Рекомендации к действию. 1. Правительствам и работникам здравоохранения следует разработать политику рационального управления для контроля диарейных заболеваний

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1. Правительствам и работникам здравоохранения следует разработать политику рационального управления для контроля диарейных заболеваний. В нее должно входить предоставление ясной и объективной информации, а также обучение пациентов и потребителей надлежащему лечению диареи.

2. Следует изъять с фармацевтического рынка все продукты, обозначенные как противодиарейные препараты и содержащие противомикробные средства.

3. Использование противомикробных препаратов в лечении диареи должно быть ограничено теми лекарствами и особыми показаниями, которые установила ВОЗ (смотри таблицу 5.4)

4. Следует изъять с рынка все педиатрические лекарственные продукты, содержащие средства, которые понижают моторику кишечника.

5. Следует изъять с рынка противодиарейные препараты, эффективность которых не доказана, такие как адсорбенты и препараты кишечных бактерий.

6. У всех противодиарейных препаратов на упаковке должно быть крупно и ясно написано, что основным видом лечения при диарее является ПРТ; такая же информация должна содержаться во всех информационных и рекламных материалах.

Источники

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2. WHO, The rational use of drugs in the management of acute diarrhoea in children, Geneva, WHO, 1990, p1 WHO, A manual for the treatment of diarrhoea, (WHO/CDD/ SER/80.2 Rev.2 1990), Geneva, WHO, 1990, p1.

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13. Huilan, S., Lu, G.Z., Mathan, M.M., et al, "Etiology of acute diarrhoea among children in developing countries: a multicentre study in five countries", Bulletin of the World Health Organization, Vol 69, No 5, 1991, pp549-55.

14. Gilman, A.G., Rail, T.W., Nies, A.S., and Taylor, P., Goodman and Gilman's The Pharmacological Basis of Therapeutics, New York, Pergamon Press, (8th edn) 1990, p924
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15. AHRTAG, Preventing and Treating Diarrhoea in the Community, undated
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16. Feachem, G., "Prevention better than cure", World Health, Apr 1986, pp18-19.

17. Rhode, J.E., "Selective Primary Health Care: Strategies for control of disease in the developing world. XV. Acute Diarrhoea", Reviews of Infectious Diseases, Vol 6, No 6, Nov-Dec 1984, pp840-54.

18. UNICEF, WHO and UNESCO, Facts for Life: A Communication Challenge, New York, UNICEF, 1989, p19.

19. Elarabi, I.I., "Where drugs don't help", World Health, Apr 1986, pp10-11.

20. Laurence, D. and Bennett, P.N., op cit at note 14, p633.

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23. Heymann, D.L., Mbvundula, M., Macheso, A., et al, "Oral rehydration therapy in Malawi: impact on the severity of disease and on hospital admissions, treatment practices and recurrent costs", Bulletin of the World Health Organisation, Vol 68, No 2, 1990, pp 193-7.

24. Phillips, M., Kumate-Rodr’guez, J., and Mota-Hernandez, F., "Costs of treating diarrhoea in a children’s hospital in Mexico City", Bulletin of the World Health Organization, Vol 67, No 3, 1989, pp273-280.

25. Hatch, D.L., Vreuls, C., Toole, M.J., et al, "The effective case management of childhood diarrhoea with oral rehydration therapy in the Kingdom of Lesotho", International Journal of Epidemiology, Vol 19, No 4, 1990, pp1066-71.

26. El-Rafie, M., Hassouna, W.A., Hirschhorn, N., et al, "Effect of diarrhoeal disease control on infant and childhood mortality in Egypt: Report from the National Control of Diarrheal Diseases: Project", Lancet, 10 Feb 1990, pp334-8.

27. Carriere, C., "India; ORT survey", Dialogue on Diarrhoea, No 29, June 1987, p2.

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29. Cruz, H., Paredes, P., and Haak, H., Medicamentos Inapropiados en Diarrea: la magnitud del problema, Lima, Peru, Pan-American Health Organisation, Nov 1989.

30. Ibid., pp41-2.

31. Phillips, M., Kumate-Rodriguez, J., and Mota-Hernández, F., op cit, pp276.

32. Bhardwa, C., "Iran: attitudes to treatment and use of antibiotics", Dialogue on Diarrhoea, No 33, June 1988, p2.

33. Nastasi, A., Massenti, M.F., Scarlata, G., et al, "A study on oral rehydration therapy of diarrheal disease in western Sicily", European Journal of Epidemiology, Vol 3, No 2, June 1987, pp151-4.

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38. WHO, The treatment and prevention of acute diarrhoea: Practical Guidelines, Geneva, WHO, (2nd edn) 1989.

39. UNICEF, WHO and UNESCO, op cit at note 18, p47.

40. UNICEF, The State of the World's Children 1991, Oxford and New York, Oxford University Press, 1990, p12.

41. WHO, The rational use of ..., 1990, op cit, pp13 & 20.

42. WHO, 1989, op cit, p4.

43. Chetley, A., Antibiotics: the wrong drugs for diarrhoea. The Hague: HAI, 1987.

44. Parish, P., Medicines: a guide for everyone, London, Penguin, (6th edn, revised), 1989, p144.

45. WHO, 1989, op cit, p3.

46. Balistreri, W.F., "Oral rehydration in acute infantile diarrhea", American Journal of Medicine, Vol 88 (Suppi 6A), 20 June 1990, pp6A:30S-33S.

47. Gorbach, S.L., op cit at note 12, p1381.

48. de Zoysa, I. and Feachem, G., "Interventions for the control of diarrhoeal diseases among young children: chemoprophylaxis", Bulletin of the World Health Organization, Vol 63, No 2, 1985, pp295-315.

49. Based on a world market of US $438 million (a 1983-84 figure) for all antidiarrhoeal products, derived from industry sources, and from a calculation made by an industry representative at a 1983 workshop on diarrhoea held in Frankfurt, that 34% of the total world market in antidiarrhoeals was made up of antibiotics and other antimicrobial agents.

50. AMA, 1986, op cit at note 9, p964.

51. Claeson, M.E. and Clements, M.L., op cit at note 21, pp527-8.

52. WHO, 1989, op cit, p3.

53. AMA, 1986, op cit at note 9, p971.

54. Bhutta, T.I., "Agents for diarrhoea in children", Lancet, 337:8746, 13 Apr 1991, p925.

55. Reynolds, J.E.F. (ed.), Martindale: The Extra Pharmacopoeia, London, The Pharmaceutical Press, (29th edn) 1989, p1582.

56. Medawar С. and Freese, В., Drug Diplomacy, London, Social Audit, 1982, p51.

57. Lanza, O. and Kerkvliet, E., Ojo con los antidiarreicos: el abuso de antidiarreicos en America Latina, Montevideo, AIS/IOCU, 1991, pp35-40.

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