Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy
Pattern of drug utilization for treatment of uncomplicated malaria in urban Ghana following national treatment policy change to artemisinin-combination therapy
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DOI：
10.1186/1475-2875-8-2
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发表时间：
2009-01-05
期刊：
影响因子：
3
通讯作者：
Ofori-Adjei, David
中科院分区：
文献类型：
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作者：
Dodoo, Alexander N. O.;Fogg, Carole;Ofori-Adjei, David
背景：在非洲，将无并发症疟疾的一线治疗改为青蒿素联合疗法的做法很普遍。为了扩展ACT安全性特征的知识，在治疗变更的实施过程中纳入了药物警戒活动。加纳在2005年实施了青蒿琥酯-阿莫地喹一线疗法。药物利用数据是一个重要组成部分，确定药物安全性，本文介绍了如何在一个前瞻性的药物警戒研究在加纳抗疟疾治疗policy changes.Methods规定的抗疟疾：诊断为单纯性疟疾的患者被招募从药房的卫生设施在整个阿克拉的队列事件监测研究。主要的药物利用结局是患者年龄、性别、就诊机构类型、诊断模式和伴随治疗与处方抗疟方案的关系。Logistic回归分析用于预测国家推荐的一线治疗处方和合并抗生素处方。90.8%（n = 2，574）的患者接受了含有青蒿素衍生物的治疗方案，尽管33%（n = 936）的患者接受了基于青蒿素的单药治疗。一线治疗的预测因素为实验室确诊、年龄> 5岁、在政府机构就诊。镇痛药和抗生素是最常处方的合并用药，每例患者的合并处方中位数为2份（范围1-9份）。12岁以上的患者与5岁以下的患者相比，联合使用抗生素的可能性明显降低;那些使用非青蒿素单一疗法的患者更有可能接受抗生素治疗。二氢青蒿素-阿莫地喹组合是最常用的治疗5岁以下的儿童（29.0%，n = 177）。结论：这项研究表明，虽然一线治疗的建议可能会改变，临床实践可能仍然受到影响的因素以外的决定或能力诊断疟疾。年龄，诊断确认和疑似并发症导致受益：临床医生对个体患者进行风险评估，以确定处方抗疟疾治疗。这对坚持旨在有效使用ACT的政策变化产生了影响。这些结果应告知卫生专业人员的教育和合理使用药物的政策，以减少多种药物，并建议增加在卫生设施和家庭中进行疟疾检测的可能产生的积极影响。
Background: Change of first-line treatment of uncomplicated malaria to artemisinin-combination therapy (ACT) is widespread in Africa. To expand knowledge of safety profiles of ACT, pharmacovigilance activities are included in the implementation process of therapy changes. Ghana implemented first-line therapy of artesunate-amodiaquine in 2005. Drug utilization data is an important component of determining drug safety, and this paper describes how anti-malarials were prescribed within a prospective pharmacovigilance study in Ghana following anti-malarial treatment policy change.Methods: Patients with diagnosis of uncomplicated malaria were recruited from pharmacies of health facilities throughout Accra in a cohort-event monitoring study. The main drug utilization outcomes were the relation of patient age, gender, type of facility attended, mode of diagnosis and concomitant treatments to the anti-malarial regimen prescribed. Logistic regression was used to predict prescription of nationally recommended first-line therapy and concomitant prescription of antibiotics.Results: The cohort comprised 2,831 patients. Curative regimens containing an artemisinin derivative were given to 90.8% (n = 2,574) of patients, although 33% (n = 936) of patients received an artemisinin-based monotherapy. Predictors of first-line therapy were laboratory-confirmed diagnosis, age > 5 years, and attending a government facility. Analgesics and antibiotics were the most commonly prescribed concomitant medications, with a median of two co-prescriptions per patient (range 1-9). Patients above 12 years were significantly less likely to have antibiotics co-prescribed than patients under five years; those prescribed non-artemisinin monotherapies were more likely to receive antibiotics. A dihydroartemisinin-amodiaquine combination was the most used therapy for children under five years of age (29.0%, n = 177).Conclusion: This study shows that though first-line therapy recommendations may change, clinical practice may still be affected by factors other than the decision or ability to diagnose malaria. Age, diagnostic confirmation and suspected concurrent conditions lead to benefit: risk assessments for individual patients by clinicians as to which anti-malarial treatment to prescribe. This has implications for adherence to policy changes aiming to implement effective use of ACT. These results should inform education of health professionals and rational drug use policies to reduce poly-pharmacy, and also suggest a potential positive impact of increased access to testing for malaria both within health facilities and in homes.