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Grigg J, Peacock A, Lenton S, Salom C, Agramunt S, Thomas N, Lyons T, Sutherland R. Real or fake? Sourcing and marketing of non-prescribed benzodiazepines amongst two samples of people who regularly use illicit drugs in Australia. Drug Alcohol Rev 2023; 42:1559-1565. [PMID: 37490407 PMCID: PMC10947514 DOI: 10.1111/dar.13722] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/15/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION There is concern around non-prescribed benzodiazepine use, particularly with increasing detections of counterfeit products containing high-risk novel compounds. The aims of this study were to investigate how and which non-prescribed benzodiazepines are being sourced; forms, appearance and packaging; and awareness of risks associated with non-prescribed benzodiazepines. METHODS Data were collected from a sample of Australians who inject drugs or use ecstasy and/or other illicit stimulants on a monthly or more frequent basis, and who reported past 6-month use of non-prescribed benzodiazepines (n = 235 and n = 250, respectively). Data were collected on source, diversion from a known/trusted prescription, product name and aesthetic characteristics for the last non-prescribed benzodiazepine obtained. RESULTS Amongst participants who injected drugs, 71% reported that their last non-prescribed benzodiazepines were diverted from a known/trusted prescription, compared to 59% of participants who used ecstasy/other stimulants. Sourcing via cryptomarkets was rare. Across both samples, the majority reported last obtaining substances sold/marketed as diazepam or alprazolam. Participants sourcing via non-diverted means were twice as likely to obtain alprazolam. Known sourcing of novel compounds was rare. Amongst participants who used ecstasy/other stimulants, 36% reported confidence in the content/dose of non-prescribed benzodiazepines even when the source is unknown. DISCUSSION AND CONCLUSIONS Most participants obtained substances sold as classic/registered benzodiazepines, mostly via diverted prescriptions, with a substantial minority potentially unaware of counterfeits circulating. While diverted use undeniably presents risks, tightening of prescriptions in Australia could inadvertently lead to greater supply of novel benzodiazepines as seen internationally, reinforcing prioritisation of demand and harm reduction strategies.
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Affiliation(s)
- Jodie Grigg
- National Drug Research Institute and enAble InstituteCurtin UniversityPerthAustralia
| | - Amy Peacock
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
- School of PsychologyUniversity of TasmaniaHobartAustralia
| | - Simon Lenton
- National Drug Research Institute and enAble InstituteCurtin UniversityPerthAustralia
| | - Caroline Salom
- Institute for Social Science ResearchUniversity of QueenslandBrisbaneAustralia
| | - Seraina Agramunt
- National Drug Research Institute and enAble InstituteCurtin UniversityPerthAustralia
| | - Natalie Thomas
- Institute for Social Science ResearchUniversity of QueenslandBrisbaneAustralia
| | - Tom Lyons
- Mental Health and Wellbeing Division, Department of HealthMelbourneVictoriaAustralia
| | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
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Mallah N, Orsini N, Figueiras A, Takkouche B. Education level and misuse of antibiotics in the general population: a systematic review and dose-response meta-analysis. Antimicrob Resist Infect Control 2022; 11:24. [PMID: 35115030 PMCID: PMC8815169 DOI: 10.1186/s13756-022-01063-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Numerous studies evaluated the association of education level with misuse of antibiotics by the general population, yet divergent findings were reported. Therefore, a meta-analysis was conducted to summarize this association. METHODS A categorical and continuous dose-response meta-analysis of the association of education level with antibiotic misuse was undertaken. Summary odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using random-effect model. RESULTS The meta-analysis included 85 studies from 42 countries of different socioeconomic status. Compared to low education (≤ 9 years), medium education (> 9-12 years) is associated with 20% lower odds of antibiotic misuse in high-income countries (OR = 0.80; 95% CI 0.66, 0.97), while high education (> 12 years) is associated with 14% lower odds of any aspect of antibiotic misuse (OR = 0.86; 95% CI 0.72, 1.03). The association is more pronounced in Middle East (OR = 0.64; 95% CI 0.42, 1.00) and countries of lower-middle economies (OR = 0.67, 95% CI 0.41, 1.11). Inversely, in Europe, high education is associated with 25% higher odds of antibiotic misuse (OR = 1.25, 95% CI 1.00, 1.58). Each additional year of education was associated with 4% lower odds of any aspect of antibiotic misuse in lower-middle economies (OR = 0.96; 95% CI 0.92, 1.00) and in Middle East (OR = 0.96; 95% CI 0.93, 1.00). Conversely, it was associated with 3% higher odds of antibiotic storage, a specific type of misuse (OR = 1.03, 95% CI 1.01, 1.06). CONCLUSION Individuals misuse antibiotics irrespective of their education level. Intervention programs to enhance the proper use of antibiotics should target all communities independent of their education level.
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Affiliation(s)
- Narmeen Mallah
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Preventive Medicine, University of Santiago de Compostela, R/ San Francisco, s/n, 15782, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Nicola Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Adolfo Figueiras
- Department of Preventive Medicine, University of Santiago de Compostela, R/ San Francisco, s/n, 15782, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, R/ San Francisco, s/n, 15782, Santiago de Compostela, Spain.
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain.
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
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Abstract
The coronavirus disease 2019 (Covid-19) pandemic intensified the already catastrophic drug overdose and substance use disorder (SUD) epidemic, signaling a syndemic as social isolation, economic and mental health distress, and disrupted treatment services disproportionally impacted this vulnerable population. Along with these social and societal factors, biological factors triggered by intense stress intertwined with incumbent overactivity of the immune system and the resulting inflammatory outcomes may impact the functional status of the central nervous system (CNS). We review the literature concerning SARS-CoV2 infiltration and infection in the CNS and the prospects of synergy between stress, inflammation, and kynurenine pathway function during illness and recovery from Covid-19. Taken together, inflammation and neuroimmune signaling, a consequence of Covid-19 infection, may dysregulate critical pathways and underlie maladaptive changes in the CNS, to exacerbate the development of neuropsychiatric symptoms and in the vulnerability to develop SUD. This article is part of the special Issue on 'Vulnerabilities to Substance Abuse'.
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Affiliation(s)
- I E Cisneros
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA; Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA; Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA; Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA; Center for Biodefense and Emerging Infectious Diseases, University of Texas Medical Branch, Galveston, TX, USA.
| | - K A Cunningham
- Center for Addiction Research, University of Texas Medical Branch, Galveston, TX, USA; Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA; Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA
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Do NTT, Vu HTL, Nguyen CTK, Punpuing S, Khan WA, Gyapong M, Asante KP, Munguambe K, Gómez-Olivé FX, John-Langba J, Tran TK, Sunpuwan M, Sevene E, Nguyen HH, Ho PD, Matin MA, Ahmed S, Karim MM, Cambaco O, Afari-Asiedu S, Boamah-Kaali E, Abdulai MA, Williams J, Asiamah S, Amankwah G, Agyekum MP, Wagner F, Ariana P, Sigauque B, Tollman S, van Doorn HR, Sankoh O, Kinsman J, Wertheim HFL. Community-based antibiotic access and use in six low-income and middle-income countries: a mixed-method approach. Lancet Glob Health 2021; 9:e610-e619. [PMID: 33713630 PMCID: PMC8050200 DOI: 10.1016/s2214-109x(21)00024-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Antimicrobial misuse is common in low-income and middle-income countries (LMICs), and this practice is a driver of antibiotic resistance. We compared community-based antibiotic access and use practices across communities in LMICs to identify contextually specific targets for interventions to improve antibiotic use practices. METHODS We did quantitative and qualitative assessments of antibiotic access and use in six LMICs across Africa (Mozambique, Ghana, and South Africa) and Asia (Bangladesh, Vietnam, and Thailand) over a 2·5-year study period (July 1, 2016-Dec 31, 2018). We did quantitative assessments of community antibiotic access and use through supplier mapping, customer exit interviews, and household surveys. These quantitative assessments were triangulated with qualitative drug supplier and consumer interviews and discussions. FINDINGS Vietnam and Bangladesh had the largest proportions of non-licensed antibiotic dispensing points. For mild illness, drug stores were the most common point of contact when seeking antibiotics in most countries, except South Africa and Mozambique, where public facilities were most common. Self-medication with antibiotics was found to be widespread in Vietnam (55·2% of antibiotics dispensed without prescription), Bangladesh (45·7%), and Ghana (36·1%), but less so in Mozambique (8·0%), South Africa (1·2%), and Thailand (3·9%). Self-medication was considered to be less time consuming, cheaper, and overall, more convenient than accessing them through health-care facilities. Factors determining where treatment was sought often involved relevant policies, trust in the supplier and the drug, disease severity, and whether the antibiotic was intended for a child. Confusion regarding how to identify oral antibiotics was revealed in both Africa and Asia. INTERPRETATION Contextual complexities and differences between countries with different incomes, policy frameworks, and cultural norms were revealed. These contextual differences render a single strategy inadequate and instead necessitate context-tailored, integrated intervention packages to improve antibiotic use in LMICs as part of global efforts to combat antibiotic resistance. FUNDING Wellcome Trust and Volkswagen Foundation.
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Affiliation(s)
- Nga T T Do
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Huong T L Vu
- Oxford University Clinical Research Unit, Hanoi, Vietnam
| | - Chuc T K Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Sureeporn Punpuing
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Margaret Gyapong
- Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | | | - Khatia Munguambe
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - F Xavier Gómez-Olivé
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Johannes John-Langba
- School of Applied Human Sciences, University of Kwazulu-Natal, Durban, South Africa
| | - Toan K Tran
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Malee Sunpuwan
- Institute for Population and Social Research, Mahidol University, Nakhonpathom, Thailand
| | - Esperanca Sevene
- Manhiça Health Research Centre, Manhiça, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Hanh H Nguyen
- Department of Family Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Phuc D Ho
- Institute of Mathematics, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | | | - Sabeena Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Olga Cambaco
- Manhiça Health Research Centre, Manhiça, Mozambique
| | | | | | | | | | | | | | | | - Fezile Wagner
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - Proochista Ariana
- Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | | | - Stephen Tollman
- MRC-Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Nuffied Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Osman Sankoh
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Statistics Sierra Leone, Freetown, Sierra Leone; University Secretariat, Njala University, Njala, Sierra Leone; Heidelberg Institute for Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - John Kinsman
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Heiman F L Wertheim
- Oxford University Clinical Research Unit, Hanoi, Vietnam; Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
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Barakat M, Al-Qudah R, Akour A, Al-Qudah N, Dallal Bashi YH. Unforeseen uses of oral contraceptive pills: Exploratory study in Jordanian community pharmacies. PLoS One 2020; 15:e0244373. [PMID: 33347511 PMCID: PMC7751968 DOI: 10.1371/journal.pone.0244373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 09/12/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background The use of oral contraceptive pills (OCPs) as a birth control method is very common worldwide. OCPs have many other labeled non-contraceptive indications, and as a result there is an associated risk of improper use, as with any other medications. This study was designed to assess the unforeseen improper uses of OCPs observed by community pharmacists in Jordan. Method A cross-sectional study design was conducted using a self-administered survey. A convenience sample (n = 380) of Jordanian community pharmacists, were recruited through social media resources. The survey included multiple-choice and open-ended questions. Descriptive statistics and correlation analyses were completed using SPSS. Results More than half of the recruited pharmacists (55.3%) were female, and the mean age of the participants was 32.58 ± 9.94. The majority of the pharmacists (85%) had good knowledge about the non-contraceptive indications of OCPs. About 53% of them confirmed their exposure to cases of the improper use of OCPs. About 67.5% of the pharmacists who confirmed exposure to such cases, reported the topical use of OCPs for the enhancement of hair growth. Around 15% of those pharmacists stated that OCPs were used to give negative results for addictive drug screening tests. In the event that the pharmacists suspected improper use, more than 90% suggested they would refrain from dispensing the pills. Conclusion This study has spotlighted many unforeseen uses of OCPs in Jordan and highlighted the need for restricted national regulations on the monitoring of OCP prescription/selling patterns in Jordan by policymakers. Moreover, there is a need for the establishment of national educational programs for the Jordanian community regarding the safe proper use of OCPs.
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Affiliation(s)
- Muna Barakat
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
- * E-mail:
| | - Raja’a Al-Qudah
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Amal Akour
- Faculty of Pharmacy, Department of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
- School of Pharmacy, Department of Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Najem Al-Qudah
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
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Torrente F, Bustin J, Triskier F, Ajzenman N, Tomio A, Mastai R, Lopez Boo F. Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2027082. [PMID: 33306114 PMCID: PMC7733153 DOI: 10.1001/jamanetworkopen.2020.27082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE Nimodipine is a highly prescribed drug for the treatment of cognitive impairment and dementia in Argentina. There is little evidence to support the use of nimodipine for cognitive impairment and dementia. OBJECTIVE To test the effectiveness of a behavioral intervention based on social norm feedback to reduce prescription of nimodipine for cognitive impairment in Argentina. DESIGN, SETTING, AND PARTICIPANTS This pragmatic parallel-group randomized clinical trial included 2 arms with a 1:1 allocation ratio. General practitioner physicians in the national health care system for older adults in Argentina (INSSJP-PAMI) with history of high nimodipine prescription rate were enrolled. The study was conducted from May 2019 to October 2019, and data were analyzed from November 2019 to February 2020. INTERVENTIONS The treatment group received 2 emails with evidence-based information about nimodipine plus the individual's level of nimodipine prescription compared with their peers. The control group received 2 emails with general information about the risks of overprescription in older adults. MAIN OUTCOMES AND MEASURES The primary outcome was the cumulative number of nimodipine prescriptions per 1000 prescriptions of all drugs made by the targeted physicians during the 6 months of the study. Secondary outcomes included annual monetary savings attributable to the intervention and physicians' qualitative perceptions of the acceptability of the procedure. RESULTS Of 1811 physicians enrolled, 906 physicians (354 [39.1%] women; mean [SD] age, 57.10 [10.73] years) were randomized to treatment and 905 participants (331 [36.6%] women; mean [SD] age, 56.49 [10.47] years) to the control group. Physicians in the treatment group wrote a mean of 93.25 (95% CI, 89.27 to 97.24) prescriptions of nimodipine, compared with 98.99 (95% CI, 95.00 to 102.98) prescriptions among practitioners in the control group during the half-year of the intervention (mean difference, -5.73 [95% CI, -11.38 to -0.10] prescriptions; P = .046), which meant a 5.79% reduction. Regression analysis revealed a significant association of the group condition with number of prescriptions per 1000 total prescriptions when controlling for baseline prescriptions (B = -0.312 [95% CI, -0.465 to -0.160]; P < .001). The observed difference corresponds to a 4.48% reduction in nimodipine prescriptions per 1000 prescriptions of all drugs made by physicians in the treated group compared with the control group. Physicians who effectively opened the email in the treatment group (427 physicians [47.1%]) prescribed the drug 11.3% less compared with the control group (426 physicians) (mean difference, -10.78 [95% CI, -18.53 to -3.03] prescriptions; P = .006). Expenditures were 7.18% lower in the treatment group, resulting in an estimated annual net cost benefit of US $234 893.35 (95% CI, $225 565.35 to $237 112.30). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, the social norm email feedback program showed an effect on curbing the nonrecommended prescription of nimodipine. It was highly cost-effective and well accepted by participants. TRIAL REGISTRATION ISRCTN.org identifier: ISRCTN17823729.
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Affiliation(s)
- Fernando Torrente
- Institute of Neuroscience and Public Policy, INECO Foundation, Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, CONICET, Ineco Foundation, Favaloro University, Buenos Aires, Argentina
| | - Julián Bustin
- Institute of Neuroscience and Public Policy, INECO Foundation, Buenos Aires, Argentina
- Institute of Cognitive and Translational Neuroscience, CONICET, Ineco Foundation, Favaloro University, Buenos Aires, Argentina
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados, Buenos Aires, Argentina
| | - Fabian Triskier
- Institute of Cognitive and Translational Neuroscience, CONICET, Ineco Foundation, Favaloro University, Buenos Aires, Argentina
- Instituto Nacional de Servicios Sociales para Jubilados y Pensionados, Buenos Aires, Argentina
| | | | - Ailin Tomio
- Institute of Neuroscience and Public Policy, INECO Foundation, Buenos Aires, Argentina
| | - Ricardo Mastai
- Liver Transplant Unit, Hospital Alemán, Buenos Aires, Argentina
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Schechtman H, Valle D, Souza MO. From resistance to persistence: Insights of a mathematical model on the indiscriminate use of insecticide. PLoS Negl Trop Dis 2020; 14:e0008862. [PMID: 33206645 PMCID: PMC7723293 DOI: 10.1371/journal.pntd.0008862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/08/2020] [Accepted: 10/08/2020] [Indexed: 12/22/2022] Open
Abstract
The development of insecticide resistance is becoming a threat to many arboviruses control programs worldwide. While this has been attributed to the indiscriminate use of insecticide, a more theoretical study is apparently not available. Using in-silico experiments, we investigated the effects of two different policies: one used by the Brazilian Ministry of Health (which follows the World Health Organization protocol) and a more permissive one, akin to those employed by various gated communities and private companies. The results show that the public policy does not lead to resistance fixation. On the other hand, permissive application of adulticide, such as intensive domestic use mainly during epidemic periods, might lead to the fixation of a resistant population, even when resistance is associated with moderate fitness costs.
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Affiliation(s)
- Helio Schechtman
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Denise Valle
- Laboratório de Biologia Molecular de Flavivírus, Insituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular (INCT-EM)/CNPq, Rio de Janeiro, Brazil
| | - Max O. Souza
- Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
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Moreno P, Cerón A, Sosa K, Morales M, Grajeda LM, Lopez MR, McCraken JP, Cordón-Rosales C, Palmer GH, Call DR, Ramay BM. Availability of over-the-counter antibiotics in Guatemalan corner stores. PLoS One 2020; 15:e0239873. [PMID: 32976542 PMCID: PMC7518585 DOI: 10.1371/journal.pone.0239873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/05/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Widespread availability of antibiotics without prescription potentially facilitates overuse and contributes to selection pressure for antimicrobial resistant bacteria. Prior to this study, anecdotal observations in Guatemala identified corner stores as primary antibiotic dispensaries, where people purchase antibiotics without prescriptions. We carried out a cross sectional study to document the number and types of antibiotics available in corner stores, in four study areas in Guatemala. A total of 443 corner stores were surveyed, of which 295 (67%) sold antibiotics. The most commonly available antibiotics were amoxicillin, found in 246/295 (83%) stores, and tetracycline, found in 195/295 (66%) stores. Over the counter sales result from laissez-faire enforcement of antibiotic dispensing regulations in Guatemala combined with patient demand. This study serves as a baseline to document changes in the availability of antibiotics in informal establishments in light of new pharmacy regulations for antibiotic dispensing, which were adopted after this study was completed.
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Affiliation(s)
- Purificación Moreno
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Alejandro Cerón
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Anthropology, University of Denver, Denver, CO, United States of America
| | - Karen Sosa
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Marinees Morales
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Laura M. Grajeda
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Maria Renee Lopez
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - John P. McCraken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Celia Cordón-Rosales
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | - Guy H. Palmer
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
| | - Douglas R. Call
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
| | - Brooke M. Ramay
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, Guatemala City, Guatemala
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America
- * E-mail:
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Zhang W, Williams A, Griffith N, Gaskins J, Bookstaver PB. Online availability of fish antibiotics and documented intent for self-medication. PLoS One 2020; 15:e0238538. [PMID: 32881969 PMCID: PMC7470343 DOI: 10.1371/journal.pone.0238538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/18/2020] [Indexed: 11/19/2022] Open
Abstract
Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of having consequences to human misuse. The cost and availability of fish antibiotics was recorded. The proportion of reviews and comments related to human consumption was calculated. Consumer review traffic based on “likes” and “dislikes” received was compared between human- and non-human consumption-related reviews. Selected fish antibiotics were purchased and evaluated for physical appearance and compared to FDA-approved available equivalents. We found 24 website vendors with online ordering available for OTC fish antibiotics. Cost varied significantly by antibiotic and quantity ranging from USD $8.99 to $119.99. There were 2,288 reviews documented for the 9 selected antibiotics being sold. Among consumer reviews, 2.4% were potentially associated with human consumption. Human consumption-related reviews constituted 30.2% of all “likes” received and 37.5% of all “dislikes” received. Human consumption-related reviews received an average of 9.2 likes compared to 0.52 likes for non-human consumption-related reviews. The 8 fish antibiotics purchased were consistent with FDA-approved equivalents in physical appearance. Although infrequent, antibiotics intended for fish use are being purchased online without a prescription for self-medication to circumvent professional medical care. Reviews related to human consumption generate significant online traffic compared to reviews unrelated to human consumption.
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Affiliation(s)
- Weiwei Zhang
- Department of Clinical Pharmacy, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- * E-mail: (PBB); (WZ)
| | - Austin Williams
- University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
| | - Nicole Griffith
- University of Virginia Health, Charlottesville, Virginia, United States of America
| | - Jessica Gaskins
- South Carolina Aquarium, Charleston, South Carolina, United States of America
| | - P. Brandon Bookstaver
- University of South Carolina College of Pharmacy, Columbia, South Carolina, United States of America
- Prisma Health Richland, Columbia, South Carolina, United States of America
- * E-mail: (PBB); (WZ)
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Mallah N, Badro DA, Figueiras A, Takkouche B. Association of knowledge and beliefs with the misuse of antibiotics in parents: A study in Beirut (Lebanon). PLoS One 2020; 15:e0232464. [PMID: 32697808 PMCID: PMC7375529 DOI: 10.1371/journal.pone.0232464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Antibiotic resistance is a major public health concern. It has been associated with factors such as uncontrolled consumption, lack of knowledge, beliefs, and sociodemographic characteristics. Lebanon is characterized by high levels of antibiotic misuse, as almost half of the population self-medicates with antibiotics and over 30% of the antibiotics are dispensed without prescription. To-date, no studies determined adequately the association between knowledge, beliefs and antibiotic misuse in Lebanon. Objective To assess the association between level of knowledge and beliefs about antibiotics, and antibiotic misuse in Lebanon. Methods We conducted a cross-sectional study among 1,421 parents of schoolchildren using an anonymous self-administered Knowledge, Attitude and Practices questionnaire. The participants´ level of agreement with each item of knowledge and beliefs was measured using a Likert-type (0–10) scale. Misuse practices in the last month were detected through a series of questions aimed at determining the level of compliance with physicians´ instructions in terms of dosage and duration. Data were analyzed using logistic regression. Results 277 participants (16%) acknowledged using antibiotics in the previous month, 41% of whom showed at least one misuse behavior. Misconceptions and beliefs about antibiotics substantially increased the odds of their misuse. For instance, participants who believed that antibiotics were effective in treating viruses, cold, or sore throat infections were twice as likely to misuse antibiotics [Adjusted Interquartile Odds Ratio (aIqOR): 2.08 (95%CI: 1.32, 3.19), aIqOR: 1.81 (95%CI: 1.41, 2.29), aIqOR: 2.19 (95%CI: 1.61, 2.93), respectively]. Parents who usually keep antibiotics at home antibiotics for future use were more likely to misuse antibiotics [aIqOR: 2.44 (95%CI: 1.68, 3.46)]. Conclusions Our findings indicate that the low level of knowledge and the existence of erroneous beliefs about antibiotics are associated with increased odds of antibiotic misuse. Key elements including rationale prescription and control of dispensing should be addressed when designing educational campaigns against antibiotic misuse.
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Affiliation(s)
- Narmeen Mallah
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
| | - Danielle A. Badro
- Faculty of Health Sciences, American University of Science and Technology, Beirut, Lebanon
| | - Adolfo Figueiras
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Bahi Takkouche
- Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBER-ESP), Madrid, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- * E-mail:
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Affiliation(s)
- Mohammad Ali
- Centre for Biotechnology and Microbiology, University of Swat, Swat-19200, Pakistan.
| | | | - Nisar Ahmad
- Centre for Biotechnology and Microbiology, University of Swat, Swat-19200, Pakistan
| | - Hina Fazal
- Pakistan Council of Scientific and Industrial Research, Peshawar, Pakistan
| | - Jafar Khan
- Centre for Biotechnology and Microbiology, University of Swat, Swat-19200, Pakistan
| | - Syed Shujait Ali
- Centre for Biotechnology and Microbiology, University of Swat, Swat-19200, Pakistan
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Fan M, Tscheng D, Hamilton M, Trbovich P. Opioid losses in terms of dosage and value, January 2012 to September 2017: a retrospective analysis of Health Canada data. CMAJ Open 2020; 8:E113-E119. [PMID: 32094140 PMCID: PMC7043894 DOI: 10.9778/cmajo.20190112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Canadian health care facilities must report losses or thefts of opioids to Health Canada. To broaden the understanding of opioid loss in Canada, we analyzed data describing these losses to estimate the amount of opioid lost, estimate the wholesale and street value, compare the distribution of loss types between facility types and compare loss trends. METHODS We analyzed Health Canada records of losses of codeine, fentanyl, hydromorphone, morphine and oxycodone reported by Canadian facilities from January 2012 to September 2017. We conducted descriptive analyses of the opioid losses by calculating milligrams of drug lost, oral morphine equivalents, daily defined doses, approximate wholesale value and approximate street value, and compared loss trends when counted by incidents, dosage units or milligrams. RESULTS There were 64 963 reports of loss of codeine, fentanyl, hydromorphone, morphine or oxycodone over the study period. Over 112 kg of opioids were lost, an estimated $8.7 million in wholesale cost and $136 million in street value. The dominant loss categories varied by facility type: armed robbery (30.9 kg [31.1%]) for community pharmacies, unexplained losses (6.4 kg [55.8%]) for companies and pilferage (0.8 kg [57.4%]) for hospitals. Loss trends over the study period varied by reporting metric and facility type: community pharmacy losses increased when measured by dosage units and incidents of loss, and remained stable when measured by milligrams; hospital losses increased when measured by milligrams and showed no clear trend when measured by dosage units and incidents of loss. Companies showed no clear loss trend with any reporting metric. INTERPRETATION Large quantities of opioids were lost or stolen from community pharmacies, companies and hospitals over the study period, and these losses are valued in millions of dollars. Publishing milligrams of opioids lost annually alongside metrics such as dosage units and incidents of loss would help characterize the economic cost and the magnitude of drug losses.
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Affiliation(s)
- Mark Fan
- HumanEra (Fan, Trbovich), Office of Research and Innovation, North York General Hospital; Institute for Safe Medication Practices Canada (Tscheng, Hamilton); Institute of Health Policy, Management and Evaluation (Trbovich), University of Toronto, Toronto, Ont.
| | - Dorothy Tscheng
- HumanEra (Fan, Trbovich), Office of Research and Innovation, North York General Hospital; Institute for Safe Medication Practices Canada (Tscheng, Hamilton); Institute of Health Policy, Management and Evaluation (Trbovich), University of Toronto, Toronto, Ont
| | - Michael Hamilton
- HumanEra (Fan, Trbovich), Office of Research and Innovation, North York General Hospital; Institute for Safe Medication Practices Canada (Tscheng, Hamilton); Institute of Health Policy, Management and Evaluation (Trbovich), University of Toronto, Toronto, Ont
| | - Patricia Trbovich
- HumanEra (Fan, Trbovich), Office of Research and Innovation, North York General Hospital; Institute for Safe Medication Practices Canada (Tscheng, Hamilton); Institute of Health Policy, Management and Evaluation (Trbovich), University of Toronto, Toronto, Ont
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13
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Toepfer S, Bolbrinker J, König M, Steinhagen-Thiessen E, Kreutz R, Demuth I. Potentially inappropriate medication in older participants of the Berlin Aging Study II (BASE-II) - Sex differences and associations with morbidity and medication use. PLoS One 2019; 14:e0226511. [PMID: 31887163 PMCID: PMC6936809 DOI: 10.1371/journal.pone.0226511] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022] Open
Abstract
Introduction Multimorbidity in advanced age and the need for drug treatment may lead to polypharmacy, while pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug events (ADEs). Objective The aim of this study was to determine the proportion of subjects using potentially inappropriate medication (PIM) in a cohort of older and predominantly healthy adults in relation to polypharmacy and morbidity. Methods Cross-sectional data were available from 1,382 study participants (median age 69 years, IQR 67–71, 51.3% females) of the Berlin Aging Study II (BASE-II). PIM was classified according to the EU(7)-PIM and German PRISCUS (representing a subset of the former) list. Polypharmacy was defined as the concomitant use of at least five drugs. A morbidity index (MI) largely based on the Charlson Index was applied to evaluate the morbidity burden. Results Overall, 24.1% of the participants were affected by polypharmacy. On average, men used 2 (IQR 1–4) and women 3 drugs (IQR 1–5). According to PRISCUS and EU(7)-PIM, 5.9% and 22.6% of participants received at least one PIM, while use was significantly more prevalent in females (25.5%) compared to males (19.6%) considering EU(7)-PIM (p = 0.01). In addition, morbidity in males receiving PIM according to EU(7)-PIM was higher (median MI 1, IQR 1–3) compared to males without PIM use (median MI 1, IQR 0–2, p<0.001). Conclusion PIM use occurred more frequently in women than in men, while it was associated with higher morbidity in males. As expected, EU(7)-PIM identifies more subjects as PIM users than the PRISCUS list but further studies are needed to investigate the differential impact of both lists on ADEs and outcome. Key points We found PIM use to be associated with a higher number of regular medications and with increased morbidity. Additionally, we detected a higher prevalence of PIM use in females compared to males, suggesting that women and people needing intensive drug treatment are patient groups, who are particularly affected by PIM use.
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Affiliation(s)
- Sarah Toepfer
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | - Juliane Bolbrinker
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Maximilian König
- Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité-Universitätsmedizin, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
| | - Reinhold Kreutz
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Ilja Demuth
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Lipid Clinic at the Interdisciplinary Metabolism Center, Berlin, Germany
- Berlin Insitute of Health Center for Regenerative Therapies”oder ausführlicher „Charité—Universitätsmedizin Berlin, BCRT—Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
- * E-mail:
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Abstract
OBJECTIVE To understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). DATA SOURCES/STUDY SETTING Participants in 24 Community Deliberation groups (CD; n = 263), four Citizens' Panel groups (CP; n = 96), and a control group (n = 348). Data were collected in 2012 in four U.S. LOCATIONS STUDY DESIGN Using mixed methods, we analyzed quantitative and qualitative data from a randomized control trial. DATA COLLECTION/EXTRACTION METHODS Using pre/postdeliberation surveys, we compared CD and CP participant attitude changes regarding antibiotic use to the control group. We analyzed deliberation transcripts using qualitative techniques to provide context for survey results. PRINCIPAL FINDINGS Compared to control group participants, CD and CP participants had a larger postdeliberation shift in attitudes toward support of government limits on when doctors can prescribe antibiotics. Participants described unawareness about antibiotic overuse and called for education. When discussing prescription limits, participants debated tensions between preserving patient/doctor autonomy and protecting society from antibiotic-related harms. Participants saw patient, physician, and government roles in antibiotic stewardship policies/programs. CONCLUSION When informed about individual and social consequences of antibiotic overuse, patients may be more receptive to antibiotic prescription limits. Community-physician-government partnerships are needed to create solutions.
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Affiliation(s)
- Jennifer Richmond
- Research and EvaluationAmerican Institutes for ResearchChapel HillNorth Carolina
- Department of Health BehaviorUniversity of North Carolina at Chapel Hill Gillings School of Global Public HealthChapel HillNorth Carolina
| | - Rikki Mangrum
- Research and EvaluationAmerican Institutes for ResearchChapel HillNorth Carolina
| | - Grace Wang
- IMPAQ International, LLCSeattleWashington
| | - Maureen Maurer
- Research and EvaluationAmerican Institutes for ResearchChapel HillNorth Carolina
| | - Shoshanna Sofaer
- Research and EvaluationAmerican Institutes for ResearchNew YorkNew York
| | - Manshu Yang
- Research and EvaluationAmerican Institutes for ResearchChapel HillNorth Carolina
| | - Kristin L. Carman
- Patient‐Centered Outcomes Research InstituteWashingtonDistrict of Columbia
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15
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Bolshakova M, Bluthenthal R, Sussman S. Opioid use and misuse: health impact, prevalence, correlates and interventions. Psychol Health 2019; 34:1105-1139. [PMID: 31177850 PMCID: PMC7456364 DOI: 10.1080/08870446.2019.1622013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/09/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
Objective: To provide a broad overview of the state of drug misuse research, particularly focusing on opioid drug use in the U.S.A. Design: An overview of published reviews of the literature. Results: Prescription opioid use has increased globally from 2008 to 2013, while use of opiates such as heroin and opium have remained stable in many countries, although, decreases have been observed in parts of Europe. Opioid misuse is highest in the United States; approximately 11.8 million Americans misused opioids in 2016. Demographic, genetic, psychosocial and structural/environmental factors all play a role in determining who will become an opioid misuser. Strategies such as increased prescribing of non-opioid derived pain relievers, expansion of medication treatment, distribution of naloxone for overdose reversal and supervised consumption sites are some of the solutions posed to reduce the spread and consequences of opioid misuse. Conclusion: Research focused on understanding of opioid neurobiology, as well as empirically based, effective alternatives to pain management and implementation studies on combined prevention and treatment approaches are needed. It will take the combined effort of community members, healthcare professionals, policymakers and researchers in order to prevent and treat opioid misuse.
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Affiliation(s)
- Maria Bolshakova
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
| | - Ricky Bluthenthal
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
| | - Steve Sussman
- Department of Preventive Medicine, University of Southern California , Los Angeles , CA , USA
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Azzi EA, Kritikos V, Peters MJ, Price DB, Srour P, Cvetkovski B, Bosnic-Anticevich S. Understanding reliever overuse in patients purchasing over-the-counter short-acting beta 2 agonists: an Australian community pharmacy-based survey. BMJ Open 2019; 9:e028995. [PMID: 31412998 PMCID: PMC6701672 DOI: 10.1136/bmjopen-2019-028995] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Overuse of asthma relievers is associated with significant adverse consequences. This study aimed to better understand the population purchasing and using short-acting beta agonists (SABA) over the counter (OTC); and compare the demographic, clinical and behavioural characteristics of those who overuse SABA with those who do not. DESIGN AND SETTING Real-world cross-sectional observational study in community pharmacy. PARTICIPANTS Of 412 participants ≥16 years requesting SABA OTC, 289 were SABA overusers (used SABA more than twice per week in the past 4 weeks). MAIN OUTCOME MEASURE Reliever use, Global Initiative for Asthma-defined control, healthcare utilisation, patterns of preventer use. RESULTS 70.1% of participants were classified as SABA overusers, that is, reporting SABA use more than twice a week within the last 4 weeks, 73.6% reported not using a preventer daily and only 81.6% reported a doctor diagnosis of asthma. SABA overusers were more likely to have moderate-severe nasal symptoms (80.8% vs 63.0%, p<0.001) and a diagnosis of depression (11.1% vs 5.7%, p<0.001), when compared with SABA non-overusers. A higher proportion of SABA overusers had uncontrolled asthma (59.0% vs 15.4%, p<0.001), were more likely to use oral corticosteroids to manage worsening asthma symptoms (26.2% vs 13.5%, p<0.01) and visit the doctor for their asthma in the past 12 months (74.5% vs 62.5%, p<0.01), when compared to SABA non-overusers. CONCLUSIONS This study uncovers a hidden population of people who can only be identified in pharmacy with suboptimal asthma, coexisting rhinitis, poor preventer adherence and, in some cases, no asthma diagnosis.
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Affiliation(s)
- Elizabeth A Azzi
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Matthew J Peters
- Department of Respiratory Medicine, Concord Hospital, Concord, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - David B Price
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - Pamela Srour
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines, Clinical Management, Woolcock Institute of Medical Research, Glebe, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Saukko PM, Oppenheim BA, Cooper M, Rousham EK. Gaps in communication between different staff groups and older adult patients foster unnecessary antibiotic prescribing for urinary tract infections in hospitals: a qualitative translation approach. Antimicrob Resist Infect Control 2019; 8:130. [PMID: 31404364 PMCID: PMC6683464 DOI: 10.1186/s13756-019-0587-2] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022] Open
Abstract
Background Studies have reported large scale overprescribing of antibiotics for urinary tract infection (UTI) in hospitalised older adults. Older adults often have asymptomatic bacteriuria, and clinicians have been found to diagnose UTIs inappropriately based on vague symptoms and positive urinalysis and microbiology. However, the joined perspectives of different staff groups and older adult patients on UTI diagnosis have not been investigated. Methods Thematic analysis of qualitative interviews with healthcare staff (n = 27) and older adult patients (n = 14) in two UK hospitals. Results Interviews featured a recurrent theme of discrepant understandings and gaps in communication or translation between different social groups in three key forms: First, between clinicians and older adult patients about symptom recognition. Second, between nurses and doctors about the use and reliability of point-of-care urinary dipsticks. Third, between nurses, patients, microbiologists and doctors about collection of urine specimens, contamination of the specimens and interpretation of mixed growth laboratory results. The three gaps in communication could all foster inappropriate diagnosis and antibiotic prescribing. Conclusion Interventions to improve diagnosis and prescribing for UTIs in older adults typically focus on educating clinicians. Drawing on the sociological concept of translation and interviews with staff and patients our findings suggest that inappropriate diagnosis and antibiotic prescribing in hospitals can be fuelled by gaps in communication or translation between different staff groups and older adult patients, using different languages and technologies or interpreting them differently. We suggest that interventions in this area may be improved by also addressing discrepant understandings and communication about symptoms, urinary dipsticks and the process of urinalysis.
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Affiliation(s)
- Paula M. Saukko
- School of Social Sciences, Loughborough University, Loughborough, LE11 3TU UK
| | - Beryl A. Oppenheim
- Infection Prevention Team, New Cross Hospital, Royal Wolverhampton NHS Foundation Trust, Wolverhampton, WV10 0QP UK
| | - Mike Cooper
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
| | - Emily K. Rousham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU UK
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Chang Y, Chusri S, Sangthong R, McNeil E, Hu J, Du W, Li D, Fan X, Zhou H, Chongsuvivatwong V, Tang L. Clinical pattern of antibiotic overuse and misuse in primary healthcare hospitals in the southwest of China. PLoS One 2019; 14:e0214779. [PMID: 31242185 PMCID: PMC6594576 DOI: 10.1371/journal.pone.0214779] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/03/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Overuse and misuse of antibiotics are the primary risk factors for antibiotics resistance. Inadequate professional competence of primary care physicians might exacerbate these problems in China. This retrospective study aims to document the clinical pattern of antibiotics use and its overuse and misuse rates in rural primary care institutions and to evaluate the association between antibiotics use and characteristics of physicians and their patients. Methods Medical records from 16 primary care hospitals in rural areas of Guizhou province, China were obtained from the Health Information System in 2018. Classification of unnecessary use, incorrect spectrum of antibiotic, escalated use of extended spectrum and combined antibiotics use was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the US Centers for Disease Control and Prevention. Generalized Estimating Equations were employed to determine predictive factors for inappropriate antibiotics use. Results A total of 74,648 antibiotics prescriptions were retrieved. Uncomplicated respiratory infection was the most common disease accounting for 58.6% of all prescriptions. The main antibiotic group used was penicillins (51.5%) followed by cephalosporins and macrolides (14% each). Of 57,009 patient visits, only 8.7% of the antibiotic prescriptions were appropriate. Combined use, escalated use of extended spectrum antibiotics, incorrect spectrum and unnecessary antibiotics use was found in 7.8%, 1.9%, 4.3% and 77.3% of patient visits, respectively, of which 28.7% were given intravenously. Antibiotics misuse was significantly more likely among newly employed physicians with lower levels of professional education. Adult patients and those who had public insurance had a higher risk of being prescribed unnecessary antibiotics. Conclusion Overuse of antibiotics for uncomplicated respiratory infection and use of cephalosporins, macrolides and injection antibiotics in primary care are the major problems of clinical practice in rural areas of Guizhou.
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Affiliation(s)
- Yue Chang
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sarunyou Chusri
- Division of Infectious Disease, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- Department of Biomedical Sciences, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Rassamee Sangthong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Jiaqi Hu
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Wei Du
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Duan Li
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Xingying Fan
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Hanni Zhou
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
| | - Virasakdi Chongsuvivatwong
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail: (VC); (TL)
| | - Lei Tang
- School of Medicine and Health Management, Guizhou Medical University, Guizhou, China
- * E-mail: (VC); (TL)
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Elong Ekambi GA, Okalla Ebongue C, Penda IC, Nnanga Nga E, Mpondo Mpondo E, Eboumbou Moukoko CE. Knowledge, practices and attitudes on antibiotics use in Cameroon: Self-medication and prescription survey among children, adolescents and adults in private pharmacies. PLoS One 2019; 14:e0212875. [PMID: 30818373 PMCID: PMC6394986 DOI: 10.1371/journal.pone.0212875] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 11/10/2018] [Accepted: 02/11/2019] [Indexed: 12/04/2022] Open
Abstract
Benefits of antibiotics are threatened by the self-medication, people's lack of knowledge and inappropriate use of antibiotics, especially in developing countries. This study was designed to determine knowledge; attitudes and practices toward antibiotics use in an urban community, and evaluate the factors that are associated with antibiotic use. Between January and March 2015, a cross sectional and prospective study was conducted in all pharmacies within the Douala IV health district, Cameroon. Anonymous interviews including both open and closed ended questions were conducted in participants selected by convenience sampling Descriptive and logistic regression analysis were performed using StataSE11 software (version 11 SE) and R software (version 3.1.1) in data analysis. Overall 402 (33.7%) of 1,192 customers purchased antibiotics and of these, 47% bought antibiotics without a prescription. 60.7% of purchased antibiotics was for adult 'patients and around 60% of parents carried out self-medication on their children. The vast majority reported that all microbes can be treated with antibiotics (88.3%). The belief that antibiotics are appropriate for bacterial infections was more common among those with a higher level education (OR = 4.03, 95%CI:1.89-8.57, p<0.0001) and among public/private servants (OR = 2.47, 95%CI:1.21-5.08, p = 0.013). Physicians provide less explanations about antibiotics are and their potential side effects than the pharmacy auxiliaries (OR = 0.205, 95%CI = 0.09-0.46, p<0.0001), but more than pharmacists (OR = 3.692, 95%CI:1.44-9.25, p = 0.005). Indications on antibiotics use were 7 times more given to customers with a prescription compared to those without a prescription (OR = 7.37, 95% CI = 2.13-25.43, p = 0.002). Adult male (OR = 2.32, 95%CI:1.24-4.34, p = 0.009) and higher education (OR = 2.05, 95%CI:1.08-3.89, p = 0.027) were significantly associated with self-medication. Misuse, little "practical knowledge" and high self-medication confirm the unsatisfactory prescription and dispensing practices of the antibiotics in our country. These results highlight the important of the development and implementation appropriate guidelines for the responsible use of antibiotics for health care providers and health education targeting community members themselves.
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Affiliation(s)
- Grace-Ange Elong Ekambi
- Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Cécile Okalla Ebongue
- Biological Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Ida Calixte Penda
- Clinical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Emmanuel Nnanga Nga
- Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Emmanuel Mpondo Mpondo
- Pharmaceutical Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Carole Else Eboumbou Moukoko
- Biological Sciences Department, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
- Centre Pasteur Cameroon, Yaoundé, Cameroon
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Machowska A, Stålsby Lundborg C. Drivers of Irrational Use of Antibiotics in Europe. Int J Environ Res Public Health 2018; 16:E27. [PMID: 30583571 PMCID: PMC6338985 DOI: 10.3390/ijerph16010027] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/13/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022]
Abstract
The unnecessary use of antibiotics and concomitant rapid growth of antibiotic resistance (ABR) is a widely acknowledged threat to global health, development, and sustainability. While the underlying cause of ABR is undoubtedly the overall volume of antibiotic use in general, irrational antibiotic use, which is influenced by several interrelated factors, is a major contributory factor. Here, we aimed to present and describe selected main drivers of irrational use of antibiotics in Europe. We performed a broad search of the current literature in databases such as PubMed, Google Scholar, Cochrane, as well as various institutional websites (World Health Organization, European Observatory, European Commission) to provide a new perspective on selected drivers of irrational antibiotic use in Europe. We also searched for relevant literature using snowballing, i.e., using reference lists of papers to identify additional papers. In this narrative review, we present that major factors among the general public driving antibiotic resistance are lack of public knowledge and awareness, access to antibiotics without prescription and leftover antibiotics, and knowledge attitude and perception of prescribers and dispensers, inadequate medical training, pharmaceutical promotion, lack of rapid and sufficient diagnostic tests, and patient⁻doctor interaction as major factors among healthcare providers. We further discuss initiatives that, if taken and implemented, can have an impact on and improve the current situation in Europe.
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Affiliation(s)
- Anna Machowska
- Global Health-Health Systems and Policy: Medicines, Focusing Antibiotics, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
| | - Cecilia Stålsby Lundborg
- Global Health-Health Systems and Policy: Medicines, Focusing Antibiotics, Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
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Pv A, Abdin E, Jun Wen T, Subramaniam M, Cheok C, Song G. Correlates of Non-Medical Prescription Drug Misuse Among a Treatment-Seeking Population: A Comparison with Illicit Drug Users. Int J Environ Res Public Health 2018; 15:ijerph15091978. [PMID: 30208591 PMCID: PMC6164738 DOI: 10.3390/ijerph15091978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/07/2018] [Indexed: 12/24/2022]
Abstract
Prescription drugs (PD) undoubtedly help people with various physical or psychiatric ailments. Nevertheless, they are often diverted and misused (use without prescription or for purposes/in ways not intended by the prescriber). This study compared the sociodemographic and clinical correlates of those who misused PDs, used illegal drugs and co-ingested both, to identify those who were at a high risk of misusing these drugs. Retrospective analysis of the treatment outcome monitoring (TOM) data for the period of 2013–2017 identified 1369 subjects for the study; 295 patients presented with PD use disorder (PDUD alone), 811 with illegal drug use disorder (IDUD alone), and 263 had both PDUD and IDUD. The study sample included treatment seeking population (Singaporeans and permanent residents). TOM data included data collected through direct interviews (addiction severity, quality of life) and from the clinical case notes (diagnosis, co-morbidities, socio demographic information, etc.). The most commonly misused prescription and illegal drugs were benzodiazepines (63.1%) and heroin (63.4%), respectively. Those who co-ingested both PD and illegal drugs (PDUD+IDUD) had a significantly higher addiction severity score, lower quality of life and higher psychiatric co-morbidities than that of IDUD alone at baseline. When compared to Chinese patients, Malay and Indian patients had lower odds (p < 0.05) of PDUD alone and PDUD+IDUD than Chinese patients; divorcees had higher odds of PDUD+IDUD than those who were married. Those with primary and secondary qualifications had higher odds (2.1 and 2.9 times, respectively) of PDUD+IDUD than those with tertiary qualification and those in managerial or professional roles had higher odds of PDUD alone than those who were unemployed. Gender, ethnicity, marital status, education and occupational classes were associated with PDUD and IDUD. These characteristics can be helpful to identify those who are at the risk of PDUD and incorporate strict prescription monitoring to their care.
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Affiliation(s)
- Asharani Pv
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Tan Jun Wen
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Christopher Cheok
- Forensic Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Guo Song
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
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Abstract
BACKGROUND The consumption of antibiotics has been widely discussed, mainly because of antibacterial resistance, which has become a worldwide concern. In Brazil, sale of antibiotics is currently ruled by Agência Nacional de Vigilância Sanitária (ANVISA) regulation RDC 20/2011, which restricts sales to those made under medical prescription. The aims of this study were to evaluate antibiotic use and associated factors among adults in the Metropolitan Region of Manaus, Amazonas, Brazil, and to assess the proportion of self-medication from this use. DESIGN AND SETTING Population-based cross-sectional study conducted in the Metropolitan Region of Manaus between May and August 2015. METHODS Adults aged ≥ 18 years were selected through probabilistic sampling in three stages. Trained interviewers collected data from the participants in their homes. Antibiotic consumption over the last 15 days was reported. Bivariate analysis was used to calculate the prevalence ratio (PR) of antibiotic usage, with 95% confidence interval (95% CI). A multivariate model adjusted according to significant variables at P ≤ 0.20 using Poisson regression with robust variance was constructed. RESULTS The prevalence of antibiotic use was 3.4% (95% CI 2.8-4.0%). Adjusted analysis showed that consumption was higher among women than among men (PR 1.58; 95% CI 1.11-2.24) and among people with fair health status than among those with good health (PR 1.52; 95% CI 1.08-2.15). The prevalence of self-medication was 19.0%; amoxicillin was the most self-medicated antibiotic (10/26). CONCLUSION Antibiotic use was associated with women and individuals with fair health status. One fifth of the antibiotics were consumed through self-medication, contrary to the current Brazilian legislation.
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Affiliation(s)
- Jéssica Quintão Pereira
- BPharm. Pharmacist and Assistant Scientist at Johnson & Johnson Brasil, São José dos Campos (SP), Brazil.
| | - Marcus Tolentino Silva
- MSc, PhD. Pharmacist and Professor, School of Medicine, Universidade Federal do Amazonas (UFAM), Manaus (AM), Brazil, and Postgraduate Program on Pharmaceutical Sciences, Universidade de Sorocaba (UNISO), Sorocaba (SP), Brazil.
| | - Taís Freire Galvão
- MSc, PhD. Pharmacist and Professor, School of Pharmaceutical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil.
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Shanting M, Qing X. Adverse reaction and rational use of paracetamol tablets and its drug content detection based on spectral test. Pak J Pharm Sci 2018; 31:1743-1749. [PMID: 30203773] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Paracetamol and amantadine hydrochloride tablet is a commonly used drug to relieve the common cold. Its main ingredient is 4-Acetamidophenol. The safety of acetaminophen containing cold drugs has attracted more and more attention in recent years. In order to promote the clinical safety of drugs, the adverse reaction and clinical application of acetaminophen drugs are analyzed in this paper. The adverse reactions induced by acetaminophen mainly include: allergic reaction (46.1%), liver and kidney injury (25%), blood system (15.7%) and digestive system (5.2%). At the same time, we tested the content of acetaminophen by using spectral test. It can be seen that the method can be extended to the quantitative analysis and quality control of the effective components of other compound drugs.
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Affiliation(s)
- Mao Shanting
- Jingzhou Institute for Food and Drug Control, Jingzhou City, Hubei Province, China
| | - Xin Qing
- Yangtze University, Jingzhou City, Hubei Province, China
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Wang S, Guan L, Dong C, Ji Y. Evaluation of the drug effect and rational use of antiseptic drugs in outpatient and emergency department of hospital. Pak J Pharm Sci 2018; 31:1701-1705. [PMID: 30203766] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With the popularization and application of antiseptic drugs, the abuse of antiseptic drugs and various unreasonable applications have also become a serious medical problem. The prescriptions of antibiotics in our hospital were randomly selected for statistical analysis. Further, we analyzed the various situations of the use of antibiotics in outpatient department, and calculated the DDDs of different drugs based on the defined daily dose (DDD). The results showed that there were 403 unreasonable prescriptions, accounting for 24.9% of the drug prescriptions. The main problems of irrational prescriptions were unsuitable drugs, non indications and improper frequency of administration, which accounted for 27.1%, 21.3% and 18.3%. It is suggested that the quality department of the hospital should strengthen the special training for rational use of antimicrobial agents, intervene in time and effectively, and gradually change post evaluation into prevention and intervention in advance.
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Affiliation(s)
- Suwen Wang
- Department of Emergency, The affiliated Yantai Yuhuangding hospital of Qingdao University Medical College, Yantai, China
| | - Lina Guan
- Department of Neurology Intensive Care Unit, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai, China
| | - Changyan Dong
- Department of Gynecology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai, China
| | - Yongqiang Ji
- Department of Nephrology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University Medical College, Yantai, China
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Abstract
Research regarding sex or gender difference in chronic pain proliferated in this decade. This study was to analyze gender difference in Taiwan patients receiving long-term opioids for chronic noncancer pain.An observational cross-sectional survey was conducted among the registered outpatients by the Taiwan Food and Drug Administration. Participants completed a self-report questionnaire, including the Taiwanese version of Brief Pain Inventory and enquiry regarding sexual activities, depressive symptoms, and misuse behaviors.In total, 68 female and 142 male patients were analyzed. Both pain intensity and daily function interference reduced comparably (around 50%) between women and men after taking opioids in the past 1 week. The opioid-related adverse effects, including constipation, decreased sexual desire and satisfaction, and misuse behaviors were not significantly different. Women were exceedingly diagnosed with depression (67.7% vs 49.3%, P = .012) and had a higher mean depressive symptom score in the past 1 month, especially among those age <40 years (23.3 vs 11.9, P = .009), as compared with men. In addition, women had a lower mean self-rated health score (37.9 vs 44.3, P = .047). The mean morphine equivalent dose was significantly lower in women (131.6 vs 198.2 mg/day, P = .008), which was not correlated with their depressive scores.Gender differences in the effectiveness and adverse effects of long-term opioids were not found among Taiwan registered outpatients with chronic noncancer pain. However, more female patients inclined to have a coexisting depression diagnosis, depressive symptoms, and a lower perceived health score, needing regular screening and closer monitoring.
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Affiliation(s)
- Tso-Chou Lin
- Department of Anesthesiology, Tri-Service General Hospital
| | - Shung-Tai Ho
- Department of Anesthesiology, Taipei Veterans General Hospital, National Defense Medical Center, Taipei
| | - Luo-Ping Ger
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Huei-Han Liou
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Shu-Ling Hwang
- Center for General Education, National Defense Medical Center, Taipei, Taiwan
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Kimergård A, Foley M, Davey Z, Dunne J, Drummond C, Deluca P. Codeine use, dependence and help-seeking behaviour in the UK and Ireland: an online cross-sectional survey. QJM 2017; 110:559-564. [PMID: 28379496 DOI: 10.1093/qjmed/hcx076] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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] [Received: 12/07/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Codeine misuse and dependence poses a clinical and public health challenge. However, little is known about dependence and treatment needs in the UK and Ireland. AIM To characterize codeine use, dependence and help-seeking behaviour. DESIGN An online cross-sectional survey advertised on Facebook, Twitter, health and drug websites and e-mail circulars. METHODS The survey collected data on demographics and codeine use amongst adults from the UK and Ireland. The Severity of Dependence Scale measured the level of codeine dependence. RESULTS The sample of 316 respondents had a mean age of 35.3 years (SD = 12.3) and 67% were women. Of the 316 respondents, 54 scored ≥5 on the Severity of Dependence Scale indicating codeine dependence (17.1%). Our study found that codeine dependence is a problem with both prescribed and 'over-the-counter' codeine. Codeine dependence was associated with daily use of codeine, faking or exaggerating symptoms to get a prescription for codeine and 'pharmacy shopping' ( P < 0.01). A higher number of respondents had sought advice on the Internet (12%) rather than from their general medical practitioner (GP) (5.4%). Less than 1% of respondents had sought advice from a pharmacist. CONCLUSIONS Codeine dependent users were more likely to seek help on the Internet to control their use of codeine than from a GP, which may indicate a potential for greater specialized addiction treatment demand through increased identification and referrals in primary care.
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Affiliation(s)
- A Kimergård
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, SE5 8BB, London, UK
| | - M Foley
- School of Health Sciences, Waterford Institute of Technology, Main Campus Cork Road, X91 K0EK, Waterford, Ireland
| | - Z Davey
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, SE5 8BB, London, UK
| | - J Dunne
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, SE5 8BB, London, UK
| | - C Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, SE5 8BB, London, UK
| | - P Deluca
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, SE5 8BB, London, UK
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Blanchard BE, Stevens AK, Littlefield AK, Talley AE, Brown JL. Examining the link between nonmedical use of sedatives, tranquilizers, and pain relievers with dispositions toward impulsivity among college students. Addict Behav 2017; 69:8-13. [PMID: 28107654 DOI: 10.1016/j.addbeh.2017.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/06/2016] [Accepted: 01/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The association between impulsive dispositions and the use of the central nervous system (CNS) depressant alcohol has been examined extensively; however, the links between other depressant use (sedatives, tranquilizers, and pain relievers) and impulsivity have been less studied, and findings have been equivocal. This may be due, in part, to varying operationalizations of "impulsivity," as well as issues related to the lumping versus splitting of various depressant substances when assessing use. The effect of gender on the impulsivity-depressant use relation has also yielded mixed results and remains understudied. The current study sought to determine whether lumping versus splitting of depressant substances and distinct impulsivity-related dispositions, as well as participant gender, impact the depressant-impulsivity relation. METHOD Participants were 778 undergraduate students (72% female, 80% White, 23% Hispanic), who completed a battery of self-report assessments online, including the UPPS-P. RESULTS Hierarchical linear models indicated that specific impulsive dispositions differentiated between users and non-users of specific depressant substances, and these relations varied by gender. For example, sensation seeking significantly differentiated between users and non-users of pain relievers for females only, whereas sensation seeking differentiated between users and non-users of tranquilizers among males but not females. CONCLUSIONS In addition to informing substance use research practices by providing evidence that lumping of depressant substances leads to loss of vital information, as well as demonstrating nuanced gender differences, findings can also inform screening and personality-targeted treatment practices.
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Affiliation(s)
- Brittany E Blanchard
- Department of Psychological Sciences, MS 2051 Psychological Sciences Building, Texas Tech University, Lubbock, TX 79409-2051, USA.
| | - Angela K Stevens
- Department of Psychological Sciences, MS 2051 Psychological Sciences Building, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Andrew K Littlefield
- Department of Psychological Sciences, MS 2051 Psychological Sciences Building, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Amelia E Talley
- Department of Psychological Sciences, MS 2051 Psychological Sciences Building, Texas Tech University, Lubbock, TX 79409-2051, USA
| | - Jennifer L Brown
- Department of Psychological Sciences, MS 2051 Psychological Sciences Building, Texas Tech University, Lubbock, TX 79409-2051, USA
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Pace JB, Nave V, Moulis M, Bourdelin M, Coursier S, Jean-Bart É, Leroy B, Bonnefous JL, Bontemps H, Coutet J, Eyssette C, Pont E. [Prescription of acetaminophen in five French hospitals: What are the practices?]. Therapie 2017; 72:579-586. [PMID: 28336157 DOI: 10.1016/j.therap.2017.01.007] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/12/2017] [Indexed: 02/03/2023]
Abstract
AIM Acetaminophen is widely used in hospital settings and often considered as nontoxic. We conducted a multicentric study in order to evaluate its proper use. METHOD Prescriptions from five general hospitals were analyzed, according to dose adjustments required in renal or liver failure, weight or chronic alcoholism, determined using a literature review. Other criteria have been assessed: indication for parenteral access, accuracy of administration time and pain assessment. RESULTS Among the 1256 analyzed prescriptions, 21% are non-compliants. The main causes of non-compliance (NC) are adjustments to weight and renal failure. Higher NC rates concern chronic alcoholism and liver failure. CONCLUSION Misuse of acetaminophen seems related to a lack of official recommendations concerning dose adjustments. Hospital pharmacists have an important role to play in the promotion of proper use of acetaminophen. Therefore we established a prescribing aid.
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Affiliation(s)
- Jean-Baptiste Pace
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France.
| | - Viviane Nave
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France
| | - Mélanie Moulis
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France
| | - Magali Bourdelin
- Service pharmacie, hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France
| | - Sandra Coursier
- Service pharmacie, hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France
| | - Élodie Jean-Bart
- Service pharmacie, hôpital Fleyriat, 01012 Bourg-en-Bresse, France
| | - Bertrand Leroy
- Service pharmacie, centre hospitalier William-Morey, 71100 Chalon-sur-Saône, France
| | | | - Hervé Bontemps
- Service pharmacie, hôpital Nord-Ouest, 69655 Villefranche-sur-Saône, France
| | - Jérôme Coutet
- Service pharmacie, centre hospitalier William-Morey, 71100 Chalon-sur-Saône, France
| | - Carine Eyssette
- Service pharmacie, hôpital Les Charmes, 71604 Paray-Le-Monial, France
| | - Emmanuelle Pont
- Service pharmacie, centre hospitalier Pierre-Oudot, 30, avenue du Médipôle, BP 40348, 38300 Bourgoin-Jallieu, France
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Mistretta V, Charlier C. [Chelating agents : alert to misuses!]. Rev Med Liege 2016; 71:551-556. [PMID: 28387095] [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] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Exposure to heavy metals is a common phenomenon due to their prevalence in food and environment; their toxicity remains a major concern for public health. Chelating agents are drugs used to increase the elimination of metals present at abnormally high levels in the body. Their approved clinical indications are limited, particularly because of their potential adverse effects. Unfortunately, too often, chelating agents are used to test the body impregnation level by heavy metals. It is an inappropriate and abusive use. In order to attract attention to this problematic, the good and bad uses of metal chelators are reviewed.
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Affiliation(s)
- V Mistretta
- , Service de Toxicologie Clinique, Médico-Légale, de l'Environnement et en Entreprise, CHU de Liège, Site du Sart Tilman, Liège, Belgique
| | - C Charlier
- , Service de Toxicologie Clinique, Médico-Légale, de l'Environnement et en Entreprise, CHU de Liège, Site du Sart Tilman, Liège, Belgique
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