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Interventions and innovations to improve antibiotic use: Stories from EPN

Global Forum on Bacterial Infections Just and compassionate quality pharmaceutical services for all

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 Just and compassionate quality pharmaceutical services for all

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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….

Medicine listed Ciprofloxacin

n 10

P/F P = all

Manufacturer 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

Phenoxymethyl 8 Penicillin (Pen V) SMX/TMP 11

P=8, F=1

Flamingo Meditab Rayat Pharmachem – India; others P=7, F= 1 M & G -­‐ Ghana, Shellys – Tanzania, Elys – Kenya, Regal – Kenya, North China group – China, Sparsh Biotech – India P = 8, F = Microlabs – India, Elys – Kenya, ZT Pharma – China, Caisa Pharma – DRC, Regal – Kenya, Medopharm – India 3 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 Just and compassionate quality pharmaceutical services for all

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Investigating antibiotic use (1) Surveys on practices influence prescribing of antibiotics

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 o

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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) Antibiotic-related interventions (59% of all Interventions) 20.0 18.0 16.0 14.0

Percentage

12.0 10.0 8.0 6.0 4.0 2.0 0.0

Percentage

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

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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 Just and compassionate quality pharmaceutical services for all

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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 Just and compassionate quality pharmaceutical services for all

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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 Just and compassionate quality pharmaceutical services for all

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Thank you

Ecumenical Pharmaceutical Network (EPN) CHAK Complex - Musa Gitau road, O 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: info@epnetwork.org Web site: www.epnetwork.org Just and compassionate quality pharmaceutical services for all

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