Antimicrobial self medication in patients attending a sexually transmitted diseases clinic.

One of the health education messages given in sexually transmitted disease (STD) control is patients' adopting appropriate health seeking behaviour. This includes reporting to health facilities for appropriate diagnosis and treatment. In parts of the world where STD aetiologic agents have assumed resistance to commonly used antimicrobials, this is important. The antimicrobial self medication practices of 764 patients attending an STD clinic in a developing country were studied. Seventy-four and a half per cent admitted to self medication before reporting to the clinic. The antibiotics taken in inappropriate dosages were purchased over the counter, given by friends or were 'left-overs' from previous medications. In the fight to control STD spread as a means of reducing the incidence of HIV/AIDS, indiscriminate use of antimicrobials needs to be guarded against.

PIP: Self-medication with antibiotics is especially widespread in developing countries where such medications are sold over the counter by both trained pharmacists and untrained personnel. The present study investigated patterns of antibiotic intake by 764 consecutive men and women 15-65 years of age with sexually transmitted disease (STD) symptoms prior to their presentation at the STD/AIDS Clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. 272 of the 384 male patients had a urethral discharge and 314 of the 380 female patients had a vaginal discharge. A total of 569 patients (74.5%) had self-medicated with 1-3 antimicrobials. There were no significant differences in antimicrobial intake between men and women or based on symptomatology. The most commonly used antimicrobials were penicillin (82%), septrin (73%), and tetracycline (70%). In all cases, the antimicrobials had been used in incorrect dosages. Drug sources included over-the-counter purchases (68.2%), leftover medications for unrelated conditions (15.8%), and friends or relatives (9.6%). This pattern of widespread, indiscriminate self-medication has contributed to antibiotic resistance and makes patients susceptible to complicated STDs, including HIV. Patients must be counseled on appropriate health-seeking behaviors and stricter controls need to be placed on the sale of antimicrobials.

HIV antibody testing in a teaching hospital: policy versus practice.

The cost of HIV antibody testing can be phenomenal. Thus many countries, Ghana included, have adopted policies to guide physicians in making judicious test requests. An analysis of compliance with this policy in a teaching hospital in Ghana, shows that 70% of physician requests meet the stated Ministry of Health guidelines. However, while 84.5% of all test requests which turned positive were within stated guidelines, 48.6% of those turning out negative were not indicated by the policy. The cost of HIV antibody testing could be minimised if clinicians operated within the stated guidelines which make considerations for judicious use of health resources. Compliance with policy also needs evaluating.

The potential effect on Neisseria gonorrhoeae of the use of clindamycin vaginal cream in the empirical treatment of vaginal discharge.

The minimum inhibitory concentrations (MIC) of clindamycin for 62 consecutive isolates of Neisseria gonorrhoeae were found to be 0.03-4 mg/L; the MIC50 and MIC90 were 0.125 and 2.0 mg/L respectively. Seven women treated with clindamycin vaginal cream had cervical mucus samples taken after seven days treatment. The concentrations of clindamycin achieved in the cervical mucus were 30-150 times higher (141-337 mg/L) than the highest MIC of the 62 N. gonorrhoeae isolates. Clindamycin vaginal cream is being used increasingly in Genitourinary Medicine clinics and General Practice for the treatment of bacterial vaginosis. This study shows that clindamycin vaginal cream achieves intra cervical concentrations that are high enough to inhibit N. gonorrhoeae. Empirical use of this therapy should be preceded by urethral and cervical swabs for N. gonorrhoeae in any woman at risk of gonorrhoeae.