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Just and compassionate quality pharmaceutical services for all
Interventions and
innovations to
improve antibiotic
use: Stories from EPN
Global Forum on
Bacterial Infections
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EPN- A network aimed at PSS
o EPN is a worldwide network with members from across Africa and beyond including:
n India
n Australia
n the United States
n Europe
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Working mainly with church health
systems
o Up to 40% of health services in the rural areas of most African countries are provided by church health facilities. This contribution is critical for the attainment of the MDGs on health.
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Access to and rational use of
medicines
o The objectives of this programme are to
n facilitate increased access
to affordable quality
medicines and
n ensure rational use of
medicines
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Strategies to improve use of
antibiotics
o Address availability
n Promoting intra Africa trade in medicines supply
from Kenya to Malawi, Chad and Zimbabwe
…..has also addressed
quality and cost
n Advocating for the use of the
in country pharmaceutical suppliers
n Campaign against informal sources
and channels
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Strategies to improve use of
antibiotics
o Improve pricing
n Pooled procurement initiatives
n Share price information
o Provide information and promote its use to
improve practice
n Collect data on local resistance patterns
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Strategies to improve use of
antibiotics
o Building quality systems
n Pooled QC testing
n Sharing information – manufacturers, regulators….
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Medicine listed n P/F Manufacturer
Ciprofloxacin 10 P = all JB Chemicals, Cosmos, Kopran, Phat kin -‐ DRC; BDH, Micro labs, Cipla
– India, Pharma quick – Benin
Amoxicillin 9 P= all Addis Pharma -‐ Ethiopia, SAI PH – Tunisia, Zenufa Shellys Tanzania,
Caisa Pharma -‐ DRC, Medivet – Kenya,
Doxycycline 9 P=8, F=1 Flamingo Meditab Rayat Pharmachem – India; others
Phenoxymethyl
Penicillin (Pen V)
8 P=7, F= 1
M & G -‐ Ghana, Shellys – Tanzania, Elys – Kenya, Regal – Kenya,
North China group – China, Sparsh Biotech – India
SMX/TMP 11 P = 8, F =
3
Microlabs – India, Elys – Kenya, ZT Pharma – China, Caisa Pharma –
DRC, Regal – Kenya, Medopharm – India
Astra life care – India, Cipla – India, Ethiopia Pharma -‐ Ethiopia
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Strategies to improve use of
antibiotics
o Investing in Human Resources
o Courses for health professionals
n Rational management of antibiotics has been developed
and run in Uganda
n Essentials of pharmacy practice is targeting pharmacy
assistants in hospital
o Training methodology
n Simple clear messages
n Interactive & participatory learning
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Investigating antibiotic use (1)
Surveys on practices influence prescribing of antibiotics
o 63.6% of 22 hospitals in a study in Kenya reported
having a functional medicines and therapeutics
committee (MTC)
o Only 20% of the hospitals reported having certain
antibiotics whose prescribing was limited to selected
groups of prescribers
o 42.9% of clinicians felt that locally developed
treatment guidelines would be more useful than
national guidelines
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Investigating antibiotic use (2)
o Retrospective data of culture and sensitivity of
two laboratories of the CBC Health Board
n Banso Baptist Hospital
n Mbingo Baptist Hospital
o Compilations of pharmacy Interventions at point
of dispensing
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Investigating antibiotic use (3)
Just and compassionate quality pharmaceutical services for all
Antibiotic-related interventions (59% of all Interventions)
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Per
cen
tag
e
Inappropriate Dose 19.0
Wrong Drug/Omission 17.2
Duplicate Therapy w current drug 15.5
Drug-disease (pregnancy) interaction 15.5
Inappropriate route of administration 12.1
Allergies to Ingredients 6.9
Dosing schedule not consistent 5.1
Contraindication 5.1
Possible drug-drug interaction 3.4
Percentage
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Public education on antibiotic use
Addressing:
o Incomplete doses with
antibiotics
o Dangers of poor quality
medicines
o Importance of laboratory
testing
o Buying medicines from
licensed outlets
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Public education on antibiotic use
Tailored to the needs of the community
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Public education on antibiotic use
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Practice Improvements
o Promoting use of available tools
e.g. MSH ICAT tool was used in St. Martin Hospital
Cameroon to give an insight into the state of selected
practices »»»» basis for intervention
o Investing in MTCs »»» 6 hospitals in
Arusha: clear TOR, supported by
hospital management
o Development of local treatment
guidelines for infectious diseases
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15
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Challenges
o Effectiveness of
interventions – how to
reach as many countries
(communities) as possible
o Inadequate documentation
of interventions and
mechanisms to
demonstrate that antibiotic
use practice has improved
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Acknowledgements
University of Nairobi
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Thank you
Ecumenical Pharmaceutical Network (EPN)
CHAK Complex - Musa Gitau road, Off Waiyaki Way, Lavington
P. O. Box 749 - 00606 Sarit Centre
Nairobi, Kenya
Tel: +254 20 4444832/4445020
Mob: +254 724 301755
Fax: +254 20 2678147
E-mail: [email protected]
Web site: www.epnetwork.org
