Morbidity Pattern in the Medical Wards of a Nigerian Teaching Hospital During the COVID-19 Pandemic.

BACKGROUND: Morbidity patterns change due to emerging and re-emerging infections. Information obtained from alteration in patterns of morbidity is vital in structuring and providing safe health care services. OBJECTIVES: To determine disease patterns and highlight the prevalent disease entity in the medical wards at the University of Benin Teaching Hospital, Benin City, during the COVID-19 pandemic. METHODS: This was a retrospective study of 430 patient case records recruited between January 1st to 31st December 2020. The diagnosis was made during their hospital stay and classified using the International Classification of Disease Version 11. The demographics of the patients were also recorded in the data collection form. The data were analyzed descriptively. RESULTS: A total of 430 case records were evaluated during the study period, and the final diagnoses were noted. The commonest diagnostic classes were diseases of the nervous system (90, 20.9%), diseases of the respiratory system (78, 18.1%), diseases of the digestive system (67, 15.6%), and diseases of the circulatory system (61, 14.2%). The least prevalent was neoplasm (1, 0.2%), and the most prevalent disease entity was hypertension (48.5%). There was a statistical significance between age and the number of morbidities (Χ²=79.0, p=<0.01), but there was no statistical significance between the gender of the patient and the international classification of disease version 11 (Χ²=16.9, p=0.12). CONCLUSION: The study showed a higher trend in diseases of the nervous system during this period. Furthermore, this trend in morbidity appeared to be influenced by the number of morbidities, age, and gender.

CONTEXTE: Les schémas de morbidité changent en raison des infections émergentes et ré-émergentes. Les informations obtenues à partir de l'altération des schémas de morbidité sont essentielles pour structurer et fournir des services de santé sûrs. OBJECTIFS: Déterminer les schémas de maladies et mettre en évidence l'entité pathologique prévalente dans les services de médecine de l'Hôpital d'Enseignement de l'Université de Benin, à Benin-City, pendant la pandémie de COVID-19. MÉTHODES: Il s'agissait d'une étude rétrospective de 430 dossiers de patients recrutés entre le 1er janvier et le 31 décembre 2020. Le diagnostic a été établi pendant leur séjour à l'hôpital et classé selon la Classification Internationale des Maladies, 11ème version. Les données démographiques des patients ont également été enregistrées dans le formulaire de collecte de données. Les données ont été analysées de manière descriptive. RÉSULTATS: Un total de 430 dossiers de cas ont été évalués pendant la période d'étude, et les diagnostics finaux ont été notés. Les classes diagnostiques les plus courantes étaient les maladies du système nerveux (90, 20,9 %), les maladies du système respiratoire (78, 18,1 %), les maladies du système digestif (67, 15,6 %), et les maladies du système circulatoire (61, 14,2 %). La moins prévalente était le néoplasme (1, 0,2 %), et l'entité pathologique la plus prévalente était l'hypertension (48,5 %). Il y avait une signification statistique entre l'âge et le nombre de morbidités (Χ²=79,0, p=<0,01), mais il n'y avait pas de signification statistique entre le sexe du patient et la classification internationale des maladies version 11 (Χ²=16,9, p=0,12). CONCLUSION: L'étude a montré une tendance accrue dans les maladies du système nerveux au cours de cette période. De plus, cette tendance de la morbidité semblait être influencée par le nombre de morbidités, l'âge et le sexe. MOTS-CLÉS: Schéma de Morbidité, Hôpitaux d'Enseignement, COVID-19.

An Evaluation of the Knowledge and Utilization of the Essential Medicines List among Health Professionals in Six Tertiary Institutions in Nigeria.

BACKGROUND: The introduction and operationalization of the Essential Medicines (EM) concept remains a major achievement of the WHO. This study assessed the current knowledge, utilization, and perception of the Essential Medicines programme in Nigeria. METHODS: This was a cross-sectional study conducted across six tertiary health institutions in Southern Nigeria from January to July 2018. A total of 750 semi-structured questionnaires were administered to doctors, pharmacists, and nurses. The information sought included the demographic characteristics of respondents, knowledge of definition of the essential medicines concept, date of launch at the national level, current edition, current use, the advantages and disadvantages of the EM List (EML). The data were analyzed qualitatively and presented descriptively as means (SD) and percentage frequencies. RESULTS: A total of 748 respondents (487 doctors, 208 nurses, and 53 pharmacists) participated in the study. Healthcare professionals' (HCP) knowledge of the EM concept and list was poor (15%), as determined by their ability to define or describe the concept of the EML, with less than 3% of respondents aware of the current edition of the EML in use in Nigeria. Less than 20% of all respondents used the EML during their internship, with nurses using it the least and only 8% using it during their first year of practice. Over 70% of respondents could not identify notable advantages of the EML and only 14.6% agreed that the program had been successful in Nigeria. CONCLUSION: The initial global momentum following the introduction of the EM program appears to have declined with the new generation of HCPs, likely due to lack of educational reinforcement. This negatively impacts the drug use scenario within our healthcare system.

CONTEXTE: L'introduction et l'opérationnalisation du concept de médicaments essentiels (ME) restent une réalisation majeure de l'OMS. Cette étude évalue la connaissance, l'utilisation et la perception actuelles du programme des médicaments essentiels au Nigeria. METHODES: Il s'agissait d'une étude transversale menée dans six établissements de santé tertiaires du sud du Nigéria de janvier à juillet 2018. Au total, 750 questionnaires semi-structurés ont été administrés aux médecins, pharmaciens et infirmiers. Les informations recherchées comprenaient les caractéristiques démographiques, la définition du concept de médicaments essentiels, la date de lancement au niveau national, l'édition actuelle, l'utilisation actuelle, les avantages et les inconvénients de la liste des ME (LME). Les données ont été analysées de manière qualitative et présentées de manière descriptive sous forme de moyenne (SD) et de pourcentage de fréquences. RESULTATS: Un total de 748 répondants (487 médecins, 208 infirmiers et 53 pharmaciens) ont participé à l'étude. Les connaissances des professionnels de santé (PSS) sur le concept et la liste des LME étaient faibles (15%), comme le montre leur capacité à définir, fournir ou décrire le concept de LME, avec moins de 3% des répondants connaissant l'édition actuelle de la LME utilisée au Nigeria. Moins de 20% de tous les répondants ont utilisé l'EML pendant leur stage, les infirmières étant celles qui l'ont le moins utilisé, avec seulement 8% l'utilisant pendant leur première année de pratique. Plus de 70% des répondants n'ont pas pu identifier d'avantages notables de l'EML, et seulement 14,6% étaient d'accord pour dire que le programme a été une réussite au Nigeria. CONCLUSION: L'élan initial qui a suivi l'introduction du programme d'EM semble avoir diminué avec la nouvelle génération de HCP, probablement en raison du manque de renforcement éducatif. Cela a un impact négatif sur le scénario d'utilisation des médicaments au sein de notre système de santé. Mots-clés: Médicaments essentiels; Médicaments essentiels; Professionnels de la santé; Connaissances, Attitudes, Pratiques (KAP); Organisation mondiale de la santé (OMS); Nigeria.

Impact of an Educational Intervention on Adverse Drug Reaction reporting in Tertiary Hospitals in South-South Nigeria.

BACKGROUND: Nigeria is yet to achieve the internationally recommended number of Adverse Drug Reactions (ADRs) reports. OBJECTIVE: This study evaluated the impact of an educational lecture followed by repeated text messages via the Short Messaging System (SMS) on ADR reporting. METHODS: Six teaching hospitals in the South-South zone of Nigeria were randomized in 1:1 ratio into intervention and non-intervention hospitals. The intervention hospitals received an educational lecture followed by monthly SMS reinforcements over 12 months. The number and quality of ADR reports from the local pharmacovigilance centers of each teaching hospital over the 12 months before and after the intervention were described. RESULTS: A total of 4912 healthcare professionals were working in the 6 hospitals at the time of the study (3099 in the intervention and 1813 in the control) and the educational intervention was conducted between January and March 2016. In the intervention hospitals, the number of ADR reports increased from 57 in the pre-intervention period (from January 1st 2015) to 75 in the post- intervention period. However, the proportion of serious ADRs decreased slightly from 26(45.6%) to 33(44%). Post-intervention, the report of suspected drug details in the ADR report form also improved. CONCLUSION: There was a trend to increased absolute number and quality of reports following educational intervention and SMS reminders.

CONTEXTE: Le Nigéria n'a pas encore atteint le nombre recommandé au niveau international de rapports sur les effets indésirables des médicaments (EIM). OBJECTIF: Cette étude a évalué l'impact d'une conférence éducative suivie par les messages texte répétés via le système de messagerie courte (SMS) sur les rapports d'ADR. MÉTHODES: Six hôpitaux universitaires de la zone Sud-Sud du Nigeria ont été randomisés dans un rapport 1:1 en hôpitaux d'intervention et de non-intervention. Les hôpitaux d'intervention ont reçu une conférence pédagogique suivie de renforcements SMS mensuels sur 12 mois. Le nombre et la qualité des rapports d'EIM des centres locaux de pharmacovigilance de chaque hôpital universitaire au cours des 12 mois avant et après l'intervention ont été décrits. RÉSULTATS: Au total, 4912 professionnels de santé travaillaient dans les 6 hôpitaux au moment de l'étude (3099 dans l'intervention et 1813 dans le contrôle) et l'intervention éducative a été menée entre janvier et mars 2016. Dans les hôpitaux d'intervention, le nombre des notifications d'EIM sont passés de 57 dans la période pré-intervention (à partir du 1er janvier 2015) à 75 dans la période post-intervention. Cependant, la proportion d'effets indésirables graves a légèrement diminué, passant de 26 (45,6 %) à 33 (44 %). Après l'intervention, le rapport des détails sur les médicaments suspects dans le formulaire de rapport d'EIM s'est également amélioré. CONCLUSION: Il y avait une tendance à l'augmentation du nombre absolu et de la qualité des rapports après une intervention éducative et des rappels par SMS. MOTS CLÉS: Effet indésirable médicamenteux, Intervention éducative, Professionnels de santé, Rappels SMS, Hôpitaux universitaires, Nigéria.

Drug Prescription Patterns in Old Age:A Prospective Study of Prescribed Drugs at Hospital Discharge.

BACKGROUND: Irrational prescription of medicine is a common problem in medical practice. This is more so in the immediate post admission period. The aim of this study was to characterize drug prescriptions patterns for elderly patients at hospital discharge and to detect areas of irrational and inappropriate prescription. STUDY DESIGN: This was a longitudinal prospective study of drugs prescribed at hospital discharge for patients aged 65years and above. The World Health Organization (WHO) drug use indicators were used to characterize the drug prescription. The drugs prescribed were classified using the Anatomical Therapeutic Chemical (ATC) classification systemwhile potentially inappropriate medications were determined using the Beers criteria by the American Geriatric Society. RESULTS: A total of 1,679 drugs were prescribed in 269 patient encounters surveyed. The average number of drugs prescribed per encounter was 6.2 ± 2.1. Vitamins and antihypertensive agents accounted for 23.2% (n=390/1,679) and 15.2% (n=256/1,679) of prescribed drugs respectively. At least one potentially inappropriate medicationwas prescribed for 48 patients giving a rate of 17.8%(48/269) and the non-steroidal anti-inflammatory drugs (NSAIDs)were the most frequently prescribed potentially inappropriate medications. CONCLUSION: The average number of medicines per patient encounter which is a measure of the degree of polypharmacywas high in the study and suggests irrational drug prescription. Thefrequent prescription of potentially inappropriate medicines noted in the study further highlights the need forfurther training of the prescriberson geriatric drug prescriptions.

Effects of species and season on chemical composition and ruminal crude protein and organic matter degradability of some multi-purpose tree species by West African dwarf rams.

Seasonal chemical composition and ruminal organic matter (OM) and crude protein (CP) degradabilities were determined in four tropical multi-purpose tree species (MPTS) namely; Pterocarpus santalinoides, Grewia pubescens, Enterolobium cyclocarpum and Leucaena leucocephala. Three West African dwarf (WAD) rams fitted with permanent rumen cannula were used for the degradability trials. Foliage samples were collected four times to represent seasonal variations as follows: January--mid dry; April--late dry; July--mid rainy and October--late rainy seasons. Leaf samples were randomly collected from the trees for estimation of dry matter (DM) and chemical composition. Ruminal in sacco OM and CP degradabilities were estimated from residues in nylon bags. All samples had high CP (161-259 g/kg DM) and moderate fibre concentrations [neutral detergent fibre (without residual ash], 300-501 g/kg DM; acid detergent fibre (without residual ash), 225-409 g/kg DM and acid detergent lignin, 87-179 g/kg DM across seasons. Interaction effects of species and season on chemical composition were highly significant (p = 0.001) except for trypsin inhibitor (p = 0.614). The MPTS recorded more than 60% OM and CP degradability at 24 h, which implied that they were all highly degradable in the rumen. Their incorporation into ruminant feeding systems as dry season forage supplements is therefore recommended.

Toxicological effect of Artemisinin-Based Combination Therapies plus Paracetamol in malaria patients.

BACKGROUND: Following the paucity of safety reports in the use of Artemisinin-Based Combination Therapies (ACTs) plus paracetamol, the study assessed safety potential of artemether-lumefantrine (ALP), artesunate-amodiaquine (AAP), artesunate-mefloquine (AMP), artesunate-sulphadoxine-pyrimethamine (ASPP) and dihydroartemisinin-piperaquine (DHPP) combination with paracetamol in malaria patients. METHODS: ACTs and paracetamol were administered concomitantly in conventional doses/regimen to randomly selected patients. Blood samples were collected from the ante-cubital vein before and after completion of therapies. Toxicity markers such as weights, glucose, lipids, renal electrolytes, liver enzymes and haematological indices were assessed using standard protocols. RESULTS: The total numbers of participants were 57 patients. Male to female ratio was 1:1.1. Mean body weight and ages were 59.19 ± 1.39 kg and 42.86 ± 1.32 years respectively. The mean temperatures prior to and after therapy were 37.49 ± 1.02 °C and 37.50 ± 0.17 °C respectively. Mean parasitaemia before the commencement of therapy was 6282 ± 21.01 parasites/µl. Out of thirty-seven toxicological indices evaluated, twenty-four were significantly altered by ACTs plus paracetamol (P < 0.05). Increased serum toxicity markers due to the drug combinations were glucose (AAP, AMP), urea (ALP, ASPP), bicarbonate ion (ALP, AAP, AMP, ASPP), chloride ion (ALP, AAP, AMP), creatinine (ALP, AAP, AMP, ASPP), alkaline phosphatase (ALP, AAP), aspartate aminotransferase and alanine aminotransferase (ALP, AAP, AMP, ASPP, DHPP), total protein (AMP, DHPP) and albumin (AMP, DHPP). Decreased serum toxicity markers due to the drugs were glucose (ALP, ASPP, DHPP), urea (AMP), bicarbonate ion (DHPP), chloride ion (ASPP, DHPP), creatinine (DHPP), alkaline phosphatase (AMP, ASPP, DHPP), total protein (ALP, AAP, and ASPP) and albumin (ALP, AAP, ASPP). Altered haematological indices were white blood cells, red blood cells, mean cell haemoglobin and platelets. CONCLUSION: Since ACTs plus paracetamol altered human system, discrete selection is essential in managing uncomplicated malaria most especially in patients with co-morbid conditions.

Multiple digital gangrene arising from traditional therapy: a case report.

BACKGROUND: Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects. OBJECTIVE: To report an unusual complication of traditional therapy. METHODS: A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention. RESULTS: Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits. CONCLUSION: Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.

Multiple digital grengrene arising from traditional therapy: a case report.

BACKGROUND: Traditional medicine has being advocated as an alternative to Orthodox medicine in Nigeria despite, its reported adverse effects. OBJECTIVE: To report an unusual complication of traditional therapy. METHODS: A 20-year-old house-wife who was bitten by a crawling insect presented to a hospital with complaints of swollen body and pain in three digits. After clinical evaluation and investigations, she had both medical and surgical intervention. RESULTS: Two weeks following an insect bite, the patient noticed periorbital and bilateral leg swellings. She sought help from a traditional medicine practitioner who incised and tied the affected digits for three days. He repeated the cycle thrice. She had generalized oedema, massive proteinuria, hypoalbuminaemia, hypercholesterolaemia features consistent with a diagnosis of nephritic syndrome. There was gangrene of the left middle finger and both index toes. Oedema responded to diuretics, lisinopril and low salt diet. She had surgery for the gangrenous digits. CONCLUSION: Development of gangrene is an unusual finding in nephrotic syndrome. It occurred in this case as an aftermath of traditional medical intervention. This report reiterates the danger of this form of medical practice and the need for measures to protect the populace to be put in place.

Knowledge of malaria and the practices towards its control among urban dwellers in Benin City.

OBJECTIVE: To determine the knowledge of malaria and its control methods among urban dwellers in Benin City, Edo State with a view to making recommendations on its prevention. METHODS: The study was of a cross-sectional descriptive type, using multi-stage sampling technique. Semi-structured questionnaires were researcher-administered and data analysed by means of the Computer Programme for Epidemiologic Research (CPER). RESULTS: The indices of the knowledge of malaria were generally high. 92.5% had correct knowledge about the symptoms, 98.0% its mode of transmission, all the respondents knew at least one method of its preventive measures and 87.0% knew about therapy with chloroquine and other drugs. There was however, poor knowledge of the new artemisinin-based combination therapy (10.6%) and the Roll Back Malaria Initiative (31.5%). In spite of the positive findings on the knowledge, the practice of preventive measures were poor with only 27.8% using door and window nettings, 0.8% using insecticide treated mosquito nets and 25.6% using insecticides. CONCLUSION: Despite the availability of extensive sources of health information, there is the need for appropriate health education to stimulate positive changes in both knowledge and practice of malaria control. In addition, the campaign to " Roll Back Malaria" requires intensification.

Artemisinin-based antimalarial combination therapy amongst healthcare professionals in a tertiary facility in south-south Nigeria: preferences, tolerability, and cost considerations

Background: Nigeria adopted the Artemisinin-Based Combination Therapy (ACT) as the mainstay of treating uncomplicated malaria in February 2005. However, the individual preferences for the use of these medicines by health care professionals (HCP) as distinct from their observed prescribing practices is largely unknown. This study determined the preferences, tolerability and cost of the ACTs among HCP in Benin-City. Methods: This descriptive cross-sectional study was conducted in the University of Benin Teaching Hospital, Benin-City, Nigeria. Consenting HCPs were recruited consecutively for the study. Semi structured questionnaires were administered to doctors, nurses and pharmacists in the hospital. Information obtained included demographics, treatment of malaria in the previous year, antimalarial medication preferences and tolerability as well as cost of ACT. Results: A total of 556 HCPs, 295 doctors (54.1%), nurses 200 (36.0%), pharmacists 61(11.0%) completed the questionnaire. In the previous year, 224 (75.9%) doctors, 153 (79.1%) nurses, and 48 (70.5%) pharmacists had treatment for malaria and self-medication was highest among doctors (228,77.3%). Artemether-Lumenfantrine was the most preferred antimalarial used, 294 (52.8%); however, 1.6% used chloroquine sulphate and ACTs were perceived to be ineffective by 25.4%. Adverse effects were experienced by 167 (29.1%) resulting in 50 (9.0%) discontinuing their medication. Between 500 and 1500 Naira (~US$1-4) was expended on ACT by 66.3% of the staff, while 21.4% were concerned about the high cost of medications. Conclusion: This study highlights the use and preferences, self-medication practices, perceived lack of effectiveness and high cost of ACTs from a HCP perspective. There is an urgent need to address these concerns in view of adverse consequences as well as the likely possibility of its the impact on prescribing practices.

The current use of the artemisinin-based combination therapies in adult patients at a tertiary hospital, South-South Nigeria

Objective:The antimalarial preferences, tolerability, and cost of the Artemisinin-based combination therapies (ACTs) among adult patients and caregivers are largely understudied despite being the recommendedtreatment for Plasmodium falciparum.We, therefore, evaluated antimalarial preferences, tolerability, and cost of the ACTs among adult patients attending the University of Benin Teaching Hospital, Nigeria. Methods:This was a cross-sectional study conducted among adult patients and their caregivers atthe University of Benin Teaching Hospital, Nigeria,using a semi-structured questionnaire. Their preferred antimalarial medication, previous use of antimalarial monotherapies, current ACT use; cost considerations, and adverse effects profile were sought.Result:Six hundred respondents were recruited with a mean age of 41.4±16.3years and M/F ratio of 1.4. The majority (88.0%), reported that they had between 1-5 episodes of malaria fever in a year. Only 28.2% received doctors' prescriptions while 85.8% purchased their antimalarial medications from a pharmacy. Sixty percent of the respondents used at least one ACT; mainly Artemether-Lumefantrine (AL) 312(52.0%). Only 9.3% reported previous adverse effects with the ACTs with 4.0% of respondents discontinuing their medications. The mean (SD) cost of purchasing ACTs was 1,516.47±760.3 (3.65 USD) Naira.Conclusion: This study showed adult patients' preference for the ACTs, especially Artemether-Lumefantrine despite some inclination towards antimalarial monotherapies and parenteral route. There was also a high rate of use of malaria presumptive treatment, but only a few reported adverse effects. There is a need to make ACTs affordable because the cost is still presently high for most Nigerians.

An open evaluation of the efficacy and safety of the new macrolide roxithromycin in the treatment of lower respiratory tract infections and pneumonia in Nigerian patients.

Roxithromycin, a new introduction into the macrolide class of antibiotics possesses favourable pharmacokinetic properties enabling a once daily dosing. This study evaluates its efficacy, safety and tolerability, previously demonstrated in Europe and North America, in Nigeria patients suffering from lower respiratory tract infections. 32 patients, aged 18-65 years with acute bronchitis/acute exacerbation of chronic bronchitis and pneumonia were administered roxithromycin 300 mg once daily. 25 patients (12 males, 13 females: aged 39.2 +/- 2.7 years) were evaluable for clinical efficacy at the end of the study. The mean duration of treatment was 6.9 +/- 0.5 days. 22 patients (88.0%) responded to therapy. Sputum culture was positive in 5 patients (20.0%): Streptococcus pneumonia and resistant Klebsiella pneumonia. Therapy was discontinued in 3 patients due to non-response. The two patients in whom Klebsiella were isolated did not show any significant clinical improvement. The third non responding patient developed empyema. Gram negative bacilli were identified in the pleural aspirate but no patients with resistant Streptococcus pneumonia improved clinically. Adverse effects were mild, transient and included nausea (4) and diarrhoea (1). The study suggests that roxithromycin is an effective and well tolerated antibacterial in the treatment of lower respiratory tract infection.

Chloroquine-induced Pruritus.

Chloroquine-induced pruritus remains one of the most common side-effects in the use of chloroquine in the prophylaxis and treatment of uncomplicated malaria before the advent of artemisinin-based combination therapies. It has been reported to vary from a tolerable to intolerable intensity among susceptible individuals resulting in disruption of treatment and development of resistance to the drug thus leading to therapeutic failures as reported. This scourge is quite challenging due to the complex physiologic mechanism that has not been fully elucidated. Factors observed to be responsible in the induction of pruritus such as age, race, heredity, density of parasitaemia; impurities in formulations, plasmodial specie, dosage form and metabolites have been discussed in this review. Efforts to ameliorate this burden have necessitated the use of drugs of diverse pharmacological classes such as antihistamines, corticosteroids and multivitamins either alone or as a combination. This review is to look into the use of chloroquine retrospectively, and consider its re-introduction due to its safety. Efficacy can be attained if the pruritic effect is resolved.

The pharmacokinetics and effects of prochlorperazine in elderly female volunteers.

The pharmacokinetics and effects of prochlorperazine (PCZ) have been studied in six healthy elderly female volunteers in a double-blind placebo-controlled study of 3.125 mg intravenous (IV) and 25 mg oral PCZ. The pharmacokinetics of IV PCZ in elderly subjects appear similar to those previously obtained in young subjects, with a terminal half-life of 7.5 +/- 1.8 h after intravenous dosing. Oral bioavailability was low (14.7 +/- 1.5%). The pharmacological actions of prochlorperazine in elderly people appear to include antidopaminergic (prolactin rise) and anticholinergic (reduced salivary flow) effects. At the dose of PCZ used in this study, no significant haemodynamic or psychomotor changes were observed though there was a trend to prolongation of the movement component of the reaction time.

Clinical pharmacology of prochlorperazine in healthy young males.

1. The pharmacokinetics and pharmacodynamics of prochlorperazine (PCZ) have been studied in healthy young males following single 12.5 mg i.v. and 50 mg oral doses, and during repeated doses (25 mg twice daily) for 14 days. 2. Oral bioavailability was low and an N-desmethyl metabolite was detected. Plasma clearance was high (0.98 1 kg-1 h) and the volume of distribution was large (12.9 1 kg-1) after i.v. dosing. 3. The terminal elimination half-life of PCZ was 9 +/- 1 h and 8 +/- 2 h after i.v. and single oral dosing, respectively. The urinary recoveries of drug and metabolite were low. 4. Accumulation of PCZ and its metabolite occurred following repeated dosing. The half-life at the end of 14 days therapy was 18 +/- 4 h. 5. Postural tachycardia, decreased salivary flow, impaired psychomotor function and a diminished level of arousal were observed after intravenous PCZ. Similar effects, but of lower magnitude were observed after single oral doses. During chronic dosing postural tachycardia and antihistaminic effects were observed, the latter not being observed after single doses. 6. After single intravenous dosing the maximal drug effects occurred 2-4 h after peak plasma drug concentrations for all measures except for plasma prolactin and self-scored restlessness 7. An antagonist action at dopamine (D2), muscarinic-cholinergic and alpha-adrenoceptors is postulated after single doses, with antihistaminic effects during chronic dosing, possibly indicating the presence of an active metabolite.

Drug use profile in a Nigerian city hospital.

The newly introduced WHO Drug Use Indicators enable the delineation of drug use patterns, identification of inappropriate use and evaluation of interventional strategies. This study highlights the drug use pattern in a city hospital and further identifies areas of inappropriate use that need to be addressed. Records of 614 patient encounters (January-December 1993) were obtained by systematic random sampling at the Central Hospital, Benin City. The WHO prescribing indicators were calculated and detailed review in various therapeutic categories was carried out. The average number of drugs per encounter was 3.7. The percentage of encounters with injection and antibiotics were 37.0% and 54.2% respectively. Forty-eight per cent of drugs were prescribed by generic name and 94.4% of all prescribed products were in the National Essential Drug List. Drugs were not prescribed in 2.8% of encounters. Of injections, 74.1% were for treatment of febrile illness, usually presumed to be malaria. Analgesics/antipyretics, mainly paracetamol, were prescribed in 72.3% of encounters. In 57.8% of encounters vitamin preparations were prescribed. Certain differences were observed between children and adults with children receiving more vitamins and antimalarials. These findings suggest some inappropriate use of drugs which may in turn reflect current practice throughout Nigeria. Proper case management of febrile illness is likely to promote more rational use of drugs.

Some studies on the rodenticidal action of indomethacin.

The oral LD50 of indomethacin for a seven-day observation was found to be 12.58 +/- 1.15 mg/kg. At LD10 of 6.61 mg/kg, a dose to weight ratio of 28 was obtained for a 240 g rat, while at a maximum single dose of 3 mg/kg in man it is only 0.04. Neither diazepam nor phenobarbital influenced death at the doses of both drugs used. However, cholestyramine 2 g/kg/day was found to protect by 50% from the LD100 of indomethacin. Gross pathological studies showed dose-dependent ulceration and perforation (P < 0.001, 12 vs 24 mg/kg) and such lesions occurred in starved rats, were low in bile duct-ligated compared to sham-operated rats (P < 0.001) and were also low in cholestyramine-treated rats. Indomethacin-induced lethality in rats was found to be dose-dependent.