Pharmacotherapy Principles & Practice, 6e

Chapter 5: Global Health and Travel Medicine

Sonak D. Pastakia; Alyssa P. Gould; Benson N. Njuguna; Jeffrey W. Hall

For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact userservices@mhprofessional.com.

Content Update

August 21, 2023

Ending the HIV epidemic through preventative measures: HIV remains a global challenge, with millions affected and comprehensive strategies to end the epidemic set by UNAIDS and the U.S. Department of Health and Human Services. Despite progress, many lack access to prevention and treatment. Recent advancements focus on preventing perinatal transmission, simplifying regimens for post-exposure prophylaxis (PEP) and preexposure prophylaxis (PrEP), and achieving virologic suppression through widespread use of antiretroviral therapy to reduce transmission. Pharmacist involvement is pivotal in disseminating prevention strategies, personalized interventions, and resources, to end the HIV epidemic.

Content Update

January 09, 2023

Short-course rifapentine-based regimen for the treatment of drug-susceptible pulmonary tuberculosis The Centers for Disease Control and Prevention now recommends a four-month, four-drug regimen for certain patient populations with newly diagnosed, drug-susceptible tuberculosis. The regimen consisting of an intensive phase with once daily rifapentine, isoniazid, pyrazinamide, and moxifloxacin for 8 weeks, followed by once daily RPT, INH, MOX for 9 weeks was found to be non-inferior to traditional 4-drug regimen. The shorter course is intended to facilitate rapid cure and improve patient compliance and quality of life.

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

Discern the difference between equality and equity.
Explain the social determinants of health and their contribution to health outcomes.
Identify the main contributors to the global burden of disease.
Contrast benefits and possible harms of cross-cultural health work.
Discuss neglected tropical diseases and the different treatment approaches used to manage them.
Discuss the different components of medication access to optimize health outcomes.
Describe the key components of a pretravel consultation.
Summarize the advantages and disadvantages of four antimalarial prophylactic regimens.
Explain the difference between prophylactic and self-directed therapy for traveler’s diarrhea.
Identify two reasons for urgent evaluation of returned travelers with illness.

INTRODUCTION

Global health is an effort to reduce health inequities for people all over the world. Prior to the 1800s, average life expectancy was 30 to 40 years globally. Since then, advancements in agriculture, economics, public health, medicine, and society have led to dramatic improvements in health, including increased life expectancy and decreased under-five mortality (Figure 5–1). However, significant variations persist across different world regions, underlined by health inequities.^1,2

FIGURE 5–1.

Estimated and projected life expectancy at birth and child mortality rate by region between 1975 and 2050. Reproduced with permission from World Population Prospects 2017 - Data Booklet United Nations, Department of Economic and Social Affairs, Population Division; 2017. Report No.: Contract No.: (ST/ESA/SER.A/401).