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Nadeshkumar A, Sathiadas G, Sri Ranganathan S. Quality of measuring devices enclosed with paediatric oral liquid dosage forms of medicines registered in Sri Lanka. PLoS One 2023; 18:e0294690. [PMID: 37992067 PMCID: PMC10664896 DOI: 10.1371/journal.pone.0294690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023] Open
Abstract
INTRODUCTION Oral liquid dosage forms remain popular in several middle income countries. The accuracy of liquid dosage form dosing depends on the accuracy and availability of measuring devices. Lack of quality oral liquid measuring devices will lead to medication errors. Hence there is an urgent need to describe the quality of manufacturer supplied measuring devices enclosed with paediatric oral liquid dosage forms currently registered in Sri Lanka. METHODOLOGY Standards for measuring devices were developed after a detailed literature search. Multidisciplinary panel rated each standard for the necessity criteria on a 9 point Likert scale. Standards with overall panel median score of ≥ 7 with agreement were selected. A cross-sectional study was done. All the measuring devices, labels and instructions enclosed with the registered products were assessed against the standards developed. Three volumes of liquid antibacterials were measured using the enclosed measuring device. Accuracy of the volumes was measured. RESULTS Of the total products (n = 202) only 126 were packed with a dosing device. Around quarter of the oral liquid dosage forms (n = 36) did not have a measuring device. More than half of the measuring devices aligned with all the standards developed. Out of 44 oral liquid paediatric antimicrobials measuring cups (n = 25, 56.8%, 95% CI: 41%-72%) were enclosed more and less error was seen with measuring cups. CONCLUSION The quality of oral liquid measuring devices were not satisfactory. Quality could be further improved if the regulatory body request the manufactures/importers to adhere to the standards developed. Correct volumes were not measured using the measuring devices provided with the liquid antimicrobial agents.
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Affiliation(s)
- Abarna Nadeshkumar
- Faculty of Allied Health Sciences, Department of Pharmacy and Pharmaceutical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Faculty of Medicine, Department of Pharmacology, University of Colombo, Colombo, Sri Lanka
| | - Gitanjali Sathiadas
- Faculty of Medicine, Department of Paediatrics, University of Jaffna, Jaffna, Sri Lanka
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Sri Ranganathan S, Navaratinaraja TS, Balasubramaniam R, Beneragama H. Price and affordability of key essential medicines for children in Sri Lanka, a lower-middle-income country: comparison of two national cross-sectional surveys done 8 years apart. BMJ Open 2023; 13:e069733. [PMID: 36806061 PMCID: PMC9944639 DOI: 10.1136/bmjopen-2022-069733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVE To describe the price and affordability of key essential medicines for children in the private sector in Sri Lanka in 2017/2018, and compare the findings with 2009 data. DESIGN National cross-sectional descriptive survey using the WHO/Health Action International medicine price methodology. SETTING AND PARTICIPANTS Data were collected from a representative sample of 54 private sector pharmacies selected from all 9 provinces in Sri Lanka using a multistage clustered approach. MAIN OUTCOMES Median price ratio (MPR) and affordability of originator brand (OB) and lowest priced generics (LPG) of 25 key essential medicines for children. RESULTS The median MPR was 2.69 for OBs and 1.45 for LPGs compared with 3.7 and 1.35 in 2009. MPR of OB of all but one (chlorphenamine syrup) were higher than that of the LPG. MPR-OB>5 was observed for ceftriaxone injection, amoxicillin capsule, mebendazole chewable tablet and metronidazole tablet. This was documented in 2009 as well except for amoxicillin capsule. Prices of LPGs of seven medicines (amoxicillin capsule, amoxicillin suspension, clotrimazole cream, mebendazole chewable tablet, metronidazole tablet) were estimated as excessive (MPR ≥2.5) compared with chlorphenamine syrup, clotrimazole topical cream, ibuprofen syrup and paracetamol syrup in 2009. Compared with 2009, MPRs of OBs of 8 medicines and LPGs of 12 medicines were higher in 2017/2018. Compared with 2009, no change in affordability was noted except for asthma, which has been assessed as affordable in 2017/2018. Standard drug therapy for mild lower respiratory tract infections and acute gastroenteritis remained affordable, and treating epilepsy with carbamazepine syrup remained unaffordable. CONCLUSION Economic access to key essential medicines for children has not improved in Sri Lanka in the 8 years' time since the initial survey in 2009.
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Affiliation(s)
| | | | | | - Hemantha Beneragama
- Ministry of Healthcare Nutrition and Indigenous Medicine, Colombo, Sri Lanka
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Nadeshkumar A, Sathiadas G, Sri Ranganathan S. Administration of oral dosage forms of medicines to children in a resource limited setting. PLoS One 2022; 17:e0276379. [PMID: 36548310 PMCID: PMC9778530 DOI: 10.1371/journal.pone.0276379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are many paediatric specific challenges such as lack of age-appropriate dosage forms, inability of young children to swallow tablets and capsules and poor acceptability, during administration of oral dosage forms of medications to children. Parents adopt various methods which they consider best to circumvent this problem. The objective of this study was to describe the administration practice by parents when giving oral dosage forms of medications to children. METHODS A descriptive cross-sectional study was conducted to assess the administration practice of 1800 oral dosage forms of medications administered to children under the age of 12 years using validated indicators. A pre-tested interviewer-administered questionnaire given to parents or caregivers was used to collect the necessary data. The data were analysed using descriptive statistics. RESULTS Data from 1800 oral dosage forms was obtained from 663 children. Of the 1287 solid dosage forms, almost one-third were manipulated by parents at the time of giving the medications to children. They were crushed and dissolved in water given to children. In about 17% of instances safety of water was questionable. In 92% of instances, measuring device was found to be inappropriate. CONCLUSION Administration of oral dosage forms of medications to children is far from ideal and hinders successful use of medications in children.
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Affiliation(s)
- Abarna Nadeshkumar
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka,Department of Pharmacology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka,* E-mail:
| | - Gitanjali Sathiadas
- Department of Paediatrics, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
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Guruparan Y, Navaratinaraja TS, Selvaratnam G, Gunawardena N, Sri Ranganathan S. Development and validation of a set of patient reported outcome measures to assess effectiveness of asthma prophylaxis. BMC Pulm Med 2021; 21:295. [PMID: 34535111 PMCID: PMC8449463 DOI: 10.1186/s12890-021-01665-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Background In the local setting, asthma control is assessed by symptoms and signs elicited by clinicians because of the limited availability of spirometry. Hence, we intended to develop a patient reported outcome measure (PROM) with more holistic interpretation that could also serve as a tool to measure the asthma control in resource limited settings. Therefore, this study was carried out in Northern Sri Lanka to develop and validate the Asthma Control PROM (AC-PROM) Tamil to measure the effectiveness of asthma prophylaxis based on symptoms, exacerbation and limitation of activity which could also serve as an easy measure of asthma control to the provider. Methods The AC-PROM Tamil was developed in 3 steps: item generation, item reduction and psychometric evaluation. Items were generated through thematic analysis from focus group discussions among patients with asthma. Items were converted to an interviewer administered questionnaire in Tamil in the format of 5-point Likert scale. Item reduction was done by two rounds of online Delphi surveys among 10 experts and an exploratory factor analysis among 200 patients with asthma. The face and content validity were assessed by a panel of experts during Delphi survey and patients during the pre-test of the tool. Criterion validity of the tool was assessed against the forced expiratory volume in one second of 187 patients with asthma. The cut-off value to assess the asthma control was determined by receiver operating characteristic curve. Reliability was verified by Cronbach’s alpha coefficient. Results From thematic analysis of focus group discussions 10 items were generated. One item was removed during Delphi survey. Exploratory factor analysis indicated removal of another item with 8 items categorised into two factors. Cronbach’s alpha coefficient of factors 1 and 2 were 0.821 and 0.903 respectively, indicating good reliability. Observations made by experts and responses made by patients were incorporated to improve the clarity and relevance of the items. Criterion validity was demonstrated by significant correlation between the AC-PROM Tamil and forced expiratory volume in one second (r = 0.66, p = 0.001). The cut-off value of the AC-PROM Tamil to detect asthma control was 28.5 with 79% (95% CI 71.3–86.9) sensitivity and 71% (95% CI 61.9–79.6) specificity. The AC-PROM Tamil showed moderate accuracy (the area under the receiver operating characteristic curve = 0.796; 95% CI 0.73–0.86). Response rate of the AC-PROM Tamil was 100% and time taken to complete was 3–4 min. Conclusion The AC-PROM Tamil is a simple, feasible and reasonably accurate tool to assesses the effectiveness of asthma prophylaxis, particularly in resource limited settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01665-6.
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Affiliation(s)
- Yalini Guruparan
- Department of Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka.
| | | | - Gowry Selvaratnam
- Department of Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
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Sri Ranganathan S, Wanigatunge C, Senadheera GPSG, Beneragama BVSH. A national survey of antibacterial consumption in Sri Lanka. PLoS One 2021; 16:e0257424. [PMID: 34520501 PMCID: PMC8439449 DOI: 10.1371/journal.pone.0257424] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy. OBJECTIVES To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector. METHODS The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors. FINDINGS From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively. CONCLUSIONS A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.
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Affiliation(s)
| | - Chandanie Wanigatunge
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka
| | - G. P. S. G. Senadheera
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka
| | - B. V. S. H. Beneragama
- National focal point for combating antimicrobial resistance in Sri Lanka, Ministry of Health, Colombo, Sri Lanka
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Wanigasinghe J, Arambepola C, Ranganathan SS, Jayasundara K, Weerasinghe A, Wickramarachchi P. Epilepsy Outcome at Four Years in a Randomized Clinical Trial Comparing Oral Prednisolone and Intramuscular ACTH in West Syndrome. Pediatr Neurol 2021; 119:22-26. [PMID: 33836476 DOI: 10.1016/j.pediatrneurol.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 01/01/2021] [Accepted: 01/24/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND This article explores the role of initial treatment on control of spasms and other epilepsies at four years in children previously treated for West syndrome. METHODS The Sri Lanka Infantile Spasm Study is a prospective clinical trial evaluating response to intra-muscular adrenocorticotropic hormone (ACTH) versus oral prednisolone. A previous report documented response through age 12 months. This article provides four-year follow-up data. RESULTS At age four years, 65 of the original 97 were available for follow-up; another 13 had died, and 19 moved and could not be contacted. Of the 65 children, 37 (57%) continued to have seizures and 28 were seizure free. In the 37 children with ongoing epilepsy, 32.4% continued to have spasms, either alone or in combination with other seizure types. The epilepsy types seen in these children were focal epilepsy (59.4%), mixed focal and generalized epilepsy (24%), generalized epilepsy only (10.8%), and uncertain (5%). The majority of those still having epilepsy (66.7%) were controlled on medication. There was no significant difference in the rate of epilepsy or spasms or their control by medication between those treated with ACTH or oral prednisolone. Spasm control at day 14 did not influence the four-year spasm or epilepsy outcome. CONCLUSIONS A majority of children diagnosed with West syndrome continued to have seizures at age four years, although most were controlled on antiseizure medication. The long-term risk of developing epilepsy or its control was the same, regardless of whether ACTH or prednisolone was initially used as treatment.
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Affiliation(s)
- Jithangi Wanigasinghe
- Faculty of Medicine, Department of Paediatrics, University of Colombo, Colombo, Sri Lanka.
| | - Carukshi Arambepola
- Faculty of Medicine, Department of Community Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Kasun Jayasundara
- University Paediatric Unit, Lady Ridgeway Hospital, Colombo, Sri Lanka
| | - Ashangi Weerasinghe
- Faculty of Medicine, Department of Paediatrics, University of Colombo, Colombo, Sri Lanka
| | - Piyumi Wickramarachchi
- Faculty of Medicine, Department of Paediatrics, University of Colombo, Colombo, Sri Lanka
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Sumanasena SP, Wanigasinghe J, Arambepola C, Sri Ranganathan S, Muhandiram E. Effect of intramuscular ACTH versus oral prednisolone on the developmental trajectories of children with West syndrome over 24 months: A randomised control study. Eur J Paediatr Neurol 2021; 32:98-105. [PMID: 33894665 DOI: 10.1016/j.ejpn.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/02/2021] [Accepted: 04/03/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the developmental progression and compare the developmental attainments of children treated with two hormonal therapies for infantile spasms (IS) over two years (seizure and EEG outcomes of this RCT published previously). METHODS Newly diagnosed infants with IS were randomised to receive adrenocorticotrophin (ACTH) or prednisolone for 14 days. All underwent Bayley III Infant and Toddler Assessments in cognitive (Cog), receptive (RC) and expressive (EC) communication, fine (FM) and gross (GM) motor developmental subsets at baseline (T0), one-year (T1) and two-years (T2). RESULTS 95 infants randomised to prednisolone (n = 48) and ACTH (n = 47) groups were eligible for developmental assessments. Mean age at initial assessment was 8.75 months (SD = 6.37, range 1.46-34.4 months). 48 children presented for all three assessments. Mean composite scores of each developmental domain improved across the three time points; but the progression was significant only in relation to motor development (p = 0.04). When comparing the treatment outcomes at 2-years, mean composite scores of children treated with ACTH were significantly lower in motor domain (p = 0.023). As for developmental delay, the ACTH group (n = 32) showed significant delay in expressive communication (adjusted OR 5.46, 95% CI: 1.1, 28.57; p = 0.04) and fine motor (adjusted OR 9.4, 95% CI: 1.1, 83.3; p = 0.04) at T2 compared to the prednisolone (n = 30) in a regression analysis. CONCLUSION The number of children with delay at the 2 year follow up were significantly higher in two domains in the ACTH group compared to the prednisolone group. Overall results do not show a significant advantage of ACTH over prednisolone for developmental outcomes at two years, but further comparative studies over longer periods are required for more definitive conclusions.
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Affiliation(s)
- Samanmali P Sumanasena
- Paediatric Disabilities and Consultant Paediatrician, Postal address Department of Disability Studies Faculty of Medicine University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama Sri Lanka.
| | - Jithangi Wanigasinghe
- Paediatrics and Specialist Pediatric Neurologist, Postal address Department of Paediatrics Faculty of Medicine University of Colombo, No. 25, Kynsey Road, Colombo 08, Sri Lanka.
| | - Carukshi Arambepola
- Community Medicine and Specialist in Community Medicine, Postal address Department of Community Medicine Faculty of Medicine University of Colombo, No. 25, Kynsey Road, Colombo 08, Sri Lanka.
| | - Shalini Sri Ranganathan
- Pharmacology and Specialist in Paediatrics, Department of Pharmacology, Faculty of Medicine University of Colombo, No. 25, Kynsey Road, Colombo 08, Sri Lanka.
| | - Eindrini Muhandiram
- Department of Paediatrics, Faculty of Medicine University of Colombo, No. 25, Kynsey Road, Colombo 08, Sri Lanka.
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Lamontagne F, Stegemann M, Agarwal A, Agoritsas T, Siemieniuk R, Rochwerg B, Bartoszko J, Askie L, Macdonald H, Al-Maslamani M, Amin W, Da Silva ARA, Barragan FAJ, Bausch FJ, Burhan E, Cecconi M, Chacko B, Chanda D, Dat VQ, Du B, Geduld H, Gee P, Haider M, Nerina H, Hashimi M, Jehan F, Hui D, Hunt BJ, Ismail M, Kabra S, Kanda S, Kawano-Dourado L, Kim YJ, Kissoon N, Krishna S, Kwizera A, Lisboa T, Leo YS, Mahaka I, Hela M, Migliori GB, Mino G, Nsutebu E, Pshenichnaya N, Qadir N, Ranganathan SS, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Souza JP, Tshokey T, Ugarte S, Uyeki T, Venkatapuram S, Wachinou AP, Wijewickrama A, Vuyiseka D, Preller J, Brignardello-Petersen R, Kum E, Qasim A, Zeraatkar D, Owen A, Guyatt G, Lytvyn L, Jacobs M, Vandvik PO, Diaz J. A living WHO guideline on drugs to prevent covid-19. BMJ 2021; 372:n526. [PMID: 33649077 DOI: 10.1136/bmj.n526] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CLINICAL QUESTION What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. RECOMMENDATION The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. UNDERSTANDING THE NEW RECOMMENDATION The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. UPDATES This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.
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Affiliation(s)
- François Lamontagne
- Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Sherbrooke, Quebec, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Miriam Stegemann
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Arnav Agarwal
- Division of General Internal Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Reed Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Jessica Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Lisa Askie
- World Health Organization, Geneva, Switzerland
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Helen Macdonald
- The BMJ, London, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
| | | | - Wagdy Amin
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Binila Chacko
- Division of Critical Care Medicine at Christian Medical College, Vellore, India
| | - Duncan Chanda
- Adult Infectious Disease Centre, University Teaching Hospital, Lusaka, Zambia
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | | | | | | | | | - David Hui
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, Hong Kong SAR, China
| | | | | | - Sushil Kabra
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor)- HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil and Research Institute, Hospital do Coração (HCor), São Paulo, Brazil
| | - Yae-Jean Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Niranjan Kissoon
- Department of Paediatrics and Emergency Medicine, University of British Columbia, Vancouver, Canada
| | | | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Yee-Sin Leo
- National Center for Infectious Diseases, Singapore
| | | | - Manai Hela
- Emergency Medical Services, Faculty of Medicine, Tunis, Tunisia
| | | | | | | | | | - Nida Qadir
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - Rohit Sarin
- National Institute of Tuberculosis and Respiratory Diseases, New Delhi, India
| | | | | | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | | | | | - Sebastian Ugarte
- Faculty of Medicine Andres Bello University, Indisa Clinic, Santiago, Chile
| | - Tim Uyeki
- Influenza Division, Centers for Disease Control and Prevention, USA
| | | | | | | | | | - Jacobus Preller
- World Health Organization, Geneva, Switzerland
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Elena Kum
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Anila Qasim
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Andrew Owen
- University of Liverpool, Liverpool, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not guideline development group member; resource for methodology, systematic review, and content support
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust, London, UK
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Not guideline development group member; resource for methodology, systematic review, and content support
- co-senior author
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Sri Ranganathan S, Thiyahiny SN, Balasubramaniam R, Beneragama BVSH. Changing Trend in the Availability of Key Essential Medicines for Children in a Resource-Limited Country. Indian J Pediatr 2021; 88:178-179. [PMID: 32564296 DOI: 10.1007/s12098-020-03409-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - S N Thiyahiny
- Department of Pharmacology, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - R Balasubramaniam
- National Hospital of Sri Lanka, Ministry of Healthcare and Nutrition, Colombo, Sri Lanka
| | - B V S H Beneragama
- Office of Deputy Director/Laboratory Services, Ministry of Healthcare and Nutrition, Colombo, Sri Lanka
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Agarwal A, Hunt B, Stegemann M, Rochwerg B, Lamontagne F, Siemieniuk RA, Agoritsas T, Askie L, Lytvyn L, Leo YS, Macdonald H, Zeng L, Alhadyan A, Muna AM, Amin W, da Silva ARA, Aryal D, Barragan FAJ, Bausch FJ, Burhan E, Calfee CS, Cecconi M, Chacko B, Chanda D, Dat VQ, De Sutter A, Du B, Freedman S, Geduld H, Gee P, Haider M, Gotte M, Harley N, Hashimi M, Hui D, Ismail M, Jehan F, Kabra SK, Kanda S, Kim YJ, Kissoon N, Krishna S, Kuppalli K, Kwizera A, Lado Castro-Rial M, Lisboa T, Lodha R, Mahaka I, Manai H, Mendelson M, Migliori GB, Mino G, Nsutebu E, Peter J, Preller J, Pshenichnaya N, Qadir N, Ranganathan SS, Relan P, Rylance J, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Souza JP, Swanstrom R, Tshokey T, Ugarte S, Uyeki T, Evangelina VC, Venkatapuram S, Vuyiseka D, Wijewickrama A, Tran L, Zeraatkar D, Bartoszko JJ, Ge L, Brignardello-Petersen R, Owen A, Guyatt G, Diaz J, Kawano-Dourado L, Jacobs M, Vandvik PO. A living WHO guideline on drugs for covid-19. BMJ 2020; 370:m3379. [PMID: 32887691 DOI: 10.1136/bmj.m3379] [Citation(s) in RCA: 475] [Impact Index Per Article: 118.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Updates This is the fourteenth version (thirteenth update) of the living guideline, replacing earlier versions (available as data supplements). New recommendations will be published as updates to this guideline. Clinical question What is the role of drugs in the treatment of patients with covid-19? Context The evidence base for therapeutics for covid-19 is evolving with numerous randomised controlled trials (RCTs) recently completed and underway. Emerging SARS-CoV-2 variants and subvariants are changing the role of therapeutics. What is new? The guideline development group (GDG) defined 1.5% as a new threshold for an important reduction in risk of hospitalisation in patients with non-severe covid-19. Combined with updated baseline risk estimates, this resulted in stratification into patients at low, moderate, and high risk for hospitalisation. New recommendations were added for moderate risk of hospitalisation for nirmatrelvir/ritonavir, and for moderate and low risk of hospitalisation for molnupiravir and remdesivir. New pharmacokinetic evidence was included for nirmatrelvir/ritonavir and molnupiravir, supporting existing recommendations for patients at high risk of hospitalisation. The recommendation for ivermectin in patients with non-severe illness was updated in light of additional trial evidence which reduced the high degree of uncertainty informing previous guidance. A new recommendation was made against the antiviral agent VV116 for patients with non-severe and with severe or critical illness outside of randomised clinical trials based on one RCT comparing the drug with nirmatrelvir/ritonavir. The structure of the guideline publication has also been changed; recommendations are now ordered by severity of covid-19. About this guideline This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF on the WHO website, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact. Future recommendations Recommendations on anticoagulation are planned for the next update to this guideline. Updated data regarding systemic corticosteroids, azithromycin, favipiravir and umefenovir for non-severe illness, and convalescent plasma and statin therapy for severe or critical illness, are planned for review in upcoming guideline iterations.
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Affiliation(s)
- Arnav Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Beverly Hunt
- St Thomas’ Hospital, London, UK
- ivermectin and IL-6 receptor blocker panel member
| | - Miriam Stegemann
- Charité - Universitätsmedizin Berlin, Germany
- ivermectin and IL-6 receptor blocker panel member
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - François Lamontagne
- Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Quebec, Canada
- Not panel member; resource for methodology, systematic review, and content support
- Corticosteroid panel member
| | - Reed Ac Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Not panel member; resource for methodology, systematic review, and content support
- Corticosteroid panel member
| | - Lisa Askie
- World Health Organization, Geneva, Switzerland
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Yee-Sin Leo
- National Center for Infectious Diseases, Singapore
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Helen Macdonald
- The BMJ, London, UK
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
- Not panel member; resource for methodology, systematic review, and content support
| | - Linan Zeng
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | | | | | - Wagdy Amin
- Ministry of Health and Population, Cairo, Egypt
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | | | - Frederique Jacquerioz Bausch
- Geneva University Hospital, Switzerland
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Carolyn S Calfee
- University of California, San Francisco, USA
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
| | | | - Duncan Chanda
- Adult Infectious Disease Centre, University Teaching Hospital, Lusaka, Zambia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - An De Sutter
- University of Gent, Belgium
- ivermectin and IL-6 receptor blocker panel member
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Stephen Freedman
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Patrick Gee
- USA
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Nerina Harley
- Royal Melbourne Hospital and Epworth Healthcare, Melbourne, Australia
- ivermectin and IL-6 receptor blocker panel member
| | - Madiha Hashimi
- Ziauddin University, Karachi, Pakistan
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - David Hui
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, China
| | | | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Seema Kanda
- McMaster University (alumnus)
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Yae-Jean Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Niranjan Kissoon
- Department of Paediatrics and Emergency Medicine, University of British Columbia, Vancouver, Canada
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | - Imelda Mahaka
- Zimbabwe
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Hela Manai
- Emergency Medical Services, Faculty of Medicine, Tunis, Tunisia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Marc Mendelson
- Groote Schuur Hospital, University of Cape Town, South Africa
| | | | - Greta Mino
- Alcivar Hospital in Guayaquil, Ecuador
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Emmanuel Nsutebu
- Sheikh Shakhbout Medical City, Abu Dhabi
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Natalia Pshenichnaya
- Central Research Institute of Epidemiology of Rospotrebnadzor, Moscow, Russia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Nida Qadir
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Shalini Sri Ranganathan
- University of Colombo, Sri Lanka
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Saniya Sabzwari
- Aga Khan University, Karachi, Pakistan
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Rohit Sarin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Manu Shankar-Hari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- ivermectin and IL-6 receptor blocker panel member
| | - Michael Sharland
- St. George’s University Hospital, UK
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Joao P Souza
- University of Sao Paulo, Brazil
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Sebastian Ugarte
- Faculty of Medicine Andres Bello University, Indisa Clinic, Santiago, Chile)
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Timothy Uyeki
- Influenza Division, U.S. Centers for Disease Control and Prevention, United States
| | | | - Sridhar Venkatapuram
- King’s College, London, UK
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Dubula Vuyiseka
- University of Stellenbosch, South Africa
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Ananda Wijewickrama
- Ministry of Health, Sri Lanka
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Lien Tran
- Infectious Diseases Data Observatory (IDDO), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Long Ge
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- The BMJ, London, UK
- Not panel member; resource for methodology, systematic review, and content support
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, England
- Not panel member; resource for methodology, systematic review, and content support
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
- Not panel member; resource for methodology, systematic review, and content support
- co-senior author
| | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor)- HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil and Research Institute, Hospital do Coração (HCor), São Paulo, Brazil
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
- co-senior author
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
- Not panel member; resource for methodology, systematic review, and content support
- co-senior author
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Nadeshkumar A, Sathiadas G, Sri Ranganathan S. Rational dispensing of oral dosage forms of medicines to children at a teaching hospital in Sri Lanka. BMC Health Serv Res 2020; 20:377. [PMID: 32375749 PMCID: PMC7201638 DOI: 10.1186/s12913-020-05246-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 04/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Good dispensing practice is vital for rational use of medicines. There are many paediatric specific challenges when maintaining good dispensing practices to children. Lack of age appropriate dosage forms, lack of medicines in strengths suitable for children, lack of palatable medicines, lack of expertise in paediatric pharmacy are few challenges faced when maintaining good dispensing practices to children. These challenges contribute to poor dispensing practices. Hence there is an urgent need to investigate whether oral dosage forms of medicines are dispensed rationally to children. The objective of this study was to describe the rational dispensing practice of oral dosage forms of medicines to children in a Teaching Hospital in Sri Lanka. Methods A descriptive cross sectional study was conducted to assess the dispensing practice of 1800 oral dosage forms of medicines dispensed to children under the age of 12 years in two outdoor pharmacies over a period of 1 year using validated indicators. Required data were extracted from the prescriptions and by observation using a structured pre-tested observation sheet. Descriptive statistics and wherever relevant, chi square test were used in analysing the data. Results Information on 1800 oral dosage forms was obtained from 1889 medicines dispensed to 727 children. Liquids were 52% [95% CI: 50–55%] of these oral dosage forms. Of the solid dosage forms, about one quarter required manipulation prior to administration such as splitting and dissolving or crushing the adult dosage form. None of the medicine packs or bottles had the patient name on the label. Conclusion Dispensing practice of oral dosage forms of medicines to children has room for improvement.
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Affiliation(s)
- Abarna Nadeshkumar
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | - Gitanjali Sathiadas
- Department of Paediatrics, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
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Sumanasena SP, Wanigasinghe J, Arambepola C, Sri Ranganathan S, Muhandiram E. Developmental profile at initial presentation in children with infantile spasms. Dev Med Child Neurol 2019; 61:1295-1301. [PMID: 30854631 DOI: 10.1111/dmcn.14205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe the baseline developmental profile and influence of clinical and demographic factors on the developmental skills of infants diagnosed with infantile spasms. METHOD Ninety-five infants (55 males, 40 females) newly diagnosed with infantile spasms were recruited for a cross-sectional, longitudinal study. All infants underwent Bayley Scales of Infant and Toddler Development assessments in the cognitive, receptive communication, expressive communication, and fine and gross motor developmental domains; they also underwent visual, auditory, and social behaviour assessments. Infants were categorized as 'early' (<6mo) or 'late' (≥6mo) presenters; if presented within 28 days, this was considered as 'early presentation', whereas a delay greater than 28 days was considered as a 'delay in presentation'. Antenatal, perinatal, and postnatal risk factors were identified. RESULTS Over 90% of infants showed impairment in all domains, with the majority having severe delay; 99% showed cognitive impairment. Delayed presentation was significantly associated with receptive communication delay (odds ratio [OR]=5.35; 95% confidence interval [CI]=1.05-27.32). Onset at 6 months or less influenced auditory (OR=2.8; 95% CI=1.16-6.8) and visual (OR=3.03; 95% CI=1.22-7.57) behaviours. Neonatal infections impacted both receptive (OR=1.12; 95% CI=1.04-1.2) and expressive communication (OR=1.08; 95% CI=1.02-1.14) delay. Neonatal seizures significantly influenced visual, auditory, and social impairments. Expressive communication and gross motor development shared common perinatal risk factors. INTERPRETATION Adverse developmental status at presentation, associated with delayed presentation and neonatal risk factors should alert clinicians to the surveillance of at-risk infants and seek out timely interventions. WHAT THIS PAPER ADDS Ninety per cent of infants showed impaired cognitive, communication, and motor skills at presentation. Visual, auditory, and social behaviour impairments were significantly associated with perinatal risks. Visual, auditory, and social behaviour impairments were significantly associated with neonatal seizures.
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Affiliation(s)
- Samanmali P Sumanasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Eindrini Muhandiram
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Nadeshkumar A, Sathiadas G, Pathmeswaran A, Ranganathan SS. Prescribing, dispensing and administration indicators to describe rational use of oral dosage forms of medicines given to children. WHO South East Asia J Public Health 2019; 8:42-49. [PMID: 30950430 DOI: 10.4103/2224-3151.255349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Owing to lack of indicators, researchers are compelled to use non-specific indicators to assess rational use of medicines in children. Thus, paediatric-specific issues are poorly described. This study aims to develop a set of indicators to describe rational use of oral dosage forms of medicines given to children. Methods A modified RAND/UCLA Appropriateness Method was used. A comprehensive draft list of 40 indicators was compiled, based on the results of a literature review. Twelve experts rated these indicators in two rounds, using a nine-point Likert scale, first in an online survey, for clarity, necessity and scientific merit, and secondly in a face-to-face meeting, for necessity, feasibility and predictive value. An overall panel median score of ≥7 and agreement within the experts were used in indicators. The indicators were ranked independently by the research team and a final list of indicators was prepared. These indicators were pilot-tested for acceptability and interrater reliability. Results Nine prescribing indicators, such as weight, appropriate dose and age-appropriate dosage form; five dispensing indicators, such as adequacy of labelling and inappropriate manipulation by pharmacists; and five administration indicators, such as inappropriate manipulation by parents and full completion of dose, were finalized in the second round. Conclusion This novel approach has provided a set of indicators to describe the use of oral dosage forms of medicines given to children, which can be used by researchers as a supplement to the World Health Organization's drug use indicators when investigating rational use of medicines in children.
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Affiliation(s)
- Abarna Nadeshkumar
- Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
| | - Gitanjali Sathiadas
- Department of Paediatrics, Faculty of Medicine, University of Jaffna, Sri Lanka
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Karbwang J, Koonrungsesomboon N, Torres CE, Jimenez EB, Kaur G, Mathur R, Sholikhah EN, Wanigatunge C, Wong CS, Yimtae K, Abdul Malek M, Ahamad Fouzi L, Ali A, Chan BZ, Chandratilake M, Chiew SC, Chin MYC, Gamage M, Gitek I, Hakimi M, Hussin N, Jamil MFA, Janarsan P, Julia M, Kanungo S, Karunanayake P, Kollanthavelu S, Kong KK, Kueh BL, Kulkarni R, Kumaran PP, Kumarasiri R, Lim WH, Lim XJ, Mahmud F, Mantaring JBV, Md Ali SM, Mohd Noor N, Muhunthan K, Nagandran E, Noor M, Ooi KH, Pradeepan JA, Sadewa AH, Samaranayake N, Sri Ranganathan S, Subasingha W, Subramaniam S, Sulaiman N, Tay JF, Teng LH, Tew MM, Tharavanij T, Tok PSK, Weeratna J, Wibawa T, Wickremasinghe R, Wongwai P, Yadav S. What information and the extent of information research participants need in informed consent forms: a multi-country survey. BMC Med Ethics 2018; 19:79. [PMID: 30219106 PMCID: PMC6139128 DOI: 10.1186/s12910-018-0318-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022] Open
Abstract
Background The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. Methods This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). Results Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be ‘moderately important’ to ‘very important’ for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively). Conclusions Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF. Electronic supplementary material The online version of this article (10.1186/s12910-018-0318-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juntra Karbwang
- Department of Clinical Product Development, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
| | - Nut Koonrungsesomboon
- Department of Pharmacology, Faculty of Medicine, Chiang Mai University, 110 Muang Chiang Mai, Chiang Mai, 50200, Thailand.
| | - Cristina E Torres
- Forum for Ethical Review Committees in the Asian and Western Pacific region, WHO-TDR Clinical Coordination and Training Center, Thammasat University, Pathum Thani, Thailand.,National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Edlyn B Jimenez
- National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Gurpreet Kaur
- Selangor State Health Department, Ministry of Health, Putrajaya, Malaysia
| | - Roli Mathur
- ICMR Bioethics Unit, National Centre for Disease Informatics and Research, Bangalore, India
| | - Eti N Sholikhah
- Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Chandanie Wanigatunge
- Forum for Ethics Review Committees in Sri Lanka and Faculty of Medical Sciences, University of Sri Jayewardanepura, Nugegoda, Sri Lanka
| | - Chih-Shung Wong
- Department of Anesthesiology, Cathay General Hospital, Taipei, Taiwan
| | - Kwanchanok Yimtae
- Academic Clinical Research Office, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Aisyah Ali
- Sultan Ismail Hospital, Johor Bahru, Johor, Malaysia
| | | | | | - Shoen C Chiew
- Seri Manjung Hospital, Seri Manjung, Perak, Malaysia
| | | | - Manori Gamage
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | | | - Mohammad Hakimi
- Medical and Health Research Ethics Committee, Faculty of Medicine Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | | | | | | | - Madarina Julia
- Department of Pediatric, Faculty of Medicine Universitas Gadjah Mada, Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Suman Kanungo
- Division of Epidemiology, National Institute of Cholera & Enteric Diseases, Kolkata, India
| | | | | | - Kian K Kong
- Duchess of Kent Hospital, Sandakan, Malaysia
| | | | - Ragini Kulkarni
- Department of Operational Research, National Institute for Research in Reproductive Health, Mumbai, India
| | - Paul P Kumaran
- National Institute for Research in Tuberculosis, Chennai, India
| | | | - Wei H Lim
- Sibu Hospital, Sibu, Sarawak, Malaysia
| | - Xin J Lim
- Raja Permaisuri Bainun Hospital, Ipoh, Malaysia
| | | | | | - Siti M Md Ali
- Sultanah Bahiyah Hospital, Alor Setar, Kedah, Malaysia
| | | | | | | | | | - Kim H Ooi
- Tuanku Fauziah Hospital, Kangar, Perlis, Malaysia
| | | | - Ahmad H Sadewa
- Department of Biochemistry, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | | | | | | | | | | | - Ju F Tay
- Selayang Hospital, Shah Alam, Malaysia
| | | | - Mei M Tew
- Sultan Abdul Halim Hospital, Sungai Petani, Kedah, Malaysia
| | - Thipaporn Tharavanij
- Endocrinology and Metabolism Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Jayanie Weeratna
- Institute of Forensic Medicine and Toxicology, Colombo, Sri Lanka
| | - Tri Wibawa
- Department of Microbiology, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Renu Wickremasinghe
- Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Phanthipha Wongwai
- Department of Opthalmology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Subhash Yadav
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGI), Lucknow, Uttar Pradesh, India
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Murugupillai R, Ranganathan SS, Wanigasinghe J, Muniyandi R, Arambepola C. Development of outcome criteria to measure effectiveness of antiepileptic therapy in children. Epilepsy Behav 2018; 80:56-60. [PMID: 29414559 DOI: 10.1016/j.yebeh.2017.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Clinical trials of antiepileptic drugs frequently measure outcomes of seizure control, which demonstrate efficacy. Yet, functional status, quality of life, and long-term treatment effects reflecting effectiveness are scarcely assessed. We sought to use a consensus method to help identify which outcome criteria key stakeholders consider should be used to measure effectiveness in trials of antiepileptic treatments for children. METHOD A two-round Delphi survey was used; parents of children with epilepsy and local, international experts comprising academics and clinicians participated in the survey. In the first round, 32 experts, 50 parents, and 15 children with epilepsy aged >13years suggested outcomes that they considered important in determining effectiveness of antiepileptic therapy in children, separately for preschool and school age. In the second round, 29 experts and 42 parents scored the importance of outcomes from the list suggested by at least 10% of round 1 respondents and also proposed five most important outcomes. RESULTS Complete seizure freedom (67%), seizure frequency (48%), ability to perform normal day-to-day activities (45%), and quality of life (40%) were identified as the most important outcomes of antiepileptic therapy in children of both age groups. Additionally, effect on developmental milestones (47%) and child's compliance to treatment regimen (39%) were identified as most important in preschool age group and school performance (49%); adverse effects (39%) were identified as most important in school age group. CONCLUSION For the first time, this study has identified outcome priorities regarding antiepileptic treatment in children based on the key stakeholders' perspectives. It could be used as a provisional list of outcomes for inclusion in a core outcome set for children with epilepsy.
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Affiliation(s)
- Roshini Murugupillai
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University Sri Lanka, No:50, New Road, Batticaloa, Sri Lanka.
| | - Shalini Sri Ranganathan
- Department of Pharmacology, Faculty of Medicine, University of Colombo, PO Box 25, Kynsey Road, Colombo 08, Sri Lanka
| | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, PO Box 25, Kynsey Road, Colombo 08, Sri Lanka
| | - Ravi Muniyandi
- Department of Social Sciences, Faculty of Arts and Culture, Eastern University Sri Lanka, Vantharumoolai, Batticaloa, Sri Lanka
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, PO Box 25, Kynsey Road, Colombo 08, Sri Lanka
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Wanigasinghe J, Arambepola C, Ranganathan SS, Sumanasena S. Randomized, Single-Blind, Parallel Clinical Trial on Efficacy of Oral Prednisolone Versus Intramuscular Corticotropin: A 12-Month Assessment of Spasm Control in West Syndrome. Pediatr Neurol 2017; 76:14-19. [PMID: 28927673 DOI: 10.1016/j.pediatrneurol.2017.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/09/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We earlier completed a single-blind, parallel-group, randomized clinical trial to test the null hypothesis that adrenocorticotropic hormone (ACTH) is not superior to high-dose prednisolone for short-term control of West syndrome. We now present long-term follow-up data for spasm control for individuals who completed this earlier trial. METHODS Infants with untreated West syndrome were randomized to receive 14 days of prednisolone (40 to 60 mg/day) or intramuscular long-acting ACTH (40 to 60 IU every other day). They were evaluated at three, six, and 12 months to evaluate long-term spasm control. RESULTS The total number of infants treated was 97 (48 prednisolone; 49 ACTH). All completed the treatment course. Eighty-five, 82, and 76 children were available for follow-up at three, six, and 12 months. The number lost to follow-up at each interval was not statistically different. Likelihood of spasm freedom at three months was significantly higher for prednisolone (64.6%) than for ACTH (38.8%) (P = 0.01; odds ratio = 2.9; 95% confidence interval = 1.3 to 6.6). At six months (P = 0.19) and twelve months (P = 0.13), the control of spasms was not statistically different, although a trend in favor of prednisolone was documented at both of these time points (58.3% versus 44.9% for ACTH at six months and 56.2% versus 40.8% with ACTH at 12 months). After initial remission by day 14 (n = 46), the likelihood of a relapse within the next 12 months was not statistically different between the two treatment groups (P = 0.1). CONCLUSIONS Control of spasms at three months was significantly better if initially treated with prednisolone. Control of spasms at six and 12 months was not significantly different despite a trend favoring prednisolone. Risk of relapse following initial remission was similar in the two groups.
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Affiliation(s)
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Sri Lanka
| | | | - Samanmali Sumanasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Sri Lanka
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Wanigasinghe J, Arambepola C, Sri Ranganathan S, Sumanasena S, Attanapola G. Randomized, Single-Blind, Parallel Clinical Trial on Efficacy of Oral Prednisolone Versus Intramuscular Corticotropin on Immediate and Continued Spasm Control in West Syndrome. Pediatr Neurol 2015. [PMID: 26216500 DOI: 10.1016/j.pediatrneurol.2015.05.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE A single-center, single-blind, parallel-group, randomized clinical trial was performed to test the null hypothesis that adrenocorticotropic hormone is not superior to high-dose prednisolone for treatment of newly diagnosed West syndrome. METHODS Newly diagnosed infants with West syndrome were randomized to receive 14 days of oral prednisolone (40-60 mg/day) or a synthetically prepared intramuscular long-acting adrenocorticotropic hormone (40-60 IU/every other day [0.5-0.75 mg]) according to the United Kingdom Infantile Spasm Study protocol. They were blindly evaluated for infantile spasm remission by day 14, electroclinical remission (spasm cessation + resolution of hypsarrhythmia on a 30-minute electroencephalograph) by day 14 and continued spasm freedom for 28 days. RESULTS Ninety-seven patients were enrolled in the study, with 48 of them receiving prednisolone and 49 receiving ACTH. There was no significant difference in the baseline characteristics or risk factors for the two treatment groups. By day 14, cessation of infantile spasms occurred in 28/48 (58.3%) infants on prednisolone compared with only 18/49 (36.7%) infants given adrenocorticotropic hormone (P = 0.03) and electroclinical remission in 21 on prednisolone compared with nine on adrenocorticotropic hormone (P = 0.007). Sustained spasm control for 28 consecutive days following electroclinical remission occurred in 15 children on prednisolone compared with six on adrenocorticotropic hormone (P = 0.008). The total number of days required for spasm cessation was significantly less in those treated with prednisolone (3.85 days ± 2.4) compared with adrenocorticotropic hormone (8.65 days ± 3.7) (P = 0.001). Among patients who did not achieve remission, there was a non-significant trend toward greater quantitative reduction of spasms with prednisolone than with adrenocorticotropic hormone (P = 0.079). CONCLUSION Synthetic adrenocorticotropic hormone of 40-60 IU/every other day did not yield superior rates of electroencephalographic or clinical remission when compared with prednisolone of 40-60 mg/day. Significantly, more patients achieved electroclinical remission when treated with prednisolone than with adrenocorticotropic hormone.
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Affiliation(s)
- Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Samanmalie Sumanasena
- Department of Disability Studies, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka
| | - Gangani Attanapola
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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18
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Abstract
Millions of children die every year before they reach the age of 5 years, of conditions largely treatable with existing medicines. The WHO Model List of Essential Medicines was launched in 1977 to make the most necessary drugs available to populations whose basic health needs could not be met by the existing supply system. During the first 30 years of the Model List of Essential Medicines, children's needs were not systematically considered. After adoption of the 'Better medicines for children' resolution by the World Health Assembly, things changed. The first WHO Model List of Essential Medicines for Children was drawn up by a Paediatric Expert Subcommittee and adopted in October 2007. The most recent, 4th Model List of Essential Medicines for Children was adopted in 2013. Data from country surveys show that access to essential medicines for children is still generally poor; much more work is needed.
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Affiliation(s)
- Kalle Hoppu
- Hospital for Children and Adolescents and Department of Clinical Pharmacology, University of Helsinki and Poison Information Centre, Helsinki University Central Hospital, Helsinki, Finland
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19
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Wanigasinghe J, Arambepola C, Sri Ranganathan S, Sumanasena S, Muhandiram EC. The efficacy of moderate-to-high dose oral prednisolone versus low-to-moderate dose intramuscular corticotropin for improvement of hypsarrhythmia in West syndrome: a randomized, single-blind, parallel clinical trial. Pediatr Neurol 2014; 51:24-30. [PMID: 24938136 DOI: 10.1016/j.pediatrneurol.2014.03.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 03/06/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The role of therapy on improvement of hypsarrhythmia has not been systematically assessed. This study was performed to assess the efficacy of oral prednisolone and intramuscular adrenocorticotrophin hormone in improving hypsarrhythmia in West syndrome. METHOD Children (2 months-2 years), with previously untreated West syndrome, were randomized to receive 40-60 IU every other day of intramuscular adrenocorticotrophin hormone or 40-60 mg/day of oral prednisolone for 14 days. Children with tuberous sclerosis were excluded. Improvement of hypsarrhythmia was assessed blindly using a hypsarrhythmia severity scale before and after completion of therapy. Adverse effects were assessed on day 14 using symptom diary. (Clinical trial registry identifier: SLCTR/2010/010.) RESULTS From 92 newly diagnosed West syndrome infants, 48 were randomized to receive prednisolone and 44 to receive adrenocorticotrophin hormone. Eighty infants completed the posttreatment evaluation according to specifications. The hypsarrhythmia severity score, significantly improved with hormonal therapy for 2 weeks (10.45 ± 2.65 vs 3.45 ± 2.67); P < 0.01. When individual treatment arms were compared using mean differences in the improvement of scores, improvement in prednisolone arm (7.95 ± 2.76) was significantly greater than that in the adrenocorticotrophin hormone arm (6.00 ± 2.61); P < 0.01. Both forms of therapy were tolerated well. Frequent crying, irritability, weight gain, increased appetite, and abdominal distension were more common (but not statistically significant) with prednisolone. CONCLUSIONS Hypsarrhythmia severity score improved significantly with both hormonal therapies, but this improvement was significantly better with oral prednisolone than intramuscular adrenocorticotrophin hormone. This is the first ever documentation of a superior therapeutic role of oral steroids in West syndrome.
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Affiliation(s)
- Jithangi Wanigasinghe
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Carukshi Arambepola
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Samanmali Sumanasena
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Eindrini C Muhandiram
- Department of Pediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Balasubramaniam R, Benaragama BVSH, Sri Ranganathan S. A national survey of price and affordability of key essential medicines for children in Sri Lanka. Indian J Pediatr 2014; 81:362-7. [PMID: 23640698 DOI: 10.1007/s12098-013-1024-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 03/25/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To investigate the price and affordability of key essential medicines for children in Sri Lanka. METHODS This national survey investigated the prices and affordability of 25 key essential medicines for children in private sector pharmacies using the WHO/Health Action International (HAI) medicine price methodology. Data were collected from a representative sample of 48 private sector pharmacies selected from 8 Provinces using a multistage clustered approach. At each pharmacy prices of originator brand (OB) and lowest priced generics (LPG) of the selected medicines were collected. Medicine prices were compared with international reference prices to obtain a median price ratio (MPR). Income of the lowest paid unskilled government worker was used to establish the affordability. RESULTS The median MPR of retail prices to patients was 3.7 for OB (range 0.23-20) and 1.35 for LPG (range 0.05-3.75). MPR >5 was observed for OBs of 5 medicines: ceftriaxone injection, diazepam injection, mebendazole syrup, mebendazole chewable tablet and metronidazole tablet whereas MPR >2.5 was observed only for LPGs of 3 medicines: chlorphenamine syrup, clotrimazole topical cream, and paracetamol syrup. Mean percent difference in price between OB and LPG products was 365 % (range -21, 2343). Rational treatment for acute infections such as mild lower respiratory tract infections and acute gastroenteritis seems to be affordable but treatment for chronic illnesses requiring liquid or inhaled dosage forms were largely unaffordable. CONCLUSIONS Intervention is needed to improve the economic access to key essential medicines for children indicated in the treatment of chronic diseases.
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Affiliation(s)
- R Balasubramaniam
- Department of Pharmacology, Faculty of Medicine, University of Colombo, PO Box 271, Colombo 8, Sri Lanka
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21
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Abstract
Diseases causing high mortality in children under 5 years of age in resource limited settings (RLS) could be treated if children in these countries had access to existing medicines. It took 30 years before the WHO Essential Medicines List (EML) considered the issue of medicines for children, with the first EML for children being published in 2007. Recent data indicate that less than half of the key paediatric essential medicines are available in countries of sub-Saharan Africa. Problems include substandard medicines, irrational use of medicines, inefficiency and even possible corruption in pharmaceutical management systems. These are global issues which affect RLS most. Clinical trials in developing countries for the benefit of children are needed but challenging in several ways. In this review, the authors will consider the following areas where progress could improve paediatric pharmacotherapy in RLS: registration and regulation of medicines, rational use of medicines, clinical trials in children and restriction of corruption in pharmaceutical management systems.
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Affiliation(s)
- Kalle Hoppu
- Department of Clinical Pharmacology, University of Helsinki, Helsinki, Finland.
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Hoppu K, Anabwani G, Garcia-Bournissen F, Gazarian M, Kearns GL, Nakamura H, Peterson RG, Sri Ranganathan S, de Wildt SN. The status of paediatric medicines initiatives around the world--What has happened and what has not? Eur J Clin Pharmacol 2011; 68:1-10. [PMID: 21732178 DOI: 10.1007/s00228-011-1089-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 06/09/2011] [Indexed: 01/07/2023]
Abstract
PURPOSE This review was conducted to examine the current status of paediatric medicines initiatives across the globe. METHODS The authors made a non-systematic descriptive review of current world situation. RESULTS Two regions, the United States (US) and the European Union (EU), and the World Health Organization (WHO) have introduced strong paediatric initiatives to improve children's health through improving access to better paediatric medicines. The experience from the US initiative indicates that it is possible to stimulate development and study of paediatric medicines and provide important new information for improvement of paediatric therapy. The early results from the EU initiative are similarly encouraging. In Canada, Japan, Australia and other developed countries, specific paediatric medicines initiatives have been less extensive and weaker, with modest results. Disappointingly, current evidence suggests that results from clinical trials outside the US often do not benefit children in the country in which the trials were largely conducted. Pharmaceutical companies that have derived a financial benefit commensurate with the cost of doing the paediatric trials in one country do not seem to be making the results of these trials available to all countries if there is no financial incentive to the company. The WHO campaign 'make medicines child size' has produced substantive accomplishments in building improved foundations to improve mechanisms that will enhance children's access to critical medicines in resource-limited settings. However, practically all of this work has been performed using an amalgamation of short-term funding from a variety of sources as opposed to a sustained, programmatic commitment. CONCLUSIONS Although much still needs to be done, it's clear that with concerted efforts and appropriate resources, change is possible but slow. Retaining and fostering public and political interest in paediatric medicines is challenging, but pivotal for success.
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Affiliation(s)
- Kalle Hoppu
- Hospital for Children and Adolescents and Dept. of Clinical Pharmacology, University of Helsinki and Poison Information Centre, Helsinki University Central Hospital, P.O. Box 790, 00029, Helsinki, Finland.
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Gunawardena S, Sri Ranganathan S, Fernandopulle R. Pharmacovigilance through consumer feedback (reporting) in the mass treatment of lymphatic filariasis using diethylcarbamazine and albendazole in two districts of Sri Lanka. Trop Med Int Health 2008; 13:1153-8. [PMID: 18631319 DOI: 10.1111/j.1365-3156.2008.02120.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To document the types and severity of adverse drug reactions to diethylcarbamazine and albendazole in randomly selected urban populations from Colombo and rural populations from Gampaha, Sri Lanka. METHODS Interviewers administered a pre-tested questionnaire to elicit information about the type and severity of adverse drug reactions experienced by recipients. Seeking medical treatment and requiring hospital admission for the adverse drug reactions were used as indicators for severity. The sample population was selected using the cluster sampling method. RESULTS Two thousand three hundred and nineteen persons aged 10 to 90 years (median 40.0) responded to the questionnaire; 63.9% of them had received and ingested the drugs. 12.6% reported that they had experienced adverse drug reactions, the proportion being similar in urban and rural areas (chi2 = 0.05; p = 0.82). Commonly reported reactions were drowsiness (34.7%), headache (23.1%), gastrointestinal symptoms (18.7%) and dizziness or faintness (11.9%). However, most symptoms were mild (96.3%) and did not interfere with daily activities or require medical attention. 3.2% said that they sought medical advice for their symptoms; one person (0.5%) who had severe abdominal pain was hospitalized. CONCLUSIONS Fewer people experienced adverse drug reactions than in previous years, possibly due to lower microfilariaemia prevalence after several rounds of mass drug administration against filariasis. Community awareness of adverse drug reactions is essential for improving compliance and for the success of the filariasis elimination programme.
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Affiliation(s)
- Sharmini Gunawardena
- Department of Parasitology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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Ranganathan SS, Fernandopulle BM, de Silva MV, Fernandopulle M. Fulminant heptic failure in a child following paracetamol overdosing. Ceylon Med J 2001; 46:72-3. [PMID: 11727585 DOI: 10.4038/cmj.v46i2.6502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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