National List Of Essential Medicines Research Articles

Antibiotic utilization profile in surgical ward at secondary government hospital

Background: This study aimed to determine the profile of the antibiotic utilization in defined daily dose (DDD) units and DU 90% at surgical ward of secondary government hospital in Indonesia within six months period of study. Methods: A retrospective cross-sectional study was conducted over six months on surgical ward patients prescribed with at least one oral or parenteral antibiotic during hospitalization. Data were collected from pharmacy dispensing data and evaluated using World Health Organization (WHO) DDD. Antibiotics DDD were analysed using DU 90% segmentation in order to know the 90 percent cumulative of antibiotic consumption in surgical ward. WHO prescribing indicators were used to examine the antibiotic prescribing pattern in DU 90% segment. Results: Out of 319 antibiotic prescribed to surgical ward patients, 219 prescriptions were belonging to DU 90% segment including ceftriaxone (38.94%), moxifloxacin (16.41%), fosfomycin (14.06%), metronidazole (12.43%), and gentamicin (7.69%) in decreasing fashioned. Of the five groups of antibiotics belong to DU90%, ceftriaxone was the highest in DDD (272.5). The average number of antibiotic prescribed to patients were 1.64±0.92. The percentage of antibiotic prescribed by its generic name as well the prescribing of antibiotic from National list of essential medicines were 70.79% and 72.51%, respectively (optimal value 100%). Conclusions: Our findings on using drug utilization 90% and prescribing indicators are practical for assessing the most widely used antibiotics in ward or hospital setting and to evaluate the quality of prescribing pattern. The antibiotic utilization profile in this study can be used to provide comparative data between hospital and beneficial for future policy making to improve prescribing practice.

Grading of recommendations, assessment, development and evaluations concept 7: issues and insights linking guideline recommendations to trustworthy essential medicine lists

ObjectivesGuidelines and essential medicine lists (EMLs) bear similarities and differences in the process that lead to decisions. Access to essential medicines is central to achieve universal health coverage. The World Health Organization (WHO) EML has guided prioritization of essential medicines globally for nearly 50 years, and national EMLs (NEMLs) exist in over 130 countries. Guideline and EML decisions, at WHO or national levels, are not always coordinated and aligned. We sought to explore challenges, and potential solutions, for decision-making to support trustworthy medicine selection for EMLs from a Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group perspective. We primarily focus on the WHO EML; however, our findings may be applicable to NEML decisions as well. Study Design and SettingWe identified key challenges in connecting the EML to health guidelines by involving a broad group of stakeholders and assessing case studies including real applications to the WHO EML, South Africa NEML, and a multiple sclerosis guideline connected to a WHO EML application for multiple sclerosis treatments. To address challenges, we utilized the results of a survey and feedback from the stakeholders, and iteratively met as a project group. We drafted a conceptual framework of challenges and potential solutions. We presented a summary of the results for feedback to all attendees of the GRADE Working Group meetings in November 2022 (approximately 120 people) and in May 2023 (approximately 100 people) before finalizing the framework. ResultsWe prioritized issues and insights/solutions that addressed the connections between the EML and health guidelines. Our suggested solutions include early planning alignment of guideline groups and EMLs, considering shared participation to strengthen linkage, further clarity on price/cost considerations, and using explicit shared criteria to make guideline and EML decisions. We also provide recommendations to strengthen the connection between WHO EML and NEMLs including through contextualization methods. ConclusionThis GRADE concept article, jointly developed by key stakeholders from the guidelines and EMLs field, identified key conceptual issues and potential solutions to support the continued advancement of trustworthy EMLs. Adopting structured decision criteria that can be linked to guideline recommendations bears the potential to advance health equity and gaps in availability of essential medicines within and between countries.

OP66 Adoption Of The World Health Organization Algorithm For Essential Medicines In The Philippine National Formulary Listing Process

IntroductionThe Philippine National Formulary (PNF) System preceded the health technology assessment (HTA) process in the Philippines, which was institutionalized in 2019. The transition led to previously prioritized topics of expert bodies overseeing the PNF System being endorsed to the HTA Council. However, the advent of COVID-19 forced the HTA Philippines to focus on emergency assessment needs and financing recommendations for the national government, resulting in limited capacity to assess non-public health emergency topics. To address this and improve patient access to medicines, we adopted the World Health Organization (WHO) process for evaluating and selecting medicines in the National Essential Medicines List (NEML).MethodsIn assessing the pre-pandemic topics, we matched the population, intervention, comparator, and outcomes of the WHO clinical evidence reviews with those scoped with relevant stakeholders and performed local costing analyses to ensure applicability of findings to the Philippine setting. When needed, we subjected the topics to price negotiation or conducted qualitative assessments.ResultsWe found the method efficient in expediting the decision-making process of the HTA Council. However, given the limited internal capacity of the HTA Philippines to conduct assessments for all ongoing HTA tracks, some of the topics responsive to Universal Health Care will be outsourced to the HTA Research Network, which is yet to be established. There is also a need to improve alignment among the topics being assessed, since the priorities of the proponents, national health program, and national payer have already evolved.ConclusionsIt is important to identify the priority areas for stakeholders as part of the topic nomination process, account for analytic capacity when setting the number of topics for HTA, establish mechanisms to allow proponents to conduct HTAs based on the HTA Council’s methodological standards, and proactively work with the national regulatory agency on horizon scanning and early HTA. We also recommend efficient monitoring, evaluation, and updating of the Philippine HTA guidelines so that they are more responsive to the needs of the healthcare system and the Filipino people.

National health insurance scheme improves access and optimization of antimicrobial use in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Nigeria instituted the National Health Insurance Scheme (NHIS) for universal health coverage. This study compared the NHIS and out-of-pocket (OOP) antibiotic prescribing with the World Health Organization (WHO) optimal values. A total of 2190 prescription forms from the NHIS and OOP were included in this study conducted at Obafemi Awolowo University Teaching Hospitals Complex, Nigeria from January 2021 to December 2022 and analysed using WHO drug prescribing guidelines. The average number of drugs per encounter was higher in the NHIS prescribing (χ2=58.956, p=0.00) than in OOP prescribing. The percentage of encounters with an antibiotic prescribed is higher in NHIS prescribing (χ2=46.034, p=0.000) than in OOP prescribing. The percentage of parenteral antibiotic prescribing is higher in OOP prescribing (χ2=25.413, p=0.000) than in NHIS prescribing. The percentage of antibiotic prescribed from the National Essential Medicine List is higher in NHIS prescribing (χ2=8.227, p=0.000) as well as the antibiotics prescribed from the Access category of the WHO Access, Watch and Reserve (AWaRe) Classification of antibiotics (χ2=23.946, p=0.000) when compared with OOP prescribing. Prescribing indicators show better performances with NHIS antibiotic prescribing and are closer to the WHO-recommended optimal values than in OPP prescribing. Hence NHIS prescribing can be an easy target for hospital antibiotic stewardship intervention for optimal antibiotic prescribing.

Affordability After Subsidy Shift from Parallel Exchange Rate to Insurance: a Retrospective Cross Sectional Study

Background: Due to the imposition of an embargo, Iran adopted a policy of a parallel exchange rate. After three years, the advantages and disadvantages of this policy were revealed empirically. Therefore, the government decided to shift the subsidy to insurance instead of the exchange rate. However, as a result of this plan, the price of medicine rose sharply, and affordability decreased for some sections of society who were not covered by any insurance. This study evaluated the impact of this policy on the affordability of essential medicines listed by the WHO.
 Materials and Methods: The impact of this plan on the affordability of essential medicines was evaluated using the WHO recommended method. A cross-sectional study was conducted to measure the affordability of the national essential medicines list before and after the implementation of the subsidy shift from exchange rate to insurance.
 Results: Despite the benefits of this plan, 17 items in the essential medicine list became unaffordable. The affordability of essential medicines decreased, particularly for uninsured individuals.
 Conclusion: More efforts should be made to cover uninsured people to preserve their access to essential medicines. Although the shift from parallel exchange rate to insurance had several benefits, such as reducing corruption and reverse smuggling, it also decreased the affordability of essential medicines, particula rly for uninsured individuals. Therefore, policymakers should consider implementing measures to ensure that essential medicines remain affordable and accessible to all members of society.

Availability of access, watch, and reserve (AWaRe) group of antibiotics in community pharmacies located close to a tertiary care hospital in Lalitpur, Nepal.

The access, watch, and reserve (AWaRe) classification of antibiotics was developed in 2019 by the WHO Expert Committee on the Selection and Use of Essential Medicines as a tool to support antibiotic stewardship efforts at local, national, and global levels. The objectives of this study were to assess the availability of antibiotics as per WHO AWaRe classification at community pharmacies located around a tertiary care hospital in Lalitpur and to compare these antibiotics with the national essential medicine list of Nepal. The cross-sectional study was conducted at community pharmacies located within a two-kilometer radius of a teaching hospital from August to November 2022. A total of 82 community pharmacies registered with the Nepal Chemist and Druggists Association and the Department of Drug Administration were studied. Data was collected using a standard proforma containing the names of the antibiotics classified as per the WHO's AWaRe classification. Access group of antibiotics, Ampicillin, (82;100%), Amoxycillin, (82;100%), Flucloxacillin, (82;100%), and Metronidazole, (82;100%) were available in all community pharmacies. Results from the watch group showed that Azithromycin, (80; 97.6%) was available in all pharmacies followed by Cefixime, (80; 97.6%), Ciprofloxacin, (73; 89%), Levofloxacin, (74; 90.2%)and Ofloxacin, (74; 90.2%). Linezolid, (24; 29.3%) was the most common antibiotics available from the reserve group of antibiotics. Colistin was the second commonly available antibiotic. The most available antibiotic from the not recommended group were Ampicillin/Cloxacillin (82; 100%), followed by Piperacillin/Sulbactam, (39; 47.6%). There were differences in the classification of antibiotics between the WHO AWaRe list and the Essential Medicines list of Nepal in terms of numbers of antibiotics listed. Antibiotics from the not recommended and reserve groups were commonly available in community pharmacies. The implementation of antibiotic guidelines should be emphasized along with strict monitoring of the sale of antibiotics without a prescription in community pharmacy settings.

Potential drug-drug interactions of frequently prescribed medications in long COVID detected by two electronic databases.

Infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to a wide range of acute and chronic complications including long COVID, a well-known chronic sequela. Long COVID often necessitates long-term treatment, which may lead to an increased potential for drug-drug interactions (DDIs). The objective of this study was to assess potential DDIs among frequently prescribed medications in long COVID by using two electronic databases. Sixty frequently prescribed agents were selected from Thailand's National List of Essential Medicine 2022 for potential DDI analysis by Micromedex and Drugs.com. From these databases, 488 potential DDIs were identified. There were 271 and 434 DDI pairs based on Micromedex and Drugs.com, respectively. Among these DDIs, 77 pairs were labeled as contraindicated or major by both databases. The most common mechanisms for these serious interactions are cytochrome P450 (CYP) inhibition (45%), CYP induction (19%), and QT interval prolongation (7.8%). Based on Fleiss' kappa (0.073), there was only slight agreement of the DDI severity classifications between these two databases. In conclusion, a large number of potential DDIs were detected among frequently prescribed medications for long COVID. Health care providers should be aware of these DDIs, particularly those that are deemed as contraindicated or major. These DDIs are most likely to cause significant adverse events in patients with long COVID because polypharmacy is common.

Regulatory enforcement of the marketing of fixed-dose combinations in India: a case study of systemic antibiotics

BackgroundIn India, states have licensed the manufacture of large numbers of fixed-dose combination (FDC) drugs without the required prior approval of the central regulator. This paper describes two major regulatory initiatives to address the problem, which began in 2007 and 2013, and examines whether they have been sufficient to remove centrally unapproved systemic antibiotic FDCs from the market.MethodsInformation was extracted from documents published by the central regulator and the ministry of health, including the National List of Essential Medicines (NLEM), and court judgments, and analysed alongside sales volume data for 2008–2020 using PharmaTrac market dataset.ResultsThe regulatory initiatives permitted 68 formulations to be given de facto approvals (‘No Objection Certificates’) outside the statutory regime, banned 46 FDCs and restricted one FDC. Market data show that FDCs as a proportion of total antibiotic sales increased from 32.9 in 2008 to 37.3% in 2020. The total number of antibiotic FDC formulations on the market fell from 574 (2008) to 395 (2020). Formulations with a record of prior central approval increased from 86 (2008) to 94 (2020) and their share of the antibiotic FDC sales increased from 32.0 to 55.3%. In 2020, an additional 23 formulations had been permitted de facto approval, accounting for 10.6% of the antibiotic FDC sales. Even in 2020, most marketed formulations (70.4%, 278/395) were unapproved or banned, and comprised a 15.9% share of the antibiotic FDC sales. The share of NLEM-listed antibiotic FDC sales increased from 21.2 (2008) to 26.7% (2020).ConclusionThe initiatives had limited impact. Regulatory enforcement has been slow and weak, with many unapproved, and even banned, FDCs remaining on the market.

External reference pricing for medicines in Ukraine: latest trends

Compared to the previous year, the share of healthcare expenditure in the state budget of Ukraine has decreased, which is associated with increased funding for the security and defense sector. In terms of gross domestic product, healthcare spending has reduced to 2.8 %, which corresponds to the figures for 2019. These circumstances indicate the importance of proper budget utilization, including effectively regulating medicine prices. One of the key elements of rational healthcare budget usage is the development and implementation of external reference pricing (ERP). A well-formulated and implemented ERP policy for pharmaceuticals contributes to improving patient access to essential medicines (EMs). The aim of this study is to analyze the current status of ERP implementation in Ukraine and provide recommendations for improving this policy. Materials and methods. During the research process, an analysis of the ERP’s current regulatory framework was conducted, and ERP implementation in Ukraine was assessed according to adherence to the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015. Results. In Ukraine, ERP has been introduced for medicines from the National Essential Medicine Lists (NEML) and the “Affordable Medicines” program. The Ministry of Health (MoH) of Ukraine has approved a Register of marginal wholesale prices for medicines purchased with state budget funds and subject to price regulation. Currently, the register includes 1239 medicinal products, of which 1233 are from NEML and 6 have undergone Health Technology Assessment (HTA). Approximately 58 % of medicines have a set price through ERP, 24 % are regulated by internal reference pricing (IRP), and nearly 18 % have declared prices. This indicates a lack of uniformity in approaches to price regulation for medicines and requires further improvements. According to the latest update of the Register of medicines for reimbursement under the state medical guarantees program, there are 486 medicines, including 72 insulins and 21 immunosuppressive medicines (184 medicines are provided with co-payment). Different approaches, including different reference countries and price calculation algorithms, are applied for the price regulation of medicines in NEML and the “Affordable Medicines” program. An assessment of the implementation of the ERP system in Ukraine based on the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015 showed that the current policy does not adhere to all principles. Conclusions. The analysis revealed different approaches to pricing for medicines NEML and the “Affordable Medicines” program, indicating the need for harmonizing pricing policies for different lists. The adoption of a unified positive list can contribute to improving pricing policies and efficient resource utilization. Collecting, disseminating, and exchanging data on drug prices is crucial to support transparency in pricing and its control. Regular monitoring of prices in the market will help ensure compliance with pricing policies and take appropriate measures in case of violations. The implementation of a unified pricing regulation policy for medicines in Ukraine is an important step towards European integration and compliance with international standards.

Anti-inflammatory potential of a Thai traditional remedy called Prabchompoothaweep in an animal model of acute and sub-acute inflammation

Ethnopharmacological relevancePrabchompoothaweep (PCT) is a Thai remedy which is composed of 23 herbs and has been added onto the National List of Essential Medicines (NLEM) of Thailand. This remedy has been used to treat allergic rhinitis and asthma in Thai traditional medicine for many years. Furthermore, a few studies have reported anti-allergic, anti-malarial, anti-inflammatory and antioxidant activities. Aim of the studyThis study aims to evaluate anti-inflammatory activity of PCT extract in an animal model. Materials and methodsThe animal model of acute inflammation was studied over a 24-h period, utilizing the method of carrageenan-induced paw oedema. In addition, sub-acute inflammation was examined over 7 days, using the formalin-induced paw oedema method. The treatment groups received PCT extracts, via the oral route, at 1-h prior to injection and then the sub plantar of the rat right paw was injected with the named substances to generate paw oedema. The paw thickness was measured by vernier caliper at regular intervals after injection. At the end of experiment, the blood and paw tissues were collected for measurement of pro-inflammatory cytokines and histological examination respectively. ResultsIn acute inflammation, all doses of PCT extract (250, 500 and 1000 mg/kg p.o.) significantly reduced paw thickness after the first 3 h in a dose-dependent manner and the percentage of inhibition was 38.7%, 47.8% and 49.5% respectively. The pro-inflammatory cytokines, including TNF-α and IL-1β, statistically decreased with all doses of the extracts. However, the histological examination did not reveal significant results due to the short time duration. As regards to sub-acute inflammation, all doses of PCT extract significantly reduced paw thickness with 12.78%, 23.64% and 35.78%, in a dose dependent manner. Also, the pro-inflammatory cytokines (TNF-α and IL-1β) significantly decreased at day 7. Interestingly, the histological examination of paw tissue demonstrated reductions of mononuclear infiltrations of inflammatory cells, this was observed in the group receiving PCT extracts, also in a dose-dependent manner. ConclusionTherefore, PCT exerted anti-inflammatory activity in an animal model of acute and sub-acute inflammation, suggesting that it could be used as a new source for treatment of inflammatory diseases.

Essential cancer medicines and cancer outcomes: Cross-sectional study of 124 countries.

Cancer is the second leading cause of death worldwide. Alongside other interventions, access to certain medicines may decrease cancer-associated mortality. Listing medicines on national essential medicines lists may improve health outcomes. We examine the association between cancer mortality amenable to care and the listing of cancer medicines on national essential medicines lists (NEMLs) of 124 countries. In this cross-sectional study, we determined the number of medicines used to treat eight cancers on NEMLs and used multiple linear regression to analyze the association between cancer health outcome scores and the number of medicines on NEMLs while controlling for GDP. A sensitivity analysis was also conducted using selected medicines. The number of cancer medicines on NEMLs was not associated with cancer health outcome scores when GDP was controlled for non-melanoma skin (p = 0.224), uterine (p = 0.221), breast (p = 0.145), Hodgkin's lymphoma (p = 0.697), colon (p = 0.299), leukemia (p = 0.103), cervical (p = 0.834), and testicular cancers (p = 0.178). There was a weak association between listing medicines for eight cancers in NEMLs and amenable mortality. Further studies are required to explore association between cancer health outcomes and other factors such as actual availability of medicines listed, access to surgeries, accurate diagnosis, radiotherapy, and early detection.

Accessibility crisis of essential medicines at Sudanese primary healthcare facilities: a cross-sectional drugs’ dispensaries assessment and patients’ perspectives

BackgroundAccess to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn’t well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients’ perceived affordability of essential medicines, and accommodation and acceptability of the public facility.MethodsA cross-sectional study was carried out at 30 primary healthcare facilities’ drug dispensaries across three districts in Khartoum state. Within each Centre’s dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan’s national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26.ResultsParticipants’ ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets.ConclusionPatients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients’ access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients’ satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan.

Rituximab for the treatment of relapsing-remitting multiple sclerosis in Thailand: an economic evaluation and budget impact analysis

BackgroundMultiple sclerosis is an inflammatory demyelination process in the central nervous system (CNS) causing neurological disability and poor quality of life. Currently, Thai Food and Drug Administration (FDA)-approved disease-modifying therapy is costly, and most patients with multiple sclerosis are ineligible for treatment in Thailand as previous studies have challenged its cost-effectiveness. Off-label use of rituximab is inexpensive and highly effective in treating multiple sclerosis, but evidence of its cost-effectiveness in Thailand is yet to be collected.MethodsThis study aimed to evaluate the cost-utility and budget impact of rituximab for multiple sclerosis treatment compared with best supportive care, the standard practice in Thailand to treat the disease. A Markov model with a one-month cycle length and lifetime horizon was applied to compare the costs and outcomes of rituximab and best supportive care based on a societal perspective. Accordingly, incremental cost-effectiveness ratios were estimated. Probabilistic and one-way sensitivity analyses were conducted to investigate parameter uncertainty. In addition, the Markov model was used to assess the 5-year budget impact from the government perspective.ResultsA rituximab biosimilar demonstrated higher effectiveness and lower associated costs, compared to best supportive care, with the highest probability of being cost-effective (96%). The probability of relapse was the most sensitive parameter according to the one-way sensitivity analysis. The calculated budget impact of treating patients with multiple sclerosis in Thailand was 26,360,000 Thai baht (THB) or 844,255 United States dollars (USD) in the first fiscal year, and approximately 20,810,000–23,080,000 THB (666,608–739,388 USD) in the next four fiscal years.ConclusionIn Thailand, a rituximab biosimilar would reduce the overall costs of multiple sclerosis treatment and should, therefore, be included in the National List of Essential Medicines.

Access and use of WHO essential medicines in Italy.

Many countries use the WHO Essential Medicines List (EML) as a guide for health policy choices to promote the efficient use of healthcare resources or adopt the concept of essential medicines (EMs) to develop their own national list of essential medicines. The aim of this study is to analyse the availability and use of medicines included in the 22nd WHO EML in Italy. Using the ATC code (5th level), a comparison was made between the medicines included in the WHO EML and those retrieved from the Italian Medicines Agency (AIFA) database. The availability (regulatory and reimbursement status) of EMs, as well as the market share in expenditure (million euros) and consumption [measured in WHO-defined daily doses (DDDs)], compared to all reimbursed medicines in 2021, were analysed. In 2021, approximately 85.2% (n = 414) of medicines included in the WHO EML were commonly marketed in Italy. Of these, 396 EMs were fully reimbursed by the Italian National Healthcare Service (INHS), corresponding to 81.5% (396/486) of the WHO EML, while the remaining 18.5% (90/486) were neither authorised (n = 72) nor reimbursed (n = 18). The study found a low coverage for anti-parasitic, insecticides, and repellent products (ATC P) in addition to medicines for the genitourinary system and sex hormones (ATC G). Even though medicines on the WHO EML, including therapeutic alternatives, accounted for ~48.5% of the expenditure for medicines reimbursed by INHS, the list covered 74% of all national drug consumed. Novel high-cost therapies indicated in high-prevalence diseases and rare conditions, mostly antineoplastic and immune-modulating agents (ATC L) not included in the WHO EML, were also guaranteed. In Italy, high coverage of EMs was found. It was largely reimbursed by the INHS, even when compared to other European countries. Essential medicines represented a high percentage of the overall expenditure and consumption in Italy. The WHO EML could be an important tool to guide the health policy choices of high-income countries, although a more frequent update and easier access to information on rejected medicines are needed.

Homoeopathy in Clotting

The current article discusses clotting through Pulmonary Embolism (PE), thereafter, it delves in to the epidemiology of PE, its clinical features, management & finally the application of homoeopathy to deal with this issue. It concludes with the cost effectiveness & therapeutic effectiveness of the homoeopathic system of medicine & suggests its involvement on a large scale in the nation. It only reinforces the age old concept of managing these chronic conditions through diet, regimen, exercise & homoeopathy. The suggestion of large scale use of homoeopathy is based on the premise of the modalities of essential medicines. The National List of Essential Medicines (NLEM) envisages that a medicine can be called essential only if it is cost effective, clinically effective & has no side effects. Homoeopathy fits into this triad fully. The article also suggests a treatment protocol based on the typical clinical features of PE & aspires that the public benefits from the protocol at large.

Exploring in vitro and in vivo anti-inflammatory activities of the Thai traditional remedy Kheaw-Hom and its bioactive compound, ethyl p-methoxycinnamate, and ethnopharmacological analysis

Ethnopharmacological relevanceKheaw-Hom (KH) remedy, a Thai traditional medicine (TTM) on the National List of Essential Medicines, has long been clinically used to treat fever and inflammation in children. However, no in vitro or in vivo anti-inflammatory or bioactive compound studies are published in the literature. Aims of the studyTo explore the in vitro and in vivo anti-inflammatory activities of KH remedy and its bioactive compound and analyze relationships between flavor and ethnopharmacological activities of plant components in KH remedy according to TTM theory. Materials and methodsEthyl p-methoxycinnamate (EPMC), a bioactive compound of KH remedy was analyzed using high performance liquid chromatography (HPLC). In vitro anti-inflammatory activities of ethanolic extract (KHE), aqueous extract (KHA), acid-hydrolysis of KHA (KHA-h), acid-hydrolysis of KH powder (KHP-h), and EPMC were investigated using lipopolysaccharide (LPS)-induced nitric oxide (NO), prostaglandin E2 (PGE2), and tumor necrosis factor-alpha (TNF-α) production in murine macrophage RAW 264.7 cells. In vivo anti-inflammatory activities of KH powder (KHP) and KHE were determined using carrageenan-induced paw edema and ethyl phenylpropiolate (EPP)-induced ear edema in rats and PGE2 production in tissue samples was examined. ResultsKHP-h showed the highest EPMC content (21.33 ± 1.08 mg/g of extract) and inhibited PGE2, NO, and TNF-α production with IC50 values of 11.92 ± 0.21, 30.61 ± 3.12, and 56.71 ± 2.91 μg/mL, respectively, followed by KHE and KHA-h while KHA did not. EPMC, a bioactive compound of KH remedy showed high anti-inflammatory activities through three pathways. KHP oral administration (100 mg/kg) significantly minimized rat paw inflammation at 1, 2, and 3 h while KHE (100 mg/kg) noticeably reduced at 2 and 3 h. KHP (100, 200, and 400 mg/kg) and KHE (100 mg/kg) significantly inhibited PGE2 production. KHP (1% w/v) notably reduced rat ear edema at 30, 60, and 120 min whereas KHE at all concentrations decreased swelling at 120 min. KHP and KHE at all doses significantly inhibited PGE2 production. Cool flavor was the main KH remedy flavor. Spicy plant components and some fragrant components showed high anti-inflammatory activity. ConclusionsResults from the in vivo study strongly paralleled the in vitro study. These findings support the rational use of KH remedy according to TTM theory for fever treatment and inflammation in children.

Drug use Pattern with Standard Indicators in Chattogram Medical College Hospital in Bangladesh

Irrational prescription being a global problem leading to ineffective, unsafe treatment. This study was conducted between November 10, 2019 to January 20, 2020 to assess drug use pattern using WHO/INRUD core prescribing indicators at Chattogram Medical College Hospital (CMCH). Total 500 patients were selected randomly. The results showed average number of drugs per encounter is 4.41 (optimal range = 1.6–1.8), generic drug prescription was 1.54% (optimal value = 100%), encounters with an antibiotic prescribed were 32.6% (optimal range =20.0–26.8%), encounters with an injection prescribed were 24.8% (optimal range =13.4–24.1%), drugs prescribed from EDL were 50.43% (optimal value = 100%) and drugs prescribed from the WHO EDL were 56.96% (optimal value = 100%). Average consultation time was 3.1 min (optimal value ≥10 min), average dispensing time was 35 s (optimal value ≥90 s) and the patients’ knowledge of correct dosage was 62.1% (optimal value =100%. The hospital had no copy of EDL and key drugs available in the stock were 82% (optimal value =100%). The concept of generic prescribing was negligible. There was reduced prescription of drugs from the National List of Essential Medicines, the prescription of antibiotics and injections was slightly higher than normal. Shorter consultation and dispensing time may lead to inadequate information about the medication being given to patients and patients had little chance to obtain information about their treatment. This study necessitates we are in need of strict scrutiny on the prescribing method of our country. So, we can achieve the goal of rational use of drug.

Alignment in the registration, selection, procurement and reimbursement of essential medicines for childhood cancers in South Africa

IntroductionThe effectiveness of a health system in providing access to medicines is in part determined by the alignment of several core pharmaceutical processes. For South Africa’s public health sector, these...

Pharmaceutical providing of the treatment of children with epilepsy in Ukraine and abroad

The aim: to investigate the pharmaceutical providing for the treatment of epilepsy in children in Ukraine and abroad and to conduct a marketing analysis of the domestic market of antiepileptic drugs.
 Materials and methods: domestic and foreign Internet sources, medical and technological documents on a specific research topic, the regulatory and legal base of Ukraine, materials of the State Formulary of Medicines, the State Register of Medicines of Ukraine were the objects of the study. The methods of marketing analysis, graphic, documentary and analytical generalization were used.
 Results: a comparative analysis of clinical protocols (France, Great Britain and Ukraine) for the treatment of epilepsy in children showed that there are only 12 INNs out of 37 INNs in the country. The analysis of the formulary lists of drugs of Great Britain and Ukraine showed that the BNFC has 32 INNs, and the domestic - 10 INNs. As of October 2022, 287 names of antiepileptic drugs are registered in Ukraine, and 164 of them are allowed in children's practice. The main producers of antiepileptic drugs are India and Ukraine. Children's drugs forms are mainly represented by tablets and capsules - more than 90%. A comparison of the lists of drugs for the treatment of epilepsy from the National List of Essential Medicines of Ukraine, BNFC, WHO Model List of Essential Medicines and WHO Model List of Essential Medicines for Children showed that out of 37 INNs, only 11 INNs are listed in all documents.
 Conclusions: the results prove the need of improvement of pharmaceutical providing of epilepsy treatment in Ukraine. The nomenclature and variety of dosage forms for children's practice need to be expanded. In order to increase the economic availability of epilepsy treatment, it is advisable to update the National List of the main drugs of Ukraine and include new drugs in it, which will make it possible to purchase them at the expense of the State Budget of Ukraine

Drug utilization pattern in patients of upper respiratory tract infections in pediatrics outpatient department at a tertiary care hospital

Background: Upper respiratory tract infections are the most common and frequently occurring infections in the pediatric population. These infections include conditions like common cold, laryngitis, pharyngitis, tonsillitis, acute rhinitis, acute rhinosinusitis and acute otitis media. Young children have an average of 6-8 colds per year, however 10 -15% of children have at least 12 infections per year. This study concentrates on prescription pattern of Upper Respiratory Tract Infections in children. primary objective was to study the prescription pattern of drugs used in URTI in pediatric outpatient department and the secondary objective was to determine whether the drugs being prescribed comply with those listed in the National list of essential medicines. Methods: This study was a Cross-sectional, observational study conducted at the Pediatric Outpatient Department in a tertiary care hospital, India. The data was collected from patients visiting Pediatrics OPD from June 2021 to December 2021 after taking written informed consent. Sample size was calculated to be 303. Results: Total 943 drugs were prescribed for 303 patients with an average of 3.11±1.15 drugs per prescription. Most common class of drugs prescribed was Antipyretics of which Paracetamol was the most common drug. Antibiotics were prescribed for 19.80% patients & combination of Amoxicillin and Clavulanic acid was the most common antibiotic prescribed. 68.29% drugs were prescribed by generic name. 43.16% drugs were prescribed from National List of Essential Medicines 2015. Conclusions: The study revealed that the majority of children suffering from URTI were below 5 years of age. Our study highlighted the prescribing.