Availability of antidotes in Moroccan hospitals: a national survey

AIM

The lack of availability of antidotes is a challenge for hospitals all over the world. The objective of our study was to investigate the availability of antidotes in Moroccan hospitals.

METHODS

A cross-sectional, questionnaire-based study was conducted from November 2018 to April 2019. The questionnaire was sent to 25 hospitals in order to investigate the availability of 42 selected antidotes based on the International Programme on Chemical Safety list.

RESULTS

The survey response rate was 68%. Of the 42 selected antidotes, 38 (90.5%) were available depending on the hospitals included in the study. We found a strong correlation between the availability of antidotes and hospital bed capacity, and logistic regression analysis revealed that bed capacity is the only factor strongly associated with higher antidote stock levels. Some essential antidotes such as digoxin-specific antibody, protamine sulfate, flumazenil and glucagon were unavailable in many of the small- and medium-sized hospitals, and methylene blue, sodium nitroprussiate, Prussian blue and anti-snake venom were absent in all of the hospitals.

CONCLUSION

Despite the great efforts that have been made to improve the availability of antidotes in Morocco, some of these vital products are still lacking in Moroccan hospitals.

Impact of anti-cancer drugs shortages in oncology and hematology departments in a Moroccan hospital

INTRODUCTION

Drug shortages have been a growing global problem in recent years. Some of them are of vital necessity and importance for the patient, such as those used to treat pathologies in clinical hematology and oncology departments. The objectives of this study are to determine the impact of anti-cancer drugs shortages on both: treatment and patient in the hematology and oncology departments, to describe the actions that have been put in place to manage the shortages and to survey patients about their perspectives and experiences.

MATERIALS AND METHODS

It was a prospective, observational study, it took place in the oncology and hematology departments. It was carried out with the help of an operating sheet, which contained two parts: patient and treatment data. This sheet was filled out after the interview with the patient and on the basis of the medical file.

RESULTS

Of the 101 patients interviewed, 67.3% were impacted by the shortage of drugs. The treated pathology that was most impacted by the rupture was Non-Hodgkin lymphoma (55.8%), vincristine was the drug most responsible for the shortages (34%). Most patients (51.4%) went to a non-local pharmacy to buy the medicine that was in short supply in the hospital. Delayed care was the main impact of the drug shortage (42.6%). As a result of these shortages, the majority of patients (45.6%) were frustrated and anxious about the situation.

CONCLUSION

Drug shortages have a profound impact on patient safety, clinical outcomes, quality of treatment, hospital management and other important factors. In-depth collaboration between different health actors and timely communication strategies are essential elements of an effective drug shortage management plan.

Les anti-inflammatoires et SARS-CoV-2 (COVID-19)

À ce jour, les options thérapeutiques pour le COVID-19 sévère restent limitées et il n’existe actuellement aucun médicament ni vaccin efficace pour le traitement ou la prévention du SARS-CoV-2 spécifique pour traiter les patients gravement malades. Une nouvelle stratégie de traitement, en plus de la thérapie antivirale seule, est susceptible d’être nécessaire pour avoir un impact significatif sur les résultats cliniques. Un traitement immunomodulateur pour réguler à la baisse de choc cytokinique peut fournir des informations sur le traitement de COVID-19. L’utilisation combinée d’un agent immunomodulateur avec un agent antiviral peut donner aux médecins plus de temps pour fournir un traitement de soutien aux patients atteints de COVID-19. Dans cette revue de la littérature, les rôles de plusieurs médicaments anti-inflammatoires ont été passés en revue pour explorer leur efficacité dans la lutte contre le SARS-CoV-2.

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Bacterial resistance is a major concern and the proper use of antibiotics is a global public health priority. Inappropriate use of antibiotic therapy can have serious ecological and pharmaco-economic consequences. The objective of our work was to study the reevaluation of probabilistic antibiotherapy in the burns intensive care unit. A prospective study concerning the clinical-biological reassessment of antibiotic therapy was set up in the burns intensive care unit at the Military Hospital Instruction Mohammed V of Rabat. The data was collected over a period of 6 months, from June 1, 2017 to November 30, 2017. During the study period, 142 patients received an antibiotic prescription. Only 68 serious hospitalized septic patients were included in our study. The population was predominantly male (75%). The average age of our patients was 36 years, ranging from 15 to 56 years old. The average length of hospitalization in intensive care was 10 days. Of the 68 antibiotic regimens implemented, the reassessment rate was 72.06%, with 75% justified treatment rates, and 25% not justified. Therapeutic de-escalation was performed in 8 cases (11.76%), when it could have been performed 25 times (36.76%). This is justified by the nosocomial context of the burns intensive care unit with a bacterial ecosystem of BMR type (Klebsiella pneumoniae, Acinetobacter baumanii, Escherichia coli and Staphylococcus coagulase negative), which restricts the choice of antibiotic therapy to some molecules. Clinico-biological re-evaluation of antibiotic therapy is essential to fight the misuse of antibiotics. This study allowed us to evaluate the re-evaluation practices of antibiotic therapy at 48-72h in burns resuscitation. Subsequently, several actions were carried out: the appointment of a pharmacist in antibiotherapy within the Pole Pharmacy of the Mohammed V Military Hospital in Rabat, the activation of an Anti-Infectious Committee and the dispensing of antibiotics via Pyxis MedStation.