Use of antibacterial fixed-dose combinations in the private sector in eight Latin American Countries between 1999 and 2009

<p>Objective To assesses the safety and rationale of antibacterial fixed-dose combinations in the private sector in Latin America and determine the extent of their use. Methods Analysis of FDCs was based on retail sales data for eight Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru, Uruguay and Venezuela) between 1999 and 2009. FDCs were classified according to the pre-defined criteria. Use was expressed as daily defined doses per 1000 inhabitants per day (DDD/TID). Results A total of 175 antibacterial FDCs contained a mean of 1.3 antibacterial substances and 3.2 other active substances. Thirty-seven (21%) FDCs were classified as unsafe, 124 (70%) as lacking sufficient evidence for efficacy and only 14 (9%) of all FDCs were considered rational, for example amoxicillin and clavulanic acid. Consumption of unsafe FDCs decreased by 0.011 DDD/TID (95% CI: 0.012 to 0.009) annually, from 0.173 DDD/TID in 1999 to 0.070 DDD/TID in 2009 (overall decrease, 59.7%). Consumption of FDCs lacking sufficient evidence decreased by 30.3% (0.018 DDD/TID [95% CI: 0.028 to 0.008] annually), while use of rational FDCs increased by 17.1% (from 1.283 DDD/TID to 1.497 DDD/TID annually). Conclusion The majority of antibacterial FDCs in the private sector lack therapeutic benefit. Despite the decrease in the consumption of unsafe antibacterials and those lacking sufficient evidence, their use remains high and their marketing does not fit into strategies of prudent use of antibiotics to contain antibacterial resistance. ObjectifEvaluer la securite et la justification des combinaisons d'antibacteriens a dose fixe (CADF) dans le secteur prive en Amerique latine et determiner l'etendue de leur utilisation. MethodesL'analyse des CADF a ete basee sur les donnees des ventes en detail dans huit pays d'Amerique latine (Argentine, Bresil, Chili, Colombie, Mexique, Perou, Uruguay et Venezuela) entre 1999 et 2009. Les CADF ont ete classees selon des criteres predefinis. L'utilisation a ete exprimee en Doses Journaliere Definies pour 1000 habitants par jour (DDD/TID). ResultatsUn total de 175 CADF contenaient en moyenne 1,3 substances antibacteriennes et 3,2 autres substances actives. Trente-sept (21%) CADF ont ete classees comme dangereuses, 124 (70%) comme manquant de preuves suffisantes d'efficacite et seulement 14 (9%) de toutes les CADF ont ete considerees comme justifiees, ex: amoxicilline et acide clavulanique. La consommation de CADF dangereuses a diminue de 0.011 DDD/TID (IC95%: - 0.012 a 0.009) chaque annee, passant de 0.173 DDD/TID en 1999 a 0.070 DDD/TID en 2009 (diminution globale de 59.7%). La consommation de CADF non dotees de preuves suffisantes a diminue de 30.3% (0.018 DDD/TID [IC95%: 0.028 a 0.008] par an), tandis que l'utilisation rationnelle des CADF a augmente de 17.1% (passant de 1.283 DDD/TID a 1.497 DDD/TID par an). ConclusionLa majorite des CADF dans le secteur prive manque de benefice therapeutique. Malgre une baisse de la consommation d'antibiotiques a risque et de ceux manquant des preuves suffisantes, leur utilisation reste elevee et leur commercialisation ne rentre pas dans les strategies d'utilisation prudente des antibiotiques pour endiguer la resistance aux antibacteriens. ObjetivoEvaluar la seguridad y el fundamento de combinaciones de dosis fijas (CDFs) de antibacterianos en el sector privado en America Latina y determinar la extension de su uso.</p><p>MetodosEl analisis de las CDFs se baso en datos de ventas al por menor de ocho paises Latinoamericanos (Argentina, Brasil, Chile, Colombia, Mejico, Peru, Uruguay y Venezuela) entre 1999 y 2009. Las CDFs se clasificaron segun criterios predefinidos. El uso se expreso como Dosis Diarias Definidas por cada 1000 habitantes por dia (DDD/TID). ResultadosUn total de 175 CDFs de antibacterianos contenian una media de 1.3 sustancias antibacterianas y otras 3.2 sustancias activas. Treinta y siete (21%) CDFs fueron clasificadas como no seguras, 124 (70%) como faltandoles suficiente evidencia de eficacia, y solo un 14 (9%) de todas las CDFs fueron consideradas como fundamentadas, ej. amoxicilina y acido clavulanico. El consumo de CDFs no seguras disminuyo en 0.011 DDD/TID (95% IC: 0.012 a 0.009) anualmente, de 0.173 DDD/TID en 1999 a 0.070 DDD/TID en 2009 (disminucion total 59.7%). El consumo de CDFs con falta de evidencia disminuyo en un 30.3% (0.018 DDD/TID [95% IC: 0.028 a 0.008] anualmente), mientras que el uso racional de CDFs aumento en un 17.1% (de 1.283 DDD/TID a 1.497 DDD/TID anualmente). ConclusionA la mayoria de CDFs de antibacterianos en el sector privado les hace falta un beneficio terapeutico. A pesar de la caida en el consumo de antibacterianos no seguros asi como de aquellos sin suficiente evidencia, su uso continua siendo alto y su marketing no sigue estrategias de uso prudente de antibioticos que contengan el aumento de la resistencia a antibacterianos.</p>

Overcoming the barriers of vitamin D in pregnancy: A midwifery public health perspective

Vitamin D deficiency remains a significant public health issue for childbearing women in the UK. As the effect of vitamin D appears to be unclear, and supplementation outcomes for maternal and fetal health debatable, there has been widespread confusion, with midwives unclear about recommendations and women unsure about supplementation. A partnership approach allows women to understand the public health context and view vitamin uptake as beneficial for neonatal health, with women and midwives working together to break down barriers and optimise supplementation and endogenous vitamin D intakes. Many women find a balanced diet in the childbearing continuum period difficult to achieve, and midwives can only address vitamin D deficiency on an individual, case-by-case basis. Communication, and an acknowledgement that women come from a variety of cultural and social backgrounds, can be key to public health success, via a thorough exploration of women's barriers to vitamin D uptake