PHA 406 Drug and Medical Supplies

Management II

Felix Khuluza & Lutz Heide

18. March – 29. April 2014
 The Drug Supply System
of the Refugee Health Unit, Somalia
How to establish a drug supply system?

1. Essential drug list

2. Rational use of medicines
 Malawi Standard Treatment Guidelines
& Malawi Essential Drug List (MEML)
4th Edition 2009

http://apps.who.int/medicinedocs/en/d/Js18801en/

WHO Model Formulary 2008

http://www.who.int/selection_medicines/list/en/
 Comparison MEML – WHO Model Formulary
  MELM Drug Category
Chavula Q. 1-2 Anaesthetics & Analgesics
Chimwaza C. 3-5 Antiallergics, Antidotes & Antiepileptics
Chinoko B. 6.1.-6 .2.2. Anthelmintics & Antibacterials
Chirambo E. 6.2.3.-6.3. Antileprosy, Antituberculosis and Antifungals
Kachingwe A. 6.4. Antiprotozoals
Kapelemera M. 6.5.-7 Antivirals & Antimigraine
Kunene A. 8-11 Antineoplastic, Antiparkinson & Blood
Maloni A. 12 Cardiovascular
Molande D. 13 Dermatological
Muhamba Y. 15-17 Disinfectants, Diuretics & Gastroinstetinal
Muyakha M. 18 Hormones
Mwamasmali L. 19 Immunologicals
Njere D. 20-21 Muscle relaxants & Ophthalologicals
Patel M. 22-23 Obstetrics & Dialysis
Supedi C. 24 & 25 Psychotherapeutics & Respiratory System
Yakobe T. 26 Replacement fluids & Vitamins
Zomba L. 28 Eear & Gout & Laxatives
 Comparison MEML – WHO Model Formulary
MELM Malawi, 2009   WHO Model  
Formulary,
2008
1. Anaesthetics
1.1 General anaesthetics
Halothane inhalation DVA same  
Ketamine HCI inj, 50 mg/mL, DVA same  
10 ml amp
Thiopentone sodium injection, DVA same  
0.5 g vial PFR (“thiopental”)
Ether, anaesthetic inhalation DVA -  
Nitrous oxide medical gas CEB same  
-   Oxygen  
 Comparison MEML – WHO Model Formulary
MALAWI MEML WHO Model Formulary
2.1 Non‐opioid analgesics, antipyretics
Aspirin tablet, 300 mg HVA Same (100-500 mg, and 50-150  
mg suppositories)
Paracetamol tablet, 500 mg DVA Same (100-500 mg tbl, 100 mg  
supp., 125 mg/5ml oral liquid)
Diclofenac sodium tablet, 25 mg DEA -  
Ibuprofen tablet, 200 mg DEA Same (200 and 400 mg tbl)  
Indomethacin tablet, 25 mg DEA -  
Mefenamic acid capsule, 250mg DVA -  
Comparison MEML – WHO Model Formulary
2.2 Opioid analgesics and antagonists WHO:
Morphine sulphate inj, 15 mg/ml, DVA Same, but 10 mg/ml
1 ml amp
Pethidine HCI inj, 50 mg.mL, DVA -
2 ml amp
Codeine phosphate tablet, 15 mg DEA Same, but 30 mg
Dihydrocodeine tartrate tablet, DEA -
30 mg
Naloxone HCI injection, neonatal, DEA Same under antidotes,
but 400 micrograms/ml, 1 ml amp.
20 micrograms/ml, 2 mL amp
Morphine sulphate tablet, slow‐ DVB Same
release, 10 mg
Morphine sulphate solution, DVA Same, but 10 mg/5 ml
5mg/5ml, PFR
Tramadol capsule, 50mg DEB -
     
 Comparison MEML – WHO Model Formulary
6.2.1. Penicillins and cephalosporins WHO
Benzathine benzylpenicillin injection, 1.44 g vial HVA same  
(=2.4 MU) PFR
Benzylpenicillin inj, 4 g vial PFR (=5 MU) HVA Same, but 600 mg  
Phenoxymethypenicillin tablet, 250 mg HVA Same, plus oral liquid  
Amoxycillin capsule, 250 mg DVA Same, plus 500 mg  
Amoxycillin elixir, 125 mg/5 mL DVA same  
Amoxicillin + clavulanic acid tablet, 500 + 125mg CEA same  
Ampicillin sodium inj, 250 mg vial PFR DVA same  
Flucloxacillin capsule, 250 mg DVA -  
Flucloxacillin elixir, 125 mg/5 mL DVA -  
Flucloxacillin inj, 250 mg vial PFR DVA -  
Cefotaxime inj, 500 mg PFR DVA -  
Cephalexin capsule, 250 mg DVA -  
    Cefixime cps. 400 mg  
    Ceftazidime inj. 250 mg  
Cloxacillin capsule, 250mg DEA Same, but 500 mg, 1 g plus inj. and oral liquid  
Ceftriaxone inj, 1g PFR DVA Same, plus 200 mg.  
    Cefazoline inj. 1 g  
Procaine penicillin injection, 4.8 MU vial CVB Same, but 1 mio and 2 mio units  
    Imipinem + cilastatin 250 mg/250 mg inj.; 500 mg/500  
mg inj.
 Comparison MEML – WHO Model Formulary
6.2.2 Other antibacterials WHO
Chloramphenicol sodium succinate injection, 1 g vial PFR HVA Same plus oily susp.,  
Co‐trimoxazole tablet, 480 mg HVA Same, plus oral liq. and inj.
 
(Sulphamethoxazole + Trimethoprim) (400 mg + 80 mg)
Doxycline tablet, 100 mg HVA same  
Erythromycin tablet, e/c, 250 mg base HVA Same, plus inj.  
Gentamicin injection, 40 mg HVA Same
 
(as sulphate) mL, 2 mL vial
Metronidazole tablet, 200 mg HVA Same,  
Chloramphenical capsule, 250 mg   Same  
Erythromycin ethyl succinate susp, 125 mg/5 mL (of erythromycin base) DVA same  
Metronidazole inj, 5 mg/mL, 100 mL vial (for i/v infusion) DVA same  
Metronidazole suspension, 200 mg/5 mL DVA same  
Nalidixic acid tablet, 500 mg DVA    
Chloramphenicol suspension, 125 mg/5 mL DEA same  
Gentamicin paediatric injection, 10 mg (as sulphate)/mL, 2 mL vial DEA same  
Nitrofurantoin tablet, 50 mg DEA same  
Ciprofloxacin tablet, 250 mg CVB same  
Nitrofurantoin suspension, 25 mg/5 mL CVB -  
Sodium fusidate tablet, 250 mg CVB  -  
Azithromycin capsule, 250mg CEA Same, plus 500 mg and oral liquid  
    Clindamycin 150 mg cps, and inj.  
    Spectinomycin inj. 2 g  
    Sulfadiazine 500 mg tbl and 250 mg
inj.  
    Trimethoprim 100 mg; 200 mg tbl  
    Vancomycin 250 mg inj.  
An Essential Drug List
 An
Essential Drug
Formulary:
medicine-
centered
(WHO Model Formulary 2009)
A Stardard Treatment Guideline: disease-centered
(Malawi Standard Treatment Guidelines 2009)
Drug Prices

http://erc.msh.org/dmpguide/
pdf/DrugPriceGuide_2012_en.pdf
Price of one tablet amoxicillin-clavulanic acid 875mg/125 mg
(generic drug)

= 0.19-0.31 US $ per tbl.

Drug List
By
German
Pharmaceutical
Industry
Price of one tablet amoxicillin-clavulanic acid 875mg/125 mg
(proprietary drug, brand name =Augmentan®)

= 94.88 € / 20 tbl = 4.74 €/tbl

= 6.28 US $ per tbl