Drug use evaluation of cotrimoxazole prophylaxis in people living with human immunodeficiency virus/acquired immune deficiency syndrome at Jimma University Specialized Hospital, Jimma, South West of Ethiopia, 2013

Amsalu Degu Defersha, Belayneh Kefale Gelaw, Gobezie Temesgen Tegegne

Abstract


Background: Drug use evaluation is a performance improvement method that focuses on evaluation and improvement of drug use processes to advice optimal patient outcomes. Pneumocystis carinii pneumonia (PCP) is the most common acquired immune deficiency syndrome (AIDS) defining illness. Antibiotics being the most commonly prescribed group of drugs the problem of its overuse are a global phenomenon. Cotrimoxazole (CTX) preventive therapy (CPT) was shown effectively prevents PCP in patients with clinical evidence of immune suppression. CTX has been widely used as a treatment for common infections in many resource limited areas and as a result, CTX resistance among these pathogens has increased dramatically. In response to these problems, this study aims to evaluate the use CTX prophylaxis for opportunistic infections in human immunodeficiency virus (HIV) patients at Jimma University Specialized Hospital (JUSH).

Methods: The study was done with retrospective cross-sectional review of medical records of HIV patients who have been on CTX prophylaxis in the hospital during September 11, 2012-September 10, 2013. To maintain the validity of data, the whole 135 patient cards were included in the study within the specified period. Data were collected from January 16, 2013 to February 15, 2013 using structured data collection format.

Results: From the study subjects, 82 (60.74%) were females 85.93% of patients were used appropriate dose of CPT and 13.3% patients use CTX against contraindication. Regarding to adverse drug reactions (ADRs), 3.7% of patients were developed rash while 2.2% cases were developed nausea during the follow-up period of CPT. However, only 5.9% patients have documented information about ADR of CPT. On the top of this, CD4 count and hemoglobin test were done for 82.96%, 64.4% patients respectively during initiation of CPT. However, renal function tests were performed only for 2.96% of patients while initiating CPT.

Conclusion: The use of CPT for people living with HIV/AIDS was found to be good in JUSH with regard to initiation and dosage. However, the practice of discontinuation of CTX, documentation of ADRs and follow-up for adverse effects of CTX should be improved by proper implementation and adhering to the national guideline of CPT.


Keywords


Cotrimoxazole, HIV/AIDS, Jimma, Ethiopia, Prophylaxis

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References


Moore T, Bykov A, Savelli T, Zagorski A. Guidelines for Implementing Drug Utilization Review Programs in Hospitals. Arlington: Management Sciences for Health; 1997.

Phillips MS, Gayman JE, Todd MW. ASHP guidelines on medication-use evaluation. American Society of Healthsystem Pharmacists. Am J Health Syst Pharm 1996;53:1953-5.

Gunten G, Troillet N, Beney J, Boubaker K, Luthi JC, Taffé P, et al. Impact of an interdisciplinary strategy on antibiotic use: a prospective controlled study in three hospitals. J Antimicrob Chemother. 2005;55:362-6. [DOI via Crossref]

Vilar F, Khoo S, TWalley T. The management of Pneumocystis carinii pneumonia. Br J Clin Pharmacol. 1999;47(6):605-9. [DOI via Crossref]

MOH. Guidelines for Use of Antiretroviral Drugs in Ethiopia, Federal Ministry of Health, Addis Ababa, 2005. Addis Ababa: Ministry of Health; 2005.

Robert N. Drug utilization review strategies. In: Managed Care Pharmacy Practice. Alexandria: Academy of Managed Care Pharmacy; 2008: 215-29.

Kubacka R. A primer on drug use evaluation. J Am Pharm Assoc. 1996;NS36(4):257-61, 279.

Stanley SW. Concepts in Drug Utilization Reviews. Washington: Washington State University; 1999.

Khalid A. Evaluation of drug utilization and prescribing errors in infants a primary care prescription based study. Middle East J Health Policy. 2007;81(2-3):350-7.

Deresse D, Alemayehu T. Evaluation of the use of cotrimoxazole prophylaxis in people living with HIV/AIDS in Hawassa referral hospital: a retrospective evaluation. Asian J Med Sci. 2009;1(3):88-90.

Zachriah R, Spielmann MP, Harries AD, Gomani P, Bakali E. Cotrimoxazole prophylaxis in HIV infected individuals after completing anti-tuberclusis treatment in Thyolo, Malawi. Int J Tuberc Dis. 2002;6(12):1046-50.

MOH. Guideline for Cotrimoxazole Prophylaxis in HIVl AIDS Care Treatment. Addis Ababa: Federal Ministry of Health; 2006.