

Evaluation of prescription completeness, rational drug-use patterns using WHO prescribing, patient-care and facility indicators in Debre Tabor Comprehensive Specialized Hospital, Ethiopia: A cross-sectional study.

Objective:Irrational medicine use results in diseases worsening, disability, death, and wastage of limited resources. This study was predominantly aimed to evaluate the rationality of medicine use patterns by assessing prescribing, patient-care, and facility indicators at Debre Tabor Comprehensive Specialized Hospital by using World Health Organization core drug use indicators.Methods:A cross-sectional design was conducted to collect prescribing indicator data from 780 prescriptions retrospectively from 1 July 2020 to 30 June 2021 at outpatient pharmacy of the hospital and exit interview was held prospectively on 150 patients to evaluate patient-care indicators. In addition, indicators for health-facility were assessed by actual observation of the presence of different guidelines. Descriptive analysis of the collected data was computed using SPSS version 25.Result:Totally, 1521 drugs were prescribed to 780 encounters. On average, 1.95 drugs were prescribed per prescription. Percentage of encounters by generic name, encounters with antibiotics and injection, and drugs from essential drug list were 99.9%, 35.4%, 15.3%, and 100%, respectively. From healthcare provider–related information, the names of prescribers and dispensers were correctly written in 93.59% and 77.69%, respectively. Frequency (97.18%) and route (86.15%) of drug administration were better stated in the reviewed encounters, whereas dosage form is poorly stated (7.44%). Labeling of dispensed medicine was obtained for only 10% of patients and patient knowledge for correct dose was 94%. Availability of facility indicators was 95%.Conclusion:From the results of this study, it is possible to conclude that the prescribing, patient-care, and facility indicators did not fulfill many World Health Organization standards. Therefore, it is important if all prescribers, dispensers, patients themselves, and the governing bodies take an action to improve the prescribing and patient-care indicators for the best of the end users.

Antibiotic-prescribing pattern in the outpatient departments using the WHO prescribing indicators and AWaRe assessment tool in a tertiary-care hospital in South India

Context:Rational drug use has a great role of influence in health care. The fact sheet given by the World Health Organization (WHO) shows that around 50% of the drugs are prescribed, dispensed, and sold inappropriately. One of the major consequences of irrational drug use in infections is antibiotic resistance.Aim:The present study aims to assess the antibiotic-prescribing pattern by auditing the prescriptions in a teaching hospital.Settings and Design:A prospective cross-sectional study was conducted in the pharmacy of a teaching hospital to evaluate the prescriptions of the outpatient department.Materials and Methods:The prescriptions used to treat symptoms suggestive of infections were taken into consideration. A total of 1,000 prescriptions were analyzed.Data Analysis:The data was analysed using Microsoft Excel.Results:A total of 2,536 drugs were prescribed. The average number of drugs per prescription was 2.5. The percentage of encounters with antibiotics prescribed was 17.5%. The percentage of encounters prescribed with a generic name and with drugs from the essential drug list was 87.5% and 65%, respectively. There were no injections prescribed. Amoxicillin and ciprofloxacin were the most common antibiotics prescribed. The duration of the treatment was mentioned in all the prescriptions.Conclusions:Our study shows that the percentage of antibiotic usage is within the WHO standard value. The average number of drugs per prescription was slightly higher than the WHO value. Steps should be taken to improve the generic prescribing by the physicians.

Prescription audit in post-operative patients of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru

Background: Prescribing drugs are an important skill which needs to be continuously assessed and refined accordingly. Many drugs especially antimicrobials and fixed dose combinations that maybe irrational are being prescribed. Hence, this study was undertaken to analyze the rational prescribing guidelines in post-operative patients which will help doctors to update their knowledge and improve their attitude toward selecting cost effective treatment. Aim and Objectives: The aims of this study were as follows: (i) To evaluate prevailing prescription trends and (ii) to evaluate rationality of prescriptions in post-operative cases of surgery, orthopedics, obstetrics, and gynecology (OBG), and Otorhinolaryngology (ORL) departments. Materials and Methods: A prospective observational study was conducted in post-operative wards of departments of surgery, orthopedics, ORL, and OBG of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru. The study duration was 15 months from December 2018 to March 2020 with a sample size of 2000. Results: In the present study, female preponderance (54.4%) was seen. Majority of the drugs (77.3%) were prescribed under brand name. The most common group of drugs prescribed was non-steroidal anti-inflammatory drugs (135%) and the antibiotic was Cephalosporins (77.5%). As per the World Health Organization (WHO) core prescribing indicators, 6.25 were the average drugs per prescription. Conclusion: According to the WHO core prescribing indicators, polypharmacy was observed and prescribing by generic name was also less. However, there was no irrational use of antibiotics in post-operative cases in our study which reduces the chances of development of antibiotic resistance. Practice of prescribing drugs from the essential drugs list (EDL) was less. The study suggests incorporating educative initiative, development of drug policy, and an EDL-based hospital formulary to ensure rational use of medicines.