With misuse and overuse accounting for almost half the total global use of medicines with potential severe consequences such as drug resistance and even death, the United Nations health agency today called for multilateral partnerships to set up advocacy and education programmes especially in developing countries.

"Most people see a lack of access to medicines as the main problem," the interim Director of Essential Drugs and Medicines Policy at the UN World Health Organization (WHO), Hans Hogerzeil, said in a news release on the eve of a global meeting in Chiang Mai, Thailand. "Unfortunately, the irrational use of available medicines is also a major threat to health and leads to considerable waste."

Irrational use of medicines includes over-treatment of a mild illness, inadequate treatment of a serious illness, misuse of anti-infective drugs, over-use of injections, self-medication of prescription drugs and premature interruption of treatment. Several country figures show that such practices are frequent, and not exclusively in developing countries.

At the Chiang Mai meeting opening tomorrow WHO and donor governments, foundations and non-governmental organizations (NGOs) will spend four days looking at ways to improve use of medicines in developing countries.

Almost half of all medicines globally are used irrationally, with such potential consequences as adverse drug reactions, drug resistance, protracted illness and death. In addition, financial cost incurred by individuals and governments due to irrational use is often extremely high, particularly in developing countries.

"Misuse of antibiotics, overuse of injections, and under-use of life-extending drugs for illnesses such as HIV/AIDS, heart disease, and other chronic illnesses together constitute a global epidemic of irrational use of medicines," said Jonathan Quick, incoming president of Management Sciences for Health, a meeting co-sponsor. "This epidemic results in untold needless suffering and costs millions of lives each year."

According to figures gathered by surveys presented to WHO, in 2000 about 60 per cent of antibiotics in Nigeria were prescribed unnecessarily. In Nepal, more than half of antibiotics prescribed in 1996 were not needed and 40 per cent of medicine expenditures in the same year was wasted due to inappropriate prescriptions.

Overuse of most medicines contributes to drug resistance. For example, overuse of chloroquine, the traditional remedy for malaria, has led to resistance which has been recorded in over 80 countries. Resistance to penicillin, used to treat gonorrhoea, is present in as many as 98 per cent of patients in certain regions.

Irrational use of drugs due to inappropriate prescription can also lead to adverse drug events causing illness or death. In the United Sates, adverse drug events represent one of the six leading causes of death.