[e-drug] Out Patient Parenteral Antimicrobial Therapy (cont'd)

[lo@euronet.nl]

E-DRUG: Out Patient Parenteral Antimicrobial Therapy (cont'd)
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Dear friends,

If, what I have thus far seen on E-Drug about Roche's "new" 
initative "OPAT" reflects the truth, I am quite worried. In the first 
place the introduction of a new acronym "OPAT" suggests 
something standard, a mode of practice which has been authorized 
and been around for many years. This is plainly false and 
misleading, and we should get rid of this acronym as fast as 
possible. 

There might be some isolated examples of pharmaco-
economic research projects, in which under standardized trial 
conditions the use of outpatient injection therapy have been cost-
effective compared to oral treatments with uncertain compliance 
and outcome, but such data can never be extrapolated to 
developing countries or countries which have for many years been 
scientifically backwards like Eastern Europe or China. 

What we have learnt and seen in the context of WHO and MSF activities is 
that 

(1) one has to fight against mistaken old beliefs and customs 
that injections are much better than tablets - largely a placebo 
effect in which the magic effect of the doctor/syringe complex is 
hugely important; 

(2) poverty and backwardness mean that until 
quite recently used old glass syringes and the corresponding 
needles were in short supply and were used over and over again, 
most often without proper sterilization, simply because 
appropriate sterilizing equipment (even a clean cooking pan) was 
not available - thereby spreading HIV and hepatitis. Once plastic 
syringes and disposible needles have become available this 
practice is not immediately abolished: syringes and needles are 
washed under the tap and used again. I have seen this happening 
in Albania in 1991-1992 and later in Bosnia and I am quite sure 
that the same has been and still is the case in many African 
countries. Finally 

(3) this practice is a considerable setback to the 
teaching of rational pharmacotherapy and is against the grain of 
everything we try to teach physicians and medical students.
As to the country where these data were presented: It is of course 
alright to discuss such data in a scientific medium or at a 
pharmaco-economic meeting, but countries like Turkey where 
there is an immense difference between the practice of "opinion 
leaders" working in sophisticated city hospitals and the abysmal 
level of everyday medical care in the country form an 
inappropriate target.

Best wishes,

Leo Offerhaus
Netherlands
Email: lo@euronet.nl
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