Ana Tomas

Disposal of Unused Drugs: Knowledge and Behavior Among People Around the World

The purpose of this systematic review was to determine the practice of medication disposal around the world and get insight into possible association between environmental awareness and peoples behavior regarding this issue. A literature search (2005-2015) was performed to identify reports with quantitative data on disposal practices published in peer-reviewed literature. The most common method for disposal of unused medications in households is disposal in the garbage (Kuwait, United Kingdom, Lithuania, Qatar, Serbia, Ghana, Bangladesh, Malta and Saudi Arabia). The practice of flushing drugs into the sewage system still takes place in New Zealand, USA and Bangladesh. Only in Sweden and Germany, practice of returning drugs to pharmacy was practiced to a larger extent. The environmental impact of improper medication disposal is expected in countries with poorly functioning waste management schemes (Middle Eastern, Asian and African countries). Lack of the adequate information and clear instructions on proper manners of drug disposal was reported in many surveyed countries (USA, New Zealand, Bangladesh, Malta and Ireland). Clear and definite connection between knowledge about environmental detrimental effects of improper drug disposal and the preference towards disposal methods could not be established. Many respondents were generally concerned with issues of inadequate medicines discarding but the behavior regarding disposal of unused drugs often did not equate the awareness (Serbia, USA, Kuwait, Malta and UK). The current data emphasizes the global issue of improper medicine disposal, prevalent in environmentally-aware people.

Analysis of expired medications in Serbian households.

Abstract Introduction An ongoing issue of expired medications accumulating in some households is a universal problem around the world. The aim of the study was to investigate the extent and structure of expired medications in Serbian households, and to determine which therapeutic groups generated the most waste. Methods This was an observational, cross-sectional study conducted in households in the city of Novi Sad, Serbia. The study had been performed over 8 month period (December 2011 - July 2012) and it consisted of personal insights into the medication inventory in households. Results Of 1008 families, 383 agreed to participate and complete the questionnaire (38.3% response rate). In almost a half of households (44.4%), expired medications were maintained. The amount of expired medications was 402 items, corresponding to 9.2% of total medications presented in surveyed households. The majority of expired medications (64.7%) was in solid dosage (tablets, capsules, granules, lozenges), following semisolid (ointments, creams, gel, suppositories) and liquid dosage forms (drops, syrups). Expired medications in the households belonged mostly to 3 categories: antimicrobials for systemic use (16.7%), dermatological preparation (15.9%) and medications for alimentary tract and metabolism (14.2%). Conclusions This study revealed that there were relatively large quantities of expired medications in Serbian households, with a high prevalence of antibiotics for systemic use, anti-inflammatory and antirheumatic products, and medications for alimentary tract and metabolism.

Is the level of knowledge a predictor of rational antibiotic use in Serbia

Introduction The objective of this study was to investigate the knowledge, attitudes and behavior regarding antibiotics of the general population. Methods The study sample consisted of adult subjects who consulted general practitioners at health centers in Serbia and agreed to complete the questionnaire. A total of 668 questionnaires were distributed; 500 respondents completed the entire questionnaire (response rate 74.85%). Results The average age was 51.65 ± 16.56 years, 60.80% of the respondents were women. The median antibiotic knowledge score was 9. Predictors of adequate antibiotic knowledge were higher education level and a family member whose ocuppation was related to health-care. Overall, 58.4% of respondents believed that antibiotics could be used to treat common cold. Around a half of the respondents (47.2%) self-medicated with antibiotics at least once during their life-time, and around a quarter (24.2%) during the last treatment of infection. Patients with inadequate knowledge had 3 times higher chances of self-medicating with antibiotics compared to those with adequate knowledge. Although 98.20% of respondents claimed that antibiotic treatment should be started after a visit to a doctor and receiving a prescription, only 65.8% obtained antibiotics with prescription from a doctor during the last infection. Conclusions Although these results demonstrate that respondents had a relatively adequate level of knowledge regarding antibiotics use, some areas of misconceptions and improper behavior were identified. Therefore, further rationalization should be focused on educational campaigns targeting the behavior of patients with regard to antibiotic use.

Pharmacokinetics and Pharmacodynamic dosage adaptation of cefaclor in systemic infections

August 2015 e81 PhArmAcokinetics And PhArmAcodynAmic dosAge AdAPtAtion of cefAclor in systemic infections A. Tomas; O. Horvat; M.P. Kusturica; N. Pavlović ; B. Milijašević ; Z. Tomić ; and A. Sabo Medical faculty, University of Novi Sad, Serbia Background: Cefaclor was one of the commonly used antimicrobials in Serbia, but due to fast development of resistance, other oral cephalosporins rapidly upstaged cefaclor and cefaclor was removed from the list of the drugs reimbursed by the National Health Insurance Fund. Use of recommended dosing regimen (250-500mg/812h) is likely to result in sub-therapeutic concentrations for a wide portion of dosing interval due to short half-life of cefaclor, which may facilitate development of resistance. The aim of this study was to determine adequate dosing interval for cefaclor in treatment of systemic infections using Pharmacokinetic (PK) and pharmacodznamic (PD) parameters with special regard to postantibiotic effect (PAE). Material and Methods: PK profile of cefaclor in healthy volunteers and PK/PD indices relating to efficacy of cephalosporins were determined, as well as minimum inhibitory concentration (MIC) and PAE of cefaclor on 4 susceptible bacteria. Results: Cmax of 23.142 ± 5.67 μg/mL was measured after 40-60 minutes. Tmax was 0.72 ± 0.13 hours. Calculated AUC(0-t) was 29.148 ± 9.27 μg/mL/h. MICs were in range of 1-2 μg/mL. Cefaclor induced PAE of 1-2h. There was inconsistency between standard dosing regimen and PK/PD parameters. Main PK/PD index relating to efficacy of cephalosporins (%t> MIC) for the 750mg dose was 33.5–42.1%. PK/PD breakpoints for cefaclor were between 0.3-1μg/mL. Even the maximum doze with standard dosing intervals is not appropriate for eradication of susceptible organisms. Short PAE can’t compensate for sub-inhibitory concentrations at the half of the dosing interval. Conclusions: In reference to PK/PD parameters cefaclor should be administered every 6h for the doses of 500mg and 750mg, and every 4-4.5h for the 250mg dose in order to maximize its therapeutic efficacy and minimize development of resistance. This work was supported by the Ministry of Science and Technological development, Republic of Serbia, project No III 41012.

Are There Striking Differences in Outpatient Use of Antibiotics Between South Backa District, Serbia, and Some Scandinavian Countries?

There is little published information about antibiotic utilization in outpatients in Serbia. The objective of this study was to determine the amount and structure of outpatient antibiotic use in South Backa District (SBD) in Serbia, to assess prescibing quality of antibiotics and to compare with results from Scandinavian countries. Data on the antibiotic use were collected from all private and state-owned pharmacies from January through March 2008 in SBD. Results were expressed as the number of defined daily doses/1,000 inhabitants/day. The drug utilization 90% method was also used. Penicillins were the most frequently used antibiotic subgroup in SBD (35.20%), followed by cephalosporins (19.16%) and macrolides (13.18%). Thirteen drugs accounted for 90% of total antibiotics consumption (DU90% segment). The average cost/DDD within the DU90% segment was 0.95 euros, whereas the average cost/DDD beyond the DU90% segment was 1.89 euros, indicating that less expensive antibiotics were more frequently used. High use of ampicillin, third-generation cefalosporins, co-trimoxazole, and gentamicin, will aggravate the alarming problem of resistance in Serbia. Differences in the amount and structure of antibiotic consumption between SBD and Scandinavian countries indicate the need of updated national guidelines for rational antimicrobial drug use in Serbia.