Pharmacy Sales Research Articles

The study of the range, availability and affordability of vitamin B1 medicines combined with vitamin B6 and/or B12 in the pharmaceutical market of Ukraine

Aim. To conduct a study of the range of combined neurotropic vitamins B in the pharmaceutical market, to analyze their availability and affordability for patients with neurological diseases. Materials and methods. The study was conducted using data from the State Register of Medicines of Ukraine, ATC classification, and information on statistical retail prices from the online service www.tabletki.ua. Such research methods as systematization, generalization, comparative, marketing, content analysis, pharmacoeconomic analysis by the “cost of illness” method were used. Results. The pharmaceutical market of vitamin A11DB group Vitamin B1 in combination with vitamin B6 and/or B12 registered in Ukraine as 43 trade names (TN) of medicines has been analyzed taking into account all dosage forms; among them, 53.5 % are medicines of domestic manufacturers. Among dosage forms, the vast majority are solutions for injection (65.1 %). Only 56 % of the registered medicines are accessible, i.e. available for sale in regional pharmacies, with an equal proportion of domestic and foreign manufacturers. In 63 % of the drugs studied, the price liquidity ratio indicator shows fluctuations from 0.51 to 1.0, which indicates a significant range of drug prices, a relatively low level of competition in the market, and negatively characterizes the availability of these drugs for the population. It has been found that for injectable dosage forms of the drugs studied, the coefficient of adequacy of solvency ranges from 1.41 % to 3.30 %, and for oral medicines – from 0.67 % to 6.20 %, i.e., the cost of purchasing one package of a complex vitamin B medicine does not exceed 6.20 % of the average monthly salary on the example of the Odesa region, which is not included in the List of territories where military operations are (were) conducted or temporarily occupied. A pharmacoeconomic analysis has been conducted using the “cost of illness” method; and the drugs of choice have been selected taking into account the information on their equivalence provided by the manufacturer. According to the results of this analysis, it has been found that the cost of treating polyneuropathy with complex vitamin B medicines produced in Ukraine is 1.4-6 times more affordable than in the case of imported analogues. Conclusions. The results presented indicate the need to introduce additional mechanisms for compensating the cost of vitamin B medicines in order to increase the level of socio-economic affordability of pharmaceutical care provided in pharmacies. In addition, they can be used in the formation of the range of medicines to ensure the availability of medicines of choice, taking into account the most affordable cost of the treatment course.

The prevalence and causes of self-medication among medical university students in Iran during COVID-19 outbreak and its implications for public health and health systems: A cross-sectional study.

Self-medication is a worldwide phenomenon that brings advantages and disadvantages to public health and health systems. This study investigated the extent and causes of self-medication among medical university students and its implications for public health in Iran in 2020. The present study was designed as a descriptive-analytical cross-sectional study that examined the knowledge, attitude, and practice of self-medication. The population of the study was the students of health sciences programs who all entered the study. The data collection tool included a questionnaire designed online and available to students. The content validity ratio of the questionnaire was 0.84, and the alpha Cronbach coefficient was calculated at 0.8936. The prevalence of self-medication among medical university students was 19%. The most common reason for self-medication was the safety of medicines (66.67%). The most usual form of medication used was the tablet (35.67%), the most common drug taken was acetaminophen (69.01%), and the most common disease to self-medicate for was headache (67.36%). Estimating the odds ratio of self-medication with demographic variables showed no relationship. However, after adjusting the variables, age and type of degree showed an association with self-medication, as the older participants and postgraduate students had positive attitudes toward self-medication. Self-medication may be helpful, but it often needs proper guidance and logic and can carry various risks. Considering that medical sciences students will be influential in society in the future, it is necessary to pay more attention to correcting their drug use culture and providing access to health services for everyone. Appropriate prescription of medicines, controlling drug sales in pharmacies, highlighting the role of pharmacists in safe self-medication, and controlling the prevalence of self-medication is necessary.

Come back when you're infected: pharmacy access to sterile syringes in an Arizona Secret Shopper Study, 2023.

Pharmacies are critical healthcare partners in community efforts to eliminate bloodborne illnesses. Pharmacy sale of sterile syringes is central to this effort. A mixed methods "secret shopper" syringe purchase study was conducted in the fall of 2022 with 38 community pharmacies in Maricopa and Pima Counties, Arizona. Pharmacies were geomapped to within 2 miles of areas identified as having a potentially high volume of illicit drug commerce. Daytime venue sampling was used whereby separate investigators with lived/living drug use experience attempted to purchase syringes without a prescription. Investigator response when prompted for purchase rationale was "to protect myself from HIV and hepatitis C." A 24-item instrument measured sales outcome, pharmacy staff interaction (hostile/neutral/friendly), and the buyer's subjective experience. Only 24.6% (n = 28) of 114 purchase attempts across the 38 pharmacies resulted in syringe sale. Less than one quarter (21.1%) of pharmacies always sold, while 44.7% never sold. Independent and food store pharmacies tended not to sell syringes. There emerged distinct pharmacy staff interactions characterized by body language, customer query, normalization or othering response, response to purchase request and closure. Pharmacy discretion and pharmacy policy not to sell syringes without a prescription limited sterile syringe access. Investigators reported frequent and adverse emotional impact due to pharmacy staff negative and stigmatizing interactions. Pharmacies miss opportunities to advance efforts to eliminate bloodborne infections by stringent no-sale policy and discretion about syringe sale. State regulatory policy facilitating pharmacy syringe sales,limiting pharmacist discretion for syringe sales, and targetingpharmacy-staff level education may help advance the achievement of public health goals to eliminate bloodborne infections in Arizona.

‘When I tried to explain, they shouted back at me!’: exploring how community pharmacists navigate tensions implementing antimicrobial stewardship in Vietnam

ABSTRACT Antimicrobial resistance is a major global and national health challenge, accelerated by ‘irrational’ antibiotic use. In response, Vietnam has been implementing a public health plan of antimicrobial stewardship since 2013 to reduce antibiotic sales in community pharmacies, although it has had limited effect. Given that private pharmacies are increasingly the entry point to access healthcare, reflective of the inhibited accessibility of primary healthcare, understanding how the positioning of community pharmacists shapes the delivery of antimicrobial stewardship plans warrant further investigation. This qualitative analysis draws on data from 24 in-depth interviews with licensed community pharmacists in Vietnam. Interviewees described being constrained in rationing the sale of antibiotics by tensions within their professional role, in which the delivery of antimicrobial stewardship within their public health commitments rubs up against commercial and social obligations to their livelihoods and communities respectively. The concept of ‘resistance’ provides insight into what obstructs the integration of national antimicrobial stewardship guidance and policy, hindering the transformation of local practices concerning antibiotic sales at the community level. Findings reveal opportunities to recast community pharmacists as ‘productive anchors’ who can facilitate the appropriate use of antibiotics and strengthen links to primary care within the local context. Structural changes are needed, however, so that people do not use antibiotics as a proxy for health care. Improving the accessibility of primary healthcare would also curtail the reliance on community pharmacists’ to dispense antibiotics as a local mechanism of financial protection and social care within community.

The Impact of EG and DEG Cases on Sales of Over-The-Counter Syrup

The Indonesian Food and Drug Authority (BPOM) investigated and listed safe and unsafe syrup products in response to the contamination of Ethylene Glycol (EG) and Diethylene Glycol (DEG), causing Acute Kidney Injury in pediatric patients. Unsafe products were recalled and removed from distribution, leading to uncertainty and panic among the public and significantly impacting over-the-counter syrup sales in several pharmacies. This retrospective observational study assessed the impact of EG and DEG contamination on the sales of over-the-counter syrup in Pharmacy X in South Denpasar. Data from three months before (August to October 18th, 2022) and three months following the official instruction was published (October 19th, 2022 to December 2022) were analyzed using Wilcoxon test. The findings reveal a staggering decline in the sales of over-the-counter syrup by 35,03% (p-value of 0.03). Moreover, there was a notable increase of prescriptions in powder forms. The contamination cases caused panic, resulting in changes in behavior and consumption patterns. Despite the availability of safety information on an official website, public hesitance toward syrup products persists, indicating the need to implement a more effective strategy to address misinformation and restore public trust. Each individual must be responsible for educating the public during crises to prevent the spread of misinformation, ultimately restoring trust and normal consumer behavior. Furthermore, efficient stock management should be implemented to anticipate potential health crises in the future proactively.

Community pharmacists' perceptions of the POM to P reclassification of medicines for sexual and reproductive health – A survey study

Abstract Introduction In the UK, medicines reclassification is the process of changing the legal classification of a medication, such as from a prescription-only medicine (POM) to a pharmacy (P) or general sales list (GSL) medicine.1 It is overseen by the Medicines and Healthcare products Regulatory Agency (MHRA). and improves patient access to certain medications while ensuring safeguards are in place for their safe and responsible use.2 A number of the most recent POM to P reclassifications have been for medications used in sexual and reproductive healthcare. Aim To investigate community pharmacists' (CPs’) perceptions of POM to P medicine reclassifications for sexual and reproductive health: sildenafil citrate (Viagra Connect, for erectile dysfunction), desogestrel (Hana/Lovima, for contraception), and estradiol hemihydrate (Gina, for vaginal atrophy). Methods The study population was all CPs in Greater London. The survey consisted of 59-questions in five sections. The first section was for general perceptions about the reclassification of medicines, while the other sections were specific to the medicines studied. The final section was demographics. Question types included multiple-choice, 5-point Likert scale, and free text. The recommended sample size was 340 (95% CI), therefore, 398 CPs, in 210 pharmacies, were approached. Ethical approval was obtained from the university ethics committee. Participants were posted a participant information sheet (PIS) one week before distribution of the survey as a hard copy. The survey was also available on Microsoft Forms. Data were analysed in Microsoft Excel and Statistical Package for Social Sciences (SPSS). Descriptive statistics were given in numbers and percentages. Results The response rate was 37.7% (N=150/398). Most CPs (88%) perceived that medication reclassification increased their role and provided greater access to medicines for the public. However, less than half (44%) had a good understanding of the reclassification process. Sildenafil was available to purchase in all of the visited pharmacies, however, desogestrel was only sold in 50% of them, and estradiol was sold in only 28%. Reasons cited for not selling desogestrel and/or estradiol included lack of public awareness about the availability of these products, and a lack of public interest in purchasing them. While the availability of sildenafil as a P medicine was seen as a positive for improving safe access, many CPs (86%) expressed concerns about the high risk of its misuse. In terms of training, the available training for sildenafil received higher ratings compared to that for desogestrel or estradiol. Most CPs (67%) indicated that having case studies incorporated into the training for POM to P switches helped them understand which patients could safely purchase these medications. Discussion/Conclusion CPs are positive about the availability of sexual and reproductive health medications over the counter. They do have concerns, however, about the potential of some of these medications to be misused, and also feel that more awareness of the availability of these products needs to be raised. Those producing training materials for reclassified medications should incorporate case studies as these support CP decision making. A limitation of this study was that the recommended sample size was not achieved.

Research of ways to improve the effectiveness of remote sales in pharmacies

Aim. To audit the websites of pharmacy chains to identify the main problems and directions for improving the effectiveness of the sale of medicines using information and communication systems remotely.
 Materials and methods. The content analysis, desk research methods, logical summarization of results, and the graphic method were used to achieve the goal. Data from website analytics were used for the analysis.
 Results. Six sites of pharmacy chains in Ukraine have been analyzed. It has been found that on average one user views three pages per session, the duration of the session is one minute on average, and the buyer on average collects a basket of four products in the amount of UAH 300. It has been determined that the main login pages are: product page, product list, and main page. It has been determined that search is a key feature of product selection and is used in 15 % of all sessions. It has been found that in 70 % of cases, mobile devices are used, desktops are used in on average in 26 % of cases, and tablets are used in 4 % of cases. It has been determined that, on average, twice as many conversions are made through the desktop than when using mobile devices and tablets. For the analysis, the most common scenarios of user behavior on the pharmacy chain sites have been selected. While implementing the most frequent errors on websites have been identified, when the interface does not respond to important requests of consumers, which affects their purchase decisions. The analysis and systematization of the main errors on the websites of pharmacy chains have been carried out; recommendations for their elimination have been formulated. This will make it possible to increase the effectiveness of information support for electronic sales of pharmacies in accordance with the requirements of proper pharmacy practice, will affect the customer loyalty and the economic indicators of the activity of pharmacies. 
 Conclusions. Based on the results of the study, it can be concluded that usability errors and factors contributing to growth should not be underestimated since they can significantly affect conversion rates; even a slight rapid change can improve the site’s KPIs; it is necessary to make the interface equally user-friendly on different devices.

Six years' experience and trends of serum 25-hydroxy vitamin D concentration and the effect of vitamin D3 consumption on these trends.

Introduction: Vitamin D (vitD) deficiency may have importance in some diseases, but there is a lack of data in our country to clarify the current situation. Our aim was to examine the basic characteristics of patients' vitD status, and the ratio of vitD deficiency and its relation to certain diseases, assess seasonality and trends, and reveal the indirect impact of the COVID-19 pandemic on vitD3 supplementation at the patient population level. Methods: Anonymized data on 25(OH)D test results were obtained from the clinical data registry of a tertiary teaching hospital covering the period between 1 January 2015 and 30 June 2021. VitD consumption (pharmacy sale) data were retrieved from the database of the National Health Insurance Fund of Hungary in order to calculate the defined daily dose (DDD)/1,000 inhabitants/day. Descriptive statistics and odds ratios with their 95% confidence intervals were calculated. The two-sample t-test and F-test were used to analyze our patients' data. Significant differences were considered if p <0.05. Results: Altogether, 45,567 samples were investigated; the mean age was 49 ± 19.1years and 68.4% of them were female subjects. Overall, 20% of all patients had hypovitaminosis D, and just over 7% of patients had vitD deficiency. Male subjects had higher odds for hypovitaminosis or vitD deficiency (65.4 ± 28.2nmol/L vs. 68.4 ± 28.4nmol/L; p <0.0001). The mean 25(OH)D concentration has changed during the year, reaching a peak in September and a minimum in February. Patients with diseases of the circulatory system, genitourinary system, certain conditions originating in the perinatal period, and "sine morbo" (i.e., without a disease; such as those aged over 45years and female teenagers) had statistically higher odds for lower 25(OH)D concentrations (p <0.00001). VitD consumption showed seasonality, being higher in autumn and winter. A slight increase started in the season of 2017/18, and two huge peaks were detected at the beginning of 2020 and 2021 in association with the COVID-19 waves. Conclusion: Our data are the first to describe data concerning vitD in our region. It reinforces the notion of vitD3 supplementation for some risk groups and also in healthy individuals. To prevent the winter decline, vitD3 supplementation should be started in September. This and the results during the COVID-19 pandemic highlight the importance of health education encouraging vitamin D3 supplementation.

PREPARATION AND STUDY OF JUNIPER BERRY AND SEED EXTRACTS

The study of antioxidants in plants is one of the modern scientific and practical problems. The aim of this work is to obtain the extracts of pharmacy sale juniper berries and seeds, and to study their antioxidant properties by the method of competitive reactions. In this work, a number of extraction methods were used, and the investigation of the obtained extracts was performed by spectrometric and chromatographic methods.

Syndromic Surveillance of Health Effects Due to Summer Sun Overexposure: Construction of an Indicator Based on Drug Sales in Pharmacies-Preliminary Study within the PRISME Project.

Solar radiation is classified as a known human carcinogen. In France, people frequently ask local pharmacies to dispense products for sunburns. In the PRISME project, studying this use can be a specific and sensitive way to assess these overexposures. This study aims to construct an indicator for monitoring healthcare consumption in pharmacies after overexposure to solar UV. The study, conducted between July and August 2019, covered a sample of pharmacies located in coastal communities of southern France. A list of products for sunburn was defined. When one of the products on this list was sold, the customer was asked to fill out a questionnaire to determine whether the purchase was related to UV overexposure. A positive predictive value (PPV) per active ingredient was calculated. Overall, nine pharmacies participated in the study, and 288 questionnaires were collected. The majority of products purchased were for women (60.7%), for people aged 15 and over (78.1%), and for people not living in the department (68.9%). The most frequently purchased products were our trolamine-containing products which accounted for 53% of sales. With the exception of three products, all PPVs were greater than 0.8. The high PPV confirms the suitability of the product selection as an indicator for monitoring healthcare consumption related to solar UV overexposure. Two indicators (one sensitive and one specific) were selected to maximise the chances of identifying UV-related remedies.

Community purchases of antimicrobials during the COVID-19 pandemic in Uganda: An increased risk for antimicrobial resistance.

Self-Medication (SM) involves the utilization of medicines to treat self-recognized symptoms or diseases without consultation and the irrational use of over-the-counter drugs. During the COVID-19 pandemic, the lack of definitive treatment led to increased SM. We aimed to estimate the extent of SM for drugs used to treat COVID-19 symptoms by collecting data from pharmacy sale records. The study was conducted in Kampala, Uganda, where we extracted data from community pharmacies with functional Electronic Health Records between January 2018 and October 2021 to enable a comparison of pre-and post-COVID-19. The data included the number of clients purchasing the following drugs used to treat COVID-19 and its symptoms: Antibiotics included Azithromycin, Erythromycin, and Ciprofloxacin; Supplements included Zinc and vitamin C, while Corticosteroids included dexamethasone. A negative binomial model was used to estimate the incident rate ratios for each drug to compare the effect of COVID-19 on SM. In the pre- COVID-19 period (1st January 2018 to 11th March 2020), 19,285 customers purchased antibiotics which included; Azithromycin (n = 6077), Ciprofloxacin (n = 6066) and Erythromycin (n = 997); health supplements including Vitamin C (430) and Zinc (n = 138); and Corticosteroid including Dexamethasone (n = 5577). During the COVID-19 pandemic (from 15th March 2020 to the data extraction date in October 2021), we observed a 99% increase in clients purchasing the same drugs. The number of clients purchasing Azithromycin increased by 19.7% to 279, Ciprofloxacin reduced by 58.8% to 96 clients, and those buying Erythromycin similarly reduced by 35.8% to 492 clients. In comparison, there were increases of 170%, 181%, and 377% for Vitamin C, Zinc, and Dexamethasone, respectively. The COVID-19 pandemic underscored the extent of SM in Uganda. We recommend future studies with a representation of data from pharmacies located in rural and urban areas to further study pandemics' effect on antimicrobials prescriptions, including obtaining pharmacists' perspectives using mixed methods approaches.

Clinical relevance of potential self-medication drug interactions in antineoplastic and immune-modulating therapy among online pharmacy customers.

Modern oral antineoplastic and immune-modulating drugs offer an array of therapeutic advantages, and yet pose challenges in daily use for patients, physicians and pharmacists. In contrast to intravenous administration, these drugs are not subject to direct medical control. Recently, we have seen a huge rise in sales of non-prescription over-the-counter (OTC) medicines via the internet without any advice from a healthcare professional. The aim of this study was to investigate whether the risk of known potential drug-drug interactions between modern oral antineoplastic and immune-modulating drugs and OTC drugs differs between sales in traditional community pharmacies versus online pharmacies. Real-life sales data from community and online pharmacies were used as basis for the analysis. We determined the most frequently purchased antineoplastic and immune-modulating drug-substances in 14 local community pharmacies within the Munich area, Germany and identified the OTC substance groups that could potentially cause interactions with oncological therapies. Using sales data from 11 local community pharmacies and three online pharmacies, we investigated whether OTC purchases differed between the two sales channels. We identified 10 relevant OTC substance classes and detected significant variations in patients' preferred sales channels between the drug classes. Certain OTC drugs, which seem to be bought more often over the internet, pose risks during antineoplastic and immune-modulating therapy. Patients should therefore be proactively made aware of the corresponding risks in order not to jeopardize the activity of the antineoplastic and immune-modulating drugs and thus the success of their therapy.

The Over-the-Counter Medicines Market in Poland

The market of over-the-counter drugs, so-called OTC drugs, is a dynamically developing market driven primarily by self-medication. Their use does not require consultation with a physician, and the patients themselves decide to take them. The distribution of OTC medications in the pharmaceutical market in Poland is diversified. These drugs could be purchased at a pharmacy but also at a supermarket, gas station, or via the internet. The low involvement of public funds in spending on drugs, a relatively small percentage of pharmacy sales of reimbursable prescription drugs, and the difficult access to physicians or general consent to drug advertising all create ideal conditions for creating demand for these drugs. Among the European countries, Poland also has the largest share of OTC drugs in the entire pharmaceutical market, and the percentage of OTCs (without supplements) in the whole drug market in Poland continues to grow. Unfortunately, the non-pharmacy market for the sale of OTC drugs is not adequately controlled in practice, and Polish legal regulations regarding the sale of medicines outside pharmacies are among the most liberal in the European Union. However, this does not change the general attitude of consumers toward purchasing OTC drugs. In fact, further growth of the OTC drug market is forecast. Self-medication will undoubtedly play an important role in the trends which may shape this market in the coming years.

THE MAIN TRENDS IN THE POPULATION CONSUMPTION OF MEDICINES PRESCRIBED FOR ARTERIAL HYPERTENSION IN THE RUSSIAN FEDERATION

Arterial hypertension is a widespread disease and a major risk factor for the development of lethal cardiovascular pathologies. To reduce this risk, timely detection of arterial hypertension, control of blood pressure levels and effective drug therapy for high blood pressure are necessary. Relevance. Study of population consumption of drugs used for hypertension in the retail sector of the pharmaceutical market in the Russian Federation for the period from 2017 to 2021. Methods. We used the methods of retrospective, predictive, structural, logical, comparative, graphic, marketing, pharmacoepi- demiological analyzes when conducting this study. The results were processed using the normalization method and methods of mathematical statistics. Results. The analysis of the structure and study of the characteristics of the population consumption of drugs used for arterial hy- pertension in the territory of the Russian Federation for the period 2017-2021 was carried out. The main share of sales falls on monopreparations: 92.04% - in physical terms, 74.55% - in monetary terms. In the rare pharmacy sales of antihypertensive drugs in the Russian Federation, the share of fixed combinations is 7.96% in physical terms and 25.64% in monetary terms. The most popular antihypertensive drugs in both in-kind and monetary terms over the estimated period are ACE inhibitors and β-blockers. In the subgroup of fixed combinations, “angiotensin II receptor blocker + diuretic” and “ACE inhibitor + diuretic” are in the lead. In the total consumption of antihypertensive drugs, the share of multicomponent fixed combinations accounts for only 0.44% in physical terms, but in monetary terms this figure is 2.51%. According to the results of the survey, doctors were more likely to be conservative in prescribing antihypertensive drug therapy, preferring single drugs, and medical specialists receive information about new drugs mainly at conferences, when meeting with medical representatives, and also from the Internet. Conclusion. Based on the results of the study, an educational program for medical and pharmaceutical specialists “Modern range of drugs prescribed for the prevention and treatment of hypertension” was developed.

Characteristics of Dietary Supplements with Folic Acid Available on the Polish Market.

One way of increasing folate status, especially in a state of increased demand (e.g., women of childbearing age), is dietary supplementation with folic acid (FA). The dietary supplements market in Poland shows a controversial situation and, for many reasons (the ease of placing them on the market, the lack of control of chemical composition), the possibility of inaccurate information provided on the supplement’s label arises. We questioned whether FA supplements available in Poland are indeed complying with regulations and if they could actually improve folate status amongst the target population groups consuming them. Almost 500 products containing FA were identified and available for sale in pharmacies, all of them including specific information provided by manufacturers on the packaging, such as the amount of FA, their intended use and daily dosage. HPLC analysis of FA content in 30 randomly purchased supplements exposed that in four of the tested products, FA content was less than 4% of the declared value (DV). Another 11 samples exposed that the difference with declared FA content varied from 25% up to 80% of the DV. The obtained results are in agreement with the ones from inspections previously conducted on the Polish dietary supplements market and indicate the urgent need to implement improvements in the notification system as well as the monitorization of these product’s authenticity.

Policy Recommendations for Reducing Tobacco Exposure for Youth and Adults in Wilmington, Delaware.

ObjectiveTo highlight and recommend policies that can be projected to reduce disproportionate tobacco exposure for youth and adults in Wilmington, Delaware’s densest and most disadvantaged neighborhoods. Four policy options were drawn from the literature: pharmacy tobacco bans, zoning-based tobacco retailer reductions, residential density caps, and buffers around K-12 schools.MethodChanges in tobacco retailer density and resident-to-retailer distance in Wilmington’s medium- and high- density residentially zoned neighborhoods were projected using GIS analysis of current conditions and projections for each of the four policies.ResultsBanning tobacco sales in pharmacies was found to be least effective, while 500-meter buffers around K-12 schools was projected to have the greatest impact on both retailer density and resident-to-retailer distance.Policy ImplicationsAs a result of these findings, the authors recommend a ban of tobacco sales with a 500-meter radius of all K-12 schools in the City of Wilmington.

Quality of Oral Drug Formulations of Artemisinin-Based Combination Therapy Sold in Katsina State, Nigeria

There are increasing reports of substandard antimalarial drugs, and these have been a severe under-recognised public health problem especially in developing countries. For this reason, 21 samples of different brands of artemisinin-based combination therapies (ACTs) comprising of artemether/lumefantrine and artesunate/amodiaquine oral drug formulations that are available on sale in different hospital pharmacies and patent medicine stores in Katsina State, Nigeria were evaluated for microbial and chemical qualities. Microbial limit test (MLT) and assay for the content of the active pharmaceutical ingredients (APIs) using standard high performance liquid chromatography (HPLC) procedures were carried out as described in the official monograph of the United States Pharmacopoeia (USP) and the International Pharmacopoeia (IP). The results obtained had indicated that all the ACTs oral drug preparations were free from microbial contamination except one sample of artesunate-amodiaquine showing viable total combined yeasts/moulds count (TYMC) of 1.0 x 101 colony forming units (CFU)/g. All the samples complied with the USP and IP criteria for the microbiological quality of non-sterile oral dosage forms. On the other hand, 10 (47.6%) out of the 21 samples met the specific chemical quality standards. Moreover, 8 (57.1%) and 3 (42.9%) of the artemether/lumefantrine and artesunate/amodiaquine had active ingredient outside the set pharmacopoeial limit and, therefore, were none compliant to the IP specifications for percentage content. The presence of substandard ACTs may lead to possible therapeutic failure from the use of such kind of formulations, facilitate the development and spread of drug-resistance. There is the need for effective government regulation and adequate enforcement on the production, distribution and sales of good quality medicines.

Using molecular epidemiology to trace the history of the injection-related HIV epidemic in New York City, 1985-2019.

Unintentional drug poisoning and overdose deaths in New York City (NYC) increased 175% between 2010 and 2017, partly due to the transition from noninjectable opioids to heroin injection. This transition has led to concern of a resurgent HIV epidemic among persons who inject drugs (PWID) in NYC. Thus, we sought to characterize HIV transmission dynamics in PWID. Genetic network analysis of HIV-1 public health surveillance data. We analyzed HIV diagnoses reported to public health surveillance to determine the trajectory of the HIV epidemic among PWID in NYC, from 1985 through 2019. Genetic distance-based clustering was performed using HIV-TRACE to reconstruct transmission patterns among PWID. The majority of the genetic links to PWID diagnosed in the 1980s and 1990s are to other PWID. However, since 2011, there has been a continued decline in new diagnoses among PWID, and genetic links between PWID have become increasingly rare, although links to noninjecting MSM and other people reporting sexual transmission risk have become increasingly common. However, we also find evidence suggestive of a resurgence of genetic links among PWID in 2018-2019. PWID who reported male-male sexual contact were not preferentially genetically linked to PWID over the surveillance period, emphasizing their distinct risk profile from other PWID. These trends suggest a transition from parenteral to sexual transmission among PWID in NYC, suggesting that harm reduction, syringe exchange programs, and legalization of over-the-counter syringe sales in pharmacies have mitigated HIV risk by facilitating well tolerated injection among new PWID.

Antibiotic Stewardship in Retail Pharmacies and the Access-Excess Challenge in China: A Policy Review.

In China, efforts to restrict excessive antibiotic consumption may prevent sufficient access to these life-saving drugs among the most deprived in society because of the weak primary health care system. This makes antibiotic stewardship in the retail pharmacy sector a particular challenge. We conducted an analysis to examinate policies on antibiotic sales in retail pharmacies in China and how tensions between ‘excess’ and ‘access’ are managed. The analysis was guided by the Walt and Gilson health policy analysis triangle to systematically analyse policies based on the content of policies, contexts, governance processes, and actors. Nine research studies and 25 documents identified from national and international sources were extracted, grouped into categories, and examined within and across records and categories. As of 2020, eight key policies have been introduced in China that focus on two areas: dispending prescribed medicines or antimicrobials with a prescription and having a licensed pharmacist present in the retail pharmacies, with approaches having changed over time. Inappropriate sales of antibiotics are still common in retail pharmacies, which can be linked to the lack of consistency and enforcement of published policies, the profit-driven nature of retail pharmacies, and the displacement of the demand for antibiotics from clinical into less regulated settings.

Naloxone should be available over the counter, recommend Scottish government advisors

The Scottish Drug Deaths Taskforce’s final report has recommended that naloxone should be permanently reclassified as a Pharmacy (P) or General Sales List (GSL) medicine. The taskforce was set up by the Scottish government in July 2019, with the aim of reducing the nation’s rising number of drug-related deaths. Naloxone, an emergency antidote for overdoses […]