The prevalence of side-effects: ciprofloxacin 500 mg single dose prophylaxis against Neisseria meningitidis outbreak in Potchefstroom during July 2003: research

Potchefstroom experienced an outbreak of Neisseria meningitidis (N. meningitidis) during May-July 2003. An opportunity for obtaining valuable data arose when mass prophylactic treatment to approximately 28% of the Potchefstroom community was provided by the Department of Health, North-West Province. The aim of this study was to investigate the prevalence of side-effects experienced by staff and students of the Potchefstroom University for Christian Higher Education (PU for CHE) who received a single prophylactic dose of oral ciprofloxacin 500 mg between 23 and 29 July 2003. Information gained from the Potchefstroom outbreak may be valuable for the future management of similar outbreaks in other communities. Various stakeholders have published related reports, protocols, recommendations and guidelines, which mostly focused on the prevention, management and control of meningococcal disease. Very little has been reported about the side-effects experienced, especially in cases where ciprofloxacin 500 mg single dose had been dispensed. One or more side-effects were reported by 24.2% of the participants, while 5.4% had to consult with a health care worker due to the severity of side-effects resulting from a single dose. Practical significance could not be demonstrated for any of the side-effects reported after single versus multiple doses nor when the effects of gender or requirement for medical consultation were tested. Key Words: Neisseria meningitidis; Ciprofloxacin; Single dose; Side effects; Prophylactic OPSOMMING ‘n Uitbraak van Neisseria meningitidis (N. meningitidis) gedurende Mei-Julie 2003 en die daaropvolgende verskaffing van massa-profilakse deur die Departement van Gesondheid, Noordwesprovinsie aan ongeveer 28% van die plaaslike gemeenskap het ‘n geleentheid geskep om waardevolle inligting in te win. Die doel van die studie was om die voorkoms van newe-effekte te ondersoek wat deur die personeel en studente van die Potchefstroomse Universiteit vir Christelike Hoër Onderwys ervaar is na toediening van ‘n enkel profilaktiese dosis van siprofloksasien 500 mg tussen 23-29 Julie 2003. Inligting wat hieruit voortspruit mag waardevol wees tydens toekomstige bestuur van uitbrake in ander gemeenskappe. Verskillende belanghebbendes het verslae, protokolle, aanbevelings en riglyne gepubliseer, wat meestal op die voorkoming, bestuur en beheer van meningokokkale siekte gefokus het. Daar is egter min gerapporteer oor die newe-effekte wat ondervind is veral waar siprofloksasien 500mg enkeldosis toegedien is. Een of meer newe-effekte is deur 24.2% van die deelnemers ervaar en 5.4% het dit nodig geag om ‘n gesondheidswerker te konsulteer in verband met die newe-effekte wat ervaar is. Geen prakties betekenisvolle verskille is aangedui indien die effeksgrootte bereken is vir die newe-effekte getoets tussen die enkeldosis versus die meervoudige dosis nie, selfs ook nie nadat die effek van geslag of konsultasie getoets is nie. Health SA Gesondheid Vol.9(3) 2004: 42-5

Challenges and issues in drug utilization research identified from the Latin American and African regions

Background: Despite advancements in drug utilization research (DUR), these have not been universal. Some regions such as the Latin America (LatAm) and African regions are facing challenges that are impeding the development of DUR. Objectives: To identify the main challenges and issues for DUR in the LatAm and African regions Methods: A collaborative initiative by the International Society of Pharmacoepidemiology Global Development Committee in partnership with the Latin America Drug Utilization Group and the Medicines Utilization Research in Africa Group was undertaken. A comprehensive literature review was conducted to identify local and international DUR publications. A core group of investigators and experts in DUR reviewed the publications and identified the main methodological challenges and issues. Subsequently, the group exchanged materials, participated in WebEx discussions, and reviewed the draft document. Results: Main issues: 1) Socioeconomic: high unemployment rate with poor standard of living, socioeconomic inequalities, low literacy levels, urban segregation, high migration rates, high rates of violent crime including drug trafficking and possession. 2) Healthcare-related: Disparities of social determinants of health, differences in the quality of public and private health sectors; and epidemiologic transition from communicable diseases to non-communicable diseases. Most health care systems are fragmented with variable access to medical care and medicines, and substandard record keeping. 3) Drug utilization-related: Inappropriate use of medicines including the elderly; limited infrastructure to reliably collect DU data; over-prescription of antimicrobials; polypharmacy; high rates of self-medication; and poor patient adherence (e.g. HIV/AIDS, diabetes mellitus and hypertension). Planning for DUR is affected by the multiplicity of drug distribution channels; trading in sub-standard, counterfeit medicines and insufficient quality control centers. Some publications are generated by local investigators, often suffering of methodological issues such as lack of representativeness of the population, limited data validity, and small sample sizes. Conclusions: There are common challenges for DUR when working within the LatAm and African regions. Based on our findings, the group is developing Guidance on Good Practices of Drug Utilization Research in those regions to assist researchers with issues pertaining to the planning, conduct, and evaluation of DUR

The potential market demand for biokinetics in the private health care sector of South Africa

Objective. Biokinetics, a profession registered with the Health Professions Council of South Africa (HPCSA) address inter alia chronic diseases of lifestyle (CDL) with exercise as treatment modality. The purpose of this investigation is to determine the potential market demand for biokinetic services in the private health care sector of South Africa. Methods. Secondary data from a pharmaceutical benefit management system (PBM) were analysed to determine the prevalence of chronic diseases in the private health care sector for 2007. Telephonic interviews on a sub-sample of 50 biokineticists revealed the average number of patients that can be treated monthly per biokineticist. The number of biokineticists with active practice numbers was obtained from the Board of Health Care Funders (BHF). Results. The results indicate that 46.71% (747 199/1,600,000) of the patients managed by the PBM are treated with medication for one or more CDL. The prevalence of non-steroid anti-inflammatory medication (20.8%), medication for cardiovascular diseases (13.1%) and bronchodilators (10.95%) had the highest prevalence. The sub-sample of biokineticists indicated that one biokineticist can treat an average of 100 patients per month. The potential market demand calculated from the above numbers indicate that 7 472 biokineticists are needed in the private health care sector, while only 625 active practice numbers were registered with the BHF in 2007. Conclusion. In conclusion, it is estimated that only 7.6% of patients with CDL can potentially be treated by the current number of registered biokineticists. Therefore there is an enormous potential market for biokinetics in the private health care sector of South Africa

The prevalence of side-effects: Ciprofloxacin 500 mg single dose prophylaxis against Neisseria Meningitidis outbreak in Potchefstroom during July 2003

Potchefstroom experienced an outbreak of Neisseria meningitidis (N. meningitidis) during May-July 2003. An opportunity for obtaining valuable data arose when mass prophylactic treatment to approximately 28% of the Potchefstroom community was provided by the Department of Health, North-West Province. Opsomming ‘n Uitbraak van Neisseria meningitidis (N. meningitidis) gedurende Mei-Julie 2003 en die daaropvolgende verskaffing van massa-profilakse deur die Departement van Gesondheid, Noordwesprovinsie aan ongeveer 28% van die plaaslike gemeenskap het ‘n geleentheid geskep om waardevolle inligting in te win. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text

Public knowledge, attitudes and behaviour towards antibiotic usage in Windhoek, Namibia

Background: The development of antibiotic resistance is a globally recognised human health threat. Overuse of antibiotics is a major contributory factor to the development of resistance. As end users, the public play a role in antibiotic use and the development and spread of resistance. The purpose of the study was to assess the knowledge, attitudes and behaviour of the general population of Namibia accessing care in the private sector regarding antibiotic use. Methodology: A cross-sectional survey based on self-administered questionnaire was distributed to 600 patients through pharmacies in Windhoek, Namibia. The survey was conducted from March to June 2013. Results: A total of 446 completed questionnaires were collected. Eighty percent (80%) of respondents reported to have used antibiotics in the past year mainly for colds and flu symptoms. The majority of respondents obtained antibiotics through a valid doctor’s prescription. A prevalence of fifteen percent (15%) of self-medication with antibiotics mainly obtained from pharmacies without a prescription was reported. Eighty percent (80%) of respondents reported completing the antibiotic course. Gaps in population understanding of antibiotics were observed. Sixty-four percent (64%) of the respondents thought that antibiotics were effective against viruses with just less than half revealing that they should take an antibiotic for a cold. Seventy-two percent (72%) of respondents understood that unnecessary use of antibiotics makes them ineffective. Conclusion: Major findings of this study include the sale of antibiotics without a prescription; over prescribing of antibiotics for self-limiting upper respiratory tract infections; and, the presence of gaps in knowledge, attitudes and behaviour of the general population towards antibiotics and their us

Antibiotic use in Namibia: prescriber practices for common community infections

Background: Despite the threat of resistance, the use of antibiotics globally is high and continues to increase. Much of this use is attributed to overprescribing by physicians. The objective of this study was to assess doctors’ management of common community-acquired infections in Namibia.Methodology: A cross-sectional survey based on a web-based self-administered questionnaire was conducted. Doctors belonging to the local professional associations comprised the study population. Data were collected from March to July 2014.Results: A 10% ( n = 44) response rate was achieved. Respondents were from across the country and practised mainly in the private health sector. Both awareness of local antimicrobial sensitivity rates and ownership of national Standard Treatment Guidelines were poor (20% and 31% respectively). Common practice in managing common infections, with the exception of chronic otitis media, cystitis and pyelonephritis, is to treat empirically. The reported first-line antibiotics of choice were the combination of amoxicillin with clavulanic acid for upper respiratory tract infections and ciprofloxacin for urinary tract infections. Management of infections was the same across all socio-demographic factors and was not influenced by patient workload.Conclusion: This survey revealed that first-line antibiotic choices of doctors are not informed by the Namibia Standard Treatment Guidelines and the local and regional antimicrobial sensitivity data. Interventions to improve antibiotic prescribing in Namibia should include better dissemination of guidelines and information regarding local antimicrobial sensitivity rates as well as strategies for the implementation of guidelines