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Tadesse TY, Molla M, Yimer YS, Tarekegn BS, Kefale B. Evaluation of antibiotic prescribing patterns among inpatients using World Health Organization indicators: A cross-sectional study. SAGE Open Med 2022; 10:20503121221096608. [PMID: 35600711 PMCID: PMC9118891 DOI: 10.1177/20503121221096608] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Even though antibiotic resistance is one of the most serious threats to global public health, it is becoming more common due to inappropriate antibiotic prescribing patterns. Thus, the purpose of this study is to assess antibiotic prescribing patterns among inpatients at an Ethiopian comprehensive specialized hospital. Methods: An institutional-based cross-sectional study was used. During the study period, data were collected from the charts of admitted patients in selected wards of Debre Tabor comprehensive specialized hospital. The World Health Organization’s developed questionnaire and conventional antibiotic prescribing indicators were used to assess rational drug usage, with an emphasis on antibiotic prescribing trends. The data were analyzed using SPSS 25.0 statistical software. Results: For 861 patients admitted to medical and pediatric wards, a total of 1444 antibiotics were prescribed. Overall, 60.6% of inpatients were prescribed at least one antibiotic, with an average (mean ± SD) number of antibiotics prescribed per patient of 1.7 ± 1.6. During their hospital stay, patients were given antibiotics for an average (mean ± SD) of 6.4 ± 2.7 days. Furthermore, 83.3% of antibiotics were prescribed for therapeutic purposes, whereas 100% were provided for empiric purposes. Ceftriaxone was the most commonly administered antibiotic in the study settings (49.2%). During the study period, Debre Tabor comprehensive specialized hospital had access to 67.5% of key antibiotics. Conclusion: The antibiotic prescribing pattern in our study diverged from the World Health Organization-recommended guidelines. Furthermore, all antibiotics were given without a culture or sensitivity test in every case. Setting up an antibiotic stewardship program, introducing antibiotic use based on culture and sensitivity tests, and adopting institutional guidelines could all help to address this issue.
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Affiliation(s)
- Tesfaye Yimer Tadesse
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannis Shumet Yimer
- Pharmaceutics and Social Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Belayneh Kefale
- Clinical Pharmacy Unit, Department of Pharmacy, College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Mousavi A, Zare H, Asadian A, Mohammadzadeh M. Factors Affecting the Product Life Cycle of Generic Medicines. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH 2022; 21:e127039. [PMID: 36060917 PMCID: PMC9420220 DOI: 10.5812/ijpr-127039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/24/2022] [Accepted: 02/13/2022] [Indexed: 11/26/2022]
Abstract
Background Product life cycle (PLC) refers to the time ranging from when a product is introduced into the market to when it is taken off the shelves. The PLC management can guarantee product survival and prevent its decline. Objectives This study investigated generic antibiotic PLCs and detected factors affecting them in the competitive pharmaceutical market of Iran to improve the PLC management of such drugs. Methods To study the PLC of antibiotics, data were collected from 2002 to 2017, and then the PLC curves were analyzed. Accordingly, factors affecting the PLC of antibiotics were illustrated in two sections: all PLC curves and the PLC curves with one sales peak. Using a generalized linear model combined with a machine learning approach, we identified the sales patterns and the effect of the product-related and the competition-related factors on the PLC curves, peak height, and the time to reach peak sales. Results According to the findings, 16, 11.87, 13.03, and 59% of the antibiotics had linear, binomial, one-peak, and oscillating sales patterns, respectively. The most crucial factors affecting the PLC shape were the quality, microbial spectrum, dosage forms, number of competitors, and entry arrangement. Conclusions This study examined factors affecting the PLC patterns of generic pharmaceutical products. The findings would provide more insights into the generic pharmaceutical market as one of the less-studied markets in many countries.
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Affiliation(s)
- Atefeh Mousavi
- Pharmaceutical and Health Economics and Management Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Center for Health Disparities Solutions, the University of Maryland Global Campus, Health Services Management, 624 North Broadway, Baltimore, Maryland, United States
| | - Aydin Asadian
- School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Mohammadzadeh
- Pharmaceutical and Health Economics and Management Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Pharmacoeconomy & Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Pharmacoeconomy & Administrative Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2188665692,
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Demoz GT, Kasahun GG, Hagazy K, Woldu G, Wahdey S, Tadesse DB, Niriayo YL. Prescribing Pattern of Antibiotics Using WHO Prescribing Indicators Among Inpatients in Ethiopia: A Need for Antibiotic Stewardship Program. Infect Drug Resist 2020; 13:2783-2794. [PMID: 32884305 PMCID: PMC7440886 DOI: 10.2147/idr.s262104] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/21/2020] [Indexed: 12/20/2022] Open
Abstract
Background Irrational prescribing of antibiotics is a universal public health problem, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is crucial to tackling irrational prescription. Yet, comprehensive studies regarding the prescribing pattern of antibiotics among inpatients and the need for an Antibiotic Stewardship Program (ASP) are lacking in Ethiopia. This study aimed to evaluate prescribing patterns of antibiotics and the need for an ASP. Methods A hospital-based prospective observational study was carried out from February 2019 to December 2019. This study was conducted among patients admitted to Aksum University Comprehensive Specialized Hospital, Ethiopia. Data were collected using a data abstraction format generated by World Health Organization (WHO) prescribing indicators. Data analysis was carried out using SPSS version 25.0. Results A total of 1653 antibiotics were prescribed for 822 inpatients. Overall, 52.3% of patients had at least one oral and/or injectable antibiotic prescribed, for a mean duration of 4.2 (SD=2.3) days. The average number of prescribed antibiotics per patient was 2.01 (SD=1.9). The majority (97.6%) of antibiotics were prescribed by their generic name, and all prescribed antibiotics were from the national Essential Medicine List (EML). Frequently prescribed injectable and oral antibiotics were ceftriaxone (24.5%) and azithromycin (12.9%), respectively. Culture and sensitivity testing were not performed in any of the cases. During the study period, 65.2% of key antibiotics were available in stock. Conclusion In this study, more than half of patients were on at least one antibiotic, and all antibiotics were prescribed from the national EML. However, all antibiotics were prescribed empirically. This result shows that the prescribing pattern of antibiotics in the hospital deviates from and is non-compliant with the standard endorsed by WHO. This study provides evidence for the necessity and a way forward for the establishment of an ASP in the hospital that may help to introduce the prescribing of antibiotics with the aid of culture and sensitivity tests, and to develop institutional guidelines.
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Affiliation(s)
| | | | - Kalay Hagazy
- School of Pharmacy, Aksum University, Aksum, Ethiopia
| | | | - Shishay Wahdey
- School of Public Health, Mekelle University, Mekelle, Ethiopia
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Rasheed H, Hoellein L, Bukhari KS, Holzgrabe U. Regulatory framework in Pakistan: situation analysis of medicine quality and future recommendations. J Pharm Policy Pract 2019; 12:23. [PMID: 31528352 PMCID: PMC6737614 DOI: 10.1186/s40545-019-0184-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quality issues in pharmaceuticals are identified as a huge global and public health problem, especially with reference to low- and middle-income countries like Pakistan. The 2011 "Fake Drug Crisis" acted as a driving force to reform the regulatory structures of the country and for establishing the autonomous "Drug Regulatory Authority of Pakistan". Despite the fact that Pakistan possesses a huge pharmaceutical industry, there is a severe dearth of published literature and scientific evidence for the country regarding medicine quality and the prevalence of counterfeit and low-quality products, respectively. AIMS AND OBJECTIVES This narrative review covers relevant features of the regulatory framework for pharmaceuticals in Pakistan, its national pharmaceutical industry, as well as a compilation and analysis of published literature for documentation of the country's situation regarding the overall quality of medicines. METHODS Available data including scientific publications on the quality of pharmaceuticals in peer reviewed journals, research reports, notifications, and alerts issued by the World Health Organization and other agencies were accessed and compiled. Post graduate dissertations were used to represent unpublished research data and drug safety alerts issued from the local Pakistan authority were analysed to assess the type and number of quality failures reported for pharmaceuticals. RESULTS It could be clearly shown that there is negligible scientific data available on the issue of medicine quality in Pakistan. The anticipated number of 40-50% of poor-quality drugs in Pakistan cannot be defended by data available from the literature. Accessible technologies and strategies used in recent years at global level, especially in developing countries, were also reviewed and recommendations are devised for Pakistan to combat the fight against poor-quality medicines. CONCLUSION The case reports, investigations, and general data listed for Pakistan suggest the need of strengthening regulatory systems for premises and GMP inspections, analytical laboratories, as well as an overall capacity building in the field of unravelling and controlling substandard and falsified medicines. It is proposed that well-planned and properly funded studies need to be carried out for collecting critical statistics regarding the prevalence of substandard and falsified medicines in Pakistan.
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Affiliation(s)
- Huma Rasheed
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ludwig Hoellein
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
| | - Khalid Saeed Bukhari
- USP Promoting the Quality of Medicines (PQM) Program, U.S. Pharmacopeial Convention, 12601 Twinbrook Parkway, Rockville, MD 20852-1790 USA
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Wuerzburg, am Hubland, 97074 Wuerzburg, Germany
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Souliotis K, Golna C, Kani C, Markantonis S. Exploring knowledge and perceptions on generic drugs of final year pharmacy school students in Greece. Expert Rev Pharmacoecon Outcomes Res 2019; 19:569-574. [PMID: 30658041 DOI: 10.1080/14737167.2019.1571412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The economic crisis in Greece has triggered an extensive public debate about the use of generic drugs (generics). Despite their cost-saving potential, generic market penetration remains very low. This raises questions on awareness of, perception on and preference for generics by health-care professionals and patients. This is a descriptive study on the level of knowledge and attitudes towards generics of final year pharmacy school students in Greece. Methods: An electronic questionnaire was distributed to 173 senior pharmacy school students in three Universities in Greece. Responses were submitted electronically. Results: The majority of students knew that generics contain the same active ingredient as the originator products and are cheaper. Students were somehow concerned with safety and efficacy of generics. The majority of students agreed that pharmacists should probably recommend the use of generics, and indicated that prescribing and dispensing practices would largely depend on the profit margin. Despite more than half of the students expressing a positive attitude towards generics, they were inadequately educated on their features. Conclusion: It is critical to improve knowledge of and preference for generics amongst health-care professionals from early on if to build the trust required to increase generic market penetration and achieve measurable savings in pharmaceutical expenditure.
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Affiliation(s)
- Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece.,Health Policy Institute , Athens , Greece
| | | | - Chara Kani
- Faculty of Social and Political Sciences, University of Peloponnese , Corinth , Greece
| | - Sophia Markantonis
- Department of Pharmacy, National and Kapodistrian University of Athens , Athens , Greece
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Medicine shortages in Fiji: A qualitative exploration of stakeholders' views. PLoS One 2017; 12:e0178429. [PMID: 28582409 PMCID: PMC5459560 DOI: 10.1371/journal.pone.0178429] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/13/2017] [Indexed: 12/31/2022] Open
Abstract
Objectives Medicine access is a human right; yet, concerningly, there are international instances of shortages. Quantitative data has allowed WHO to propose global solutions; however, individualised understanding of specific regions is still required to work towards national solutions. Fiji has an established issue with medication supply and the aim of this study was to use qualitative methods to gain a fuller understanding of this context. Methods Semi-structured interviews were used to gain the perspective of key stakeholders involved in the Fijian medicine supply chain in regards to causes, impacts and possible solutions of medicine shortages. Thematic analysis was used to analyse the interview data. Results In total, 48 stakeholders participated and the information was synthesised into three main themes, causes, impacts and solutions and the sub-themes including; political, system and patient causes, adverse health effects on patients, professional dissatisfaction, monetary loss and loss of faith in the health system, workarounds, operation improvements, government intervention and education and training. Conclusions The situation in Fiji is not dissimilar to other instances of shortages around the world and hence international solutions like that proposed by WHO are feasible; however, they must be modified to be uniquely Fijian to work in this context.
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Ofori-Asenso R, Brhlikova P, Pollock AM. Prescribing indicators at primary health care centers within the WHO African region: a systematic analysis (1995-2015). BMC Public Health 2016; 16:724. [PMID: 27545670 PMCID: PMC4993007 DOI: 10.1186/s12889-016-3428-8] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 08/02/2016] [Indexed: 11/23/2022] Open
Abstract
Background Rational medicine use is essential to optimize quality of healthcare delivery and resource utilization. We aim to conduct a systematic review of changes in prescribing patterns in the WHO African region and comparison with WHO indicators in two time periods 1995–2005 and 2006–2015. Methods Systematic searches were conducted in PubMed, Scopus, Web of science, Africa-Wide Nipad, Africa Journals Online (AJOL), Google scholar and International Network for Rational Use of Drugs (INRUD) Bibliography databases to identify primary studies reporting prescribing indicators at primary healthcare centres (PHCs) in Africa. This was supplemented by a manual search of retrieved references. We assessed the quality of studies using a 14-point scoring system modified from the Downs and Black checklist with inclusions of recommendations in the WHO guidelines. Results Forty-three studies conducted in 11 African countries were included in the overall analysis. These studies presented prescribing indicators based on a total 141,323 patient encounters across 572 primary care facilities. The results of prescribing indicators were determined as follows; average number of medicines prescribed per patient encounter = 3.1 (IQR 2.3–4.8), percentage of medicines prescribed by generic name =68.0 % (IQR 55.4–80.3), Percentage of encounters with antibiotic prescribed =46.8 % (IQR 33.7–62.8), percentage of encounters with injection prescribed =25.0 % (IQR 18.7–39.5) and the percentage of medicines prescribed from essential medicines list =88.0 % (IQR 76.3–94.1). Prescribing indicators were generally worse in private compared with public facilities. Analysis of prescribing across two time points 1995–2005 and 2006–2015 showed no consistent trends. Conclusions Prescribing indicators for the African region deviate significantly from the WHO reference targets. Increased collaborative efforts are urgently needed to improve medicine prescribing practices in Africa with the aim of enhancing the optimal utilization of scarce resources and averting negative health consequences.
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Affiliation(s)
| | - Petra Brhlikova
- Centre for Primary Care and Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - Allyson M Pollock
- Centre for Primary Care and Public Health, Barts and the London School of Medicine & Dentistry, Queen Mary, University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
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Dylst P, Vulto A, Simoens S. Demand-side policies to encourage the use of generic medicines: an overview. Expert Rev Pharmacoecon Outcomes Res 2014; 13:59-72. [DOI: 10.1586/erp.12.83] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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