List Of Essential Medicines Research Articles

Spironolactone in modern cardiology: from many years of experience to the latest evidence of effectiveness (literature review)

Spironolactone is a drug that plays an important role in the treatment of various diseases, especially in the field of cardiology and endocrinology. First synthesized in 1957, spironolactone gained widespread recognition due to its unique ability to block the action of aldosterone, a hormone that plays an important role in the pathogenesis of many cardiovascular diseases and increases the risk of severe cardiovascular complications. Spironolactone is included in the list of essential medicines of the World Health Organization. In cardiology, it is one of the universal remedies, because it is prescribed for resistant or secondary hypertension, heart failure, as part of hormonal therapy and in a number of other clinical conditions and situations. Resistant hypertension is a complex and serious medical problem, which is a significant challenge for doctors and patients, as it requires a specialized and individualized approach to treatment. Clinical studies found that spironolactone was the most effective adjunctive drug for the management of resistant hypertension, and this superiority of spironolactone confirmed the central role of sodium retention in the development of treatment resistance. Studies have shown that the addition of spironolactone to initial combination therapy resulted in a more potent antihypertensive effect compared to the addition of doxazosin or bisoprolol. The proportion of patients in whom spironolactone was the optimal blood pressure-lowering drug appeared to be the largest, according to the analysis on the prediction of the effect of each drug on the blood pressure level using plasma renin and the probability that different drugs will be best at different points of renin distribution in the blood plasma. Spironolactone has been used in modern cardiology for a long time to treat patients with heart failure and atrial fibrillation, but in this article, we have focused on another very important site for spironolactone administration, namely hypertension, especially in its resistant forms.

Antimicrobial Use Among Outpatients at Benjamin Mkapa Hospital in Dodoma Central Zone of Tanzania: A Prospective Descriptive Study.

Irrational antimicrobial use (AMU) has led to an exponential increase in antimicrobial resistance (AMR) in hospitals and communities, which creates challenges in treating infectious diseases caused by bacteria. This study aimed to evaluate antimicrobial prescriptions and usage patterns for treating bacterial infections among outpatients at Benjamin Mkapa Hospital (BMH). A prospective descriptive study design was used to evaluate the AMU trend. The data were collected from August 2022 to October 2022 from outpatient pharmacies at BMH using the World Health Organization/International Network of Rational Use of Drugs (WHO/INRUD) indicators. The simple random sampling method was employed to select the prescriptions. The WHO AWaRe (Access, Watch, and Reserve) classification was used to classify common antimicrobials. We analyzed the prevalence of outpatient AMU, including the types of antimicrobials, indications, and compliance with treatment guidelines. We also examined the number of antimicrobials per prescription and the adherence to drug use. We examined 1557 prescriptions, 406 (26.1%) (WHO recommendation 20.0-26.8%) of which included antimicrobials. All prescriptions with antimicrobials were written in generic names, drug utilization-90% (DU90%) was 100% (WHO recommendation 100%). The number of parenteral antimicrobials prescribed was 79 (19.5%) (WHO recommendation 13.4-24.1%). Furthermore, prescriptions with antimicrobials that complied with the current Standard Treatment Guidelines and National Essential Medicine List in Tanzania (STG/NEMLIT) were 369 (90.9%) (WHO recommendation 100%). Most antimicrobials were prescribed as monotherapy, accounting for 265 (65.3%). There were 1.4 (WHO recommendation 1.6-1.8) antimicrobials per prescription. Our study identified 21 commonly prescribed antimicrobials, whereby 9 (42.9%) (WHO recommendation >60%) antimicrobials were Access, 10 (47.6%) (WHO recommendation <20%) Watch, and 2 (9.5%) (WHO recommendation <1%) Reserved classes. Our study showed that BMH has optimal practices for prescribing and using antimicrobials for outpatients. It further underlined the need to expand and strengthen antimicrobial stewardship efforts to reinforce prescribing antimicrobials.

Comparative effects of drug interventions for the acute management of migraine episodes in adults: systematic review and network meta-analysis

ObjectiveTo compare all licensed drug interventions as oral monotherapy for the acute treatment of migraine episodes in adults.DesignSystematic review and network meta-analysis.Data sourcesCochrane Central Register of Controlled Trials, Medline, Embase,...

Exploring Antibiotic Use in the Community: A Household-Based Survey Using the Drug Bag Method in Rural Burkina Faso.

In Burkina Faso, there is lack of awareness of antibiotic use at the community level. This study aims to generate information on the commonly used antibiotics along with the reasons for which they have been used in rural Burkina Faso. The drug bag method was employed to collect information from 423 households in the health district of Nanoro. Descriptive analyses were performed using R software version 4.2.1. Of the 33 antibiotics inventoried, amoxicillin tablets and oxytetracycline were the most recognized and used antibiotics. This study indicated that antibiotics were used for a range of health problems in the community, some of which were administered as painkillers. While primary healthcare facilities constituted the primary source of drugs for households (76.8%), informal drug sellers constituted an additional option (61.5%) for community members. This is a significant concern, given that some antibiotics classified as "Watch"-such as norfloxacin-were readily available in these outlets, despite not being included on the country's Essential Medicines List. This study underscores the necessity of considering the role played by formal providers in the inappropriate use of antibiotics and the importance of understanding the circumstances and logical reasoning underlying communities' access to and use of antibiotics.

To assess the availability of antibiotics for online sale and comparison of e-pharmacies on key characteristics influencing safe and rational use of antibiotics: an exploratory analysis.

Growing antimicrobial resistance represents serious public health threat. With the increasing presence of online/e-pharmacies in India, public access to medicines has increased. Easy access coupled with lack of adequate and authentic drug information can undermine rational antibiotic use. The present study aimed at exploring the availability of antibiotics for online sale and comparing the e-pharmacies on key characteristics influencing safe and rational use of antibiotics. A cross-sectional study was conducted over a period of 3 months using the websites of 10 popular e-pharmacies in India. Availability of antibiotics for online sale was assessed in context of the National List of Essential Medicines, 2022 and WHO-AWaRe (Access, Watch, Reserve) categories. Three separate questionnaires were developed to extract and compare relevant information from e-pharmacies pertaining to their safety and authenticity (in light of the expected standards laid down in draft e-pharmacy rules, 2018), availability of drug product and consumer awareness information for promoting prudent antibiotic use. Data were summarized using descriptive statistics. Out of the 17 antibiotics studied; antibiotics belonging to all WHO-AWaRe categories i.e. Access (83.33%), Watch (88.33%) and Reserve (78%) groups were available through e-pharmacies. Wide variation exists among the e-pharmacies regarding compliance to studied parameters under three questionnaires. Increased access to Watch and Reserve groups of antibiotics can translate into antibiotic misuse. It is therefore crucial that the regulatory gaps concerning e-pharmacies are addressed urgently and consumers are educated regarding safe and rational use of antibiotics.

The management of community-acquired pneumonia in adults at a rural regional hospital in KwaZulu Natal

BackgroundPneumonia stands as a significant global contributor to mortality, particularly in South Africa, where it ranks as the second leading cause of death. The country’s high prevalence of HIV infection compounds this issue, significantly increasing mortality rates associated with community-acquired pneumonia (CAP).ObjectiveThis study aimed to audit CAP patient management at a regional rural hospital in KwaZulu-Natal.MethodA retrospective review of patient files from September to December 2016 was undertaken. Data extraction from clinical files, conducted according to inclusion criteria, was transferred to a data collection sheet and analyzed using SPSS version 21.ResultsThe review encompassed 124 patient files over four months, revealing that 117 (94.4%) patients were not managed by the Standard Treatment Guidelines and Essential Medicines List for South Africa. Of the patients admitted with CAP, 54% were HIV positive, and 49 (39.5%) patients succumbed to the illness. Notably, none of the patients underwent assessment using a severity score.ConclusionThe findings underscore a need for more adherence to South African guidelines for managing CAP among staff at the rural regional hospital. This leads to severe consequences, exemplified by the high mortality rate. Urgent intervention is required to incorporate severity assessment scores into pneumonia evaluations, thus enabling appropriate clinical management.ContributionThis study sheds light on the significant impact of CAP within the South African hospital context, delineating critical gaps in clinical care and emphasizing the imperative to address clinical inertia.

Evaluation of the Effect of Drug Promotional Literature on Prescribing Pattern using WHO Prescribing Indicators and Other Relevant Parameters

ABSTRACT Background: Medicines are an integral part of health. It becomes essential to promote rational drug use. The relationship between doctors and the pharmaceutical industry has gained increasing attention recently. So there are chances that detailing activities by pharmaceutical representatives may lead to an undesirable effect on the prescribing pattern of doctors, like polypharmacy and use of fixed drug combinations; hence this study was planned to evaluate the effect of evaluation of the effect of drug promotional literature on prescribing using WHO prescribing indicators (DPL) on the prescribing pattern of doctors. Setting and Design: This prospective observational cross-sectional study was performed in a medical college and tertiary care center in Maharashtra. Materials and Methods: 30 DPL and 10 prescriptions from each doctor were collected. Such total of 3000 DPL and 1000 prescriptions were collected from 100 doctors. Statistical Analysis: The prescriptions and DPL were analyzed together, and information was entered in Microsoft Excel; the parameters were calculated in percentage. Results: This study highlighted that drugs prescribed by generic name were 3.36%, the percentage of antibiotics prescribed was 27.37%, and the percentage of prescriptions containing medicines from the essential medicine list (EML) or formulary was 44.07%. In this study, 27.9% of drugs in the prescriptions were those drugs that are advertised in the DPL. Conclusion: Polypharmacy, prescribing drugs by brand names, drugs out of national list of essential medicine, use of more fixed drug combinations (FDC), antibiotics, and nutritional supplements could be attributed to the effect of DPL on the prescribing pattern. Hence it could be said that there is an association between a greater reliance on the promotion of medicines by the pharmaceutical companies and inappropriate prescribing patterns.

Insulin resistance dealt with homoeopathy

One of the intricacies of diabetes is to understand the phenomenon of insulin resistance (IR). The phenomenon of IR applies to all types of diabetes. IR is a condition where the body’s cells stop responding to the glucose control hormone. In the current article, the lead author focuses on the IR related intricacies of diabetes and the role of homoeopathy in all the 4 types of diabetes. The first three types ate type 1, type 2 and type 3 the 4th type is maturity onset of diabetes in the young (MODY). The IR phenomenon cuts across among all sections of population including the working group and that’s why the discussion of IR is related to the growing economy as it puts burden on the economy. The article discusses the epidemiology, patho-physiology, prevention, control and treatment of IR especially at the global and national level. Thereafter, it discusses the integration of homoeopathy in to the IR domain. The properties of homoeopathy regarding the essential medicine (EM) in the national list of EM (NLEM) and the national list of essential AYUSH medicines (NLEAM) are also dealt upon. A suggested treatment protocol based on homoeopathic therapeutics is given at the end of the article after focusing on the burden of IR at national level through data from large scale surveys. In that section, the benefits that are to be accrued as a result of homoeopathic integration is also touched upon.

Analisis Pengelolaan Obat Di Instalasi Farmasi Puskesmas X Kabupaten Sukoharjo

The management of medicines in community health centers is a key element in healthcare services. This study aims to analyze the management of medicines at the Pharmacy Installation of X Community Health Center in Sukoharjo Regency. The aim of this research is to determine the suitability of indicators for the selection, planning, procurement, distribution, and use of drugs at this community health center, and to identify the strategic position of the pharmacy installation within the SWOT matrix. This research employs a descriptive analysis study design with a nonexperimental qualitative approach. Data were collected retrospectively through a review of documented records. Data collection techniques included document review, observation, and interviews at X Community Health Center in Sukoharjo Regency. The results showed that the indicators for compliance with the community health center's formulary were in accordance with standards, but the compliance of medicine items with the national formulary and the national essential medicines list was not up to standard. In the planning and procurement stages, all indicators met standards, such as the comparison between the number of medicine items planned and those actually used, the frequency of procurement of each medicine item annually, and planning deviations. In the distribution stage, the indicators for medicine matching with stock cards and the warehouse management system met standards. In the usage stage, the percentage of prescriptions with generic medicines met standards. The SWOT analysis results indicated a position in quadrant 1.

Navigating the Asia-Pacific region plasma therapies landscape: Insights from the 2023 Asia-Pacific Plasma Leaders' Network meetings.

The Asia-Pacific Plasma Leaders' Network (APPLN) plays a crucial role in addressing the regional shortage of plasma-derived medicinal products (PDMPs), particularly in low- and middle-income countries (LMICs). It provides a platform for experts to share their expertise and drive multi-stakeholder collaborations. While several PDMPs are acknowledged by the World Health Organization (WHO) as life-saving therapeutics on the Model List of Essential Medicine for treating various chronic and acute life-threatening diseases, there are still many inadequacies in the availability and affordability of PDMPs. These challenges arise from insufficient domestic supplies of plasma suitable for fractionation, as well as a lack of technical and financial capabilities to implement contract or domestic plasma fractionation programmes. At two separate dialogue forums organized by the APPLN in 2023, experts discussed the unmet needs of PDMPs for individuals living with haemophilia and immunodeficiencies in the region. They also highlighted the limited access to early diagnosis and patient-centred care in several LMICs. To address these issues, there is an urgent need to increase the availability of high-quality domestic plasma for fractionation. Adopting a stepwise approach to utilize unused recovered plasma and establishing contract fractionation programmes could be viable strategies to potentially enhance PDMP availability in LMICs. However, achieving this goal requires improving existing domestic infrastructures for blood collection, implementing adequate policy reforms and fostering competent local leadership. Ultimately, there is no 'one-size-fits-all' strategy for securing safe plasma proteins for all patients in need. Collaborative efforts are essential for achieving progressive self-sufficiency in PDMPs.

Toward a Sociology of Plasma Products.

Over the past 20 years, plasma has become a medical treatment characterized as "liquid gold" to signal its lifesaving potential. Through a manufacturing process termed fractionation, plasma, collected through blood donation, is turned into Plasma Derived Medical Products (PDMPs). The World Health Organization (WHO) has underlined the importance of PDMPs for global health care, including a number of PDMPs on the WHO Model List of Essential Medicines. The process of collecting plasma from a donor, manufacturing plasma derived treatments, and distributing those treatments globally requires the coordination of multiple social actors operating in different social, political and economic contexts, but has received little attention in scholarly literature on public policy or the social sciences. This paper will introduce a set of analytic questions and concepts that can direct a sociology of plasma products. We build on the behavioral turn in the policy sciences to identify relevant policy questions emerging from this field and offer the analytic tools necessary to investigate how different social actors in this space make meaning of plasma. To do this, we will draw on key concepts in the sociology of health and illness.

Barriers to access to antihypertensive medicines: insights from the HEARTS initiative in latin American and Caribbean region.

Hypertension significantly impacts the global cardiovascular disease burden, presenting a pronounced challenge within Latin America and the Caribbean. The Pan American Health Organization's (PAHO) HEARTS initiative endeavours to meet this challenge by enhancing comprehensive cardiovascular risk management, inclusive of improved access to antihypertensive medications. This study scrutinises the challenges and barriers in accessing these medications, which are crucial for effective hypertension management in these regions. The research employed a two-phase approach: an initial analysis of National Essential Medicines Lists (NEMLs) from 22 countries involved in the HEARTS initiative for the presence of antihypertensive medications, followed by an in-depth pharmaceutical market analysis in six selected countries to evaluate the availability, pricing, and procurement practices of these medications. The study revealed notable inconsistencies in the inclusion of recommended antihypertensive medications across NEMLs, particularly the lack of fixed-dose combinations (FDCs). The market analysis brought to light significant limitations in medicine registration and substantial variations in pricing, which adversely impact the accessibility and affordability of essential antihypertensive treatments. Furthermore, an examination of procurement practices identified considerable diversity across countries, highlighting potential areas for optimisation, including the use of the PAHO Strategic Fund. The barriers to accessing essential antihypertensive medications in Latin America and the Caribbean are multifaceted, stemming from outmoded NEMLs, limited market availability of advised medications, and disparate procurement processes. Leveraging pooled procurement mechanisms such as the PAHO Strategic Fund, coupled with vital updates to NEMLs, stands to markedly improve both the accessibility and affordability of these treatments.

From economics to health outcomes: Delving into the significance of reduced insulin prices.

The recent substantial price reductions in insulin therapy by major manufacturers prompt an examination of their impact on South Africa (SA)'s healthcare. While Eli Lilly, Novo Nordisk, and Sanofi cut prices on long-acting basal insulin, among others, significantly, these insulins are not on SA's Essential Medicines List (EML) for primary healthcare. With a high prevalence of diabetes, especially pre-diabetes, in the country, the EML's neglect of newer long-acting insulin treatments hampers effective disease management. Despite efforts by the public and private sectors, insulin therapy initiation is delayed, impacting long-term outcomes. The introduction of smart insulin pens adds a technological dimension, but concerns persist about equitable access. Urging policy-makers to re-evaluate guidelines and decolonise the EML, the article emphasises enhancing patient quality of life and reducing the disease burden.

Risk of harm to people with haemophilia from the 2023 WHO Essential Medicines List

Risk of harm to people with haemophilia from the 2023 WHO Essential Medicines List

Energy Metabolism and Metformin: Effects on Ischemia-Reperfusion Injury in Kidney Transplantation.

Metformin (MTF) is the only biguanide included in the World Health Organization's list of essential medicines; representing a widespread drug in the management of diabetes mellitus. With its accessibility and affordability being one of its biggest assets, it has become the target of interest for many trying to find alternative treatments for varied pathologies. Over time, an increasing body of evidence has shown additional roles of MTF, with unexpected interactions of benefit in other diseases. Metformin (MTF) holds significant promise in mitigating ischemia-reperfusion injury (IRI), particularly in the realm of organ transplantation. As acceptance criteria for organ transplants expand, IRI during the preservation phase remain a major concern within the transplant community, prompting a keen interest in MTF's effects. Emerging evidence suggests that administering MTF during reperfusion may activate the reperfusion injury salvage kinase (RISK) pathway. This pathway is pivotal in alleviating IRI in transplant recipients, potentially leading to improved outcomes such as reduced rates of organ rejection. This review aims to contextualize MTF historically, explore its current uses, pharmacokinetics, and pharmacodynamics, and link these aspects to the pathophysiology of IRI to illuminate its potential future role in transplantation. A comprehensive survey of the current literature highlights MTF's potential to recondition and protect against IRI by attenuating free radical damage, activating AMP-activated protein kinase to preserve cellular energy and promote repair, as well as directly reducing inflammation and enhancing microcirculation.

Pharmacoepidemiology of Drugs Used in Indoor Patients of Orthopaedic Department at a Tertiary Care Hospital

Background: Globally, with the increasing orthopaedic admissions, the management modalities have also been evolving. With the focus mainly on reducing hospital stay and improving quality of life, pharmacotherapy is a keystone in management. Thus, the present study was undertaken to assess the drug utilization in orthopaedic inpatients. Methods: This is a cross sectional, observational study carried out over a period of one year from April 2021 to April 2022. Data was collected from prescriptions of 200 patients admitted in the Orthopaedic ward and evaluated for WHO Drug Use Indicators and potential drug-drug interactions (pDDI) and prescription pattern was noted. Adverse Drug Reactions (ADR) were noted and assessed. Results: A total of 2046 drugs were prescribed in 200 prescriptions. Average number of drugs per prescription is 10.23. Antimicrobials (25.76%) was the most common class of drug prescribed followed by supplements (20.28%) and analgesics (16.13%). 79.42% drugs were prescribed by generic name, 82.06% were from the National List of Essential Medicines (NLEM) and 99.9% drugs were from hospital pharmacy. Antibiotics prescribed were as per WHO AWaRe guidelines. ADR noted in 4 patients with drug being discontinued in one case. pDDI were seen in 98% prescriptions with 95.8% being Pharmacokinetic interactions. Conclusion: Current study provides insight into the drug utilisation pattern, highlighting the extensive use of antibiotics and analgesics in orthopaedic inpatients. Adherence to WHO guidelines helps reduce antibiotic resistance and promotes better patient care.

A quantitative comparison between the essential medicines for rheumatic diseases in children and young people in Africa and the WHO model list

BackgroundThe World Health Organisation Essential Medicines List (WHO EML) guides National Essential Medicines Lists and Standard Treatment Guidelines for clearly identified disease priorities especially in low- and middle-income countries. This study compares the degree to which the basket of medicines recommended for rheumatic diseases in children and young people in National Essential Medicines Lists of countries in the WHO Africa region, corresponds to the 2021 WHO EML and WHO EML for children, as a proxy of availability.MethodsAn online search of the WHO medicines and health technology portal, the Health Ministry websites of the 54 African countries, PUBMED and Google Scholar, with search terms for ‘National Essential Medicines List’, AND/OR ‘standard treatment guidelines’ AND/OR ‘Lista Nacional de Medicamentos Essenciais’ AND/ OR ‘Liste Nationale de Medicaments Essentiels’ AND Africa AND/OR < Name of African country > was conducted. The number of medicines on the national lists were compared according to a predefined template of medicines; and the percentage similarity calculated. Descriptive statistics were derived using STATA.ResultsForty-seven countries in the WHO Africa region have developed a National Essential Medicines List. Eleven countries do not have any medicines listed for rheumatic diseases.The majority of countries had less than or equal to 50% similarity with the WHO EML for rheumatic disease in children and young people, median 3 medicines (IQR 1— 4). The most common medicines on the national lists from Africa were methotrexate, sulfasalazine and azathioprine, with etanercept available in 6 countries. Seven countries had only one medicine, acetylsalicylic acid listed in the section ‘Juvenile Joint diseases’.A multiple linear regression model for the predictors of the number of medicines on the national lists established that 20% of the variability was predicted by health expenditure per capita, socio-demographic index and the availability of rheumatology services (adult and/or paediatric) p = 0.006, with socio-demographic index (p = 0.035, 95% CI 0.64—16.16) and the availability of rheumatology services (p = 0.033, 95% CI 0.13 – 2.90) significant.ConclusionFour countries (8.5%) in Africa have updated their National Essential Medicines Lists to reflect adequate care for children and young people with rheumatic diseases. Moving forward, efforts should focus on aligning available medicines with the WHO EML, and strengthening healthcare policy for rheumatology and pharmaceutical services, for affordable access to care and medicines.

A Survey of Availability and Affordability of Polypills for Cardiovascular Disease in Selected Countries.

The recent inclusion of polypills-fixed-dose combinations of antihypertensive medicines and a statin with or without aspirin-in the World Health Organization's Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for cardiovascular diseases (CVDs). Although there exists extensive evidence on the effectiveness, safety and acceptability of polypills, there has been no research to date assessing the real-world availability and affordability of polypills globally. We conducted a cross-sectional survey, based on the WHO/Health Action International methodology, in 13 countries around the world. In the surveyed countries, we first ascertained whether any polypill was authorised for marketing and/or included in EMLs and clinical guidelines. In each country, we collected retail and price data for polypills from at least one public-sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable if the lowest-paid worker spent more than a day's wage to purchase a monthly supply. Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. In the four countries, no surveyed public pharmacies stocked polypills. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Private sector availability was 100% in Argentina and Spain. Most combinations (n = 5) identified were in India. Combinations found in India and Spain were affordable in the local context. A lowest-paid government worker would spend between 0.2 (India) and 2.8 (Mauritius) days' wages to pay the price for one month's supply of the polypills. Polypills were likely to be affordable if they were manufactured in the same country. Low availability and affordability of polypills in the public sector suggest that implementation remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Clinical pharmacology considerations and drug-drug interactions with long-acting cabotegravir and rilpivirine relevant to sub-Saharan Africa.

Long-acting injectable (LAI) cabotegravir and rilpivirine for HIV treatment and LAI cabotegravir for pre-exposure HIV prophylaxis are being rolled out in a multitude of countries worldwide. Due to the prolonged exposure, it can be challenging to undertake 'traditional' pharmacokinetic studies and current guidance is derived from their oral equivalents or physiologically based pharmacokinetic studies. This review aims to consider pharmacokinetic characteristics of cabotegravir and rilpivirine and describe anticipated drug-drug interactions (DDIs) with frequent concomitant medications in African settings. Relevant co-medications were identified from the WHO 2021 List of Essential Medicines. All original human and physiologically based pharmacokinetic studies published in English on PubMed, discussing DDIs with LAI cabotegravir and rilpivirine prior to April 2023, were reviewed. The Liverpool HIV interaction database was also reviewed (https://www.hiv-druginteractions.org/checker). LAI cabotegravir and rilpivirine have half-lives of 6-12 and 13-28 weeks, respectively. Cabotegravir is primarily metabolized by UDP-glucuronyltransferase (UGT)-1A1 and rilpivirine by cytochrome P450 (CYP)-3A4. LAI cabotegravir and rilpivirine themselves exhibit low risk of perpetrating interactions with co-medications as they do not induce or inhibit the major drug metabolizing enzymes. However, they are victims of DDIs relating to the induction of their metabolizing enzymes by concomitantly administered medication. Noteworthy contraindicated co-medications include rifamycins, carbamazepine, phenytoin, flucloxacillin and griseofulvin, which induce CYP3A4 and/or UGT1A1, causing clinically significant reduced concentrations of rilpivirine and/or cabotegravir. In addition to virologic failure, subtherapeutic concentrations resulting from DDIs can lead to emergent drug resistance. Clinicians should be aware of potential DDIs and counsel people receiving LAI cabotegravir/rilpivirine appropriately to minimize risk.

Antibiotic Stewardship in the Management of Infected Diabetic Foot Ulcer Disease in Less Developed Countries.

Diabetic foot ulcers in developing countries often become infected. The healthcare systems are often not equipped to conduct the culture and the sensitivity tests required for prescribing a targeted antibiotic treatment for diabetic foot infection (DFI). We evaluate antibiotic stewardship programmes for DFIs, at every level of health care, with an emphasis on resource-poor settings such as in Africa. The management of DFI very often is adapted to the financial and practical realities of the resource-poor regions. The application of the point-of-care Gram stain of deep tissue samples is efficient, rapid, low cost and ubiquitously available. Upon the identification of the predominant pathogen in the Gram stain, a semi-quantitative preemptive antibiotic treatment can be started in accordance with the World Health Organization Aware, Watch and Restrict Essential Medicine List. This list is catered to every country and is a powerful tool. However, some basic knowledge of the local microbiological epidemiology is necessary to choose the most appropriate agent. We report our experience on using the rapidly available Gram stain for narrowing the preemptive choice of listed antibiotic agents, as an economic tool for antibiotic stewardship in DFIs. In the practical and resource-saving management of DFI, the 'therapeutic' use of Gram stains is not common in resource-rich countries but should be added to the arsenal of the general efforts for antibiotic stewardship.