Transfusion Strategy in Crimean-congo Hemorrhagic Fever Treatment

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ANTIBIOTICS IN THE HANDS OF COMMUNITY PHARMACISTS: A PROSPECTIVE AVENUE FOR COMMUNITY BASED ANTIMICROBIAL STEWARDSHIP INITIATIVE

Antimicrobial stewardship (AMS) is high on the agenda of global health organizations with an increasing interest in community-based AMS initiatives, as this is where the majority of antibiotic use occurs. This study sought to evaluate the practice of community pharmacists toward antibiotic use and the likely need for AMS. This was a descriptive cross-sectional study conducted among registered community pharmacists in Benin City, Nigeria. A structured questionnaire was used for data collection. All study participants were duly informed on study objectives and informed consent was sought. The data obtained from the study were analyzed using IBM SPSS version 22. Of the 101 pharmacists who participated in the study, 92 (91.1%) dispensed antibiotics without prescription. The most prescribed antibiotic is Ciprofloxacin 59(58.42%), followed by Amoxicillin 42 (41.58%) and Amoxicillin-Clavulanic acid 41 (40.59%). Ninety-six (95%) of the pharmacists use antibiotics agents as an adjunct in Typhoid fever treatment, and 78(77.2%) of them use it as an adjunct in Malaria treatment. Cost 32 (31.68%) is the most common reason for dispensing antibiotics without laboratory investigation and physician’s consultation. Most (93.1%) pharmacists agree that they need training on antimicrobial stewardship practice. The antibiotic prescription pattern among community pharmacists was high, the possibility of antibiotic misuse in the hands of community pharmacists without appropriate guidelines cannot be overlooked. This emphasizes the need for the inclusion of community pharmacies in antimicrobial stewardship programs.

Health-seeking behaviour and cost of fever treatment to households in a malaria-endemic setting of northern Ghana: a cross-sectional study

ObjectivesTo examine the health-seeking behaviour and cost of fever treatment to households in Ghana.DesignCross-sectional household survey conducted between July and September 2015.SettingKassena-Nankana East and West districts in Upper East region of Ghana.ParticipantsIndividuals with an episode of fever in the 2 weeks preceding a visit during routine health and demographic surveillance system data collection were selected for the study. Sociodemographic characteristics, treatment-seeking behaviours and cost of treatment of fever were obtained from the respondents.ResultsOut of 1845 households visited, 21% (393 of 1845) reported an episode of fever. About 50% (195 of 393) of the fever cases had blood sample taken for testing by microscopy or Rapid Diagnostic Test, and 73.3% (143 of 195) were confirmed to have malaria. Of the 393 people with fever, 70% (271 of 393) reported taking an antimalarial and 24.0% (65 of 271) took antimalarial within 24 hours of the onset of illness. About 54% (145 of 271) of the antimalarials were obtained from health facilities.The average cost (direct and indirect) incurred by households per fever treatment was GH¢27.8/US$7.3 (range: GH¢0.2/US$0.1–GH¢200/US$52.6). This cost is 4.6 times the daily minimum wage of unskilled paid jobs of Ghanaians (US$1.6). The average cost incurred by those enrolled into the National Health Insurance Scheme (NHIS) was GH¢24.8/US$6.5, and GH¢50/US$11.6 for those not enrolled.ConclusionsPrompt treatment within 24 hours of onset of fever was low (24%) compared with the Roll Back Malaria Programme target of at least 80%. Cost of treatment was relatively high when compared with average earnings of households in Ghana and enrolment into the NHIS reduced the cost of fever treatment remarkably. It is important to improve access to malaria diagnosis, antimalarials and enrolment into the NHIS in order to improve the case management of fever/malaria and accelerate universal health coverage in Ghana.

Invitro Analysis of Time-Kill Curves of Some Antimicrobial Agents Against Salmonella Typhi

Due to the high prevalence of typhoid fever and the periodic nature of Salmonella infections despite the various antimicrobial agents used to treat these infections, the need to open up new strategies for antimicrobial susceptibility rather than the MIC alone arises. This study determines the time-kill curves using four different antimicrobial agents: Gentamicin, Ceftriaxone, Cloxacillin, and Ofloxacin at different concentrations of 1x, 2x, and 4x of their respective MICs. The finding of this study reveals that at 1x MIC, all the antimicrobial agents used, except for Gentamicin, show non-bactericidal activity against the isolates after eight hours of exposure. This study suggests that analyzing the time-kill curves in typhoid fever treatment will help determine the appropriate dose to treat the infection.

Therapeutic plants used for Typhoid Fever treatment in Kaduna State Nigeria

For ages, medicinal plants play a significant role in the effective, affordable, and safe healthcare system. Medicinal plants continue to play an important role in Nigeria's healthcare system, which serves more than 70% of the country's population. For pharmaceutical exploration and conservation, it is important to document the use of medicinal plants in a specific region across time. The study's goal was to find out which plants were used to treat typhoid illness in Kaduna state. The in-depth interview guide was utilized in conjunction with an expert method and non-random probability sampling. The study discovered and recorded 31 plant species from 25 families that are used by Kaduna residents to cure typhoid diseases. Plants with a 0.45 value of relative frequency citation were documented. The highest relative frequency of citation (0.9) and fidelity level (90%) are found in Garcinia mangostana, Senna alata, Moringa oleifera, and Hibiscus sabdariffa, respectively. In Nigeria, traditional medicinal knowledge is guarded by elderly people. The study discovered plant species that could be used as a potential source of anti typhoid in Nigeria.

Time to reconsider the role of ribavirin in Lassa fever

Ribavirin is the only available Lassa fever treatment. The rationale for using ribavirin is based on one clinical study conducted in the early 1980s. However, reanalysis of previous unpublished data reveals that ribavirin may actually be harmful in some Lassa fever patients. An urgent reevaluation of ribavirin is therefore needed.

Socio-environmental Factors Influencing Preferences for Typhoid Fever Treatment Among Secondary School Students in Ikenne, South-West, Nigeria

Typhoid fever was estimated to produce 17.8 million cases each year among low-and-middle-income countries of the world. This study aimed to identify the socio-environmental factors that influence care-seeking preferences for typhoid fever treatment among students of Secondary Schools. The study adopted a cross-sectional design guided by behavioural theories that employed quantitative methods of data collection. A multistage sampling technique was used to select five (5) schools from five wards in the study area. A total of 422 students were recruited for this study but only 417 questionnaires were correctly and completely analysed. A self-administered questionnaire was used for data collection and the data was analysed using, descriptive statistics, chart, mean, standard deviation and inferential statistics of correlation, and multiple regression. The respondents’ ages ranged from 10-19 years with a mean of 15.3 ± 1.7 years. Results demonstrated that the socio-environmental factors that influence the respondents’ health-seeking behaviour for typhoid treatment were the decision of parents on the type of treatment they can receive as well as the cost of the treatment The study further revealed that of the respondents who have had typhoid fever in their lifetime, less than half sought treatment in hospitals. This study recommends that good healthcare-seeking behaviour health promotion programmes should be targeted at parents since they are stakeholders in the healthcare-seeking decision-making of adolescents.

Investigating the factors behind differences in ‘lay’ and ‘expert’ medical knowledge in the context of fever treatment in Yangon, Myanmar.

How is treatment seeking behaviour influenced by contrasting medical discourses? This paper uses the context of fever patients in Yangon, Myanmar to investigate the factors behind differences between ‘lay’ and ‘expert’ medical knowledge, which consequently guide the treatment seeking behaviour of hospital and clinic patients in Myanmar’s second largest city. By conducting the deductive thematic analysis of secondary qualitative data from both patients and medical doctors using an adapted form of Amartya Sen’s capability approach framework, this cross-sectional study uncovers how: education, socially rooted collective knowledge and unregulated pharmacies drive differences between ‘lay’ and ‘expert’ medical knowledge and therefore dictate treatment seeking behaviour. The results of this paper highlight the interdisciplinary nature of health, meaning health systems should be considered within their sociological, political and economic contexts. The current omission of traditional health discourse within the prevailing Burmese health system may limit the successfulness of biomedical treatment. Appreciating the complexity of how health is understood by populations, specifically how traditional medicine and biomedicine coexist within the Burmese context can allow policymakers to form a stronger health system by creating contextualised policies and health interventions for the general public that cater to the diversity of narratives within health.

Tebipenem as an oral alternative for the treatment of typhoid caused by extensively drug resistant (XDR) Salmonella Typhi

The emergence of multi-drug (MDR) and extensive-drug resistance (XDR) in Salmonella Typhi and Paratyphi A hinder efficacious out-patient enteric fever treatment. We show that non-XDR and XDR S. Typhi and S. Paratyphi A are susceptible to the carbapenem tebipenem in vitro. Tebipenem demonstrated partial synergy with antimicrobials including azithromycin, signifying combination therapy may limit the emergence of resistance. Given recent evidence on tebipenem inhibitory activity against MDR Shigella, its broad-spectrum activity against MDR/XDR organisms renders it a good clinical trial candidate.