[e-drug] Antibiotics still a problem (2)

["Anibal Sosa, MD" <anibal.sosa@tufts.edu>]

E-DRUG: Antibiotics still a problem (2)
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Dear Pinkoane,

I understand your frustration but please don't get discouraged in preaching
doctors. Being one from a developing country, I know that it takes not only
huge consistent efforts from person like you over time, but also government
interventions with an effective drug policy and regulatory process and a
drug and therapeutic committee who can provide the expertise and guidance to
them. More importantly, it takes continuing medical education for
prescribers to achieve judicious prescribing and learn the antimicrobial
susceptibility profiles (at least of key pathogens) from the country, from
the region, from the hospital and possibly community and even at the ward
level (for instance ICUs).

You are experiencing lack of consistent prescribing behavior from doctors
seen even in industrialized countries. Remember that in the USA, 50% of
antimicrobials are not justified. We have lot to do!

It is my experience that antimicrobial susceptibility testing and quality
control in developing countries needs standard protocols, better equipment,
well trained laboratory staff, a drug and therapeutic committee and the
production of antimicrobial profiles distributed to doctors and in remote
area where is not a doctor to nurses, and health care workers. They need to
get acquainted with this information to empirically justified their choice
of an antibiotic/antimicrobial.

In Latin America and Caribbean, Pan American Health Organization (PAHO) has
developed in most of the affiliated countries an antimicrobial resistance
surveillance network, quality control training for laboratory staff,
production and dissemination of antimicrobial resistance profiles for key
pathogens, supported an annual antibiotic training in Buenos Aires,
Argentina at the Malbran Institute and  have established coalition with
national and international organizations such as the Alliance for the
Prudent Use of Antibiotics (APUA).

The Pan American Infectious Disease Society through their members has an
antimicrobial resistance and antibiotic committee that pays attention to
prescribing issues. Some of their members are advisors for the National
Committee for Clinical Laboratory Standards (NCCLS).

Since 1981, APUA (www.apua.org ) has developed chapters in 52 countries.
These chapters are local grassroots groups composed by professionals from
different disciplines including the industry and consumers. They are the
local experts who can advocate and provide guidance to policy makers and
prescribers. APUA headquarters provides technical assistance to countries
and individuals.

I believe we can do better! Interventions like the ones described above
should be culturally competent and tailored to the country and appropriate
settings and targeted from different angles.

Thank you,

Anibal

Anibal Sosa, MD
Director, International Program & Clinical Advisor
Alliance for the Prudent Use of Antibiotics (APUA)
75 Kneeland Street
Boston, MA 02111, USA

Tel: (617) 636-2709
Fax: (617) 636-3999
E-mail: anibal.sosa@tufts.edu
www.apua.org