PHA-Exch> Profit drives drug misuse in Asia [over-medication]

[Claudio Schuftan]

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From: Vern Weitzel <vern.weitzel at gmail.com>
Date: Apr 7, 2009 9:58 AM
Subject: [health-vn] Profit drives drug misuse in Asia [over-medication]
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http://uk.reuters.com/article/healthNewsMolt/idUKTRE53501120090406

Profit drives drug misuse in Asia
Mon Apr 6, 2009 4:17am BST
By Fitri Wulandari and Tan Ee Lyn

JAKARTA/HONG KONG (Reuters) - Ria Pane took her 7-year-old daughter Kezia to
a
doctor in Jakarta to check on her fever and sore throat, and was prescribed
seven drugs, including antibiotics and medicine to prevent febrile seizures.

Experts say it was another classic, but only too common, case of
over-medication, or prescribing drugs patients do not need. Here, the
antibiotic
was unnecessary, as was the drug to prevent febrile seizures as the child
had no
history of such attacks, said several pharmacists and doctors who were asked
by
Reuters.

Experts warn that driven by profits from selling medicine, some doctors from
Indonesia to Hong Kong are overprescribing medicines, a practice they say
will
be disastrous in the longer term.

"Polypharmacy (overmedication) is very popular here, it means they use a lot
of
medicines which are unnecessary, like giving you many types of antibiotics
for a
cold," said William Chui, honorary associate professor at the Clinical
Trials
Center attached to the University of Hong Kong.

"Every time they sell a drug, they get a profit, it is a profit motive. When
they give lots of medicine, parents feel happier, more happy than when they
are
told to go home to sleep."

The consumption of multiple drugs triggers drug reaction and unpredictable
side
effects. Worse, it gives rise to bacterial resistance.

The most recent example of growing resistance involves the drug oseltamivir,
which researchers in the United States found was now ineffective against 98
percent of the H1N1 seasonal human influenza virus strains.

Oseltamivir is known by the brand Tamiflu and manufactured by Roche AG.

Oseltamivir is also recommended as a first line of defense against the H5N1
bird
flu virus in case it triggers a flu pandemic and experts are now questioning
how
well, and how long, the drug will stand up against the H5N1 virus.

SERIOUS SIDE EFFECTS

Apart from eventually reducing the effectiveness of drugs, exposing bacteria
and
viruses to drugs unnecessarily also has other serious consequences.

"They harm the patient. The more drugs, the worse the compliance, especially
for
old people. They fall easily because of drug interaction and side effects.
They
get dizzy, hypotension, it is something we don't recommend," Chui said.

Doctors in Indonesia often prescribe antibiotics to patients suffering a
common
cold when such drugs are only to be used for bacterial infections.

"Most parents rush to treat symptoms, not the disease. Doctors may feel
pressure
to give treatments, even when it is not necessary or in the best interests
of
the child's health," said Purnamawati S. Pujiarto, a pediatrician trying to
promote a more informed use of drugs in Indonesia.

Experts say such a mentality has led not only to polypharmacy, but also the
use
of compounding medicine, known in Indonesia as "puyer."

Compounding medicine is the practice of crushing different drugs into a
powder
in a bowl and dividing it into small sachets. Sometimes it is mixed with
syrups.

It is carried out under strict guidelines in some countries. But in
Indonesia,
it has been used liberally for decades, particularly to treat health
problems in
children.

Experts warn this practice could result in errors as the drugs may not be
evenly
divided or pharmacists may not clean the bowl thoroughly, leaving residues
from
previous prescriptions.

"The issue is not 'puyer' itself but the competence and knowledge," said
Iwan
Dwiprahasto, a pharmacoepidemiology professor at Gadjah Mada University in
Yogyakarta.

"Does the pharmacist know which drugs are not allowed to be compounded? Do
doctors know certain drugs are not allowed to be mixed together because they
are
dangerous to patients?"

"The compounded form makes patients unaware they have consumed many drugs as
it
looks like a single medicine," said Dwiprahasto, who is also chairman of the
Indonesian Pharmacologist Association.

RESISTANCE

In Hong Kong, Chui and his colleagues recently discovered widespread abuse
of
carbapenem, a class of the powerful, broad-spectrum antibiotic in private
hospitals.

This class of antibiotics is recommended as a prophylaxis for major
procedures
such as colorectal operations, but pharmacists found they were given to
patients
even for minor procedures.

"Alternative prophylaxis require three doses a day, but this is just one
dose
daily. Private hospitals use this as it's very convenient and it's broad
spectrum so it can block all infections," said Chui.

"But what we are most afraid of is resistance especially with the (bacteria)
stenotrophomonas maltophilia. If you abuse carbapenem, this bacteria will
get
more resistant."

Stenotrophomonas maltophilia is a bacteria that causes uncommon infections
that
are difficult to treat, such as pneumonia, urinary tract infection or blood
stream infection.

(Editing by Sugita Katyal)
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