scholarly journals Should Codeine Still be Considered a WHO Essential Medicine?

2021 ◽  
Vol 24 ◽  
pp. 329-335
Author(s):  
Boni Singu ◽  
Roger K Verbeeck
Keyword(s):  
Analgesic Effect ◽  
Low Dose ◽  
Clinical Evidence ◽  
Essential Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Randomized Controlled ◽  
Health Organization ◽  
Available Information ◽  
Analgesic Response

Codeine continues to be widely used as an analgesic, antidiarrhoeal and antitussive agent. Its analgesic effect depends on its biotransformation to morphine, a strong opioid. The highly variable biotransformation of codeine to morphine, catalysed by CYP2D6, underlies the pronounced interindividual variability of its analgesic response. Randomized controlled trials have demonstrated that codeine administered alone has the poorest analgesic effect among all commonly used analgesics in acute postoperative pain. Moreover, it is highly unlikely that the low dose of codeine contributes to the pain-relieving effect of the non-opioid component in combination analgesic products. In addition, there is a lack of reliable clinical evidence to support the use of codeine as an antitussive in acute or chronic cough. Codeine use, through its active metabolite morphine, has the potential to lead to abuse and dependence. The World Health Organization (WHO) removed codeine from the essential medicines list for children in 2011. Based on the available information in the scientific literature on the efficacy and safety of codeine, the WHO should seriously consider removing it also from the list of essential medicines for adults, which would be a strong signal for all health professionals to prescribe and dispense codeine with the utmost caution.

Essential medicines for palliative care

2021 ◽  
pp. 13-18
Author(s):  
Lukas Radbruch ◽  
Liliana De Lima
Keyword(s):  
Palliative Care ◽  
World Health Organization ◽  
Essential Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Health Conditions ◽  
Health Coverage ◽  
Loved One ◽  
The World ◽  
Health Organization

The World Health Organization defines essential medicines as those which satisfy the primary healthcare needs of the population. In 2013, the World Health Organization introduced a new section on medicines for pain and palliative care in the 18th edition of the Model List of Essential Medicine including 15 medicines for the most common symptoms in life-limiting health conditions. More recently, the Lancet Commission on palliative care developed an essential package which also includes equipment and human resources in addition to the essential medicines. The Lancet Commission specified that in order to achieve universal health coverage, coverage of the essential package is recommended by dedicated, pro-poor, public or publicly mandated funding and for all relevant health conditions. However, in many regions of the world, all or some of the essential medicines are not available at all, or if they are available in the country, they are regularly out of stock in the local pharmacy, out-of-pocket costs are so high that patients cannot afford the medicines, or whole families become impoverished buying treatment for their loved one. Problems with accessibility, affordability, and availability are particularly evident with opioid analgesics such as morphine. However, accessibility, affordability, and availability of essential medicines is a pivotal prerequisite for the delivery of quality palliative care.

scholarly journals Analysis of Essential Medicines Used for Emergency Care in Pakistan

2020 ◽  
Vol 1 (1) ◽  
pp. 75-77
Author(s):  
Talha Khalid ◽  
Amna Khokhar ◽  
Naseem Jehan ◽  
Umar Sultan ◽  
Arooj Fatima
Keyword(s):  
Health Care ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Essential Medicine ◽  
Essential Medicines ◽  
World Health ◽  
Care Hospital ◽  
Care Needs ◽  
Cross Sectional ◽  
Health Organization

Introduction: According to the World Health Organization (WHO), essential medicines (EM) have the ability to meet the health care needs of maximum individuals. High accessibility to essential medicines (EM) was proposed under the Millennium Development Goal. The access to high quality, suitable, and inexpensive essential medicines is an essential constituent of health care systems. Methodology: This retrospective cross-sectional observational study was performed at Jinnah Hospital Lahore from February 2018 to November 2018, for analysis of essential medicine usage in a public sector tertiary care hospital of Pakistan. The data were collected from records of patients admitted in the emergency department. Results: Drugs prescribed per encounter were estimated to be 3. Most patients got a single antibiotic, and cephalosporin was the most commonly prescribed antibiotic. Conclusion: The concept of essential drugs has gained high acceptance, but the EMs should be prescribed logically, appropriately and should be in line with WHO guidelines.

Chemistry of Iodinated Contrast Media (ICM): A Minireview

2020 ◽  
Vol 17 ◽  
Author(s):  
Maithili Pramod Joshi ◽  
Ameya Chaudhari ◽  
Prashant S. Kharkar ◽  
Shreerang V. Joshi
Keyword(s):  
Adverse Effects ◽  
Contrast Media ◽  
Aqueous Solubility ◽  
Synthetic Methods ◽  
Essential Medicines ◽  
World Health ◽  
Iodinated Contrast Media ◽  
Environmental Aspects ◽  
Iodinated Contrast ◽  
Health Organization

: Historically, the use of Iodinated Contrast Media (ICM) for diagnostic purposes, particularly radiography and computed tomography (CT), is well-known. Many of the ICM are included in the World Health Organization (WHO)’s List of Essential Medicines. Depending on the chemotype and the presence of ionizable functional group(s), the ICM are categorized in the ionic/nonionic monomers/dimers. The lipophilicity, aqueous solubility, viscosity and osmolality are major characteristics dictating their use for one procedure versus the other. Over last several decades, substantial advancement occurred in the design and development of novel ICM, solely to reduce their propensity to cause adverse effects. Given the nature of their acute usage, some of the agents with appreciable toxicity are still used. Understanding their chemistry aspects is crucial to appreciate, acknowledge and justify the usage of these extremely important torch-bearers of diagnostic agent’s class. The present review article presents an in-depth overview of the synthetic methods, therapeutic indications, potential adverse effects along with the commercial and environmental aspects of ICM. The safety and tolerability of these agents is a field that has gained significant importance, which is given due importance in the discussion.

scholarly journals A critical comparison between the World Health Organization list of essential medicines for children and the Brazilian list of essential medicines (Rename)

2013 ◽  
Vol 89 (2) ◽  
pp. 171-178
Author(s):  
Helena Lutéscia L. Coelho ◽  
Luís Carlos Rey ◽  
Marina S.G. de Medeiros ◽  
Ronaldo A. Barbosa ◽  
Said G. da Cruz Fonseca ◽  
...  
Keyword(s):  
World Health Organization ◽  
Essential Medicines ◽  
World Health ◽  
Critical Comparison ◽  
The World ◽  
Health Organization ◽  
Medicines For Children

scholarly journals Azithromycin Reduction to Reach Elimination of Trachoma (ARRET): study protocol for a cluster randomized trial of stopping mass azithromycin distribution for trachoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abdou Amza ◽  
Boubacar Kadri ◽  
Beido Nassirou ◽  
Ahmed M. Arzika ◽  
Ariana Austin ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Cluster Randomized Trial ◽  
World Health ◽  
Baseline Assessment ◽  
Randomized Controlled ◽  
Registration Number ◽  
Cluster Randomized ◽  
Health Organization

Abstract Background The World Health Organization (WHO) recommends annual mass azithromycin distribution until districts drop below 5% prevalence of trachomatous inflammation—follicular (TF). Districts with very low TF prevalence may have little or no transmission of the ocular strains of Chlamydia trachomatis that cause trachoma, and additional rounds of mass azithromycin distribution may not be useful. Here, we describe the protocol for a randomized controlled trial designed to evaluate whether mass azithromycin distribution can be stopped prior to the current WHO guidelines. Methods The Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) study is a 1:1 community randomized non-inferiority trial designed to evaluate whether mass azithromycin distribution can be stopped in districts with baseline prevalence of TF under 20%. Communities in Maradi, Niger are randomized after baseline assessment either to continued annual mass azithromycin distribution or stopping annual azithromycin distribution over a 3-year period. We will compare the prevalence of ocular C. trachomatis (primary outcome), TF and other clinical signs of trachoma, and serologic markers of trachoma after 3 years. We hypothesize that stopping annual azithromycin distribution will be non-inferior to continued annual azithromycin distributions for all markers of trachoma prevalence and transmission. Discussion The results of this trial are anticipated to provide potentially guideline-changing evidence for when mass azithromycin distributions can be stopped in low TF prevalence areas. Trial registration number This study is registered at clinicaltrials.gov (NCT04185402). Registered December 4, 2019; prospectively registered pre-results.

scholarly journals Evaluation of Prescribing Indicators in a Paediatric Population Seen in an Outpatient Consultation at the Gaspard Kamara Health Centre in 2019 (Senegal)

Pharmacy ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 113
Author(s):  
Oumar Bassoum ◽  
Mouhamadou Faly Ba ◽  
Ndèye Marème Sougou ◽  
Djibril Fall ◽  
Adama Faye
Keyword(s):  
Descriptive Analysis ◽  
Health Centre ◽  
Paediatric Population ◽  
Essential Medicines ◽  
World Health ◽  
Bivariate Analysis ◽  
Prescribing Indicators ◽  
Outpatient Consultation ◽  
International Nonproprietary Name ◽  
Health Organization

Introduction: Data on drug use in paediatrics are scarce in Senegal. The objective of this study was to assess the prescribing indicators in a paediatric population seen in an outpatient consultation at a Health Centre in Dakar, Senegal. Methods: A retrospective and analytical study was conducted. The study population consisted of prescriptions for children aged 0 to 14 years who were seen in ambulatory consultation between 1 June and 30 November 2019. The sample size was 600 prescriptions. The systematic survey was then conducted. Five prescription indicators recommended by the World Health Organization were calculated. The R software was used for descriptive analysis, bivariate analysis and binomial logistic regression. Results: The average number of drugs per prescription was 2.56. The proportion of drugs prescribed under the International Nonproprietary Name (INN) was 18.9%, while the proportion of drugs on the National Essential Medicines List (NEML) was 41.3%. The proportions of prescriptions with at least one antibiotic and one injectable product were 41.5% and 1.3%, respectively. Conclusions: This study showed that prescribing habits were inadequate. Thus, it would be necessary to move towards continuing training of prescribers in the wise use of medicines.

scholarly journals Low-dose amikacin in the treatment of Multidrug-resistant Tuberculosis (MDR-TB)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Natasha F. Sabur ◽  
Mantaj S. Brar ◽  
Lisa Wu ◽  
Sarah K. Brode
Keyword(s):  
Hearing Loss ◽  
Adverse Events ◽  
Low Dose ◽  
Multidrug Resistant ◽  
Significant Rise ◽  
World Health ◽  
Therapeutic Drug ◽  
Successful Treatment Outcome ◽  
Mdr Tb ◽  
Health Organization

Abstract Background The World Health Organization recommends intravenous amikacin for the treatment of MDR-TB at a dose of 15 mg/kg. However, higher doses are associated with significant toxicity. Methods Patients with MDR-TB treated at our institution receive amikacin at 8–10 mg/kg, with dose adjustment based on therapeutic drug monitoring. We conducted a retrospective cohort study of patients with MDR-TB who received amikacin between 2010 and 2016. Results Forty-nine patients were included in the study. The median starting dose of amikacin was 8.9 mg/kg (IQR 8, 10), and target therapeutic drug levels were achieved at a median of 12 days (IQR 5, 26). The median duration of amikacin treatment was 7.2 months (IQR 5.7, 8), and median time to sputum culture conversion was 1 month (IQR 1,2). Six patients (12.2%) experienced hearing loss based on formal audiometry testing (95% CI 4.6–24.8%); 22.2% had subjective hearing loss (95% CI 11.2–37.1%) and 31.9% subjective tinnitus (95% CI 19.1–47.1%). Ten patients (23%) had a significant rise in serum creatinine (95% CI 11.8–38.6%), but only 5 patients had a GFR < 60 at treatment completion. 84% of patients had a successful treatment outcome (95% CI 84–99%). Conclusions Low dose amikacin is associated with relatively low rates of aminoglycoside-related adverse events. We hypothesize that low-dose amikacin can be used as a safe and effective treatment for MDR-TB in situations where an adequate regimen cannot be constructed with Group A and B drugs, and where careful monitoring for adverse events is feasible.

scholarly journals Building the Case for Clopidogrel as a World Health Organization Essential Medicine

2015 ◽  
Vol 8 (4) ◽  
pp. 447-451 ◽  
Author(s):  
Amisha Patel ◽  
Mahesh Vidula ◽  
Sunny P. Kishore ◽  
Rajesh Vedanthan ◽  
Mark D. Huffman
Keyword(s):  
World Health Organization ◽  
Essential Medicine ◽  
World Health ◽  
Health Organization

scholarly journals Osteopathic correction in the treatment of pain in the lower back

2020 ◽  
pp. 140-146
Author(s):  
V. O. Belash ◽  
Yu. O. Novikov
Keyword(s):  
Back Pain ◽  
Developed Countries ◽  
Economic Problem ◽  
World Health ◽  
Randomized Controlled ◽  
Lower Back ◽  
The World ◽  
Working Age ◽  
Acute Back Pain ◽  
Health Organization

According to experts of the World Health Organization the lower back pain (LBP) prevalence in developed countries reaches the pandemic size, and it is a serious medical and socio-economic problem. Acute back pain is transformed into chronic in 10–20 % of working age patients′ cases; this causes serious psychological disorders appearing, forms painful behavior and persists even when the initial pain trigger is eliminated. Data from metaanalyses of randomized controlled trials indicate the effectiveness of the osteopathic approach in the treatment of LBP patients. At the same time the osteopathic correction is effective not only for acute pain, but also for chronic pain. A case from clinical practice is described demonstrating the possibility of osteopathic correction of a LBP patient.

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