Antibiotic Stewardship: Twenty Years in the Making (2)

3 February, 2019

Dear Neil and friends, I was told that Germany has imposed to doctors the obligation of writing diagnosis and relative therapy on their prescriptions.

I was told...I say, HIFA could/should verify it.

I'd like to see this rule enforced in Italy (my country of birth) and in Tanzania (my country of adoption).

In fact the all issue of prescribinģ-too-much worldwide could be solved (or at least mitigated) by the political move: doctors must write down (ideally IN the health booklet of the patient) their suspected- diagnose plus laboratory tests. Treatments must follow the National Clinical-Therapeutic Guidelines (NCTG) and be adherent to the diagnose.

I speculate that in Germany the request to doctors of writing the diagnose has been complemented by the facts that:

1) the diagnose must be one of those described in the NCTG, and not one of fantasy or fashion.

2) the lab tests and treatment must be precisely those in NCTG for that diagnose and not otherwise

3) in case of not adherence by doctors it is possible that drugs wont be delivered by the pharmacist or wont be refunded by the system.

From long I do believe that better prescription, accurate-scientific prescription is a political issue, that requires obvious mechanism of rules & regulations. We doctors misused/abused the antibiotics, ceftriaxone has become first choice drug, prescribed on the streets.

Indeed privatization of health services aggravated this practice.

NBF [BNF] distributed, even million of them will not change the situation, and they will make us doctors to prescribe more.

I'd like to have the opinion of Joseph Ana.

Are doctors in Nigeria obliged to write down the diagnose? Do they adopt the personal health booklet?

If not why?

If yes, do they prescribe a treatment by following the NCTG? Or otherwise?

Thanks and greetings from Dodoma

Massimo

HIFA profile: Massimo Serventi is a long-standing Pediatrician working in Africa since 1982. He currently works on a volunteer basis in an excellent missionary/credited hospital in north Uganda, St. Mary's Hospital-Lacor-GULU. He has worked for several NGOs in 6 African/2 Asian countries. His interests include clinical and community pediatrics, adherence to clinical guidelines and school education as the major determinant of good health. massimoser20 AT gmail.com