Utilization Trends of Antiviral and Antifungal Agents for Human Systemic Use in Tanzania From 2010 to 2017 Using the World Health Organization Collaborating Centre for Drug Statistics Methodology

IntroductionThe increase in antimicrobial consumption contributes to the emergence of antimicrobial resistance (AMR). Many studies have investigated the patterns of antibacterial consumption and antibacterial resistance. However, there is a paucity of data on the utilization of antivirals and antifungals in low and middle-income countries to serve as a baseline for monitoring and surveillance of AMR. Therefore, this study determined Tanzania’s systemic antifungal and antiviral utilization trends from 2010 to 2017, based on the Tanzania Medicines and Medical Devices Authority (TMDA) medicine importation archives.MethodologyAn analytical, longitudinal retrospective survey covering 2010 to 2017 was conducted. The study utilized the Anatomical Therapeutic and Chemical (ATC) classification and Defined Daily Dose (DDD) developed by the World Health Organization (WHO) Collaborating Centre for Drug Statistics and the WHO Collaboration Centre for International Drug Consumption Monitoring. Human medicine importation data were collected from TMDA headquarters and used to assess the systemic antiviral and antifungal consumption trends. The importation data included the date, generic name, strength, brand name, currency, quantity, ATC classification, supplier country, port of entry and product supplier. The data were cleaned, reorganized and analyzed. Reference was made to the latest revised DDD list to assign antifungals and antivirals to their respective ATC/DDDs and then adjusted to the population estimates from the National Bureau of Statistics of Tanzania.ResultsThere was a high proportion of systemic antivirals and antifungals utilization with 367.1 and 10.8 DDD per 1000 inhabitants per day (DID) respectively over eight years. In regression model, there was a significant increase in both antiviral (p-value = 0.043) and antifungal (p-value = 0.015) agents’ utilization trends in Tanzania in the study period. Fluconazole had the highest proportion of utilization for antifungals, followed by ketoconazole, itraconazole, miconazole and amphotericin B. For systemic antivirals, a high proportion was attributed to antiretrovirals used for HIV infections.ConclusionFindings from this study suggest an increase in the utilization of systemic antiviral and antifungal agents. These findings may be used to further benchmark utilization and AMR studies in Tanzania.

Peritonealis dialízis gyermekkorban. A Semmelweis Egyetem I. Gyermekgyógyászati Klinikájának eredményei

Introduction, aim and method: At the 1st Department of Paediatrics, Semmelweis University – the largest center for treating children with chronic kidney disease in Hungary – peritoneal dialysis has a leading role. Between 2010–2017, while being part of the International Pediatric Dialysis Network, we collected and analyzed our data in a prospective study. Beside our patients’ basic data, we registered medication statistics, treatment- and laboratory results every 6 months. Results: During this period we had 39 patients on peritoneal dialysis, the average age of dialysis-initiation was 9.3 ± 6.6 years, with 1.3 ± 1.3 years spent on dialysis. The most common causes of ESRD were glomerulopathies and renal-/urinary malformations. A high rate of comorbidities was found, and in 13 cases complex syndromes. Many patients’ height- and BMI SDS values differed from the normal for their age. Average glucose-monohydrate concentration was 1.6 ± 0.2%. During our investigation we used lactate-based, acidic or neutral (balanced) dialysates. Between 2010–2017 we diagnosed peritonitis in 18 of our cases. The patients were hospitalized average 70.5 ± 97.7 days. There were differences from the normal range for age in PTH- and phosphate values. Drug-statistics met the requirements of recommendations, though some medications are not available for children in Hungary. The short time spent on dialysis is due to fast- and also living-donor transplantations and efficient management of the transplantation list. The high rates of special diseases and comorbidities are due to being a tertiary referral center. Conclusion: Our practice is suitable for the international guidelines, any differences are results of individual considerations. Being a part of the Registry should be maintained. Orv Hetil. 2017; 158(46): 1831–1840.

Opioid usage in Denmark, Norway and Sweden - 2006-2014 and regulatory factors in the society that might influence it

AimsTo relate changes in the number of opioid users in Denmark, Norway and Sweden during 2006-2014 to changes in national regulatory and economic incentive factors.MethodsThe material consists of data drawn from the national prescription databases in Denmark, Norway and Sweden. Data on the number of opioid users per 1000 inhabitants were collected for all ages, both sexes and for the period 2006-2014. Concomitant changes in regulatory or economic incentives were identified and related to the drug statistics.ResultsFor all opioids in the period 2006-2014 Denmark had the lowest number ofusers but the largest increase in users. Norway had the highest number of users but a lower increase. The number of users in Sweden was very stable showing no change in number of users.The number of morphine users in Denmark increased from 2009 to 2014. The number of users of oxycodone decreased from 2010 to 2014. The Danish health authorities recommended using morphine as first drug of choice in 2010 and warned about potential drug dependency of oxycodone in 2011.In Sweden the number of users of oxycodone increased over the period with the largest increase from 2012 to 2013. The number af tramadol users decreased from 2011. Prior to these changes tramadol was declared to be classified as an addictive drug 2011.ConclusionsChanges in the countries’ opioid use appeared in the public prescription-databases in a timely manner after introduction of national recommendations not to use oxycodone and prefer morphine as first choice, or classify tramadol as an addictive drug. National drug statistics show the end-result of the doctors’ prescribing behavior and the population’s use of opioids. Thorough investigation of prescription-data can help to detect and explain the interplay between culture, society and medical reasons for prescribing opioids.

Diagnosis-prescription studies – important steps towards a national drug prescription statistics in Norway

<strong><span style="font-family: TimesNewRomanPS-BoldMT;"><font face="TimesNewRomanPS-BoldMT"><p align="left"> </p></font></span><p align="left"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">ABSTRACT</span></span></p></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">In the first part of this article, drug utilization and prescribing practice is discussed as seen from a</p><p align="left">Norwegian general practice perspective. Which are the data sources available? What kind of studies</p><p align="left">have been performed? Prescription-diagnosis studies are reviewed, in particular the Møre & Romsdal</p><p align="left">Prescription Study (MRPS). Because the wholesales drug statistics do not include information about</p><p align="left">neither patients, prescribers or diagnoses, there is a current need for establishing a more comprehensive</p><p align="left">statistics giving wider and deeper insights into the prescribing and utilization of drugs in the Norwegian</p><p align="left">society. The proposed Norwegian prescription statistics is discussed in relation to previous experiences</p><p align="left">from prescription-diagnosis studies and current needs for research and statistics in the field. Some</p><p align="left">examples are given illustrating why the 11-digit person number probably should be included in the</p><p align="left">database. Lack of diagnostic information may to some extent be compensated for by introducing a more</p><p align="left">differentiated list of diagnoses for the drugs reimbursed. The use of data from this statistics for quality</p><p align="left">assurance in e.g. general practice is discussed. Finally, some suggestions are given for how the Norwegian</p><p>prescription statistics may be organised.</p></span></span>

Coding and classification in drug statistics – From national to global application

<strong><span style="font-family: TimesNewRomanPS-BoldMT;"><font face="TimesNewRomanPS-BoldMT"><p align="left"> </p></font></span><p align="left"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">SUMMARY</span></span></p><p align="left"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"></span></p></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">The Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD)<p align="left">was developed in Norway in the early seventies. The creation of the ATC/DDD methodology was an</p><p align="left">important basis for presenting drug utilisation statistics in a sensible way. Norway was in 1977 also the</p><p align="left">first country to publish national drug utilisation statistics from wholesalers on an annual basis. The</p><p align="left">combination of these activities in Norway in the seventies made us a pioneer country in the area of drug</p><p align="left">utilisation research. Over the years, the use of the ATC/DDD methodology has gradually increased in</p><p align="left">countries outside Norway. Since 1996, the methodology has been recommended by WHO for use in</p><p align="left">international drug utilisation studies. The WHO Collaborating Centre for Drug Statistics Methodology</p><p align="left">in Oslo handles the maintenance and development of the ATC/DDD system. The Centre is now responsible</p><p align="left">for the global co-ordination. After nearly 30 years of experience with ATC/DDD, the methodology</p><p align="left">has demonstrated its suitability in drug use research. The main challenge in the coming years is to</p><p>educate the users worldwide in how to use the methodology properly.</p></span></span>