Antibiotic Stewardship: Twenty Years in the Making

11 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) and everywhere there is a person (doctor-prescriber) that decides about the health of another person (patient).

In fact the all issue of prescribing too much worldwide could be solved or mitigated by the following political move: doctors must write down in the health booklet of the patient their suspected- diagnose plus laboratory tests. Treatment then will follow the National Clinical-Therapeutic Guidelines (NCTG).

In absence of the written diagnosis, that medical contact is incorrect, unethical, the patient is abused and his/her right is neglected.

I do speculate that in Germany the request to doctors of writing the diagnose has been complemented by the addition 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 precisily those in NCTG for that

diagnose, and not those of fantasy or fashion.

3) In case of not adherence to the points 1) and 2) drugs prescribed won't be refunded or the prescription rejected by the pharmacist.

From long I do believe that better prescription, accurate-scientific prescription is a matter of political concern, that requires mechanism of rules & regulations.

I'd like to have the opinion of my colleagues paediatricians in Africa. Do doctors/prescribers in their countries write down the diagnose? Do they adopt the patient's health booklet or they just write few drugs to buy on a leaflet?

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.

Email: massimoser20 AT gmail.com