Dramé B S I, Dabo M, Diani N, Cissé B
CHU Hôpital du Mali, Missabougou, Bamako, Mali.
Bull Soc Pathol Exot. 2012 Aug;105(3):179-83. doi: 10.1007/s13149-012-0239-8. Epub 2012 Jun 16.
The aim of this study is to describe the difficulties related to problems of supply and use of antivenom serum (SAV) in the district of Bamako. A retrospective study over a span of five years (January 1998-December 2002) and an interview with the staff of various facilities were conducted. The study included 2 wholesalers of pharmaceuticals, 20 private pharmacies, and 2 hospital pharmacies as they were involved in antivenom trades. A market-driving ability survey of driving practice was conducted in 37 community health centers (CHCs) and 4 dispensaries because they performed antivenom treatments during the study period. A total of 3,318 doses of antivenom were bought, including 84.4% by the People Pharmacy of Mali (PPM), a public organization, and 15.6% by Laborex, a private company. These were out of stock in 1999. Three kinds of SAV were ordered: the polyvalent IPSER Africa (1,200 vials or 36.2%), FAV Africa (318 vials or 9.6%), and Sii anti-snake venom polyvalent serum (1,800 vials or 54.2%). Orders from PPM involved IPSER Africa (Pasteur Mérieux Serum & Vaccines) and Sii anti-snake venom polyvalent serum (Serum Institute of India), and those from Laborex involved IPSER Africa and FAVAfrica (Aventis Pasteur). Onehalf of private pharmacies (54.3%) had made at least one order of SAV. The PPM lost 50% of 2,000 vials of SAV in 1996 due to the expiration of vials that were bought. Private pharmacies lost 3.6% of stocks due to expiration. Prices varied depending on the type of service and the point of sale. Costs of vials were 19,440-35,000 CFA francs (29.6-53.4 euros) for Sii antivenom and 50,200-63,000 CFA francs (76.5-96.1 euros) for FAV Africa antivenom. In CHCs, 59.5% of prescribers were unaware of the indications and methods of proper administration of the SAV, 32.3% ignored the existence of SAV, and 30.9% were skeptical about its effectiveness in treatment of envenomation by snakebite.
本研究旨在描述巴马科地区抗蛇毒血清（SAV）供应和使用问题所涉及的困难。开展了一项为期五年（1998年1月至2002年12月）的回顾性研究，并对各机构工作人员进行了访谈。该研究涵盖了2家药品批发商、20家私人药店和2家医院药房，因为它们都参与了抗蛇毒血清交易。对37家社区卫生中心（CHC）和4家诊所进行了驱动实践的市场驱动能力调查，因为它们在研究期间进行抗蛇毒血清治疗。共购买了3318剂抗蛇毒血清，其中84.4%由公共组织马里人民药房（PPM）购买，15.6%由私人公司Laborex购买。这些血清在1999年缺货。订购了三种抗蛇毒血清：非洲多价IPSER（1200瓶，占36.2%）、非洲FAV（318瓶，占9.6%）和印度抗蛇毒多价血清（1800瓶，占54.2%）。PPM的订单涉及非洲IPSER（巴斯德梅里厄血清与疫苗公司）和印度抗蛇毒多价血清（印度血清研究所），Laborex的订单涉及非洲IPSER和非洲FAV（安万特巴斯德公司）。一半的私人药店（54.3%）至少订购过一次抗蛇毒血清。1996年，PPM因所购小瓶过期损失了2000瓶抗蛇毒血清中的50%。私人药店因过期损失了3.6%的库存。价格因服务类型和销售点而异。印度抗蛇毒血清小瓶的成本为19440 - 35000非洲法郎（29.6 - 53.4欧元），非洲FAV抗蛇毒血清小瓶的成本为50200 - 63000非洲法郎（76.5 - 96.1欧元）。在社区卫生中心，59.5%的开处方者不知道抗蛇毒血清的适应症和正确给药方法，32.3%不知道有抗蛇毒血清，30.9%对其治疗蛇咬伤中毒的有效性表示怀疑。
