RUM 5- Cheaper Medicines and AMR

Getting cheap, if not free, medicines and vaccines is a primacy concern for many people, especially the poor. And understandably so. But people seldom realize that while drugs can heal, they can also kill -- via non-rational use of medicines (RUM) and its variants: non-rational storage, non-disposal of possibly expired or ineffective medicines. And one adverse health outcome due to non-RUM is the development of anti-microbial resistance (AMR).

Below are some discussion papers about proper use, care, storage, and disposal of medicines. One from the  World Health Organization (WHO) and three from Reiner Gloor, PHAP Executive Director, in his columns in BusinessWorld (www.bworldonline.com) last year.

1. Antimicrobial resistance -- from WHO
2. Disposing medicines -- from Reiner Gloor
3. Storing medicines
4. Ensuring patient safety

Enjoy reading.
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(1) Antimicrobial resistance
http://www.who.int/mediacentre/factsheets/fs194/en/

Fact sheet N°194
Reviewed March 2012

Key facts

* Infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death.
* About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths.
* Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.
* A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
* Inappropriate and irrational use of antimicrobial medicines provides favourable conditions for resistant microorganisms to emerge, spread and persist.

What is antimicrobial resistance?

Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene.....


(2) Disposing medicines

Medicine Cabinet -- By Reiner W. Gloor
May 6, 2011

Medicines offer a promise to provide prevention, management and cure for simple to complex illnesses. Many of us find it necessary to take some personal medicines at home. But when the time comes when medicines are no longer needed, disposing them properly is important to avoid causing unnecessary harm to people, animals, food supply chain and the environment.

Proper medicine storage is as important as its proper disposal. The same applies to antibiotics, which inappropriate and irrational use lead to anti-microbial resistance (AMR).

One of the industry medical directors, Dr. Luis Abola of Bayer said that patients must not self-medicate to avoid developing AMR.

Storing leftover antibiotics even after the course of treatment is completed increases the chances of self-medication the next time around.

A number of safe methods for safe disposal of medicines were outlined by the WHO (World Health Organization) Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies. Developed in 1999, the document stressed that the improper disposal of medicines may be hazardous if it leads to contamination of water supplies or local sources used by nearby communities or wildlife.

If medicines are not disposed properly, they may end up with scavengers, children and animals or may even be diverted to the market for resale and misuse.

In the Philippines, the proper disposal of medicines became an issue when expired products were found buried in a provincial government compound in 1999. About 26 kinds of medicines were reportedly dug up in a 10-foot-deep pit in the engineering office compound in a northern province.

Earlier, the Department of Health (DoH) and the Department of Natural Resources (DENR) produced the Health Care Waste Management Manual with the goal of minimizing health and environmental concerns associated with the disposal of unneeded medicines, among others.

RUM 4: Dealing with Drug-Resistant Diseases

Cases of illness that are drug-resistant are a growing problem worldwide. That's because diseases -- like people, animals, insects, bacteria, plants, trees, all other living matter and organisms -- are evolving and mutating. The appearance of "superbugs" or the killer diseases that do not respond even to the strongest medicines was also noted by some sectors recently.

Do we need more government presence -- via the WHO, other foreign aid, DOH, local governments, other government agencies -- in dealing with this problem?

I have an ambivalent position on this issue. That's because I recognize that there is room for government assistance and intervention in dealing with infectious and communicable diseases, as well as pediatric diseases. But I also insist that better personal care, more personal responsibility in preventing the spread of those infectious diseases -- like washing hands more often, covering the mouth when coughing, eating healthy diet, drinking lots of water, having sufficient rest and sleep, observing rational use of medicines (RUM),  etc. -- is also important.

I am posting four articles by Reiner Gloor, the Executive Director of the Pharmaceutical and Healthcare Association of the Philippines (PHAP, http://phap.org.ph/) about this subject. These papers were posted in his weekly column in BusinessWorld (http://www.bworldonline.com/) on days indicator. He is more knowledgeable about this subject than me because they know what are those old and new or emerging diseases, as well as the existing supply of medicines, both innovator and generics, in dealing with this problem. These four papers are:

1. The fight vs. drug-resistant diseases, March 23, 2012
2. Appreciating antibiotics, April 15, 2011
3. Global action vs. AMR, April 08, 2011
4. World Health Day and drug resistance, April 01, 2011.

A bit long, enjoy reading.
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(1) The fight vs drug-resistant diseases

Reiner W. Gloor
March 23, 2012

http://www.bworldonline.com/weekender/content.php?id=48829


Often driven by economics and politics, humans have always been on the move. The International Organization for Migration reported that there were about 214 million global migrants in 2010 and their number could reach 405 million by year 2050.

But aside from people, drug-resistant pathogens are also constantly on the move. In her address at the conference on combating anti-microbial resistance (AMR): time for action in Copenhagen last week, World Health Organization (WHO) Director-General Margaret Chan reminded us that these pathogens are “notorious globe-trotters”.

The WHO chief said that drug-resistant microorganisms travel well in infected air passengers and through global trade in food.

And instead of providing cure for patients, some hospitals have also become hotbeds for highly resistant pathogens. Chan noted that the growth of medical tourism has expedited the international spread of hospital-acquired infections that are frequently resistant to multiple drugs.

Apart from increased mortality and substantial financial burden, AMR has consequences far beyond the patient, their families and the health sector. AMR can also leave a damaging aftermath on international travel and trade resulting from the cross-border spread of drug-resistant infections.