Odermatt Peter, Ly Sowath, Simmala Chansimmaly, Angerth Tomas, Phongsamouth Vonphrachane, Mac Tu Luong, Ratsimbazafy Voa, Gaulier Jean-Michel, Strobel Michel, Preux Pierre-Marie
Institut de la francophonie pour la médecine tropicale, Vientiane, Lao PDR.
Neuroepidemiology. 2007;28(3):169-74. doi: 10.1159/000103270. Epub 2007 May 29.
In developing countries, availability and quality of drugs are critical factors for effective management and control of epilepsy. This study investigated the availability and costs of antiepileptic drugs (AEDs), and the quality of phenobarbital in Vientiane Municipality, Lao PDR.
In March 2004, we enrolled all pharmacies (categories I and II) of four central districts of Vientiane eligible to sell AEDs. Two hundred and eight pharmacies of category III (75.1% of all registered pharmacies) were excluded as the sale of AEDs was not authorized. All pharmacists were interviewed with a standard questionnaire. Whenever phenobarbital was available, a sample was purchased and assayed by liquid chromatography. Phenobarbital was defined as being of correct quality if the active substance average content corresponded to +/-15% of the indicated amount.
66 pharmacies were enrolled (13 and 45 of categories I and II, respectively, and 8 hospital pharmacies). Six generics of AEDs were found (phenobarbital, phenytoin, valproic acid, clonazepam, carbamazepine, diazepam) and all pharmacies sold at least 1 AED. The 2 most widely available drugs were diazepam (5 mg) and phenobarbital (100 mg), present in 87.9 and 53.0% of the pharmacies, respectively. All 34 phenobarbital samples examined showed a correct concentration of the active compound. However, the concentration of phenobarbital 100 mg tablets produced in Lao PDR (mean concentration 94.7 mg) was significantly lower (p = 0.005) than the imported equivalent (mean concentration 99.7 mg). The direct drug costs of a yearly treatment with phenobarbital were estimated to be at least 25.2 USD.
A variety of AEDs are present. Their availability, particularly of phenobarbital, is restricted to higher-category pharmacies and within those it is rather limited. To meet the costs of AEDs in this setting is a major challenge for people with epilepsy. However, the quality of the available phenobarbital was rather satisfactory.
在发展中国家，药品的可获得性和质量是有效管理和控制癫痫的关键因素。本研究调查了老挝万象市抗癫痫药物（AEDs）的可获得性、成本以及苯巴比妥的质量。
2004年3月，我们纳入了万象四个中心区所有有资格销售AEDs的药店（一类和二类）。排除了208家三类药店（占所有注册药店的75.1%），因为它们未获授权销售AEDs。所有药剂师都接受了标准问卷访谈。只要有苯巴比妥，就购买一份样品并用液相色谱法进行检测。如果活性物质平均含量与标示量的±15%相符，则苯巴比妥被定义为质量合格。
共纳入66家药店（一类13家，二类45家，8家医院药房）。发现了6种AEDs通用名药物（苯巴比妥、苯妥英、丙戊酸、氯硝西泮、卡马西平、地西泮），所有药店至少销售1种AED。两种最普遍可得的药物是地西泮（5毫克）和苯巴比妥（100毫克），分别有87.9%和53.0%的药店有售。所检测的34份苯巴比妥样品的活性化合物浓度均合格。然而，老挝生产的100毫克苯巴比妥片剂的浓度（平均浓度94.7毫克）显著低于进口同类产品（平均浓度99.7毫克）（p = 0.005）。用苯巴比妥进行一年治疗的直接药物成本估计至少为25.2美元。
有多种AEDs可供使用。它们的可获得性，尤其是苯巴比妥，仅限于较高等级的药店，而且在这些药店中供应也相当有限。在这种情况下，癫痫患者承担AEDs的费用是一项重大挑战。然而，现有苯巴比妥的质量相当令人满意。
