Background: Prophylactic venous thromboembolism (VTE) strategies have the greatest impact on patient outcomes. Both global and local guidelines support VTE prophylaxis for hospitalised patients. However, studies have reported that these measures are routinely under-prescribed. This study evaluated prescribing patterns of VTE prophylaxis in one of the largest South African (SA) private hospital groups.Methods: A quantitative, retrospective analysis of the hospital group’s patient database was conducted for patients admitted between 01 September 2015 and 31 August 2016. Those younger than 18 years with trauma or suffering from contraindications to anticoagulation were excluded. Additionally, patients with warfarin billed were also excluded as they possibly required therapeutic anticoagulation. Included prophylactic measures were compared with published SA guidelines by abstracting prophylaxis type and dosing, according to corresponding individual patients’ VTE risk ratings.Results: Amongst the 373 020 patients included as the study population, 77% required prophylaxis. Of these, 38.36% (n = 85 486) received guideline-appropriate prophylactic measures during their hospital stay. Patients in whom prophylaxis was indicated, only 24.56% (n = 42 715) complied with the SA guidelines. The most commonly used prophylactic measures were enoxaparin (89.09%) and fondaparinux (2.68%). Prophylactic measures differed per speciality, with the most compliant amongst intensivists. A low uptake of the risk assessment model use (n = 222 860, 59.75%) was, however, reported for this data set.Conclusion: Less than 24.56% of patients who required prophylaxis received guideline-appropriate interventions. Further studies should focus on understanding differences in practice and improving acceptance and application of guideline-driven care.

The use of papaver somniferum (from the Latin fero ferre = 'to bear/bring' and somnium = 'sleep') as a narcotic, goes back to the 13 th century BC. The works of ancient authors such as Dioscorides, Celsus, Galen, Theophrastus and Pliny the Elder provide us with detailed information about the morphology of the plant, its processing and the administration of the drug. 1 These authors make it clear that opium was mainly employed as anodyne and narcotic but they also documented its use as a drug in the treatment of a variety of ailments, either as one of many ingredients in a medicinal recipe or as the main ingredient. Modern botanical and pharmaceutical analysis of the plant and its active ingredients provide us with some surprising conclusions regarding its effectiveness in the treatment of the medical conditions for which it was prescribed in the 1 st and 2 nd century. The early history of poppyA 775 mm high statuette (Fig. 1) of a Minoan (13 th century BC) goddess with uplifted hands probably provides us with the oldest ancient evidence for poppy and opium. It is known as 'The Poppy Goddess' because it bears on the head three movable pins in the likeness of heads of the sleep-inducing poppy (Kerényi 1976:24; Sakellarakis, 1987:91). It can be seen in the Museum at Herakleion. Greek archaeologists have concluded that:1. The vertical notches in the capsules are more deeply coloured, and relate to the extraction of the juice.2. The Minoan goddess appears to have her eyes closed as though asleep. 1References to the information supplied by these sources will be found throughout this article.2

Background: Little is known about longitudinal prescribing practices for anti-epileptic drugs (AEDs) in South Africa. The prescribing patterns and associated direct medicine costs of AEDs in the private health sector were investigated, using claims data from January 1, 2008 to December 31, 2013. Methods: The annual prevalence of prescriptions, AEDs and AED generics per patient with epilepsy (ICD-10 code G40) was determined. Cost analyses conducted included the calculation of the total direct cost of AEDs (medical scheme contribution, patient co-payment, and single exit price (SEP)), and the average cost per AED per year. Results: Prevalence of patients claiming anti-epileptics ranged between 0.87% and 0.91% from 2008 to 2013. AED prescriptions/ patient ranged from 11.76 (95% CI, 11.56-11.95)] in 2008 to 11.90 (95% CI, 11.71-12.09) in 2013. Patients aged 40-65 years had the highest number of AED prescriptions/year. Valproate was most prescribed, followed by lamotrigine and carbamazepine. Average cost per AED increased from R237.12 (95% CI, 233.58-240.65) in 2008 to R522.32 (95% CI, 515.24-529.41) in 2013, while the average patient co-payments increased from R27.76 (95% CI, 26.63-28.89) to R264.32 (95% CI, 260.61-268.03). Prescribing of generics increased by 12.84%. Conclusions: Generic prescribing increased over time; however, patient co-payments increased dramatically.

ObjectiveTo determine the adherence status to antiepileptic drugs (AEDs) among epilepsy patients; to observe the association between adherence status and age, sex, active ingredient prescribed, treatment period, and number of comorbidities; and to determine the effect of nonadherence on direct medicine treatment cost of AEDs.MethodsA retrospective study analyzing medicine claims data obtained from a South African pharmaceutical benefit management company was performed. Patients of all ages (N=19,168), who received more than one prescription for an AED, were observed from 2008 to 2013. The modified medicine possession ratio (MPRm) was used as proxy to determine the adherence status to AED treatment. The MPRm was considered acceptable (adherent) if the calculated value was ≥80%, but ≤110%, whereas an MPRm of <80% (unacceptably low) or >110% (unacceptably high) was considered nonadherent. Direct medicine treatment cost was calculated by summing the medical scheme contribution and patient co-payment associated with each AED prescription.ResultsOnly 55% of AEDs prescribed to 19,168 patients during the study period had an acceptable MPRm. MPRm categories depended on the treatment period (P>0.0001; Cramer’s V=0.208) but were independent of sex (P<0.182; Cramer’s V=0.009). Age group (P<0.0001; Cramer’s V=0.067), active ingredient (P<0.0001; Cramer’s V=0.071), and number of comor-bidities (P<0.0001; Cramer’s V=0.050) were statistically but not practically significantly associated with MPRm categories. AEDs with an unacceptably high MPRm contributed to 3.74% (US$736,376.23) of the total direct cost of all AEDs included in the study, whereas those with an unacceptably low MPRm amounted to US$3,227,894.85 (16.38%).ConclusionNonadherence to antiepileptic treatment is a major problem, encompassing ~20% of cost in our study. Adherence, however, is likely to improve with the treatment period. Further research is needed to determine the factors influencing epileptic patients’ prescription refill adherence.

Background: The World Health Organization (WHO) classified antibiotics into three categories in 2017 – Access, Watch and Reserve (AWaRe) – intending to reduce the consumption of Watch and Reserve antibiotics while increasing the use of Access antibiotics. Antibiotic consumption by AWaRe in South Africa is undetermined because of data and research scarcity.Objectives: The aim of this study was to quantify, describe and track antibiotic consumption between 2014 and 2018 in the public sector of the Limpopo province, South Africa, using the WHO’s AWaRe classification for 2021.Method: Antibiotic consumption was quantified from pharmaceutical sales data for 2014–2018 by defined daily dose (DDD) per 1000 inhabitants per day (DID) and described according to the AWaRe classification. The change in antibiotic consumption was measured by compound annual growth rate (CAGR), Access-to-Watch index (AW-I), 75% drug utilisation index (DU75%) and amoxicillin index (AI).Results: The absolute consumption of Access antibiotics decreased by a 4.0% CAGR from 3.7 DID in 2014 to 3.0 DID in 2018, with relative consumption remaining above 80.0%. Relative consumption of Watch antibiotics increased by 15.8% CAGR from 7.8% in 2014 to 19.7% by 2018. The AW-I decreased from 10.4 in 2015 to 4.1 in 2018. The AI increased from 17.8% in 2015 to 42.0% in 2018. Parenteral formulations’ DU75% comprised one Watch (ceftriaxone) and two Access (metronidazole and benzylpenicillin) antibiotics.Conclusion: In Limpopo province’s public sector, the consumption of Watch antibiotics increased, while Access antibiotics consumption decreased, as reflected by both relative consumption and the decrease in the AW-I. The determinants of the Watch antibiotics increase require research attention.Contribution: Our study addressed the paucity of surveillance and research data on antibiotic consumption in the Limpopo province, South Africa, according to the WHO AWaRe classification.