Erythromycin and the newer macrolides

Recent macrolide development has been directed by clinical pharmacology dictates, ethical considerations, and patient concerns. Patient non-compliance, a major repercussion from erythromycin's side-effects, produces lost clientele, resistent bacterial strains, and escalating costs for the patient and healthcare system. Structural alteration of the macrolide molecule (after its macrocyclic lactone ring), has enhanced the antibacterial spectrum, pharmacokinetics, tissue penetration, and drug tolerance. New macrolide derivatives differ from the proto-type (erthromycin) in pharmacokinetic and dynamic profiles, and include roxithromycin, dirithromycin, clarithromycin, and azithromycin. Josamycin is less active than erythromycin. This review discusses the new macrolides widely used in the Caribbean, with reference to erythromycin (AU)

An evaluation of the Jamaica drug for the elderly programme in Kingston and St. Andrew

The presence of chronic disease is accompanied by the threat of complications that can be averted if the elderly can obtain the necessary health care. In 1996, the government of Jamaica launched the Jamaica Drug for the Elderly Programme (JADEP) to assist persons 60 years and over with any of six chronic diseases, in the purchase of medication. The study aims to evaluate public attitude toward and participation in the programme. A cross-sectional study was conducted in randomly selected pharmacies in Kingston and St. Andrew among 49 elderly persons with certain chronic diseases and 9 providers of JADEP. All elderly persons who entered the selected pharmacy, fulfilled the criteria and who consented to be interviewed were included in the study as was the main pharmacist for that location. A focus group discussion with ten persons helped to elucidate information already obtained. The study revealed that while most elderly persons had neither a positive nor negative attitude towards the programme, the level of registration was not high (52 percent, n=49). Among JADEP participants many (67.4 percent or 29/43) were unable to obtain all their medication at one time due to cost constraints. Both providers and the elderly raised concerns about the limited range of drugs available which was the reason commonly cited for not being able to use the benefit card. The study showed that the extent to which the programme was able to assist the elderly was dependent on their awareness of how the programme functioned and the availability of their medication. The service is a necessary one and its failure would have public health implications as chronic illnesses that are not well managed will increase the health burden of the population and overall health care costs. It is recommended that the range and quantity of drugs that can be prescribe for the particular chronic conditions be re-examined (AU)

General principles of drug action and drug laws of Trinidad and Tobago

A manual for the course "General principles of drug action"

Incidence of cancer of the uterine cervix in Kingston, Jamaica, 1958-1970

The incidence of cancer of the uterine cervix in the parishes of Kingston and St. Andrew, Jamaica has been evaluated for a 13-year period (1958-1970) and found to be very high (33 cases per 1000,000 population per year). When compared on an age-adjusted basis with other populations, this incidence is exceeded by only two other countries with cancer registries - Cali, Columbia and Bulawayo, Southern Rhodesia. Age-specific comparisons indicate that in Kingston, as in other Negro populations, the highest incidence is in the seventh decade whereas in white populations the peak incidence is in middle life with a gradual decline after the menopause. The findings in this study therefore replace earlier observations that cancer of the cervix in Jamaica, as in other developing countries, occurs more frequently in the younger age groups (AU)