TITLE: Promotion of the rational use of medications in the Oshakati State Hospital.

1. TITLE: Promotion of the rational use of medications in the Oshakati State Hospital. AUTHORS: Lic. Leonel Molina Pérez Dra. Monica Aurora Aguilar Roca

2. INTRODUCTION The rational use of medications has a lot of interpretations, and very few definitions. The World Health Organization (WHO) defines it like that use according to which patients receive the appropriate medication for their clinical necessities, to dose adjusted to their individual requirements, during a period of appropriate time and to the smallest cost for them and the community (1). The interpretations depend on the point of view of each one and they go clinically from the use medication more novel and theoretically more potent to treat any affection or nuisance, until the use of the medication of smaller cost and subjected to goal-analysis, refusing to the drugs of new introduction.

3. GENERAL OBJECTIVE: • To promote the rational use of the medications in The Oshakati State Hospital.

4. DEVELOPMENT The definition implies that the rational use of the medications, especially in the rational prescription should complete the following approaches: • Appropriate indication: The decision of prescribing drugs is entirely based on the rational medicine and the therapy drugs; hence it’s an effective and adequate treatment. • Appropriate medication: Drugs selection is based on effectiveness, security convenience and the considerations of the cost. • Appropriate patient: Contraindications do not exist and the possibility of side effects is minimum, therefore the medication is available for the patient.

5. Appropriate information: The patients should always have the pertinent, exact, important and clear information in regard to their condition and the prescribed medications. • Appropriate supervision: The required and side effects of medications should be appropriately supervised.

6. Incorrect Use of the medications The WHO calculates that more than a half of the medications prescribed, dispatched or sold occur in an inappropriate way. Therefore half of the patients do not take them properly. The incorrect use can adopt the form of an excessive, insufficient or unnecessary use of sale medications with or without prescription. Among the most frequent problems are: • The poly-pharmacy; • The excessive use of antibiotics and injections; • The non-adjusted prescription to clinical guidelines; • The self-medication.

7. It is also said that the use is irrational because the doctors, the pharmacists and the patients do not fulfill the following requirements of a good use of the product. More frequent examples detected in the Oshakati State Hospital. • Diazepam 5mg: 1pill 3 Times per day for 1 month. Dose: 2-10mg a day short periods of treatmare recommended to avoid the pharmaco-dependency. • Ciprofloxacin 500mg: 1pill 3 times per day for 1 month. Dose: 250-750mg every 12 hours for a period of 7-14 days should be recommended also the patient should take abundant oral fluids, not to ingest antacids, mineral supplements, iron salts or vitamins. • Ibuprofen 400MG: 1 pill a day. Dose: 200 mg every 6-8 hours if necessary, increase the dose to 400mg every 6-8 hours in adults and children bigger than 12 years.

8. Griseofulvin 125MG: 1 pill a day x 21 days in adults. Dose: 500mg a day in divided dose or a single dose and in children 10mg/kg of weight in a single dose to the day or divided dose. • Ketoconazole 200mg: 1 pill a day x 1 month. Dose: The duration of the treatment is usually: - Vaginal Candidiasis: 5 serial days. - Cutaneous Mycosis induced by dermatofitos: approximately 4 weeks. - Pityriasisversicolor: 10 days. - Cutaneous and oral Mycosis caused by Candida: 2-3 weeks. - Mycosis of the hair-beating skim: 1-2 months. - Systemic Candidiasis: 1-2 months. - Paracoccidioidomycosis, histoplasmosis, coccidioidomycosis: correct duration of the treatment varies from one to several months (3-6 months) according to the pathology and the graveness of the situation. • Metoclopramide 10mg: 1 pill a day x 1 month. Dose: 10mg before each meal. • Aluminium Hydroxide pills: 2 pills 3 times a day x 1 month. Dose: 1-2 pills or spoonfuls 5-6 times a day, to recommend the patient to administer one hour after meals and when going to bed.

9. In developing countries, the proportion of patient with illnesses common treaties of conformity with clinical guidelines in the primary attention is inferior to 40% in the public sector and of 30% in the private sector. For example: • the proportion of children with acute diarrhea not receiving the necessary oral rehydration less than to 60%, but more than 40% receive unnecessary antibiotics: • only 50% of the patients with malaria receive the recommended first line anti-malarials; • only 50% to 70% with pneumonia are treated with the appropriate antibiotics, where as up 60% of the patients with respiratory infections of viral origin receive unnecessary antibiotics.

10. Consequences of the incorrect use of the medications • Resistance to the antibiotics: The excessive use of antibiotics increases the resistance to the antibiotics and the number of medications that you/they stop to be effective to combat the infectious illnesses. Many surgical procedures and cancer treatments are not possible without antibiotics to fight against the infections. The resistance prolongs the illnesses and the hospital stays, and it can end up causing the death; their cost is of US $4-5 billions a year in the United States of America,[1] and of € 9 billions a year in Europe. [2] • Adverse reactions to the medications and the medication errors: The adverse reactions to the medications due to their erroneous use or for allergic reactions can cause, morbility suffering and death. It estimated that the adverse reactions to the medications cost millions of dollars a year. [3,4] • waste of resources: 10 to 40% of the national health budgets go into medications. The purchase of medications directly for the user can cause serious economic difficulties to the patients and their families. If the medications are not prescribed and used appropriately, thousands of millions of dollars of public and personal funds are wasted. • Loss of the patient's trust: The excessive use of scarce medications often contributes to the exhaustion of resources and the increase of the prices to inaccessible levels, so the patient's trust shrinks. The bad clinical results of inadequate use of the medications can also reduce the trust.

11. Economic consequences of the irrational use of medications: The increase of the costs of health for: • Increase in the number of consultations. • Increase of the duration of the hospitalization. • Illness or individuals' premature death working years lost. • Loss of resources (medications) by non-compliance.

12. Social consequences of the irrational use of medications: • Dissatisfaction for the attention of received health. • Poor quality of life (Work, daily-domestic life, recreation).

13. Economic Impact • With the rational use of the medications the loss for individuals' lost days in productive age diminishes, because it reduces the number of medical consultations, the duration of the hospitalizations and it reduces non-compliances.

14. CONCLUSIONS The necessity to create an area of pharmaceutical information in the pharmacy of the Oshakati State Hospital, with the objective to promote the rational use of the medications, advising or collaborating in the detection of the problems related with the medications, such as the dosage and duration of the treatment to achieve better quality of life in the patient.

15. RECOMMENDATION. • To implement center of investigation of medications in the pharmacy of the Oshakati State Hospital. • To advise and to collaborate to detect the problems related with the medications in the different services of the Oshakati State Hospital. • To carry out a cost study to quantify the saving of resources with a rational use of the medications.

16. THANK YOU