Background
Antibiotic resistance is a global health crisis and irrational prescribing behaviour has been identified as a contributing factor. The current study aimed to assess the knowledge of, attitudes towards and practices regarding antibiotic prescribing of medical doctors providing free healthcare services in the outpatient departments of public hospitals in Sierra Leone. In addition, we evaluated prescribing patterns of antibiotics.
Methods
The study has two parts. First, we conducted a cross-sectional survey using a self-administered questionnaire to assess doctor’s knowledge of, attitudes towards and practices regarding prescribing antibiotics. Second, using patient medical records, we used the World Health Organization methodology on how to assess drug use in health facilities to evaluate prescribing patterns of antibiotics in four selected public hospitals in Sierra Leone.
Results
Of 130 administered questionnaires, 119 were returned, for a response rate of 91.5%. The majority of doctors (n=83 [69.7%]) agreed that amoxicillin is safe in the first 3 weeks of pregnancy and considered antibiotic resistance a global (n=108 [90.7%]) and national (n=97 [81.5%]) public health crisis. Less than a quarter of medical doctors agreed that antibiotics may speed up the recovery when added to malaria (n=25 [21%]) or cold and cough (n=81 [68%]) therapies. Prescribing pattern results show that children <5 y of age (adjusted odds ratio 5.199 [confidence interval 2.743 to 9.855], p<0.0001) were more likely to be prescribed an antibiotic than pregnant women/lactating mothers. Penicillins were the most commonly prescribed pharmacological class of antibiotics, with amoxicillin being the most commonly prescribed penicillin.
Conclusions
Doctors demonstrated a sound knowledge of antibiotics and antibiotics resistance, with a positive attitude towards prescribing antibiotics. However, the prescribing pattern of antibiotics was irrational, necessitating the need for the establishment of audit and feedback programmes such as antimicrobial stewardship programmes.
Sub-acute and chronic toxic effects of total steroidal saponins (TSSN) extracts from Dioscorea zingiberensis C.H. Wright on various internal organs and biochemical indicators have never been studied before and this study is the first of its kind to demonstrate sub-acute and chronic toxicities of TSSN on dogs. Administration of TSSN extracts at doses up to 3000 mg/Kg daily for 14 days, no biochemical and organ changes were observed on the experimental groups of dogs. Further, chronic toxicity study through oral administration of TSSN extracts at the gradual doses of 50, 250 and 500 mg/Kg for 90 days followed by a 2-week recovery assay revealed absence of significant architectural and morphological changes in internal organs which were confirmed through histopathological examination and merely no significant alteration in the biochemical indicators including hematologic and urine analysis and electrocardiogram compared to the control dogs. This toxicological evaluation came across with the finding that the herbal preparation can be considered as nontoxic and animals could tolerate the extracts at doses up to 500 mg/Kg with LD50 greater than 3000 mg/Kg. It may serve as a preliminary scientific evidence for further therapeutic investigations.
EML) of 2017 was analyzed. List of medicines registered in Armenia (2018) was analyzed to identify authorized tracer medicines. Data on availability and prices were collected from pricelists of 5 main wholesalers, 3 pharmacy chains and 10 independent pharmacies. Affordability was calculated using methodology developed by WHO and Health Action International; it was expressed as the number of days needed by a person who earns the minimum wage that was set by legislation, to purchase a course of treatment. RESULTS: Only 72.5% of 51 antineoplastics and immunosuppressives and 65.0% of 103 formulations of these medicines listed in WHO EML are included in the new Armenian EML (72.3% and 54.3%, correspondingly, in Armenian EML of 2013); 68.6% of tracer medicines and 44.7% of their formulations are authorized. 49.0% of medicines and 25.2% of formulations were found in wholesalers' pricelists. Only 19.4% of formulations were available in different pharmacy outlets; the most of chain and all independent pharmacies did not have any tracer medicine. Only 16 of 86 formulations of cytotoxic and adjuvant medicines listed in WHO EML were available on the market; and cost of treatment only for 3 of them was less than 1 day wage. CONCLUSIONS: Only less than half of essential antineoplastics and immunosuppressives and less than one quarter of their formulations recommended by WHO are available on the pharmaceutical market of Armenia. Cost of treatment for the great majority of these essential medicines is unaffordable for those patients who are not covered by the reimbursement system.
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