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Objective To analyse sales of fixed-dose combination and single antibiotics In India In relation to World Health Organization (WHO) recommendations and national regulatory efforts to control antibiotic sales. Methods We extracted data on sales volumes of systemic antibiotics in India from a market research company sales database. We compared the market share of antibiotic sales in 2020 by WHO AWaRe (Access, Watch and Reserve) category and for those under additional national regulatory controls. We also analysed sales of fixed-dose combinations that were: formally approved for marketing or had a no-objection certificate; on the national essential medicines list; and on the WHO list of not-recommended antibiotics. Findings There were 78 single and 112 fixed-dose combination antibiotics marketed in India, accounting for 7.6 and 4.5 billion standard units of total sales, respectively. Access, Watch and Reserve antibiotics comprised 5.8, 5.6 and 0.1 billion standard units of total market sales, respectively. All additionally controlled antibiotics were Watch and Reserve antibiotics (23.6%; 2.9 billion standard units of total sales). Fixed-dose combinations on the WHO not-recommended list were marketed in 229 formulations, with 114 formulations (49.8%) having no record of formal approval or no-objection certificate. While there were no not-recommended fixed-dose combinations on the national list of essential medicines, 13 of the top-20 selling antibiotic fixed-dose combinations were WHO not-recommended. Conclusion The sale of Watch group drugs, and antibiotics banned or not approved, needs active investigation and enforcement in India. The evidence base underpinning formal approvals and no-objection certificates for not-recommended fixed-dose combinations should be audited. Objectif Analyser les ventes d'antibiotiques en association fixe et a dose unique en Inde, a la lumiere des recommandations de l'Organisation mondiale de la Sante (OMS) et des efforts de reglementation a l'echelle nationale visant a controler la vente d'antibiotiques. Methodes Nous avons preleve des donnees relatives aux volumes de vente d'antibiotiques systemiques en Inde dans la base de donnees commerciales d'une societe d'etudes de marche. Nous avons ensuite compare la part de marche qu'occupe, en 2020, la vente d'antibiotiques appartenant a chaque categorie AWaRe (Access, Watch and Reserve) etablie par l'OMS, mais aussi de ceux cibles par des mesures nationales de controle supplementaires. Enfin, nous avons examine les ventes d'associations fixes: dont la commercialisation a ete officiellement approuvee ou qui ont fait l'objet d'un certificat de non-objection; figurant sur la liste nationale de medicaments essentiels; et reprises dans la liste des antibiotiques non recommandes par l'OMS. Resultats Nous avons comptabilise 78 antibiotiques a dose unique et 112 antibiotiques en association fixe sur le marche indien, representant respectivement 7,6 et 4,5 milliards d'unites standard sur l'ensemble des ventes. Les antibiotiques des categories Access (dont l'accessibilite est essentielle), Watch (a utiliser selectivement) et Reserve (de reserve, non recommandes) equivalaient a 5,8 milliards, 5,6 milliards et 0,1 milliard d'unites standard sur le total des transactions. Tous les antibiotiques soumis a des controles supplementaires faisaient partie des categories Watch et Reserve (23,6%; 2,9 milliards d'unites standard sur l'ensemble des ventes). Des associations fixes deconseillees par l'OMS etaient commercialisees dans 229 formulations, dont 114 (49,8%) ne possedaient ni attestation d'approbation officielle, ni certificat de non-objection. Bien qu'aucune association fixe deconseillee ne soit mentionnee sur la liste nationale de medicaments essentiels, 13 des 20 antibiotiques en association fixe les plus vendus n'etaient pas recommandes par l'OMS. Conclusion Il est necessaire de mener une enquete approfondie en Inde sur la vente de medicaments appartenant a la categorie Watch et d'antibiotiques interdits ou non approuves, et de prendre des mesures concretes. Les preuves sur lesquelles reposent les autorisations officielles et les certificats de non-objection pour les associations fixes non recommandees doivent etre verifiees. Objetivo Analizar las ventas de los antibioticos combinados en dosis fijas y en dosis unicas en la India en relacion con las recomendaciones de la Organizacion Mundial de la Salud (OMS) y los esfuerzos nacionales de regulacion para controlar las ventas de los antibioticos. Metodos Se extrajeron datos sobre los volumenes de ventas de antibioticos sistemicos en la India de una base de datos de ventas de empresas de investigacion de mercado. Se comparo la cuota de mercado de las ventas de antibioticos en 2020 por categoria AWaRe (Access, Watch and Reserve) de la OMS y para los que estaban sometidos a controles regulatorios nacionales adicionales. Tambien se analizaron las ventas de combinaciones en dosis fijas que estaban: formalmente aprobadas para su comercializacion o tenian un certificado de no objecion; en la lista nacional de medicamentos esenciales; y en la lista de antibioticos no recomendados de la OMS. Resultados En la India se comercializaron 78 antibioticos en dosis unica y 112 antibioticos combinados en dosis fijas, que representaron 7,6 y 4,5 mil millones de unidades estandar de ventas totales, respectivamente. Los antibioticos de acceso, vigilancia y reserva supusieron 5,8, 5,6 y 0,1 mil millones de unidades estandar de las ventas totales del mercado, respectivamente. Todos los antibioticos controlados adicionalmente fueron antibioticos de vigilancia y reserva (23,6 %; 2,9 mil millones de unidades estandar de las ventas totales). Las combinaciones en dosis fijas incluidas en la lista no recomendada de la OMS se comercializaron en 229 formulaciones, de las que 114 (49,8 %) no tenian registro de aprobacion formal ni certificado de no objecion. Mientras que no habia combinaciones en dosis fijas no recomendadas en la lista nacional de medicamentos esenciales, 13 de las 20 combinaciones en dosis fijas de antibioticos mas vendidas no estaban recomendadas por la OMS. Conclusion Se debe investigar y controlar activamente la venta de medicamentos del grupo Watch y de antibioticos prohibidos o no aprobados en la India. Asimismo, se debe auditar la base de pruebas que sustenta las aprobaciones formales y los certificados de no objecion para las combinaciones en dosis fijas no recomendadas., Introduction The overuse and misuse of antibiotics contribute to the development of antimicrobial resistance, eroding the drugs' effectiveness. (1) Consequently, efforts continue to be made to improve antibiotic stewardship internationally [...]

Background: The COVID-19 pandemic, caused by the novel coronavirus 2 (SARS-CoV-2), has been associated with an increased risk of secondary bacterial infections. Numerous studies have reported a surge in antibiotic usage during the COVID-19 pandemic. This study aims to examine the impact of the COVID-19 pandemic on the frequency and patterns of antibiotic prescriptions at Primary Health Care Centers (PHCC) in Qatar, comparing the period before and during the pandemic. Methods: This population-based, cross-sectional study analyzed all antibiotic prescriptions issued in two-month intervals before COVID-19 (November and December 2019) and during the initial wave (June and July 2020) of COVID-19. The study included 27 PHCCs in Qatar. Results: Prior to the COVID-19 outbreak, the PHCCs dispensed a total of 74,909 antibiotic prescriptions in November and December. During the first wave of COVID-19, the number decreased to 29,273 prescriptions in June and July 2020. Antibiotics were most commonly prescribed for adults and least commonly for the elderly, both before and during the COVID-19 period. In the pre-COVID-19 period, Betalactams and macrolides accounted for the majority (73%) of all antibiotic prescriptions across all age groups. However, during the COVID-19 period, Betalactams and other antibiotics such as Nitrofurantoin and Metronidazole (73%) were the most frequently prescribed. Conclusion: The rate of antibiotic prescriptions during the first wave of COVID-19 was lower compared to the two months preceding the pandemic at the PHCC in Qatar. [ABSTRACT FROM AUTHOR]

Objective The objective of this research is to generate new evidence on financial implications of medicines out-of-pocket (OOP) payments for households. Another objective is to investigate which disease conditions contributed to a significant proportion of households’ financial burden. Setting All Indian states including union territories, 1993–2014. Design Repeated cross-sectional household surveys. Data Secondary data of nationwide Consumer Expenditure Surveys for the years 1993–1994, 2004–2005 and 2011–2012 and one wave of Social Consumption: Health for the year 2014 from National Sample Survey Organisation. Outcome measures OOP expenditure on healthcare in general and medicines in specific. Results Total OOP payments and medicines OOP payments were estimated to be 6.77% (95% CI 6.70% to 6.84%) and 4.49% (95% CI 4.45% to 4.54%) of total consumption expenditure, respectively, in the year 2011–2012 which marked significant increase since 1993–1994. These proportions were 11.46% (95% CI 11.36% to 11.56%) and 7.60% (95% CI 7.54% to 7.67%) of non-food expenditure, respectively, in the same year. Total OOP payments and medicines OOP payments were catastrophic for 17.9% (95% CI 17.7% to 18.2%) and 11.2% (95% CI 11.0% to 11.4%) households, respectively, in 2011–2012 at the 10% of total consumption expenditure threshold, implying 29 million households incurred catastrophic OOP payments in the year 2011–2012. Further, medicines OOP payments pushed 3.09% (95% CI 2.99% to 3.20%), implying 38 million persons into poverty in the year 2011–2012. Among the leading cause of diseases that caused significant OOP payments are cancers, injuries, cardiovascular diseases, genitourinary conditions and mental disorders. Conclusions Purchase of medicines constitutes the single largest component of the total OOP payments by households. Hence, strengthening government intervention in providing medicines free in public healthcare facilities has the potential to considerably reduce medicine-related spending and total OOP payments of households and reduction in OOP-induced poverty. [ABSTRACT FROM AUTHOR]

The author reflects on the universal health coverage (UHC) which also is the theme of 2018 World Health Day. Topics disscussed include the two complementary schemes under the health mission 'Ayushman Bharat' launched by the Indian government, that are, Health and Wellness Centres and National Health Protection Scheme.

Background & Objectives: Prognosis of patients with multiple myeloma (MM) has improved significantly in the past two decades. However, the symptoms burden is high at onset and treatment is generally prolonged with significant financial burden. This study was undertaken to assess the quality of life (QoL) and to analyse out-of-pocket expenditure (OOPE) incurred on MM patients being treated at a tertiary care cancer centre in north India., Methods: This observational, cross-sectional study included 116 patients (aged >18 yr) of MM (both newly diagnosed and those with recurrent disease). For QoL assessment, European Organisation for Research and Treatment of Cancer (EORTC)-validated questionnaire (EORTC QLQ C 30 version 3.0) and disease-specific QLQ MY20 were used. For assessing OOPE incurred on treatment, the National Sample Survey Organisation (NSSO) questionnaire was used., Results: Bone pains (68.1%), fatigue (59.7%) and dyspnoea (54.6%) were common symptoms. The mean global health status/QoL score was 59.62±19.21. International Staging System (ISS) score correlated with global health status score, and gastritis was the main adverse effect. QoL score showed negative correlation to side effects of treatment (-0.53) of MY20 domain. On multivariate analysis, ISS stage (P<0.001) and adverse effects of treatment (P=0.02) were predictive factors. The median OOPE was ₹ 7900 (IQR, ₹ 4950-13,550) towards medical and ₹ 1150 (IQR, ₹ 500-3100) for non-medical expenses for the past one month., Interpretation & Conclusions: Regular assessment of QoL in the clinical management of multiple myeloma patients has the potential of improving treatment outcomes. Measures to reduce out-of-pocket expenditure may improve treatment compliance.

Background: In India, access to medicine in the public sector is significantly affected by the efficiency of the drug procurement system and allied processes and policies. This study was conducted in two socioeconomically different states: Bihar and Tamil Nadu. Both have a pooled procurement system for drugs but follow different models. In Bihar, the volumes of medicines required are pooled at the state level and rate contracted (an open tender process invites bidders to quote for the lowest rate for the list of medicines), while actual invoicing and payment are done at district level. In Tamil Nadu, medicine quantities are also pooled at state level but payments are also processed at state level upon receipt of laboratory quality-assurance reports on the medicines., Methods: In this cross-sectional survey, a range of financial and non-financial data related to procurement and distribution of medicine, such as budget documents, annual reports, tender documents, details of orders issued, passbook details and policy and guidelines for procurement were analysed. In addition, a so-called ABC analysis of the procurement data was done to to identify high-value medicines., Results: It was observed that Tamil Nadu had suppliers for 100% of the drugs on their procurement list at the end of the procurement processes in 2006, 2007 and 2008, whereas Bihar's procurement agency was only able to get suppliers for 56%, 59% and 38% of drugs during the same period. Further, it was observed that Bihar's system was fuelling irrational procurement; for example, fluconazole (antifungal) alone was consuming 23.4% of the state's drug budget and was being procured by around 34% of the districts during 2008-2009. Also, the ratios of procurement prices for Bihar compared with Tamil Nadu were in the range of 1.01 to 22.50. For 50% of the analysed drugs, the price ratio was more than 2, that is, Bihar's procurement system was procuring the same medicines at more than twice the prices paid by Tamil Nadu., Conclusion: Centralized, automated pooled procurement models like that of Tamil Nadu are key to achieving the best procurement prices and highest possible access to medicines.