Letter A SciTechnol Journal
   
Availability of Different Strengths of Anti Malarial Preparations in Pakistan: Implication or Patient Safety
 
1W1Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia
2Hamdard Institute of Pharmaceutical Sciences, Hamdard University, F-8 Markaz, Johar Road Islamabad, Pakistan
Malik M1,2*,
1W1Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia Hassali MA1, 1W1Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia Shafie AA1, 2Hamdard Institute of Pharmaceutical Sciences, Hamdard University, F-8 Markaz, Johar Road Islamabad, Pakistan Hussain A2 and 3Director of Medication Safety Research Chair, College of Pharmacy, King Saud University, PO Box-2475, Riyadh 11451, Saudi Arabia Aljadhey H3
 
Corresponding author : Malik M, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia, E-mail: mady_sweet1@yahoo.com
 
Received: June 14, 2012 Accepted: June 14, 2012 Published: June 16, 2012
 
Citation: Malik M, Hassali MA, Shafie AA, Hussain A, Aljadhey H (2012) Availability of Different Strengths of Anti Malarial Preparations in Pakistan: Implication for Patient Safety. J Pharmacol Biomed Anal 1:1. doi:10.4172/jpbma.1000101
 
 
Editor
 
Pakistan is among the moderately malaria endemic countries and malaria is the second most commonly reported diseases from public sector healthcare facilities. Few of the key factors in controlling malaria and reducing related morbidity and mortality rate includes early diagnosis, appropriate treatment and good quality patient care services. But, polypharmacy, peer influence, patient demands, lack of appropriate diagnosis and treatment based on clinical impression and self-medication are few of the most important factors leading towards irrational drug use in Pakistan. Malaria is usually diagnosed through clinical impression, and most presenting fever cases are suspected and treated for malaria without any evidence of malaria parasitaemia in Pakistan [1]. When symptoms appear, patients often self-treat and later seek advice from formal healthcare providers working in public and/or private healthcare facilities. It is usually expected Pakistan has a progressively growing pharmaceutical industry which has a market value of approx. US$ 1.72 billion [2]. There are over 400 local manufacturing companies accompanied with 30 multinationals. Pharmaceutical needs of the country are well provided by these units by local manufacturing (80%) and by import (20%). Pakistan also exports pharmaceuticals regionally and world-wide. The number of currently registered pharmaceutical formulations exceeds over 45,000 [3]. The pharmaceutical market is a brand market and for an individual molecule, dozens of different brands are registered in the country. Distribution of medicines relies heavily on community pharmacies and according to an estimate, 80% of the medicines are being distributed through this channel. Thus, majority of the population relies on them for their health care needs. The private sector is more involved in malaria case management with treating over 50% of malaria cases as compared to the public sector due to easy accessibility and shorter waiting times.
 
Prescribing practices have shown influence on the emergence of resistance to anti-malarial drugs. Chloroquine, sulphadoxine/ pyremethamine (Fansidar) or artemether/lumefentrine combinations are the most commonly prescribed drugs for the treatment of malaria [1]. There are approximately 63,000 community pharmacies in the country but quite low number of qualified personnel is available in the country which could be employed at these community pharmacies for ensuring good pharmacy practices [4]. As a result, these shops are mostly managed by non qualified personnel who fill in for the mandatory pharmacist [5]. Dispensing of anti-malarial drugs at these community pharmacies without any prescription demand is a common practice in Pakistan. The dispensers present at these community pharmacies are simply unaware regarding the potential dangers of over dose of drugs, and dispensing of any prescribed drug to the patient in the available strength at the pharmacy, is a common practice by them. As the literacy rate is quite low in Pakistan, the awareness of patients about their disease and treatment is inadequate [6]. Most of the patients usually present their doctor’s prescription to the attendant at the medicine retail outlet counter and simply walk away with the drugs dispensed without verifying them with the prescription. The distress of the patient, when inappropriate prescribing by the busy doctor and consequences of over dose can only be imagined [6].
 
In this context 600 anti malarial prescriptions were analyzed for the potential of over dosing in case of antimalarial drugs prescribed at the tertiary care hospitals in Islamabad (National capital) and Rawalpindi (Twin city), Pakistan. Out of 600 cases, the drugs were prescribed by generic name in only (n=54, 9%) of the cases. Artemether/lumefantrine was the most commonly prescribed drug in case of malaria and Artem Plus® (artemether/lumefantrine) was the most commonly prescribed brand in (n=210, 35%) of the cases. However, the strength of artem plus was only present on (n=35, 5.8%) of the prescriptions. On further investigation, it was observed that Artem Plus® is being available in two different strengths i.e. (40 mg/240 and 80 mg/480) in the market. Both strengths are being marketed under the same name as Artem Plus® with only difference in color of outer carton packaging. As strength is mostly not mentioned on the prescriptions, so dispensing of available strength to the patient at the hospital pharmacies and community pharmacies is a common practice. This highlights the negligence on the part of prescribers for appropriate prescribing and failure of manufacturers and regulatory authorities to conduct rigorous risk assessments and recognize the potential for error both for nonproprietary and brand names, prior to approving new drug product names.
 
Changing the practices of prescribers is a difficult and slow process but the likelihood of achieving improvements exists through vigilance of regulatory authorities while approving brand names. Same brand name should not be given to the drug with different strength no matter having the same active ingredient. A suffix added in the brand name of drug with different strengths can minimize the risk of over dosing of drugs. Reimbursement system must be designed to pay to the community pharmacists for the provision of direct patient care services. Development of guides evidence-based policies, new diagnostic and treatment tools including rapid diagnostic tests, vaccines and effective new drugs and insecticides for malaria must be prioritized to local needs and conducted with local and regional scientists [7]. There is an urgent need to emphasize in the community the importance of prompt treatment with the correct strength of drugs while at the same time investing in improving the services of health care providers which will minimize the problem of over and under dose of drugs and their resistance.
 
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