National List Of Essential Medicines Research Articles

PRESCRIBING PATTERN OF DRUGS IN OUTPATIENT DEPARTMENT IN TERTIARY CARE HOSPITAL

Aim: The study was conducted to assess the prescribing behaviour for antimicrobials and various groups of drugs in tertiary care hospital in Puducherry. Prescription audit was done. Total 500 presc Method: riptions were analysed for sex wise distribution, no of patients for specic age group, antimicrobials prescribed in generic name, percentage of antibiotics, antacids, NSAIDs and multivitamins, among the prescribed drugs, groups of antibiotics, drugs prescribed from National List of Essential Medicines (2022), use ofxed drug combinations, injectable preparations if any. Results: Demographic analysis showed that out of 500 patients in OPD, most were female (53%) and in the age group between 41 to 60 years. In 500 number of prescriptions,9.96% of antibiotics were prescribed; uoroquinolones (5.42%) were prescribed more from antibiotics followed by extended spectrum penicillin (1.64%). 14.78%of antacids were prescribed; PPIs (11.28%) were prescribed more from antacids. 21.63% of NSAIDs were prescribed.11.66% were prescribed in generic names, 65.44% drugs were prescribed from National List of Essential Medicines (2022), 15.88% of FDCs were prescribed,6.13% of injectable preparations were prescribed. The rational use of antimicrobial agents is one of the main contribut Conclusion: ors to control worldwide emergence of bacterial resistance, side effects and reduced cost of the treatment

Long-Term Outcomes with Sequential Tyrosine Kinase Inhibitors Treatment in Chronic Myeloid Leukemia Patients

Tyrosine kinase inhibitor (TKI) is the standard treatment for chronic myeloid leukemia (CML). In the national list of essential medicines in Thailand, the first, second, and third-line treatments are imatinib, nilotinib, and dasatinib, sequentially, different from the European Leukemia Net guidelines. This study aimed to evaluate the outcomes of CML patients who received sequential treatment with TKI. This study enrolled CML patients diagnosed between 2008 and 2020 at Chiang Mai University Hospital who received TKI. Medical records were reviewed for demographic data, risk score, treatment response, event-free survival (EFS), and overall survival (OS). One hundred and fifty patients were included in the study, 68 patients (45.3%) were female. The mean age is 45.9 ± 15.8 years. Most patients (88.6%) had good ECOG status (0-1). The CML diagnosis was in the chronic phase in 136 patients (90.6%). The EUTOS long-term survival (ELTS) score revealed a high of 36.7%. At the median follow-up of 8.3 years, 88.6% of patients were in complete cytogenetic response (CCyR), whereas 58.0% were in major molecular response (MMR). The 10-year OS and EFS were 81.33% and 79.33%, respectively. The factors associated with poor OS were high ELTS score (P = 0.01), poor ECOG performance status (P < 0.001), not achieved MMR within 15 months (P = 0.014), and not achieved CCyR within 12 months (P < 0.001). The sequential treatment for CML patients had a good response. Factors predicting survival were ELTS score, ECOG performance status, and early achieving MMR and CCyR.

Analysis of the National List of Essential Medicines 2022: Hits and misses

Essential medicines are those that satisfy the “priority health care needs” of the population. Essential Medicines are selected based on efficacy and safety and comparative cost-effectiveness with due regards to public health relevance. The essential medicine list (EML) was created with the intention of ensuring that certain medications are accessible in sufficient quantities, in the proper dosage forms and strengths, and with guaranteed quality. For a country like India, with limited resources this is obviously important. In this article, we analyze the recently approved National list of essential medicine (NLEM) 2022 of India NLEM 2022 has quite significant changes as compared with NLEM 2015. The creation of NLEM 2022 followed a process which is like that adopted for NLEM 2015 includes numerous rounds of meetings with subject matter experts, various stakeholders, including non-governmental organizations (NGOs), patient groups, civil societies, the pharmaceutical industry, manufacturing associations, concerned government departments and organizations. The NLEM 2022 has been modified with new sections and subsections being added, thus helping in better classification of therapeutic classes of drugs.

Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level.

Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO's EML, India's national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year's consumption. The approximate time between procurement planning and distribution was 7-8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.

Validation of HPLC method for quantitative determination of active compounds in Thai traditional herbal medicine to treat gastrointestinal disease

Quality control is essential for determining the quality and consistency of medicinal plant products before their use. Thatbunjob is a Thai herbal formulation included in the National List of Essential Medicines for treating gastrointestinal diseases. This study aimed to develop and validate a high-performance liquid chromatography method for determining active compounds in Thatbunjob. The main compounds, gallic acid, chebulagic acid, rutin, and eugenol, were determined following the International Conference on Harmonization (ICH) guidelines. The method was validated in terms of linearity, accuracy, precision, limit of detection (LOD), and limit of quantitation (LOQ), and found to be linear, with a correlation coefficient (R2) ranging from 0.9995 to 0.9998. The LOD and LOQ values calculated from the calibration curve ranged from 7.29 to 20.29 and 22.09 to 61.48 µg/mL, respectively. The method also exhibited acceptable precision, with relative standard deviation values lower than 2%. The accuracy of the method was evaluated based on the recovery percentages, and found to be within an acceptable range (90.12–105.39%). The validated protocol developed in this study was employed to analyze the concentration levels of gallic acid, chebulagic acid, rutin, and eugenol in eight different Thatbunjob products commercially available in Thailand. The performance parameters show that the developed and validated method is appropriate for the quantitative determination of gallic acid, chebulagic acid, rutin, and eugenol in Thatbunjob.

A study on the contents of prescription of the in-patients of a tertiary care hospital, Manipur

Background: Appropriate medications are the backbone for effective control of infections and diseases. Objective of the study was to analyse the prescriptions relating to national list of essential medicines (NLEM) of a tertiary care hospital. Methods: Data was collected from 525 case sheets of the surgical in-patients for a period of 1 year which included total number of drugs prescribed, single (NLEM/non-NLEM) drugs, fixed dose combinations (NLEM/non-NLEM) drugs, most common drugs (NLEM/non-NLEM), route of administration, ADR/ADE and herbal drugs. Descriptive statistics was used for analysis of the data. Results: The total number of drugs observed in the case sheets was 2575. Out of the total drugs, 1942 drugs (75.4%) were from the list of NLEM (2022) while 633(24.6%) drugs were of non-NLEM. 266 drugs (10.33%) were generic drugs and 2309 drugs (89.67%) were proprietary drugs. The total number of single drug was 1839 (NLEM, 1805 + non-NLEM, 34) and that of the total FDC was 736 (NLEM, 137 + non-NLEM, 599). The most common drugs which were prescribed were analgesics: paracetamol 517 (NLEM); diclofenac supp.14 (non-NLEM), antibiotics: ceftriaxone 258 (NLEM, 14.5%), cefpodoxime proxetil 3 (non-NLEM, 8.9%), antihypertensive: telmisartan 13 (NLEM, 0.7%), non-NLEM nil, anti-diabetics: metformin 15 (NLEM, 0.8%), dapagliflozin 6 (non-NLEM, 16.7%), and gastroprotective drugs: pantoprazole 493 (NLEM, 27%), non-NLEM nil. Conclusions: Non-NLEM drugs should be prescribed only when there is definite advantages of the same over the NLEM drugs. Prescription of proprietary FDC drugs, factors for non-availability and under-prescription of NLEM drugs should be highlighted through CME coupled with awareness about the aim and objectives of the NLEM during clinical practice to the prescribers.

Susceptibility antibiotic screening reveals high rates of multidrug resistance of Salmonella, Shigella and Campylobacter in HIV infected and uninfected patients from Mozambique

BackgroundAntibacterial resistance is a growing concern worldwide, including in Mozambique. Diarrhea is an important cause of mortality in Mozambique, yet few local studies have reported on the resistance of bacterial pathogens in this context. Therefore, this study aims to characterize antibiotic susceptibility patterns of Salmonella, Shigella and Campylobacter spp. among patients with diarrhea, including those who are HIV-infected and-uninfected.MethodsWe conducted antibiotic susceptibility testing on 157 stool isolates recovered from 129 patients aged between 0 and 80 years with diarrhea, including HIV infected (n = 68) and-uninfected individuals (n = 61), assisted at two health centers in Maputo city. The isolates comprised of 99 Salmonella, 45 Shigella and 13 Campylobacter strains. The Kirby-Bauer disk diffusion method was used on Mueller-Hinton II agar for Salmonella and Shigella spp., while Mueller-Hinton II agar with 5% defibrinated sheep blood was used for Campylobacter spp. We tested six antibiotics listed on the national essential medicines list, including ciprofloxacin, erythromycin, azithromycin, trimethoprim-sulfamethoxazole, gentamicin, and tetracycline.ResultsAll isolates were resistant to at least one antibiotic. A high percentage of Salmonella spp. isolates were found to be resistant to trimethoprim-sulfamethoxazole (89.9%, n = 89), erythromycin (88.9%, n = 88) and tetracycline (76.8%, n = 76). In addition, 86.6% (n = 39) and 68.9% (n = 31) of Shigella isolates were resistant to trimethoprim-sulfamethoxazole and tetracycline, respectively. The majority of Campylobacter isolates (92.3%, n = 12) were resistant to erythromycin, azithromycin and tetracycline. Multidrug resistance (MDR) was observed in 79.8% of Salmonella spp., 76.9% of Campylobacter spp., and 57.8% of Shigella spp. Drug susceptibility profiles for Salmonella spp. and Campylobacter were similar in both HIV-1 infected and uninfected patients. However, Shigella spp. isolates obtained from patients without HIV infection were significantly more likely to be resistant to erythromycin, azithromycin or to exhibit multidrug resistance than those obtained from patients with HIV-1 infection (p < 0.05). All Shigella spp. and Campylobacter spp. isolates were susceptible to gentamicin.ConclusionOur study highlights concerning rates of antibiotic resistance and MDR among diarrheal bacterial pathogens in Mozambique. Further research is needed to understand the impact of HIV, ART therapy and immunosuppression on antibiotic resistance. Urgent interventions are essential to prevent the spread of resistant strains.

Anticancer medicines in Pakistan: An analysis of essential medicines lists.

The lack of anticancer drugs for curative and supportive purposes is the critical reason for the low survival rate in low-and-middle-income countries. This study aims to analyze whether the National Essential Medicines List (NEML) and Registered Essential Medicines List (REML) are in concordance with the World Health Organization (WHO) Essential Medicines List (EML) and whether the formularies prevalent in the country are parallel to each other and to the NEML. An observational study design was used in which antineoplastic drugs from the 2021 NEML and REML were compared with 2021 WHO EML to evaluate their availability in Pakistan. Market access was determined. Moreover, the formularies of six different hospital types were compared with each other and with the NEML, and REML to estimate the availability within hospitals. There were 66 anticancer drugs in 2021 WHO EML and all were found in Pakistan's 2021 NEML but only 48 drugs (73%) were found in the REML. Hydroxycarbamide and dasatinib were two registered drugs absent in all hospitals' formularies. The market access for anticancer medicines was 73% (48 of 66). Semigovernment hospital (86%) has the highest availability, followed by the government hospital (80%). All the hospitals have unregistered drugs including bortezomib, lenalidomide, and mesna. Pakistan's NEML adopts WHO EML abruptly but all medicines are not registered. The hospitals are trying their best to increase availability but optimum drug regulations to revise NEML based on the country's requirements and emphasizing registration of anticancer medicines are needed to improve the country's availability of antineoplastic agents.

THE USE OF MEDICAL AND PHYTOTHERAPIC PLANTS IN BRAZILIAN PUBLIC HEALTH.

Medicinal plants are used for the purpose of promoting quality of life, even from primordial times. This paper aimed to present the importance of the use of herbal medicines in the network public health. The practice and consumption of herbal medicines has been growing every year, with the emergence of Ordinance No. 971 of May 3, 2006 approving the National Policy for Integrative and Complementary Practices (PNPIC) in Unified Health System (SUS). But there is still a big factor to be overcome, the high requirement of the National Agency Health Surveillance Authority (ANVISA), for the production, marketing and distribution of herbal medicines in the SUS. THE Ordinance GM / MS No. 533 of March 28, 2012 (National List of Essential Medicines - RENAME), cast herbal medicines in Primary Care, consists of only 12 plant species of interest of SUS, considered low due to Brazil being considered one of the countries with the greatest biodiversity in the world. The main problems that hindering the advances of herbal products in the SUS are the lack of state and municipal public policies and the lack of of interest of the managers of these secretariats in complying also with the federal legislation in force.

Application of Microwave-Assisted Drying to Shorten Granules Drying Process for the Preparation of Thunbergia laurifolia Lindl. Leaf Tablets

Thunbergia laurifolia Lindl. is a medicinal plant that belongs to the family of Acanthaceae. It possesses several biological and pharmacological activities. According to the Thai National List of Essential Medicines, T. laurifolia leaves are used for the treatment of fever. This work sought to optimize microwave-assisted drying of Thunbergia laurifolia Lindl. leaf granules to shorten the granule drying process by the 32 full factorial design. Power was varied from 300, 450 and 600 W for 5, 10 and 15 min, to minimize moisture content and maximize rosmarinic acid content. Results showed that the optimal microwave-assisted drying condition within the design space and control space was the power of 450 W for 13 min. This condition gave the moisture content of 4.77 ± 0.24 % and rosmarinic acid content of 0.0566 ± 0.0075 %. The HPLC method was validated; it showed good linearity, specificity, precision, and accuracy. Furthermore, the system suitability was achieved. The T. laurifolia leaf granules obtained from the optimal microwave-assisted drying condition were further used to prepare T. laurifolia leaf tablets by the wet granulation method. Three batches of 650 mg tablets containing 250 mg of T. laurifolia leaf powder were prepared using different compression forces: 500, 1,000 and 1,500 psi. The suitable compression force was 1,500 psi; the tablet formulation had suitable hardness (9.88 ± 0.52 kP), low friability (0.20 %), and a short disintegration time (23.17 ± 0.76 s). Rosmarinic acid marker was dissolved from the tablets for approximately 75 % within 4 h when 0.5 % sodium lauryl sulfate aqueous solution was used as dissolution medium. In conclusion, microwave-assisted drying could be applied in preparing T. laurifolia leaf tablets by shortening the granules drying time. HIGHLIGHTS The 32 full factorial design was applied to optimize microwave-assisted drying of Thunbergia laurifolia leaf granules The optimal microwave-assisted drying condition providing the low moisture content with high rosmarinic acid content was the power of 450 W for 13 min The tablets prepared from laurifolia leaf granules had suitable hardness, low friability, short disintegration time, and a high percentage of rosmarinic acid marker dissolved GRAPHICAL ABSTRACT

Impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines

BackgroundIn many low- and middle-income countries, the 2019 novel coronavirus (COVID-19) has challenged efforts to ensure access to and availability of quality maternal, newborn, and child health (MCH) services and essential MCH commodities.ObjectivesThis study evaluated the impact of COVID-19 pandemic on the availability of maternal and child health products and childhood vaccines at selected health facilities in Ethiopia.MethodsWe have prospectively assessed 28 maternal–child health products and 14 childhood vaccines and accessories, which are listed in the Ethiopian national essential medicines list. Data were collected from 5 hospitals located in the Jimma zone of Oromia regional state in the southwestern part of Ethiopia. We extracted data on drug availability, and order fill rates for these pharmaceutical products between May 2019 and August 2020.ResultsThe overall mean availability of selected maternal and child health products was 43.2%. It was 52.9% (range 21.0–63.6%) prior COVID-19 and 42.6% (range 19–56.4) during COVID-19 time. The average monthly orders fill rates of hospitals for the selected products ranged from 39 to 79%. Before COVID-19 the average order fill rate was near 70% of total orders placed by the hospitals. However, immediately after the COVID-19 case notification in Ethiopia, the percentage of order filled correctly in items and quantities began decreasing.ConclusionThis study illustrates that the availability of key essential medicines for maternal and child health in the study area was low. The overall stock-out situation of MCH products has worsened during COVID-19 compared to pre-COVID-19 pandemic. None of the surveyed MCH products met the ideal availability benchmark of 80% in the public hospitals. To allow governments to guarantee these products are constantly available and affordable, a variety of policy frameworks and choices addressing inevitable epidemics should exist.

National List of Essential Medicines 2022 of India: Perspectives from Psychiatrists.

National List of Essential Medicines 2022 of India: Perspectives from Psychiatrists.

A validated LC–MS/MS method for clinical pharmacokinetics and presumptive phase II metabolic pathways following oral administration of Andrographis paniculata extract

Andrographis paniculata, a medicinal plant in Thailand national list of essential medicines, has been proposed for treatment of patients with mild to moderate coronavirus disease 2019. This study aims to develop a highly selective and sensitive liquid chromatography triple quadrupole tandem mass spectrometry method for quantitative determination of major diterpenoids in plasma and urine with application in pharmacokinetics. Chromatographic separation was performed on C18 column using a gradient mobile phase of water and acetonitrile. Mass spectrometry was analyzed using multiple reaction monitoring with negative ionization mode. This validated analytical method was very sensitive, less time consuming in analysis, and allowed the reliability and reproducibility on its application. The clinical pharmacokinetics was evaluated after single oral administration of A. paniculata extract (calculated as 60 mg of andrographolide). The disposition kinetics demonstrated that major diterpenoids could enter into systemic circulation, but they are mostly biotransformed (phase II) into conjugated glucuronide and sulfate metabolites. These metabolites are predominantly found in plasma and then extremely eliminated, in part through urinary excretion. The successful application of this analytical method supports its suitable uses in further clinical benefits after oral administration of A. paniculata.

Trends in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties: a three-year retrospective study in a tertiary hospital in Thailand.

The study determined a comparative three-year trend in prescribing volumes and costs of proton pump inhibitors in three outpatient specialties of a tertiary hospital. Prescription data for three consecutive fiscal years (2016-2018) were extracted from a tertiary hospital electronic database, for the gastrointestinal, cardiovascular and orthopaedic outpatient specialties. The data collected were individual proton pump inhibitors, overall and individual prescribing volumes (capsule/tablet) and costs, stratified by specialty and fiscal year. Of the three specialties, the largest volume of proton pump inhibitor prescriptions, mostly for omeprazole, comes from the orthopaedic specialty (46%). In terms of prescribing costs, at the top is the cardiovascular specialty (45.75%). Lansoprazole, which is one of the proton pump inhibitors on in the national list of essential medicines, contributed most to the cost. Prescribing proton pump inhibitors that are not included in the national list of essential medicines were responsible for over 90% of the costs in the cardiovascular and gastrointestinal specialties. An escalating trend in prescribing varied proton pump inhibitors, that is, esomeprazole, lansoprazole, pantoprazole, dexlansoprazole and rabeprazole, all of which were not on the list of essential medicines, was evident in the latter. The highest volume of proton pump inhibitor prescribing-mostly of omeprazole, was issued by the orthopaedic specialty. The cardiovascular specialty was responsible for the largest amount of cost. The increases in the uses and costs of varying proton pump inhibitors which were outside the national list of essential medicines were notable in the gastrointestinal specialty.

Bridging the gap? Local production of medicines on the national essential medicine lists of Kenya, Tanzania and Uganda

BackgroundEssential medicines (EMs) are those that satisfy the basic healthcare needs of the population. However, access to EMs remains a global health challenge. The World Health Organization (WHO) and the East African Community (EAC) manufacturing plan 2017–2027 support local production of EMs as a strategy to improve access to medicines. The aim of this study was to determine for each therapeutic class on the national essential medicine lists (NEMLs) of Kenya, Tanzania and Uganda, the number of EMs produced in each country.MethodsIn 2018, we analysed NEMLs and national drug registers (NDRs) in each country to identify local manufacturers and local products by EM status. For each local manufacturer we determined the number of EM products and individual EMs, and analysed EMs in each therapeutic class by registration status and whether produced locally.ResultsThere were nine companies manufacturing locally in Kenya, four in Tanzania and six in Uganda. Most local medicine products were non-EM products. Of the 946 locally produced products in Kenya, 310 were EM products; of the 97 locally produced products in Tanzania, 39 were EM products; and of the 181 locally produced products in Uganda, 100 were EM products. Many local EM products were duplicate. Only a small proportion of EMs on each NEML were produced locally: 21% (92/430) in Kenya, 5% (24/510) in Tanzania, and 10% (55/526) in Uganda. Kenya, Tanzania and Uganda had no local EM products in 13/32, 17/28 and 15/32 therapeutic classes, respectively. The proportion of EMs that were registered varied across the countries from 327 (76%) in Kenya, 269 (53%) in Tanzania, and 319 (60%) in Uganda.ConclusionsThis study highlights the importance of auditing NDRs and NEMLs for local production to inform regional and national local manufacturing strategies. EMs should be prioritized for local production and drug registration to ensure that production is aligned with local health needs.

Essential medicines for mental disorders: comparison of 121 national lists with WHO recommendations

BackgroundTo compare the medicines for mental disorders included in national essential medicines lists with the World Health Organization (WHO) essential medicines list and assess the extent to which economic status and WHO Region account for the differences.MethodsWe searched WHO repository and government sites for national essential medicines lists and we abstracted medicines for mental disorders. We calculated the proportion of WHO essential medicines included, the total number of differences (counting both additions and deletions) between national and WHO model list and the proportion of lists including one second-generation oral antipsychotic plus one new-generation antidepressant. Non-parametric statistics was used to investigate whether these indicators were dependent on economic status and WHO Region.ResultsAmongst the 121 identified national lists, the total number of medicines for mental disorders ranged from 2 to 63 (median: 18; IQR: 14 to 25). The median proportion of WHO essential medicines for mental disorders included was 86% (IQR: 71–93%), with 16 countries (13%, 95% CI 7.75–20.5%) including all WHO essential medicines, while the median number of differences with the WHO EML was 11 (IQR: 7 to 15). Country economic level was positively associated with both the proportion of WHO essential medicines included (Spearman's rho = 0.417, p < 0.001) and the number of differences (Spearman's rho = 0.345, p < 0.001), implying that countries with higher income level included more WHO essential medicines, but also more additional medicines. Significant differences were observed in relation to WHO Region, with the African and Western Pacific Region showing the lowest proportions of WHO essential medicines, and the European Region showing the highest median number of differences. Overall, 88 national lists (73%, 95% CI 63–80%) included at least one second-generation oral antipsychotic and new-generation antidepressant, with differences by income level and WHO Region.ConclusionsThe degree of alignment of national lists with the WHO model list is substantial, but there are considerable differences in relation to economic status and WHO Region. These findings may help decision-makers to identify opportunities to improve national lists, aiming to increase access to essential medicines for mental disorders.

Cefazolin access and use in Ethiopia: A policy implication.

Healthcare systems in resource-limited nations have been challenged by the shortage of essential medicines. This study explores cefazolin access and uses history in the Ethiopian healthcare delivery system, for possible policy implications. An exploratory qualitative study was conducted from July to August 2021. Semi-structured questions and observation guides were used to extract necessary data from people, documents, and field visits to hospitals, government supply agencies, and pharmaceutical business firms. The data were transcribed, coded, organized into themes, and presented. Cefazoline is the recommended first-line surgical antibiotic prophylaxis (SAP) in the Ethiopian Standard Treatment Guideline (STG) and is included in the national Essential Medicine List (EML). However, it was not available for use in the Ethiopian pharmaceutical markets for years. While the shortage might stem from supply-demand mismatches, multiple unknown issues exist in the background of the shortage. This is evidenced by the removal of cefazolin from the recent government procurement list regardless of the recommendation set in the national EML and STG. This study found a historic shortage of cefazolin in Ethiopian healthcare settings. This implies that the antibiotic availability in the pull market may not reflect required usage at facilities for several reasons including the misalignment of national guidelines and national procurement processes, and miscommunication between pharmacies and clinicians at sites on drug availability. Changing the essential medicines list and/or procurement requests without active review of the supply chain system and prescribing practices at facilities can lead to the elimination of necessary antimicrobial agents from the national public health sector supply.

Effect on mortality of inclusion of drugs in Thailand's National List of Essential Medicines, 2005–2016

ObjectiveTo assess the effect of long-run changes in the drugs included in the National List of Essential Medicines (NLEM) on mortality in Thailand. MethodsUsing longitudinal data on many diseases, I estimate difference-in-differences (2-way fixed effects) models to investigate whether diseases for which there were larger increases in the number of NLEM drugs had larger subsequent reductions (or smaller increases) in mortality. This design controls for the effects on mortality of general economic and societal factors (e.g. income, education, and behavioral risk factors), to the extent that those effects are similar across diseases. ResultsThe addition of drugs to the NLEM between 2003 and 2014 reduced the number of years of potential life lost before age 75 in 2016 by about 650 thousand. The addition of a new (post-2002) drug for a disease to the NLEM is estimated to have reduced the number of deaths from that disease two years later by 25%, while the addition of an old (pre-2003) drug is estimated to have reduced the number of deaths two years later by 5%. ConclusionThe expansion of the NLEM reduced the number of deaths and the number of years of potential life lost before ages 75 and 65 2–5 years later. A preliminary estimate of pharmaceutical expenditure per life-year before age 75 gained in 2016 from drugs added to the NLEM between 2003 and 2014 is 888 USD.

A Cross Sectional Study to Analyze Drug Utilization Pattern of Pain Clinic in a Tertiary Care Hospital of Central India

Background: Pain is associated with increased prevalence of chronic diseases which adversely affects the quality of life of patients. This also leads to increased demand of drugs for chronic pain relief. Drug utilization pattern studies of pain clinic are therefore important to ascertain rational use of medicines in healthcare system.The study aims to evaluate drug utilization pattern in pain clinic of a tertiary care teaching hospital.&#x0D; Methods: A cross sectional study was done by analyzing prescriptions of patients at pain clinic of MYH Hospital of Indore, MP, India, for a period of 3 months from November 2021 to January 2022. Total 260 prescriptions were analyzed on the basis of WHO core prescribing indicators, FDC (Fixed Dose Combinations) &amp; NLEM (National List of Essential Medicines) list by using descriptive statistics.&#x0D; Results: Study results showed that analgesics were most commonly prescribed in the age grou p 41-60 years. Lower back pain (28.8%) was the most common indication for prescribing analgesics in pain clinic with a female preponderance of 57.7%. Out of total 639 drugs, Fixed Dose Combinations (FDC)(76.2%) were more than single drugs (24.8%). 59.3% of drugs were concomitant medications. 80% (220) FDCs were generic and Gabapentin+Nortryptiline (31.8%) was the commonest FDC. Pregabalin was the most commonly prescribed single drug preparation. Average number of drugs per encounter were 2.45 and generic prescribing was 85.7%. Total 46% of medicines were prescribed from NLEM.&#x0D; Conclusion: We found that FDC, generic prescribing and concomitant medications use was higher in our study. The study guides for rational prescribing of analgesics to maximize pain relief and minimize adverse effects associated with it.

Drug utilization pattern among patients of chronic renal failure on maintenance hemodialysis in a tertiary care teaching hospital

Background: In India, end-stage renal disease incidence is 100 patients/million population/year, which means every year for a population of 1 billion almost more than 100,000 new patients will occur. Nowadays, the prevalence of chronic kidney disease (CKD) is augmenting due to the advancement of age, polypharmacy, and drug interactions. Drug utilization studies determine the rational prescription of drugs. Aim and Objectives: The aims of this study were to determine the drug utilization pattern among CKD patients who were on maintenance hemodialysis and to identify the comorbidities among them. Materials and Methods: After obtaining approval from the Institutional Ethics Committee a prospective, observational study was conducted by the Department of Pharmacology, Guntur Medical College, Guntur, from January to June 2022. The details of demographic, biochemical, clinical data, and drugs prescribed in CKD patients undergoing maintenance hemodialysis were recorded in a structured case report form. To analyze the data, descriptive statistics were used. Results: Among 100 patients evaluated, males and females were 72 and 28, respectively. Their mean ages were 47.55 ± 11.49 years and 39.82 ± 13.56 years, respectively. The majority of the patients received hematinics followed by multivitamins, anti-hypertensives, drugs used in gastrointestinal disorders, antioxidants, respiratory drugs, CNS drugs, diuretics, and antibiotics. The most common comorbidity was hypertension followed by diabetes, epilepsy, tuberculosis, and HIV. Among the prescribed drugs, 74% were from the Indian national list of essential medicine and only 3% were by generic name. About 74% of patients received five or more drugs. Conclusion: This study describes the pattern of drug utilization in CKD patients undergoing maintenance hemodialysis. As polypharmacy is more prevalent, among them elements such as adverse drug reactions and adherence to therapy must be investigated further to minimize drug interactions and to improve patient quality life.