List Of Essential Medicines Research Articles

Treatment of chronic viral hepatitis c in perm Krai

Objective. To analyze the effectiveness of etiotropic antiviral therapy with direct antiviral drugs against chronic viral hepatitis C in the adult population of the Perm Krai.
 Materials and methods. In the regional register of Perm Krai, 20095 patients with chronic viral hepatitis C were registered. In 2019–2021, antiviral therapy with direct antiviral drugs, registered in the Russian Federation, and included in the list of vital and essential medicines for medical use was prescribed to 282 patients with chronic hepatitis C. There were 137 men (48.6 %), 145 (51.4 %) – women. The age of the patients ranged from 26 to 82 years, the duration of the disease – from 3 to 25 years.
 Results. All the therapy regimes we used showed 100 % effectiveness in the population of patients suffering from chronic hepatitis C associated with mild liver fibrosis regardless of genotype, whereas in the population of patients with grade 3 fibrosis or liver cirrhosis, 100 % effectiveness was achieved only after the use of sofosbuvir-containing schemes. The pangenotypic schemes resulted in 100 % achievement of a stable virological response among patients with genotype 1 regardless of the stage of liver fibrosis and previous therapy experience. In the treatment of patients infected with genotype 3 of hepatitis C virus with severe fibrosis, the effectiveness of 100 % was noted after the use of sofosbuvir-containing regimes.
 Conclusions. Among the adult population of Perm Krai, the overall effectiveness of therapy in patients with chronic hepatitis C, who used direct antiviral drugs, was 97.8 %.

User-experience testing of an evidence-to-decision framework for selecting essential medicines.

Essential medicine lists (EMLs) are important medicine prioritization tools used by the World Health Organization (WHO) EML and over 130 countries. The criteria used by WHO's Expert Committee on the Selection and Use of Essential Medicines has parallels to the GRADE Evidence-to-Decision (EtD) frameworks. In this study, we explored the EtD frameworks and a visual abstract as adjunctive tools to strengthen the integrate evidence and improve the transparency of decisions of EML applications. We conducted user-experience testing interviews of key EML stakeholders using Morville's honeycomb model. Interviews explored multifaceted dimensions (e.g., usability) on two EML applications for the 2021 WHO EML-long-acting insulin analogues for diabetes and immune checkpoint inhibitors for lung cancer. Using a pre-determined coding framework and thematic analysis we iteratively improved both the EtD framework and the visual abstract. We coded the transcripts of 17 interviews with 13 respondents in 103 locations of the interview texts across all dimensions of the user-experience honeycomb. Respondents felt the EtD framework and visual abstract presented complementary useful and findable adjuncts to the traditional EML application. They felt this would increase transparency and efficiency in evidence assessed by EML committees. As EtD frameworks are also used in health practice guidelines, including those by the WHO, respondents articulated that the adoption of the EtD by EML applications represents a tangible mechanism to align EMLs and guidelines, decrease duplication of work and improve coordination. Improvements were made to clarify instructions for the EtD and visual abstract, and to refine the design and content included. 'Availability' was added as an additional criterion for EML applications to highlight this criterion in alignment with WHO EML criteria. EtD frameworks and visual abstracts present additional important tools to communicate evidence and support decision-criteria in EML applications, which have global health impact. Access to essential medicines is important for achieving universal health coverage, and the development of essential medicine lists should be as evidence-based and trustworthy as possible.

Influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: a case of Rwanda Southern Province

BackgroundStock-outs of some life-saving drugs, such as emergency obstetric drugs, are evident in many health facilities and have been reported to be the leading cause of maternal mortality and morbidity for women from low and middle income countries (LMICs). For many cases, this situation is associated with poor inventory management practices. The aim of this study was to investigate the influence of inventory management practices on the availability of emergency obstetric drugs in Rwandan public hospitals: case of the Rwanda Southern Province. Moreover, to gain a better grasp of the problem and to suggest possible areas for improvement.MethodsAn institutional-based cross-sectional study was carried out in all ten district hospitals (DHs) providing maternal health care and dispensing emergency obstetric drugs namely; Kigeme DH, Munini DH, Kabutare DH, Kibilizi DH, Gakoma DH, Nyanza DH, Ruhango DH, Gitwe DH, Kabgayi DH and Remera Rukoma DH. Both quantitative and qualitative data were collected and analyzed. Oxytocin injection, Misoprostol tablet and Magnesium sulphate injection as recommended emergency obstetric drugs by WHO, UNFPA and Rwanda Essential Medicines list were included in the study.ResultsThe study revealed that keeping logistics management tools up to date is the backbone of inventory management practices in the availability of medicines and medical supplies. The results showed that hospitals with up-to-date logistics tools for their pharmaceutical management were 33.25 times more likely to have their emergency obstetric drugs in stock at all times compared to those that do not regularly update their logistics tools. The proper use of bin cards and electronic software (e-LMIS) contributed greatly to reducing the stock-out rate of emergency obstetric drugs by 89.9% and reduction of unusable to usable stock ratio by appropriate use of simple techniques such as the Min–Max inventory control model by 79%. Over an 18-month period, misoprostol tablet had the highest average days (32) of stock-outs (5.9%), followed by magnesium sulphate injection with an average of 31 days (5.7%), and oxytocin injection with an average of 13 days (2.4%).ConclusionProper use of pharmaceutical management tools within hospitals premises positively influence the availability of life-saving drugs, such as emergency obstetric drugs. Adequate supply chain staffing in health facilities is the most important key to improving inventory management practices and medicine availability.

Uptake of orphan drugs in the WHO essential medicines lists.

We evaluated the uptake of medicines licensed as orphan drugs by the United States Food and Drug Administration (FDA) or European Medicines Agency (EMA) into the WHO Model list of essential medicines and the WHO Model list of essential medicines for children from 1977 to 2021. We collated and analysed data on drug characteristics, reasons for adding or rejecting medicines, and time between regulatory approval and inclusion in the lists. We compared trends in listing orphan drugs before and after revisions to the inclusion criteria of the essential medicines lists in 2001, as well as differences in trends for listing orphan and non-orphan drugs, respectively. The proportion of orphan drugs in the essential medicines lists increased from 1.9% (4/208) in 1977 to 14.6% (70/478) in 2021. While orphan drugs for communicable diseases have remained stable over time, we observed a considerable shift towards more orphan drugs for noncommunicable diseases, particularly for cancer. The median period for inclusion in the essential medicines lists after either FDA or EMA first approval was 13.5years (range: 1-28 years). Limited clinical evidence base and uncertainty about the magnitude of net benefit were the most frequent reasons to reject proposals to add new orphan drugs to the essential medicines lists. Despite lack of a global definition of rare diseases, the essential medicines lists have broadened their scope to include medicines for rare conditions. However, the high costs of many listed orphan drugs pose accessibility and reimbursement challenges in resource-constrained settings.

The Essentiality of Effective Anticancer Drugs in the Essential Medicines Lists: A Comparative Analysis

ABSTRACT Background: Drugs for cancer management constitute a large part of essential medicine lists (EMLs) prepared by many countries globally. Here, we compared anticancer drugs suggested by the World Health Organization (WHO) as essential medicines and the extent to which Government of India (GOI) included them in the National list of essential medicines (NLEMs). Aim: The current study was carried out to reiterate the importance of effective alternatives listed in the WHO-EMLs to all the members of core committee under Ministry of Health and Family Welfare, GOI, and inclusion of cost-effective targeted anticancer drugs in the NLEMs at regular intervals. Materials and Methods: A descriptive, observational study was conducted to analyze the essential anticancer drugs included in the WHO-EMLs and NLEMs published during the period 2015–2023. A total of 7 EMLs (5 from WHO and 2 from India) were included in the study. The collected data were assessed for the number of cytotoxic drugs, targeted drugs, immunomodulators, and hormonal drugs recommended treating various types of cancers. Microsoft Office Excel 2007 was used for tabulation and analysis. Descriptive statistics were used for the analysis. Results: Compared with NLEMs, the WHO-EMLs included more number of cytotoxic drugs (33 vs. 29). Except for the year 2015, where more number of targeted anticancer drugs were designated as essential medicines by the GOI (6) compared to the WHO (4), subsequent EMLs from the WHO (2019–2023) included more targeted drugs (10 in 2019, 12 in 2021, and 2023 respectively). We also witnessed substantial increase in the number of immunomodulators and hormonal agents used for cancer management in the latest editions of WHO-EMLs (4,15) as compared to the NLEMs (2,8). Conclusion: Targeted anticancer drugs, including immunomodulators and hormonal agents, are more efficacious with high response rates compared to the conventional cytotoxic drugs. Efforts to include them in the Indian-EMLs must be enhanced to cope up with the pace of WHO-EMLs. Special emphasis must be given to the economical therapeutic substitutes such as dasatinib, included in the WHO-EMLs that are effective against resistant cancers.

Closing gaps in the oxygen supply chain in nations with limited resources.

Oxygen is an essential medication used across all levels of healthcare for conditions such as surgery, trauma, heart failure, asthma, pneumonia, and maternal and child care. Despite its critical importance and inclusion on the World Health Organization's list of essential medicines, many low- and middle-income countries (LMICs) face significant challenges in providing adequate oxygen supplies. These challenges are exacerbated by the COVID-19 pandemic, which has drastically increased global oxygen demand. This paper examines the current challenges and advancements in the oxygen supply chain within LMICs, focusing on availability, infrastructure, and usage. It highlights the innovative solutions being implemented to improve oxygen access and offers strategic recommendations for enhancing oxygen delivery and maintenance in resource-limited settings.

Morbidity pattern and drug utilization study in cancer patients in a tertiary care hospital

Background: Cancer is a set of diseases that include the unchecked proliferation and spread of abnormal body cell types. The primary treatment modalities are surgery, radiation, chemotherapy, immunotherapy, and hormones. As it describes the scope, nature, and causes of drug exposures, drug use research is a key and vital component of pharmacoepidemiology. Aim and Objectives: Utilization study seeks to encourage communities to use medications rationally. Materials and Methods: A prospective, cross-sectional, observational study was conducted in indoor patients of the radiotherapy department of a tertiary care teaching hospital. Six hundred patients of different types of cancers were involved in the study. At the end of data collection, the data were entered and analyzed with Microsoft Excel 2019. Descriptive statistics were used to analyze the results. Results: Buccal mucosa, tongue, and breast cancers had the highest admission rate with 24.17%, 13.33%, and 12.83%, respectively. The average number of drugs per encounter was 13.58 with a range of 5–17. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Out of 32 drugs used, 30 drugs were prescribed from the World Health Organization Model List of Essential Medicines, 2021, and National List of Essential Medicines, 2022, and 8 drugs were by brand name. Conclusion: Compared to other systems such as the pulmonary, breast, genitourinary, and gastrointestinal tract, oral malignancies were more common. The most frequently used anticancer drugs were cisplatin, carboplatin, paclitaxel, 5-fluorouracil, cyclophosphamide, and Adriamycin. Prescribing drugs were mainly from Essential Drug List with generic names.

Prescription, Dispensing, and Rational Medicine Use in a Nigerian Teaching Hospital

Abstract Background: Rational use of medicine in a teaching hospital is critical for effective and efficient patient care. This study assessed prescription, dispensing, and rational medicine in a Nigerian tertiary care facility. Materials and Method: This was an analytic cross-sectional study with data collected using validated tools underpinned by the World Health Organisation (WHO) and the International Network for the Rational Use of Drugs (INRUD) core indicators for prescription, patient care, and facility. A cluster sample of 10 specialist clinics and servicing pharmacies were selected. Simple random sampling was deployed to retrieve 600 medicine prescriptions in the pharmacies over a six-month period (June 1, 2021–November 30, 2021). Patient care indicators were assessed using 330 patient encounters, and 48 prescribers across the 10 clinics were randomly selected for assessing factors influencing prescribing practices. Exploratory and confirmatory analyses were conducted with SPSS version 25, and findings were compared with WHO/INRUD recommendations. Results: The mean medicine count per visit was 3.4 ± 1.9 with 40.2% and 24.8% of prescriptions containing antibiotics and injections, respectively. Nonproprietary prescriptions were 43.6% and 97.1% of medicines prescribed were contained the essential medicines list (EML). The mean times spent were 17.5 ± 8.0 and 7.7 ± 3.8 min with prescribers and dispensers, respectively. Most (99.8%) of the dispensed medicines were labeled properly while 82% of patients knew the regimen. Most (93.3%) tracer medicines were in the pharmacies, but no clinic had copies of the EML. Significant differences in prescription and patient care indicators were reported across specialty units. Conclusion: Gaps exist in medicine prescription and dispensing. The preponderance of brand prescription, polypharmacy, and antibiotic prescription calls for implementation of extant policies and guidelines on the use of medicines as well as training and monitoring on rational medicine use among prescribers and dispensers in the teaching hospital.

Study on prescription pattern in acute myocardial infarction in a tertiary care teaching hospital

Background: Prescription pattern monitoring studies refer to drug utilization studies that primarily examine the prescribing, dispensing, and administration of medications to promote the rational use of drugs. Aims and Objectives: The present study aimed to examine the prescription patterns among patients with acute myocardial infarction (MI) who were admitted to intensive care unit of a tertiary care center. Materials and Methods: This was a prospective, cross-sectional study carried out in 201 acute MI patients. Patients’ demographics, clinical history, laboratory and imaging findings, the name of the drug (brand name or generic name), dosage form, and percentage of drugs prescribed from the WHO and National Essential Medicine List were noted. Results: In the present study, the majority of the study participants (73.14%) belonged to the age group of 41–65 years, with male predominance (60.20%). Most patients reported having a mixed diet (49.26%) and were from rural areas (63.68%). Aspirin, clopidogrel, and atorvastatin were prescribed to all the patients, followed by pentazocine (70.42%) and streptokinase. Percentage of drugs prescribed by generic name was 62%, while percentage of drugs prescribed from the WHO Model List of Essential Medicines (2021) and National Essential Drugs List (2022) was 70% and 68%, respectively. Conclusion: The present study findings revealed that the majority of patients belonged to the age group of 41–65 years, with male predominance. The present study revealed a low percentage of prescriptions with generic names, indicating a pressing need to revise the prescription standards in tertiary care hospitals.

Antimicrobial Use and Adverse Drug Reaction in Newborns with Neonatal Sepsis: A Prospective Observational Study from a Tertiary Care Teaching Hospital

Introduction: Neonatal Sepsis (NS) is a major cause of morbidity and mortality worldwide, especially in developing countries like India. The role of antimicrobials is life-saving in NS. To achieve a good prognosis, early diagnosis and appropriate treatment are required. Data related to the irrational use of antimicrobials in neonates are limited. Aim: To evaluate the drug usage pattern and Adverse Drug Reactions (ADRs) of antimicrobials in NS. Materials and Methods: A prospective observational study was conducted among 350 neonates who were admitted and diagnosed with NS from January to December 2021 in the Neonatal Intensive Care Unit (NICU) of PDU Medical College and Civil Hospital, Rajkot, Gujarat, India. Demographic data such as age, sex, birth weight, and clinical data such as type of delivery, type of sepsis, culture-sensitivity status, and antimicrobials used were recorded. Suspected ADRs were reported in the pharmacovigilance database. Categorical data were analysed in percentage, whereas some clinical data were analysed with mean and median using Microsoft Office Excel-2019. Results: In the present study, 172 (49.15%) male and 178 (50.85%) female neonates were almost equally affected. The mean gestational age and birth weight were 35 ± 3.6 weeks and 2 ± 0.7 kg, respectively. Early-Onset Neonatal Sepsis (EONS) cases were more at 273 (78%) compared to Late-Onset Neonatal Sepsis (LONS). Seventeen different antimicrobials were used. The average number of antimicrobials used per case was 2.9. The Piperacillin Tazobactam was the most commonly used antimicrobial in 173 cases (49.43%) in early-onset sepsis, while Meropenem was used in 40 cases (11.43%) in late-onset sepsis. Coagulase-negative Staphylococcus was the most commonly isolated organism in 15 cases (4.2%), followed by Klebsiella Pneumoniae in 13 cases (3.7%). Twelve out of 17 antimicrobials (70.59%) were not included in the first list of essential medicines for children of India in 2011. Six ADRs were reported in the present study. Conclusion: In all admitted cases of sepsis, empirical therapy was given, but variations from standard recommendations were observed in dose and frequency. A periodic survey of antimicrobial use patterns in NS will be useful in the rational selection of empirical therapy.

Ground-breaking change to the mental health section of the WHO Model List of Essential Medicines: implications for low- and middle-income countries.

Ground-breaking change to the mental health section of the WHO Model List of Essential Medicines: implications for low- and middle-income countries.

Pharmacology Progresses and Applications of Chloroquine in Cancer Therapy.

Chloroquine is a common antimalarial drug and is listed in the World Health Organization Standard List of Essential Medicines because of its safety, low cost and ease of use. Besides its antimalarial property, chloroquine also was used in anti-inflammatory and antivirus, especially in antitumor therapy. A mount of data showed that chloroquine mainly relied on autophagy inhibition to exert its antitumor effects. However, recently, more and more researches have revealed that chloroquine acts through other mechanisms that are autophagy-independent. Nevertheless, the current reviews lacked a comprehensive summary of the antitumor mechanism and combined pharmacotherapy of chloroquine. So here we focused on the antitumor properties of chloroquine, summarized the pharmacological mechanisms of antitumor progression of chloroquine dependent or independent of autophagy inhibition. Moreover, we also discussed the side effects and possible application developments of chloroquine. This review provided a more systematic and cutting-edge knowledge involved in the anti-tumor mechanisms and combined pharmacotherapy of chloroquine in hope of carrying out more in-depth exploration of chloroquine and obtaining more clinical applications.

Acquaintance of medical students with the National List of Essential Medicines

Background: Undergraduate medical students are future prescribers of medicines, and they must understand the concept of essential medicines and their importance in healthcare. Regulations on Graduate Medical Education Amendment 2019, has revolutionized Indian medical education by introducing competency-based medical education which states that the major goals for an Indian medical graduate are to acquire the competency of a “clinician who understands and provides preventive, promotive, curative, palliative, and holistic care with compassion.” The National List of Essential Medicines (NLEM) has been included as a core topic in the curriculum of undergraduate medical students. This research attempted to understand the level of knowledge regarding the NLEM among undergraduate medical students. Aim and Objective: To assess the baseline level of knowledge regarding the NLEM among undergraduate medical students. Materials and Methods: A questionnaire-based study was done among medical students of a government tertiary care teaching hospital in India. 1st year students were excluded as they were not taught about Essential Medicines and NLEM. A pre-validated multiple-choice questionnaire was distributed to medical students and information was collected related to knowledge regarding NLEM significance, criteria for inclusion in NLEM, terminologies, and drugs in NLEM that are used for common conditions. Results: Out of 600 students 237 (39.50%) students responded. 98 (41.35%) students were aware of recent NLEM-2022, 91 (38.40%) students were aware of terminologies used in NLEM, and 71 (29.96%) students were aware of the criteria for inclusion of any drug in NLEM. 175 (73.84%) students were unaware of updates in NLEM-2022. 165 (69.62%) students were unaware of the number of medicines added and deleted in NLEM-2022.155 (65.40%) students were not able to answer the questions regarding drugs for anaphylaxis and new antihypertensive drugs included in recent NLEM-2022. Conclusion: Knowledge regarding NLEM is limited among undergraduate medical students. To sensitize medical students to rational drug therapy, there is an urgent need to improve their knowledge related to NLEM via educational interventions.

Prescribing Pattern of Antimicrobial Agents in Patients with Pelvic Inflammatory Disease in a Tertiary Care Hospital at Rural Part of Western Nepal

Introduction: Antibiotics are the most frequently prescribed drugs in patients with Pelvic Inflammatory Diseases. Appropriate antibiotic prescriptions in health care institutions are an important element in quality of care, infection management and cost control.
 Aims: To analyze prescription pattern of antimicrobial agents in patients with pelvic inflammatory diseases.
 Methods: This quantitative cross-sectional study was conducted including 300 patients' prescriptions, at Karnali Academy of Health Sciences Jumla Nepal for period of six months during August 2021 to January 2022. This study was based on medication utilization form, which was designed on basis of World Health Organization core drug use indicator format.
 Results: Females were in ages from 12 to 69 years, with mean of 30.46 ± 18.71 years. Chronic Pelvic inflammatory Disease was most prevalent in 20–29 age group (47%) while, lowest in 60–69 age group (1.67%). The total number of prescribed drugs was 796 averaging 2.65 drugs per prescription. The most commonly prescribed antimicrobials were azithromycin (30.15%), tinidazoles (25.25%) and ofloxacin (8.16%). Only 15.5% of drugs were prescribed with generic names and all were from essential list of medicines. 92.8% of prescriptions were administered orally, while 7.8% parenteral. However 76.34% of prescriptions were considered irrational.
 Conclusion: The high prevalence of irrational prescriptions suggests need for interventions to improve healthcare provider's adherence to established treatment guidelines. Dominance of specific drug classes underscores importance of tailoring treatments to the specific pathogens involved in Pelvic Inflammatory Disease. Suggesting potential room for improvement inadherence to evidence-based guidelines.

Antibiotics Prescribing Pattern of Outpatients in a Tertiary Level Hospital in Nepal

Introduction. Antibiotics are most abundantly used drugs of major global concern for rapid ongoing emergence of resistant strains, increase overall cost of treatment and impact on national economy. Optimized use of antibiotic on the basis of proper diagnosis, prescriber’s attention about the problem and antimicrobial stewardship programs may become a way to rationalize the use.
 Methods. This is a cross-sectional descriptive study done in patients visiting to various OPD of tertiary referral hospital. Prescriptions were randomly selected and Antibiotics utilization was assessed by WHO prescribing Indicator form. Prescribed drugs were checked for adherence to guidelines and essential medicine list.
 Results. Among 731 sampled prescriptions, 384 (52.53%) were found with at least one antibiotic; 214 prescriptions (55.72%) were of female patients. Mean age was 37.71 years with SD 25.01. Highest numbers of patients (21.09%) belong to the 15-29 age group. Highest number of patients 158 (41.15%) treated with antibiotics were seen in patient attending Medicine department, 30 antibiotics were prescribed for 577 times. Amoxicillin-Clavulanate 70 (12.13%) was the most frequently prescribed followed by Azithromycin and Metronidazole with frequency of 39 (6.76%). Drug availability is 50.36%, in the facility and only 2.4 % of drugs were prescribed in generic.
 Conclusions. More than half of the patients were prescribed with antibiotics and all antibiotics were prescribed empirically. Newer generation antibiotics with broad spectrum efficacy were used in remarkable frequency. This study provides evidence for antibiotic stewardship, drug use review and establishment of institutional guidelines.

Drug Utilization Pattern of Antimicrobial Agents in Medicine IPD of a Tertiary Care Teaching Hospital of Western Odisha

Background: Around the world, doctors frequently prescribe antimicrobial agents (AMAs). However, irrational and inappropriate use of AMAs results in several negative outcomes, including antimicrobial resistance, connected health issues, lengthened hospital stays, and increased treatment costs. Antimicrobial resistance (AMR) is becoming a more serious global challenge in hospitals and communities. Hence, Drug Utilization Evaluation (DUE) studies are created primarily to evaluate and improve prescribing procedures and enhance the rational use of pharmaceuticals to address this significant condition. Materials and methods: A prospective observational study was conducted in a tertiary care hospital’s in-patient department of medicine. Analyses were done on the antibacterial agent drug usage patterns. Using Defined Daily Doses (DDDs) and Anatomical Therapeutic Chemical (ATC) Classification. The cost of the AMA therapy was estimated using the government’s approval rate for generic drugs. Results: Sixty-seven of the 100 patients were women, and 33 were men. Throughout the research period, 432 medications were prescribed, of which 39.8% were antibiotics and 77 % of patients had their AMA prescriptions based on data from bacteriological culture and sensitivity tests. The National List of Essential Medicines (NLEM) of India and the state essential drug lists were followed for prescribing the antimicrobial drugs by their generic names, respectively. In 27% of prescriptions, there was evidence of polypharmacy, and 70% of the combinations were logical. The patient spent 3.47 days in the hospital on average throughout their stay. It was discovered that antibiotics cost an average of Rs 200.17 per patient every day. Conclusion: Hospital antibiotic policy according to the ASP (Antibacterial Stewardship Programme) is essential for the optimization of antimicrobial therapy in this institution to ensure rational use of AMAs and to fight antimicrobial resistance.

Hospital prescribing patterns of antibiotics in Zambia using the WHO prescribing indicators post-COVID-19 pandemic: findings and implications.

Antimicrobial resistance (AMR) is a global public health problem that is fuelled by the inappropriate prescribing of antibiotics, especially those from the 'watch' and 'reserve' antibiotic lists. The irrational prescribing of antibiotics is particularly prevalent in developing countries, including Zambia. Consequently, there is a need to better understand prescribing patterns across sectors in Zambia as a basis for future interventions. This study evaluated the prescribing patterns of antibiotics using the WHO prescribing indicators alongside the 'access, watch and reserve' (AWaRe) classification system post-COVID pandemic at a faith-based hospital in Zambia. A cross-sectional study was conducted from August 2023 to October 2023 involving the review of medical records at St. Francis' Mission Hospital in Zambia. A WHO-validated tool was used to evaluate antibiotic prescribing patterns alongside the AWaRe classification tool. Out of 800 medical records reviewed, 2003 medicines were prescribed. Each patient received an average of 2.5 medicines per prescription. Antibiotics were prescribed in 72.3% of encounters, of which 28.4% were injectable. The most frequently prescribed antibiotics were amoxicillin (23.4%-access), metronidazole (17.1%-access), ciprofloxacin (8%-watch) and ceftriaxone (7.4%-watch), with 77.1% overall from the 'access' list. Encouragingly, 96.5% of the medicines were prescribed by their generic names and 98% were from the Zambia Essential Medicines List. There were high rates of antibiotic prescribing, including injectable antibiotics, which needs addressing going forward. It is crucial to implement targeted measures, including antimicrobial stewardship programmes, to improve future antibiotic prescribing in Zambia and reduce the risk of AMR.

Implementing the WHO AWaRe antibiotic book guidance in lower-resource settings: the case of the Lao PDR.

In 2022, WHO released the WHO AWaRe (Access, Watch, Reserve) antibiotic book to promote the rational use of antibiotics. Here, we review the AWaRe antibiotic book from the perspective of implementation in low-resource settings, using the Lao PDR (Laos) as a case study. Not all recommendations in the AWaRe antibiotic book match the epidemiology of infectious diseases and antimicrobial susceptibility patterns in Laos and other low- and middle-income countries (LMICs), e.g. melioidosis, rickettsial disease and leptospirosis are common causes of sepsis and febrile illness in Laos but do not feature in the AWaRe book. Conversely, some infectious diseases like Clostridioides difficile-associated diarrhoea are in the AWaRe antibiotic book but rarely considered in Laos with no diagnostic tests available. Only 29/39 antibiotics in the AWaRe book are available in Laos, with no Reserve group antimicrobials available. The AWaRe book stimulates countries such as Laos to consider alternative diagnoses and include additional antimicrobials in the national essential medicines list (NEML). However, it should be updated to include regional important pathogens that are not included. Comprehensive antibiotic use guidelines alone might not assure appropriate use or control overuse of antibiotics. Access to antibiotics is challenging in low-resource settings in terms of unavailability in the country (low demand or small market size), patchy access, especially for those living in remote areas, and unaffordability. All these systemic factors can contribute to inappropriate use of antibiotics. Improved access to antibiotics, strengthening diagnostic capacity and promoting antibiotic stewardship should be combined.

Developments in the chemistry and biology of 1,2,3-triazolyl-C-nucleosides.

In the last 50 years, nucleoside analogs have been introduced to drug therapy as antivirals for different types of cancer due to their interference in cellular proliferation. Among the first line of nucleoside treatment drugs, ribavirin (RBV) is a synthetic N-nucleoside with a 1,2,4-triazole moiety that acts as a broad-spectrum antiviral. It is on the World Health Organization (WHO) list of essential medicines. However, this important drug therapy causes several side effects due to its nonspecific mechanism of action. There is thus a need for a continuous study of its scaffold. A particular approach consists of connecting d-ribose to the nitrogen-containing base with a C-C bond. It provides more stability against enzymatic action and a better pharmacologic profile. The coronavirus disease (COVID) pandemic has increased the need for more solutions for the treatment of viral infections. Among these solutions, remdesivir, the first C-nucleoside, has been approved by the Food and Drug Administration (FDA) for clinical use against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It drew attention to the study of the C-nucleoside scaffold. Different C-nucleoside patterns have been synthesized over the years. They show many important activities against viruses and cancer cell lines. 1,2,3-Triazolyl-C-nucleoside derivatives are a prolific and efficient subclass of RBV analogs close to the already-known RBV with a C-C bond modification. These compounds are often prepared by alkynylation of the d-ribose ring followed by azide-alkyne cycloaddition. They are reported to be active against the Crimean-Congo hemorrhagic fever virus and several tumoral cell lines, showing promising biological potential. In this review, we explore such approaches to 1,2,3-triazolyl-C-nucleosides and their evolution over the years.

A cross-sectional study to assess the drug utilization pattern and pharmacotherapeutic adherence among patients with schizophrenia and quality of life of patient’s caregiver in a tertiary care teaching hospital

Background: Schizophrenia is a chronic severe psychiatric illness affecting nearly 0.4 to 1.4% of people in India. Many newer anti-psychotic drugs are used now-a-days in schizophrenia. Poor adherence to the treatment given to patients of schizophrenia is observed very often. Although, the quality of life of schizophrenia patients is very much compromised; at the same time, quality of life of the caregiver is also compromised. Methods: A cross-sectional Observational study was conducted among patients already diagnosed with Schizophrenia and on treatment, after ethical approval. Data relevant to study variables was collected in a pre-designed case record form. Evaluation of drug utilization pattern was done by WHO core drug prescribing indicators. Medication adherence was assessed through modified Morisky scale. Quality of life of relative or caregiver was assessed through WHO-QOL BREF questionnaire scale. Results: Patients of 18 years and above were enrolled. Among them, average age was 35.8±5.5 years. In my study, female patients were 64.7% and male patients were 35.3%. Average number of drugs per prescription was 3.8. Drugs prescribed by generic name were around 86.2%. Around 56.9% of drugs were prescribed from national list of essential medicines. Atypical antipsychotics were prescribed in 32% of all prescriptions for Schizophrenia; Whereas Benzodiazepines were prescribed in 19% of all prescriptions. Average Medication adherence score using MMS scale was 3.7±2.2. Patients with high adherence to the medications prescribed were nearly 71% and patients with low adherence to the medications prescribed were 29%. Mean total WHOQOL-BREF score was 75.2±6.5 out of 120. Conclusions: Most prescribed class of drugs was atypical anti-psychotics. Pharmacotherapeutic adherence among patients with schizophrenia was relatively high. Quality of life of patients’ relative or caregiver was impaired to some extent, more impaired in physical health and social relationships domain.