Evaluation of corticosteroid use in outpatient department of dermatology of a tertiary care teaching hospital: a prospective observational study

Background: Corticosteroids are widely prescribed drugs in dermatology. Rational prescribing of steroids is important for best therapeutic outcome at lowest possible dose. A study was carried out at a tertiary care teaching hospital in order to evaluate the use of corticosteroids which provided a picture of trends in the usage of corticosteroids in dermatology at that set-up. Materials and Methods: This prospective, observational study was carried out in department of dermatology for 1 year after ethical approval. Data was analysed for parameters related to corticosteroids, their potency, WHO drug prescribing indicators, effectiveness as well as effects of corticosteroids on quality of life of patients. Statistical analysis was done using Microsoft Excel Office 365. Results: In the 223 patients, 44.84% patients belonged to 21-40 years age group. Mostcommon indication was eczema in 29.15% cases. Topical betamethasone (25.11%) and oral prednisolone (20.17%) were most frequently prescribed. 95/140 topical steroids prescribed were super highly potent. Among concomitant drugs, a majority of 38% were antihistaminics. Degree of polypharmacy showed 04 drugs in a majority (43.15%) of prescriptions. Only 6.27% drugs were prescribed by generic name. Conclusion: Corticosteroids were beneficial to a large no. of patients. Initial usage of low potency steroids topically wherever possible can be emphasized. WHO drug prescribing indicators analysis indicated the need to adhere to WHO guidelines as well as prescribing drugs by generic name. To maintain a balance between judicious use and frequent abuse with corticosteroid is important along with physician’s vigilance and patient education.

Analysis of drug promotional literatures in a tertiary care hospital: a cross sectional study

Background: Large numbers of new drugs are introduced into the market every day and pharmaceutical companies are in the business of development and selling of new drug. There are different modes of drug promotion which include visual aids, leave behind leaflets and audio visuals. Drug Promotional Literatures (DPL’s) claim to provide vital and accurate information regarding the drug. To ensure rational use of drugs a set of standards laid by the WHO for ethical drug promotion.Methods: A cross sectional observational study was performed in Department of Pharmacology at a tertiary care teaching hospital of Navi Mumbai. A total of 100 drug promotional literatures were randomly collected from different outpatient departments and were evaluated by using WHO guidelines.Results: None of drug promotional literature fulfilled all WHO criteria. Generic name, Brand name, active ingredients were mentioned in all. The problem causing ingredient was not mentioned in any of the cases. Safety information was not complete, adverse drug reactions were mentioned in only 45% of the cases, contraindications and drug interactions were mentioned in 39% of the cases. Manufacturer details including name and address of manufacturer was mentioned in 67% of the DPL’s. References were mentioned in 80% of the literature out of which 84% were from journal articles.Conclusions: None of the DPL’s satisfied all the WHO criteria. Incomplete information may lead to irrational prescription of drugs. Therefore, more strict regulations need to be implemented and physicians must critically evaluate DPL’s before considering the same for prescribing.

Drug Utilization Pattern In Paediatric Patients In A Secondary Care Hospital

Objective: The study was carried out to generate research on drug utilization pattern in paediatric patients in government headquarters hospital, Tiruppur, Tamilnadu, India using world health organization (WHO) and international network for rational use of drugs (INRUD) core indicator. Methods: The core prescribing indicators of the world health organization was used to assess the appropriate use of drugs. Index of rational drug prescribing (IRDP) developed by Zhang and Zhi was also used to find out the performance of a health care system in terms of drug utilization. Results: Out of 859 drugs in 200 cases the highest prescribed drug class is antibiotics 304(35.39%) and the majority of drugs were administered in injectable form 412(47.94%). It was analysed that a majority of prescriptions 117(58.5%) were discharged in between 4-7 d. 161(80.5%) patients were dismissed after completion of treatment. On analysing world health organization (WHO) prescribing core indicators, the average number of drugs per prescription was 4.29 which is higher than double the average number (i.e., 2). This indicates poly-pharmacy practice. 97.78% of drugs were prescribed were the generic name and percentage of encounters with antibiotic prescribed was 90.5% which is thrice greater than world health organization (WHO) standard<30%. Prescribing of injections is not within the world health organization (WHO) recommended range<20% and it was far higher showing 97.5% which is essential for paediatric inpatients. The prescribing practice in paediatric ward is in complete adherence to national essential drug list (EDL) or formulary. The mean value of the index of rational drug prescribing (IRDP) obtained was 3.09 which is very similar to that of optimal value world health organization (WHO). Conclusion: Prescription by generic name, prescribing drugs from essential drug list (EDL) and free government supply are encouraging findings in this hospital. The result shows poly-pharmacy and overuse of antibiotics are the areas to be concerned. The better clinical outcome shows rational prescribing is practised well.

Drug Prescribing Pattern of Antibiotics for Treatment of Methicillin Resistant Staphylococcus aureus.

Control of MRSA in hospital is essential. It can be achieved by proper implementation of hospital infection control measures, regular surveillance activity and selecting the right antibiotic is an important determinant of clinical outcome in such cases. Present paper deals with the antibiotics prescribing pattern for MRSA infections by doctors, which can be used to monitor the geographical spread and the selection pressure resulting from antibiotic usage. Material & Methods: For this study, a questionnaire was prepared which include list of antibiotics used for treatment of MRSA. A total of 83 doctors were surveyed, responses were received by 76 (91.6%) physicians (68 hospital setting or working in the hospital and 8 were skin specialist). Results: The vancomycin, an intravenous drug, was the most prescribed drug (53.9%). The amoxycillin+ calvulanic acid (Augmentin) and piperacillin+ tazobactum (Zosyn) were prescribed by physicians (53.9%) and (27.6%) respectively. Other cephalosporins (with or without sublactam combination) and carbapenems were prescribed by less than 20% doctors. The linezolid is next drug that was recommended by doctors (38.2%). Other drugs were prescribed by less than 20% of physicians which include amikacin, gentamicin, erythromycin, clarithromycin, levofloxacin, ofloxacin, ciprofloxacin, gatifloxacin, quinupristin-dalfopristin, clindamycin and rifampin. Mupirocin was prescribed by 4.5% of physicians. Conclusions: In conclusion, vancomycin remains a first-choice of drug by physicians for severe infections possibly caused by MRSA. As per them, other antibiotic agents may be appropriate to consider in some circumstances. Combination of â-lactam antibiotics, macrolides and aminoglycosides was generally to cover other gram-positive and/or gram-negative, aerobic and anaerobic organisms.

Morbidity and drug utilization pattern among admitted pregnant anemic women and to find out rationality of drug by using Indian guidelines.

Background: Pregnancy represents a special physiological state during which the use of drug is of growing concern due to risk of teratogenicity. Anemia is common threat to mother. Therefore, our aim was to study the drug utilization, teratogenic risk among patients of anemia in pregnancy and check rationality of prescriptions. Methods: An observational, prospective study was carried out in 150 indoor patients in the tertiary care hospital. Protocol was approved by the Institutional Review Board. The data were collected in a pre-designed proforma. Data were analyzed using SPSS version 20.0 Software. Results: Among 150 patients, 23, 111, and 16 were of <20, 20-30 and more than 30 years of age respectively. Among anemic patients Pregnancy induced hypertension (18.7%), antepartum hemorrhage (12.7%) were common. About 71% women have complaint of weakness, followed by headache. Iron (93.3%) and calcium (86.0%) were the most common drugs prescribed. Iron sucrose and packed cell volume given in severe anemia. Drug risk category, Category A (90.21%) was most frequently prescribed, which is followed by Category B (8.0%) and Category C (1.8%). Percentage of drugs prescribed by generic name and from essential drug list was 70.3 and 89.2. Overall prescribing habit was rational according to Indian guideline. Conclusion: Iron, calcium, and folic acid were most commonly prescribed drugs in anemic patients. No teratogenic risk was found out during drug use. Drug and dose of the drug was rational and appropriate. There is lesser number of drugs prescribed by generic name and hospital supply.

Prescripción de fármacos en el adulto mayor / Drug prescription in the elderly

El proceso de envejecimiento altera la forma en que los fármacos actúan en el adulto mayor. Cambios tanto en la farmacocinética como la farmacodinamia convierten la prescripción en geriatría en un proceso muy diferente al del adulto joven. El objetivo de este artículo es revisar los cambios fisiológicos del envejecimiento que deben ser considerados para el uso de fármacos en el adulto mayor. Con este fin hemos realizado una revisión bibliográfica de la literatura para generar recomendaciones para la prescripción adecuada en este grupo etario, encasillándolas en listados de fácil uso y acceso sobre medicamentos potencialmente inapropiados, de acuerdo a la calidad de la evidencia disponible y las razones para su evitación en el adulto mayor.

The aging process changes the way in which common drugs act in the elderly. Changes in both the pharmacokinetics and pharmacodynamics make prescribing drugs in geriatrics a process very different from that of the young adult. The aim of this article is to review the physiologic changes that occur with aging and that must be considered when indicating drugs in this age group. For this purpose we conducted a literature review of articles from various journals and textbooks devoted to geriatric medicine in order to extract recommendations for appropriate prescribing in the elderly, represented in easy to use listings of potentially inappropriate medications, according to the quality of evidence and rationale for their avoidance in advanced age.

A alta prevalência de prescrições de medicamentos off-label e não licenciados em unidade de terapia intensiva pediátrica brasileira / High prevalence of off-label and unlicensed drug prescribing in a Brazilian intensive care unit

OBJETIVO: Descrever o uso e determinar a prevalência de medicamentos de uso off-label enão licenciados em prescrições na unidade de terapia intensiva pediátrica de um hospital no sudeste do Brasil. MÉTODOS: Estudo transversal envolvendo os pacientes internados na unidade de terapia intensiva pediátrica durante o período de maio de 2008 a janeiro de 2009. A classificação quanto aos critérios de aprovação da Agência de Vigilância Sanitária (Anvisa) foi baseada em seu bulário eletrônico e no Dicionário de Especialidades Farmacêuticas e as análises realizadas no software R. RESULTADOS: Foram analisados 1.054 itens de prescrição de 73 pacientes. O gênero feminino foi o mais frequente (52 por cento) e a idade dos pacientes variou de zero a 16 anos. Observou-se que 23,4 por cento dos medicamentos foram prescritos de modo off-label, 12,6 por cento não licenciados e 1,4 por cento foram classificados em ambas as razões; 86 por cento receberam ao menos um item de uso off-label e 67 por cento ao menos um item de uso não licenciado. Os grupos terapêuticos mais prescritos foram os antibacterianos de uso sistêmico, os analgésicos, psicolépticos e antiasmáticos. CONCLUSÃO: Os resultados do presente trabalho confirmam a alta prevalência do uso off-label e não licenciados dos medicamentos em unidade de terapia intensiva pediátrica.

OBJECTIVE: To describe the use and determine the prevalence of off-label and unlicensed drug use prescribing in a pediatric intensive care unit in a Southeastern Brazilian hospital METHODS: Cross-sectional study of inpatients in a pediatric intensive care unit from May 2008 through January 2009. The classification according to the Brazilian regulatory agency (Agência de Vigilância Sanitária - Anvisa) approval criteria was based on the Anvisa electronic package insert list, Pharmaceuticals Dictionary, and the analysis was conducted through R software. RESULTS: We analysed 1,054 prescription items for 73 patients. Females predominated (52 percent), and the patients' age ranged from 0 to 16 years. Among the prescribed items, 23.4 percent were off-label, 12.6 percent were unlicensed, 1.4 percent were both off-label and unlicensed, 86 percent had at least one item off-label, and 67 percent had at least one unlicensed drug. The most frequently prescribed therapeutic groups were systemic anti-bacterial, analgesic, psycholeptic, and antiasmathic agents. CONCLUSION: The current study results confirm the high prevalence of unlicensed and off-label drug use in a pediatric intensive care unit.

Overall design and innovation of the separation of drug prescribing and dispensing program in Shenzhen / 中华医院管理杂志

As requested by both central government and Guangdong provincial government on the reform to separate drug prescribing and dispensing,Shenzhen has introduced its 1 + 6 comprehensive program.Breaking through from the drug price addition system,the program stages such six measures as the health service payment system reform,the compensation system reform among public hospitals,reform of the competition mechanism between pharmaceutical distribution enterprises and hospital pharmacies,reform of drug procurement methods,investigation and punishment of commercial briberies in drug purchase,and enhanced supervision of public hospitals.The paper detailed these measures and explained these innovative practices.

Outcomes and insights on separation of drug prescribing and dispensing policy in Shenzhen / 中华医院管理杂志

Shenzhen implemented the health reform on the separation of drug prescribing and dispensing.This policy abolished the drug price addition system,which interrupted the interest chain between hospitals and pharmaceutical enterprises,and curbed the over-medication and use of expensive drugs.Such a reform has lowered the average cost of diagnose and treatment,the out-of-pocket payment by those covered by social insurance,outpatient infusion and the utilization of antibiotics.To further strengthen these outcomes and maintain the momentum of this policy,Shenzhen will further improve the compensation system for public hospitals,encourage the medical staffs' work enthusiasm and implement the reform measures actively.

Drug Utilization in Geriatric Population im a Tertiary.

One hundred and fi fty-two prescriptions of patients aged more than 65 years were picked up from in-patients of ollr hospital and analysed for drug utilization pattern. The mean age of the patients was 69.9 ±5.7 years. The mean number of drugs per prescription were 6.33 ± 2.35. Tablets were used in 48.5%, injections in 39.6%, capsules and syrups in 5.5% each and inhalers in 1.1% of patients. Antibiotics were prescribed for 140 patients, diuretics for 34, ACE inhibitors for 33, Calcium channel blockers for 59, H2 blockers for 84, narcotic analgesics and NSAlDs for 36 and 33 patients respectively. Beta blocker usage was minimal. Digoxin, aspirin and thrombolytics were used in 10, 50 and 5 patients respectively. Compliance was 100% and side effects Iike haemoptysis, gastritis, palpitation and vomiting were seen in I patient each.