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The Drug Specialist KE, Tom Mboya Street, Mombasa (2026)

06/02/2026

“It expired just one week ago — can it really cause harm?”
A nurse asked me this about Dextrose 50% injection, and it’s a question worth pausing on.

On the surface, the answer feels obvious:
➡️ The glucose doesn’t suddenly turn toxic after one week.

But in clinical practice, the real issue isn’t toxicity.

🔬 It’s sterility.
💉 It’s patient safety.
⚖️ It’s professional accountability.

Injectables are held to the highest standards because:

Expiry dates guarantee potency, stability, AND sterility

Even minimal contamination can lead to serious bloodstream infections

“Almost safe” is not safe in IV therapy

So while a recently expired D50 may look harmless, using it crosses a safety and ethical line.

👉 In healthcare, we don’t practice based on probability.
👉 We practice based on standards.

Expired injectable = discard. No negotiations.

This is why pharmacy–nursing collaboration matters:
Not to point fingers, but to protect patients.

💬 What similar “it’s just a small thing” moments have you encountered in clinical practice?

03/02/2026

In the ward, these two IV bags often look interchangeable.
They’re not.

Ciprofloxacin IV and Levofloxacin IV are both fluoroquinolones, but their clinical intent differs. One leans toward Gram-negative and Pseudomonas coverage, the other toward respiratory pathogens and atypicals. Choosing between them should be driven by suspected source, patient risk factors, and culture data not convenience.

From a pharmacy and ward perspective, fluoroquinolones also raise key safety and systems questions: QT prolongation, dysglycaemia, C. difficile risk, and rapid resistance selection. With their high oral bioavailability, many stable patients benefit from an early IV-to-oral switch, reducing line-related risks and hospital stay.

Good antimicrobial stewardship isn’t about denying access; it’s about right drug, right patient, right duration. On the ward, that decision often starts with pharmacy.

30/01/2026

When did antibiotics become as “normal” as paracetamol?

In many settings today, Ampicillin + Cloxacillin is taken casually for fever, sore throat, body pain, or “just in case.” Sometimes, it’s used even more freely than paracetamol.
And that should alarm us.

Antibiotics are being overused, misused, and abused, often without proper diagnosis or prescription. This is not harmless convenience; it is a slow-moving public health crisis.

The consequences are already here:

• Rising antimicrobial resistance (AMR)
• Treatment failures with first-line antibiotics
• Harder-to-treat infections requiring stronger, more expensive drugs
• Increased healthcare costs, complications, and preventable deaths

What makes this more concerning is that such casual antibiotic use is rare in highly regulated systems like the US and much of Europe, where antibiotics are strictly prescription-only and antimicrobial stewardship is enforced.

So the real question is:
👉 Are we treating infections or quietly breeding superbugs?

A functional health system treats antibiotics as a finite, shared resource. Once resistance develops, there is no reset button.

This is a call to action:

• Stronger regulation and enforcement
• Better patient education
• Responsible prescribing and dispensing
• Commitment to antimicrobial stewardship

28/01/2026

💊 IV Paracetamol: Familiar, Effective — but Not Always Benign

Intravenous paracetamol is widely used in inpatient and peri-operative care often as part of routine protocols for pain and fever management.

A recent systematic review and meta-analysis published in Anaesthesia Critical Care & Pain Medicine (2025) highlights an important clinical insight:
IV paracetamol is associated with a measurable reduction in blood pressure, including mean arterial pressure, with hypotension observed in nearly 45% of critically ill patients; particularly when administered for fever.

While this evidence comes from ICU populations, it raises relevant questions for everyday inpatient care, especially in surgical and post-operative settings where:

• patients may already be hemodynamically vulnerable,
• IV paracetamol is administered routinely, and
• monitoring may be less intensive.

From a clinical pharmacy perspective, this is not an argument against paracetamol it remains a valuable, opioid-sparing analgesic.
Rather, it is a reminder that no medication is truly “neutral”, and that context matters.

Thoughtful prescribing should consider:

• baseline blood pressure and volume status,
• timing relative to surgery or anesthesia,
• indication (pain vs fever),
• and the need for monitoring in at-risk patients.

Small physiological effects, when multiplied across many patients and routine practices, can become system-level safety issues.

💬 Perhaps it’s time we move from protocol-driven administration to risk-aware use — even for the medicines we trust most.

28/01/2026

🔔 TB Treatment in 2026: A Turning Point — But Are We Ready in Kenya?

Tuberculosis remains a major global health threat with over 10 million people falling ill each year worldwide and more than 1.2 million deaths, despite decades of control efforts.

The 2025 WHO-aligned treatment updates including a shorter 4-month regimen for drug-susceptible TB with rifapentine and moxifloxacin represent a paradigm shift that could improve adherence, reduce toxicity, and help curb drug resistance.

In Kenya, TB still burdens our health system:
• We consistently diagnose ~97,000 new TB cases annually but many more remain undetected and untreated.
• Coverage for TB treatment reached ~78% in 2023, showing real progress but also a significant gap in reaching all who need care.
• Certain data suggest Kenya may face ~169,000 TB cases yearly with tens of thousands missed due to diagnostic challenges.

From a clinical pharmacy perspective, the promise of shorter, more tolerable regimens invites us to rethink not just what we prescribe, but how we deliver care:
✔ Improve drug supply planning especially for newer agents.
✔ Strengthen pharmacovigilance and stewardship to safeguard efficacy.
✔ Expand community outreach to find the “missing” cases early.

Yet policy barriers remain: updating national guidelines, aligning procurement systems, training clinicians, and ensuring equitable access across all counties.

👉 Policymakers and health system leaders: this is a moment to accelerate guideline adoption, invest in diagnostics, and strengthen TB care pathways.

👉 NGOs and partners: support operational research and capacity building to translate global evidence into local impact.

👉 Pharmacists and clinicians: lead the implementation — from rational drug use to patient-centred adherence support.

💬 Shorter TB treatment could transform outcomes but only if Kenya’s health system rises to the challenge.

Let’s move beyond guidelines to sustainable implementation. How prepared is Kenya to operationalise these new TB standards at scale?

27/01/2026

𝗟𝗮𝘀𝘁-𝗺𝗶𝗹𝗲 𝗱𝗲𝗹𝗶𝘃𝗲𝗿𝘆 𝗼𝗳 𝗺𝗲𝗱𝗶𝗰𝗶𝗻𝗲𝘀 𝗶𝗻 𝗿𝘂𝗿𝗮𝗹 𝗔𝗳𝗿𝗶𝗰𝗮: 𝗹𝗲𝘀𝘀𝗼𝗻𝘀 𝗳𝗿𝗼𝗺 𝗗𝗶𝗳𝗳𝗲𝗿𝗲𝗻𝘁𝗶𝗮𝘁𝗲𝗱 𝗦𝗲𝗿𝘃𝗶𝗰𝗲 𝗗𝗲𝗹𝗶𝘃𝗲𝗿𝘆

Recently, I reflected on key lessons from the Differentiated Service Delivery (DSD) for HIV Treatment and Prevention training by the International AIDS Society.

One truth stood out clearly:

Last-mile medicine delivery fails not because medicines are unavailable; but because systems are not designed around patients.

DSD challenges the traditional “facility-centric” model and asks a simple but powerful question:
What model of care best fits the patient’s reality?

What evidence and practice consistently show:

🔹 Community-based distribution works
Multi-month dispensing, community ART groups, and outreach points reduce missed appointments and improve retention in care. Studies across sub-Saharan Africa show 15–30% improvements in retention when DSD models are applied effectively.

🔹 Logistics must follow differentiated care, not the other way around
Supplying medicines without adapting forecasting, stock accountability, and refill schedules leads to wastage, stock-outs, and treatment interruptions even when national supply is adequate.

🔹 Cold chain success is behavioral, not mechanical
Fridges, vaccine carriers, and temperature monitors are necessary but adherence to SOPs, documentation, and accountability is what truly protects medicine quality at the last mile.

What repeatedly undermines last-mile delivery:

🔸 One-size-fits-all supply chain models
🔸 Weak data use at facility and community level
🔸 Ignoring patient mobility, stigma, transport cost, and waiting time

The key lesson from DSD:

Medicines reach patients reliably when pharmacy systems are flexible, data-driven, and patient-centered.

For pharmaceutical professionals, this means our role goes beyond dispensing:

• We design systems
• We protect quality
• We translate policy into practice

This is where pharmacy, public health, and community systems intersect and where lasting impact happens.

25/01/2026

Frequent Analgesic Use and Reproductive Health: What the Evidence Suggests

Analgesics are essential medicines when used appropriately. However, chronic or inappropriate use, particularly of certain non-steroidal anti-inflammatory drugs (NSAIDs) and other commonly used pain medications, may have clinically relevant effects on reproductive health.

Most commonly used painkillers undergo hepatic metabolism. The liver plays a central role in:

• Steroid hormone metabolism (including estrogen and testosterone)
• Regulation of inflammatory mediators
• Activation and clearance of thyroid hormones
• Maintenance of endocrine balance

When analgesics are used frequently or at high doses, especially without medical oversight, several mechanisms may be affected:

✓ Inhibition of prostaglandin synthesis (particularly with NSAIDs), which is known to interfere with:

• Ovulation and follicular rupture
• Endometrial receptivity and implantation
• Normal reproductive signaling pathways

✓ Endocrine disruption, observed in some studies as:

• Altered ovulatory patterns
• Menstrual irregularities
• Reduced s***m quality and motility
• Changes in androgen levels with long-term exposure

✓ Increased inflammatory and metabolic burden, particularly in individuals with underlying liver, hormonal, or metabolic vulnerability.

It is important to emphasize that occasional, appropriate use of painkillers is generally safe. The concern lies with habitual, unsupervised, or prolonged use, especially when pain becomes a surrogate treatment for stress, fatigue, or chronic conditions that require proper clinical evaluation.

Fertility is not solely a reproductive issue.
It is biochemical, hormonal, metabolic, and inflammatory in nature.

From a clinical and public health perspective, rational medicine use, patient education, and lifestyle factors (including nutrition and overall metabolic health) are critical components of reproductive well-being.

As pharmaceutical professionals and researchers, our responsibility is to:

• Promote evidence-based medicine use
• Encourage early clinical evaluation of chronic pain
• Reduce preventable medication-related harm through education and systems strengthening

This is particularly relevant in resource-limited and humanitarian settings, where over-the-counter medicines are often used without adequate guidance.

14/01/2026

At the intersection of science and hope, fertility medicine continues to evolve in ways many people are still unaware of.

In assisted reproduction, it is now possible to determine the s*x of an embryo before pregnancy occurs. This is done through a process called Preimplantation Genetic Testing (PGT) most commonly PGT-A (Preimplantation Genetic Testing for Aneuploidy).

How it works (in simple terms):

During an IVF cycle, eggs are stimulated, retrieved, and fertilized in the laboratory. As embryos develop to the blastocyst stage (day 5–6), a few cells are carefully biopsied and genetically analyzed. This testing assesses chromosomal health and also identifies the embryo’s s*x (XX or XY). Only healthy embryos are then selected for transfer.

For women in their early to mid-40s, this technology is especially valuable; not only for embryo selection, but for improving implantation outcomes and reducing chromosomal risks associated with advanced maternal age.

From a pharmaceutical perspective, these outcomes are made possible by precisely coordinated medication protocols; ovarian stimulation regimens, trigger agents, luteal phase support, and supportive therapies, all of which play a critical role in embryo quality, endometrial readiness, and overall success.

As fertility care advances, informed, ethical, and patient-centred counselling remains essential. Technology should always serve health, safety, and dignity guided by clinical judgment and regulatory frameworks.

Fertility medicine is no longer just about conception; it’s about precision, timing, and informed choice.

12/01/2026

What Japan’s Universal Health Coverage (UHC) Achieved and What Kenya Can Learn

I recently completed a Global Health Policy certification from The University of Tokyo, strengthening my understanding of health systems, financing, and equity in low-resource and humanitarian settings.

Japan’s UHC system, established over 60 years ago, provides affordable access to healthcare for all citizens and is widely regarded as one of the most successful UHC models globally. Its impact is evident in:

• Exceptional life expectancy, averaging ~84.5 years, among the highest worldwide
• Strong preventive care systems, including routine health checkups, early disease detection, and health education embedded in national policy
• Sustained reductions in mortality from both communicable and major non-communicable diseases over decades

Japan’s health system also balances universal access with cost-control mechanisms, maintaining affordability while supporting one of the world’s most rapidly aging populations.

Kenya’s UHC journey is still evolving.

• Life expectancy stands at ~68.4 years, significantly lower than Japan’s
• Important gains have been made programs such as Linda Mama and maternal/child health investments have increased facility-based deliveries and reduced child mortality
• Current UHC efforts emphasize health financing reform, quality of care, and preventive services, often supported through partnerships and external development assistance

Key Lessons for Kenya and Similar Low-Resource Settings

Japan’s experience highlights several priorities:

1. Institutionalizing preventive care and routine health screenings to enable early detection
2. Strengthening health financing and risk-pooling mechanisms to reduce out-of-pocket expenditure
3. Scaling quality primary health care and health education, empowering communities to actively manage their health
4. Fostering cross-sectoral collaboration among governments, donors, and civil society to build resilient systems

Why This Matters for Humanitarian and NGO Work

In humanitarian and low-resource contexts, UHC principles translate into strong primary health care, rational and safe use of medicines, reliable supply chains, and financial protection for vulnerable populations. These are the foundations of sustainable emergency response and long-term development health programs.

Japan’s model shows that UHC is not just a policy, but a long-term commitment to equity, prevention, and systems strengthening. Translating these principles into resource-constrained settings remains one of the most important global health challenges and opportunities of our time.

If Kenya continues to build on current gains with deliberate policy action, innovation, and sustained investment in people and prevention, meaningful progress toward health for all is achievable.

11/01/2026

Klacid 500 mg vs Klacid XL 500 mg: Same Drug, Different Strategy

A patient recently asked me:

“Naje doc, Klacid XL mtu anaweza tumia BD? Na k**a ni OD, does it give the same effect as Klacid plain 500 mg BD?”

This is a very valid clinical question;

The Short Answer

✔ Yes, they offer comparable therapeutic effect when used correctly.
❌ No, Klacid XL should NOT be taken BD.

Here’s the Clinical Explanation

🔹 Klacid 500 mg (Immediate Release)

• Dose: 500 mg twice daily (BD)
• Releases the drug quickly
• Requires 12-hourly dosing to maintain effective plasma levels

🔹 Klacid XL 500 mg (Extended Release)

• Dose: 500 mg once daily (OD)
• Designed to release clarithromycin slowly over 24 hours
• Maintains therapeutic levels with one daily dose

👉 Taking Klacid XL BD would lead to unnecessary drug accumulation, increasing the risk of adverse effects without added benefit.

So does OD = BD in effect?

Yes✅ when each formulation is used as intended.

• Klacid 500 mg BD = steady levels via repeated dosing
• Klacid XL 500 mg OD = steady levels via controlled release

Different pharmacokinetic design, same clinical goal.

Patient safety doesn’t stop at choosing the drug; it extends to how we explain it.

10/01/2026

A Small Pill with a Massive Global Impact

Did you know that up to 70% of Neural Tube Defects (NTDs) are preventable?

As its World Folic Acid Awareness Week, it’s time to talk about the "Prevention Gap", Despite knowing the solution for decades, over 300,000 babies are still born every year with NTDs like Spina Bifida and Anencephaly.

The Reality of the Burden; NTDs are not just medical statistics, they represent a significant global health challenge i. e its mortality, disability and economic impact is significant.

94% of these serious birth defects occur in resource-limited settings where folic acid fortification is not yet mandatory.

The Science; Folic Acid isn't just "another vitamin", It is the biological architect of the early nervous system, essential for DNA Synthesis & Repair, its "Zip-Up" Effect (between day 21 and 28 of gestation, the neural tube must close completely and folic acid provides the cellular "fuel" to ensure this tube zips up from top to bottom).

The Catch; This happens before most women even know they are pregnant, so start folic acid supplementation BEFORE conception (waiting until the first prenatal visit is often too late).

Take home message; we have the tool which is simple, We have the science, Now we need the awareness!

10/01/2026

Tramadol: Why Some Countries Ban It — and Why Kenya Still Teaches Us to Use It Carefully

Recent bans of tramadol in countries like Sierra Leone raise an important clinical question for us in Kenya:
Is tramadol inherently unsafe, or does safety depend on the system using it?

The Kenyan context

In Kenya, tramadol remains prescription-only under PPB regulation. Yet, PPB alerts and hospital audits have repeatedly flagged:

• Inappropriate repeat dispensing
• Use without clear pain indication
• Escalation beyond 50 mg dosing
• Co-prescription with benzodiazepines and alcohol exposure

These are system failures, not pharmacological surprises.

Clinically, why tramadol is difficult

• Dual mechanism: weak opioid + serotonin/noradrenaline reuptake inhibition
• Risk of dependence, seizures, serotonin syndrome
• Highly variable CYP2D6 metabolism ~ unpredictable response and toxicity
• “Perceived safety” compared to morphine leads to overuse

Why Kenya regulates instead of banning

Kenya’s health system still supports:

• Defined dosing (usually 50 mg)
• Clinical pain assessment
• Prescription control
• Pharmacist-led counseling

Where systems can manage risk, benefit outweighs harm.

Teaching point for practice

Tramadol sits at the intersection of:

• Pain management
• Mental health
• Substance misuse
• Weak pharmacovigilance

As pharmacists and clinicians, our role is not just to dispense or prescribe but to interrupt misuse early, educate patients, and document outcomes.

Medicines don’t become dangerous overnight.
They become dangerous when systems stop paying attention.

The Drug Specialist KE

06/02/2026

03/02/2026

30/01/2026

28/01/2026

28/01/2026

27/01/2026

25/01/2026

14/01/2026

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