Transcript Antimicrobial resistance

Promoting the use of oxytocin
for the prevention of PPH
Hans V. Hogerzeil, MD, PhD, FRCP Edin
Director, Medicines Policy and Standards
World Health Organization
Summary of stability studies 1988-1996
Hogerzeil HV, Walker GJA. Instability of (methyl)ergometrinein tropical climates: an overview. Eur J
Obs Gyn Reprod Biol 1996; 69: 25-29

Ergometrine injection is very unstable, sensitive to light, with
much variation between brands

2
Recommended solutions: careful supplier selection; refrigerated
storage; protect from light; check colour; do not use discoloured
products

Methylergometrine is not more stable per se; some products are

Oxytocin injection is more stable than (methyl)ergometrine, and
not sensitive to light. But oral oxytocin is even less stable than
(methyl)ergometrine injection

Better stability and lower cost support clinical arguments that
oxytocin is the drug of choice for AMTSL/prevention of PPH
Medicines Policy and Standards
Summary of new information since 1996

There is a more stable methylergometrine injection (1 year at
25°, and 6 months at 30°) – but one brand only (IDA)

Oxytocin brands are consistent in stability (IDA)

Heat-stable oxytocin has been recognized by WHO as a
"missing essential medicine", inviting product development
(Priority medicines – a public health approach to innovation. WHO, 2004)
3

Oxytocin has been included in set of "WHO policy advice",
summarizing RH clinical evidence for national programmes

Oxytocin has been listed for inclusion in the WHO/UN
prequalification project in 2006 (pending funding)
Medicines Policy and Standards
What is the problem?

Oxytocin is recommended drug of choice for AMTSL/PPPH;
yet it is insufficiently been used at country level








4
No AMTSL done at all
Ergometrine or misoprostol used instead
Oxytocin not recommended in national guidelines
Oxytocin listed but not supplied
Oxytocin supplied but wrongly stored;
Oxytocin use by some clinicians but not by all, not by SBAs
Other non-compliance with clinical AMTSL procedures
There is much difference between countries; this implies the
need for individual country approaches
Medicines Policy and Standards
Use clinical arguments, not stability data,
to change behaviour
5

(Re)formulate WHO clinical guidance on AMTSL; involve and get
support from important professional associations; present
counterarguments to common objections; adapt / strengthen
WHO policy guidance for national programmes

Get oxytocin included in national clinical guidelines and training
programmes, and on national essential medicines lists; use
Human Rights arguments (right to health, right to life)

Advocate procurement of prequalified oxytocin only

Develop individual country programmes to change behaviour:
(1) survey / analyse situation, (2) identify reasons, (3) develop
intervention with national opinion leaders, (4) monitor effect with
self-monitoring systems (5) report good impact
Medicines Policy and Standards
Saving lives
with the right (to) medicines
www.who.int / medicines
6
Medicines Policy and Standards