[e-drug] WHO Model Formulary released (cont)

[Kibumba George <kibumba@yahoo.com>]

E-drug: WHO Model Formulary released (cont)
---------------------------------------------

First WHO thank you for producing the Model Formulary.  The current 
edition of the Model Formulary presents information on the 
recommended use, dosage, adverse effects, contra-indications and 
warnings of essential medicines.  I have a few comments which I have 
tried to describe.  Descriptions are numbered.  You may get the 
description(s) below.

In a bid to enhance the safety of patients, we could in the next 
edition purposely, categorically  add:

    Internationally acceptable dose-forms (1)
    Patient information upon issuing or dispensing the medicine (2)
    Where applicable special storage instructions to patients (3), and 
to pharmacists
    May be under warning; special drug-drug, food-drug interactions 
and how to ACTUALLY HANDLE THEM.  For foods, we could name 
ingredients which inter-act with the specified drugs (4)
    Under the section for dose; when specified organs of our bodies 
are functioning poorly, we could specify  fractions by which to 
reduce standard doses (5). Also how to determine doses of medicines 
when they are presented in slow or modified release forms. 
Antiepileptics, corticosteroids, some times antihypertensives need 
tapering doses after a while.  We need to be particular about when, 
how to exactly reduce or wean patients off such medicines.

Essential Drugs -- Practical Guidelines, first edition, a manual 
developed by MSF, and published in 1993 by Hatier Paris, ISBN 
2-218-02651-1 -- could be a good template.  The manual contains all 
the vital information that WHO included in the Model Formulary, PLUS 
SOME of the above bulleted issues. In addition to what is already in 
the Model Formulary, the issues raised are pivotal pillars which when 
addressed will fill the gap of a fundamental lack of a practical 
source of information.

In most animistic cultures (and animism is rampant in poor settings) 
however, reading, and implementing programmes requires unique 
strategies -- providing sources of information alone isn't enough. 
Hence for the formulary to benefit the poor, a carefully thought-out 
process can be developed.

As of now in order to improve patient safety, why not make the 
macro-level Model Formulary for nations be as explicit as practical?


1. As a case in point, whereas injectable amipicillin is widely used, 
oral forms of this medicine are out-dated.  Oral amoxycillin is 
better than oral forms of ampicillin

2.  Including what to do when they miss a dose, side-effects which 
don't require stopping medicine as well as side-effects that require 
stopping the treatment.  We have seen people who persistently swallow 
sulfa drugs, even when they receive danger signals -- signals that 
indicate they are allergic to sulfa.

3. Take the case of how a poor person on insulin and who lacks a 
refrigerator should store the medicine at home

4. Some foods indicated in foreign formularies may be absent in 
certain countries.  So stating ingredients will make it generic. 
Where feasible, nevertherless, stating examples of foods containing 
ingredients that inter-act with certain medicines will make it easy. 
National experts in nutrition will then hopefully help to cite foods 
in their countries which contain the quoted ingredients

5. From our experience on ward rounds, there is often little 
information on antimalarials, and medicines for tuberculosis.  When 
malaria and tuberculosis afflict patients with renal disease, liver 
disease, it is hard to get information on fractions by which to 
reduce standard doses.   Giving patients with renal, or liver disease 
standard doses of malaria medicines can be a risk.

George Kibumba, MPS

Teaching Assistant, Clinical Pharmacy, Makerere University, P.O.BOX 
7072, KAMPALA.
e-mail: kibumba@yahoo.com
Mob:071 81 54 28

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