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RATIONAL PHARMACOTHERAPY: DIFFERENCES
AMONG EUROPEAN COUNTRIES
SILVIO GARATTINI
Istituto di Ricerche FarmacologicheMario Negri - Milan Italy
COPENHAGEN 6 NOVEMBER 2002
Pharmaceutical products among the 50 most sold drugs in Italy, UK, Germany and France
1992 1996 2001
Omeprazole Omeprazole Omeprazole
Simvastatin Simvastatin Simvastatin
- - Atorvastatin
- Amlodipine Amlodipine
- - Cyclosporine
Ranitidine Ranitidine -
Nifedipine - -
Enalapril - -
Captopril Captopril -
Acyclovir - -
ACTIVE PRINCIPLES COMMONTO THREE COUNTRIES
ACTIVE PRINCIPLES COMMONTO TWO COUNTRIES
ACTIVE PRINCIPLES PRESENTONLY IN ONE COUNTRY
19
17
63
CEFTRIAZONE MORNIFLUMATE ESAMEPRAZOLE FENOFIBRATE
CLARITHROMYCIN GOSERELINE NADROPARINE PARACETAMOL
LORAZEPAM LAMOTRIGINE CERTOPARINE ROXYTHROMYCIN
ALPRAZOLAM GABAPENTINE ENOXAPARINE BUPRENORPHINE
TAMSULOSINE SUMATRIPTAN FILGASTRIM GLICAZIDE
BICALUTAMIDE MIRTAZAPINE DONEXEPIL
TICLOPIDINE CERIVASTATIN
NIMESULIDE
ITALY UK GERMANY FRANCE
50 MOST SOLD DRUGS BY VALUE: DRUGS PRESENT IN ONLY ONE COUNTRY (2001)
Surveying antibiotic policy for bacteraemia in different countries
BASIC (BActeraemia Study in Intensive Care)
ITALY 81
10BELGIUM
NETHERLANDS 8
PORTUGAL 9
SPAIN 16
GERMANY 10
UNITED KINGDOM 32
TOTAL 166
Duration of antibiotic therapy in primary bacteremia
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
UNITED KINGDOM
NETHERLAND
GERMANY
ITALY
BELGIUM
SPAIN
PORTUGAL
short (<6 days) medium (6-9 days) long (>9 days)
Duration of antibiotic therapy in peritonitis related bacteremia
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
UNITED KINGDOM
NETHERLAND
GERMANY
ITALY
BELGIUM
SPAIN
PORTUGAL
short (<6 days) medium (6-9 days) long (>9 days)
Spectrum of antibiotic therapy in community acquired Gram + bacteremia
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
UNITED KINGDOM
GERMANY
ITALY
BELGIUM
SPAIN
NETHERLAND
PORTUGAL
restricted broad
WHY IS SO DIFFICULT TO IMPLEMENTRATIONAL PHARMACOTERAPY ?
INDUSTRIAL vs PUBLIC HEALTH INTEREST
THE CASE OF EMEA
WHY IS SO DIFFICULT TO IMPLEMENTRATIONAL PHARMACOTERAPY ?
SPC vs ADVERTISEMENT
HOW TO PROMOTE INDIPENDENT INFORMATION?
WHY IS SO DIFFICULT TO IMPLEMENTRATIONAL PHARMACOTERAPY ?
PASSIVE vs ACTIVE PHARMACOVIGILANCE
THE NEED TO CENTRALIZE INFORMATIONS ON ADVERSE REACTIONS
WHY IS SO DIFFICULT TO IMPLEMENTRATIONAL PHARMACOTERAPY ?
REVISION OF USELESS DRUGS
ONLY FOR TOXICITY?
WHY IS SO DIFFICULT TO IMPLEMENTRATIONAL PHARMACOTERAPY ?
MORE COMPARATIVE STUDIES AND LESS EQUIVALENCE STUDIES
THE EUROPEAN LEGISLATION
WHY IS SO DIFFICULT TO IMPLEMENTRATIONAL PHARMACOTERAPY ?
THE NEED OF INDIPENDENT STUDIES
A PUBLIC EUROPEAN FUND FOR CLINICAL TRIALS
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