|Essential Drugs - Practical Guidelines (Médecins Sans Frontières)|
This guide is not a pharmacological dictionary, it is a practical manual. It is meant for health professionals, physicians, nurses, pharmacists and health auxiliaries whether they are working in curative care, or the use and management of drugs and medical equipment.
We have tried to answer as simply as possible the problems and questions that confront health staff with solutions practiced and tested on the field by Médecins Sans Frontières. We have taken into account the recommendations of reference organisations such as the World Health Organization (WHO) and the advice of specialized publications (see bibliography page 255).
Some of the medicines listed are not on the essential drug list of the WHO, but are still frequently used in certain countries and, although their use is sometimes not advised, we have chosen to include them in this guide.
The level of information on the drug sheets is adapted to the level of training of the health worker:
- the sheets marked "Health post" give simple information for
community health workers;
- the sheets marked "Health clinic" and "District hospital" are more detailed and are meant for qualified auxiliaries, nurses and doctors.;
- the sheets marked "Special department"are included for specialized health services (obstetrics, surgery, anaesthesia) and for programmes for the major endemic diseases (tuberculosis, leprosy, trypanosomiasis...).
Obviously the level of health care training and health workers varies from country to country.
The drug sheets are classified in terms of administration, and within each class, in alphabetical order. This classification is an integral part of the whole proposed drug management system (see chapter "Organization and management of a pharmacy", page 179).
Only the main side-effects, contra-indications and precautions are mentioned in this book. For more complete information, we refer to specialized literature.
We would like those who use this book to send us their comments and criticisms so that it remains adapted to the realities of the field.
Please send to:
Médecins sans Frontières - Service médical
8 rue Saint-Sabin - 75544 Paris Cedex 11 - FRANCE
Tel. (33) 1- 22.214.171.124 - Fax (33) 1- 48.06.68.68 - Tlx 214360 MSF F
GENERAL RECOMMENDATIONS FOR THE PRESCRIPTION OF DRUGS
(see also "Prescription, cost, compliance", page 199)
When patients are hospitalized, the administration of drugs is controlled, so in general they are used well.
With prescriptions for out-patients, however, it is important to adopt certain rules to encourage proper use of the prescribed treatments:
1° Limit the number of drugs prescribed at any one time:
2° Limit the duration of treatment (should be maximum five days).
Whenever possible, the patient should preferably take his/her medication daily in the health clinic.
3° Give the patient all the necessary information or' how to
take the treatment:
- how (preparation on an oral rehydration salt solution...).
Dispensing staff must be trained to do this and the drugs should be labelled with adequate instructions.
Use of the guide
Three easy ways to find information:
- A summary in the beginning of the guide lists the chapters and their corresponding pages.
- Two indexes of essential drugs in the final pages:
· a pharmaco-therapeutical index with the international generic names, integrated in the essential drug list of the WHO,
· an alphabetical index with double entry with international generic and commercial names.
Every sheet has a table showing an average dose by weight and age. The dosage is given in the unit of the drug (tablet, ampoule...).
With malnourished patients one has to bear in mind the weight and adapt the dose of the prescription accordingly in mg/kg.
Designation of drugs
The international nonproprietary names (INN) classification is used in this guide. Some frequently used commercial names, followed by the symbol (R), are given.
E.g.: ampicillin (Amfipen(R), Penbritin(R)
Drugs on sheets marked with a grey diagonal line are:
- either potentially dangerous and forbidden in certain countries;
- or obsolete, ineffective or capable to produce resistant bacterial strains.
These drugs are still widely used, therefore we draw attention to the risk and unnecessary cost of the prescription.
Health post - Community health worker level
Health clinic - Nurse and auxiliary staff level
District hospital - Doctor and medical assistant level
Special department - For the major endemic diseases or in specialised services (surgery, obstetrics, anaesthesia)
PRESCRIPTIONS AND FOLLOW-UP OF TREATMENT MUST BE UNDER MEDICAL SUPERVISION
This box is found on certain sheets at District hospital level to show that the nurse or medical assistant working at the hospital will not be authorized to prescribe this drug in absence of a doctor.
kg = kilogram
g = gram
mg = milligram (1 g = 1,000 mg)
IU = international unit
ml = millilitre (1 cc = 1ml)
tsp= teaspoon (=5ml)
Route of drug administration
P.O. = per os - orally
IM = intramuscular
IV = intravenous
SC = subcutaneous
tab = tablet
vl = vial
amp = ampoule
susp = suspension
x ... d = during ... days
Example: 300 mg/d divided in 3 doses x 5 d
(three hundred milligrams per day to be divided in three doses of one hundred milligrams to be taken during five days)