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With a vision to meet the changing trends and recent developments in the field of pharmacology and therapeutics, the postgraduate medical education board of the national medical commission has put forth amendments to the existing guidelines for the MD pharmacology course. Major changes include introducing a district residency-based program for 3 months apart from the clinical postings and more focus is given to the areas of rational prescribing, pharmacovigilance, and ethical aspects of research. These amendments come as a new ray of hope in developing the postgraduate student as a complete professional equipped to meet the increasing standards in the workplace be it a hospital or a research arena. Including the simulation-based approaches for training as a lesson learned from the pandemic and adopting patient-oriented learning during the course are some of the key changes in the new guidelines. This review focuses on highlighting these amendments and correlating the same with the current scenario and discusses the future areas that can be improved for comprehensive development in the pharmacology curriculum.
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Background: A package insert (PI) accompanying medicinal products is a concise and accessible source of evidence-based information for health professionals and consumers alike. In India, the supplied information should be adequate and fulfill the statutory regulations of the Drug and Cosmetics Rules (1945) to ensure the safe and effective drug use. Aim and Objectives: The present observational study aimed to evaluate the uniformity and adequacy of information on PIs available in India. Materials and Methods: PIs of approved and marketed drugs were collected from pharmacies and analyzed with the help of a 30-item checklist comprising of components of statutory guidelines and other quality indicators. Each item was assigned a weightage of two points if the information was complete, one if inadequate, and 0 if absent. The total score was calculated for each PI. Results: The median score of the 150 analyzed PIs was 41 (Inter quartile range, 36.00–45.25) out of a maximum value of 60. The major deficiencies observed were in providing missed dose instructions (91.33%), further reading resources (84.67%), supporting references (83.33%), and drug disposal instructions (76%). Other notable missing information were laboratory parameter interference (68.67%), clinical trial data (62%), adverse drug reaction reporting contact information (56.67%), and list of excipients (49.33%). Conclusion: There are important inadequacies in the clinical information provided in Indian PIs which can affect patient health and hinder rational drug use. Thorough evaluation and revision of the PIs is warranted to make them more reliable and popular among users.
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Rational prescribing is essential for adequate patient compliance and proper therapeutic outcome. Often medicines are prescribed randomly to take care of the drug induced adverse reactions without changing the culprit drug or modifying it抯 dose, rather commonly by adding another drug towards amelioration of the presenting complain, ignoring it抯 drug related occurrence. This 慞rescribing Cascade� turns out to be a vicious cycle by promoting polypharmacy thus leading to it抯 adverse consequences. This can happen to any person at any age but elderly population are more vulnerable because of their age related physiological changes and co-morbidities. There are several ways to curb the vicious cycle down like anticholinergic burden assessment, selecting the right drug for the right person, medication reconciliation etc.
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Background: Evaluation of drug prescription prototype is a significant feature of patient care, which also provides as an estimate of the quality of care provided. Thus, the current study was carried out to analyze the prescriptions of patients attending outpatient department (OPD) of a tertiary care teaching hospital.Methods: Present cross-sectional study was performed in the OPD of our tertiary care teaching hospital. The study was carrying out for duration of two years. Data was obtained from 850 prescriptions. Data was analysed as per WHO prescribing indicators.Results: Total 1700 prescriptions were analysed, that includes 55.8% males and 40.1% females. The highest numbers of prescriptions were from the age group of 18-40 (53.6%) years of age. Average number of drugs in the current study was found to be (2.1). Percentage of come across with an antibiotic prescribed was 17.12%. Percentage of come across with an injection prescribed was 11.81%.Conclusions: There is necessitate of recuperating the prescribing pattern by maintaining the number of medicines as little as possible, prescribing medicines by generic names, using medicines properly after selecting and deliberately keeping the charge of treatment low.
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Background: WHO defines Antimicrobial resistance (AMR) as “the ability of a microorganism to stop an antimicrobial from working against it”. The Global burden includes increased morbidity, prolonged illness and a higher mortality rate, along with economic burden. The cause can be tracked down to irrational usage of antibiotics and lack of awareness of rational prescribing practices.Methodology: A cross-sectional questionnaire-based observational study was carried out using a standard pre-validated questionnaire, which was administered to all the medical doctors present in their respective departments during the study period, exploring their knowledge regarding rational antibiotic usage, their attitudes and awareness towards AMR. Informed consent from the participants was obtained verbally, and confidentiality assured. The collected data was analyzed as per descriptive statistics.Results: Majority of doctors (91.3%) have a good knowledge and agree that indiscriminate use of antibiotics leads to antimicrobial resistance. 96.12% of doctors identify it as a global issue but only 85.5% consider it a problem in their hospital. Doctors (78%) have a positive attitude and do not prefer to prescribe an antibiotic for minor illnesses, but only 40% think it might contribute to antimicrobial resistance.Conclusion: Our study has demonstrated that doctors have a good knowledge about the emerging problem of antimicrobial resistance, however a minor percentage of doctors fail to acknowledge this at the level of their own hospital. Regular updates on the local antimicrobial resistance rates & antibiotic stewardship might help to control the global issue of AMR.
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Background: As medical students start their clinical training, more effort goes in the direction of proper diagnosis and appropriate methods of treatment, leading to improper training in prescription writing causing prescription errors. Physicians should also be encouraged to prescribe unbranded generic medicines which are available at a cheaper price with a comparable bioavailability of drugs and not have a misconception of being less efficacious.Methods: A cross-sectional observational study was carried out over a period of 2 months (September to October 2018). Around 256 prescriptions were randomly collected from general medicine out-patient department. Informed consent was obtained verbally, and confidentiality assured. The collected data was analyzed as per descriptive statistics and compared with the derived standard values for WHO prescribing indicators.Results: The analyzed data showed an average of 2.23±1.03 drugs per prescription. 23% of the prescriptions had at least one drug prescribed by generic name, 25% of prescriptions contained an antibiotic and 31% of prescriptions had an injection. The percentage of drugs prescribed from NLEM (National list of Essential Medicines) was only 57% as compared to the recommended 100%. Additional only 22.4% of the total number of FDCs prescribed were from NLEM.Conclusions: The average number of drugs per prescription was slightly high, indicating polypharmacy. Brand name prescribing dominates as doctors are still reluctant to use generic names being doubtful of the efficacy. Regular prescription audit with reporting might help to bring awareness among doctors to follow the recommended guidelines and minimize prescription errors.
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Background: Dengue fever is a mosquito borne viral infection which has become a global health hazard, especially in tropical and subtropical areas. Children have higher risk of developing severe forms of dengue fever, however, studies show that paediatric complications/fatalities from dengue fever are potentially avoidable by proper management. Data about drug usage patterns for dengue are particularly lacking, especially in the paediatric age group, therefore this study will help facilitate the rational use of drugs and aid in establishing a more specific management for dengue fever. The objective of the present study was to identify the prescribing pattern of dengue fever in paediatric inpatients admitted to RajaRajeswari Medical College and Hospital and assess according to the WHO core prescribing indicatorsMethods: This prospective observational study took place from March 2017 to September 2017 in the paediatric general wards. Data was collected from case files of NS1 positive patients of both genders between 1-18years. Data was analysed using descriptive statistics and expressed as percentages, means and standard deviations. The prescription pattern was analysed using the prescribing indicators mentioned in the World Health Organization core drug use indicators.Results: Total of 300 drugs were prescribed for 110 prescriptions that were analysed excluding IV fluids and blood products. Mean number of drugs prescribed was 2.7±0.8. Drugs prescribed by a generic name was 7.33%. Patients prescribed an antibiotic was 12.73%. Patients prescribed with an injection was 62.72% Majority of drugs prescribed in this study come from essential medicines list created by regulatory bodies. Intravenous fluids were administered to all patients with majority receiving normal saline (60.9%).Conclusions: Mainstay of treatment of dengue fever for paediatric patients is symptomatic along with focus on fluid management. Majority of drugs prescribed are from essential medicines lists formed by regulatory bodies. With dengue infections being a worldwide health hazard, more studies are needed to facilitate rational use of drugs in this disease.
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Background: Antimicrobial resistance(AMR) is an urgent and serious global health problem, demanding considerable attention from health care providers(HCPs) all over the world. The threat is progressing rapidly and intensifying with time. Therefore study was conducted to assess the knowledge, attitude and practices of Homeopathic HCPs about antibiotic usage and resistance(ABR).Methods: Cross-sectional, observational study. The data was collected from 75 Homeopathic HCPs practicing in Maharashtra with prior informed consent. Questionnaire based study whose responses were assessed by using five point Likert scale and analysed by using appropriate descriptive statistics.Results: 68(90.67%) respondents agreed that antibiotics are overused in India and 70(93.33%) of them facing ABR in their daily practices. Only 62(82.7%) of them were aware of the fact that bacteria are not responsible for causing colds and flu. 33(44%) believe that skipping one or two doses of antibiotic does not contribute to ABR. Only 23(30.67%) knew drug schedule H correctly. 22(29.33%) opined that antibiotics should be discontinued if patient develops mild gastrointestinal side effects. Only 28(37.33%) reads patient information leaflet(PIL) and counsel patients accordingly. 28(38.67%) feel that they don’t have enough sources of antibiotic information and 35(46.67%) find it difficult to select appropriate antibiotic.Conclusions: Most of HCPs were aware of rising issue antibiotic resistance. However, their knowledge, attitude and practices were found to be a matter of some concern. Educational intervention can be introduced to bring about behaviour changes regarding rational antibiotics prescribing. Government should take initiative against overt antibiotic promotional advertisements and to curb over the counter(OTC) sell of antibiotics.
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Background: Irrational prescribing of medicine results in serious morbidity and mortality as well as additional economic burden and also lead to reduction in the quality of treatment; thereby causing wastage of resources, increased treatment cost, increased risk for adverse drug reaction, and emergence of resistance. WHO has generated indicators in three main drug use areas; prescribing, patient care, and facility specific factors. Methods: This study was carried out with the aim of identifying prescription pattern of antibiotics and evaluates the rationality of prescriptions in accordance with WHO prescribing indicators. 300 prescriptions were examined from the inpatient department (IPD) of a tertiary care teaching hospital from the Department of Medicine, Surgery, and Orthopedics. The IPDs were visited twice a week. Each prescription was followed for the duration of 5 days. The prescribing and dispensing details from each prescription were recorded in a tabular form as mentioned in data acquisition form. The data were analyzed as per the WHO core drug use indicators. Results: This study clearly highlights the practice of polypharmacy, low uses of generic drugs, injudicious usage of antibiotic, and injection and low usage of the drug prescribed from essential drug list. Conclusions: Multi-faceted interventions are required at many levels for the benefits of the community in the form of continued medical educational programs, consumer awareness, formation of hospital formulary, and undergraduate clinical pharmacology and therapeutics teaching.
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Background: Prescription auditing studies are a part of drug utilization studies, are beneficial in clinical practice for rational prescribing of drugs and helpful for minimizing the medication errors. They are important tool to promote rational prescribing. Methods: This was a prospective drug utilization study conducted by the Department of Pharmacology in Psychiatry out-patient department at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun for a period of 6 months. A total of 311 prescriptions were evaluated for prescribing pattern using World Health Organization drug indicators and National Essential Medicine List (NEML) 2011. Results: A total of 311 prescriptions were evaluated, 157 (50.48%) were females, and 154 (49.52%) were males, mean age was 37.14±0.8 years. Majority of patients were married 207 (66.56%), housewife 116 (37.30%) and belong to middle socioeconomic group 205 (65.92%). A total of 1250 drugs were prescribed, anti-anxiety (anti-A) 379 (30.32%), anti-depressants (anti-Ds) 348 (27.84%), anti-psychotics (anti-Ps) 118 (9.44%), anti-epileptics (anti-Es) 64 (5.12%), mood stabilizer 20 (1.6%), anticholinergics 28 (2.24%) and others 293 (23.44%). Oral formulations 1247 (99.76%), 4.02 drugs/prescription, 100% drugs were prescribed by brand names. 220 (17.6%) fixed dose combinations were prescribed. Most frequently prescribed among anti-A drugs were propranolol 160 (42.22%) and diazepam 105 (27.70%), among anti-Ds drugs were amitriptyline 65 (18.68%) and escitalopram 59 (16.95%) and among anti-Ps risperidone 49 (41.53%) and olanzapine 38 (32.20%), respectively. About 51.36% drugs were prescribed from the NEML 2011. Result has revealed polypharmacy in the practice. Conclusions: Anti-A drugs were the most commonly prescribed drugs followed by anti-Ds, anti-Ps and anti-Es respectively. Rational prescribing requires further consideration with special reference to polypharmacy and providing feedback to the physicians.
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have read the Editorial entitled ‘Challenges to rational prescribing and use of essential medicines in India’ which was published in your journal with great interest. This has prompted me to address certain issues related to rational prescription of iron supplements in pregnancy.
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Background: The aim of this study was to know the pattern & rationality of antimicrobial prescription by dental practitioners. Methods: It was questionnaire based cross sectional study. A total of 175 questionnaires were distributed to dental practitioners working in a tertiary care Dental College & Hospital and private practitioners in Jaipur (Rajasthan). The questionnaire contained questions about years of practice, diagnosis for which antimicrobial were prescribed, dosage and duration of antimicrobial drugs for prophylaxis, acute and chronic conditions, patient compliance & adverse effects. Data was expressed as counts and percentages. Results: Out of 175 questionnaires distributed, 150 were included in the study. 78% dentists had practices less than 5 years duration. Most common indications for which antimicrobials were prescribed were abscess, cellulitis, irreversible pulpitis, and acute gingivitis. Most common antimicrobials used for prophylaxis were Amoxycillin and Metronidazole. For the treatment of acute and chronic conditions, Amoxycillin, Metronidazole, Ofloxacin and Ornidazole alone or in combination were used. Only 20% dentist advised culture & sensitivity tests. 74% patients completed the recommended course of antimicrobials. 56% patients reported adverse drug reactions (ADRs) with the most common being nausea and vomiting, but only 13% dentists reported them to proper authorities. Conclusions: In this study, Amoxycillin and Metronidazole were the most common drugs used for the management of oral diseases, but were prescribed without culture & sensitivity in most cases. 56% patients reported ADRs, but only 13% dentists reported them to proper authorities. Appropriate measures need to be taken to promote rational prescribing and ADR reporting.
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A prescription order is a written instruction of doctors to pharmacist to supply drugs in particular form to a patient and the directions to the patients regarding the use of medicines. This study was undertaken to observe the prescribing patterns of the private practitioners in Bangladesh, 430 prescriptions were collected randomly from Dhaka city and analyzed using WHO/INRUD indicators. There were average 3.40 drugs per prescription. Drugs were prescribed in generic name only in 0.20%. About 46.31% drugs were prescribed from the Essential Drug List, only 19% of prescriptions were complete in respect to patient medication information. Antibiotics were prescribed in 70.33% of the prescriptions; injections were prescribed in about 8.35% of the prescriptions.
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To determine the prescribing information resources and the types of information about new drugs that Indian doctors perceived as important before prescribing and how they keep their information upto date . Also to determine if hospital doctors and General practitioners differed in their use of the sources. Two hundred general practitioners (GPs) and 200 hospital doctors were asked to rate information sources in terms of their importance for prescribing ‘old’ and ‘new’ drugs, and then to name the source from which information about the last new drug prescribed was actually derived. The study was carried out by information collection, by filling a questionnaire. Among 200 GPs, the Monthly Index of Medical Specialties (MIMS), pharmaceutical representatives and medical journal articles were most frequently rated as important for information on both old and new drugs . Among 200 hospital doctors, Refreshers courses by Govt.(Trainings),Monthly Index of Medical Specialties (MIMS) , and Hospital clinical meetings were of greatest importance. Information on the last new drug prescribed was derived from a broad range of sources. GPs and hospital doctors differ in their utilization of the prescribing information resources .This study generates the information that can be sought to help in shaping the development of health policy and the implementation of the Primary Health Care Strategy.
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The present study was performed to find out the prescribing patterns of the doctors for geriatric patients, to characterize the behavior of the outdoor geriatric patients of a selected private hospital and to investigate whether polypharmacy is a suitable indicator for occurrence of unnecessary or irrational drug therapy. A prospective study was carried out with the help of a structured questionnaire and the prescriptions of the patients. Patients aged 65 year and above were included in the study. A total of 35 patients were interviewed and their prescriptions were collected after taking their consent. Among the patients, hypertension was found to be most prevalent (46%) followed by diabetes mellitus (16%). Chief complaints were chest pain (41%), joint pain (37%), muscle pain (34%) and respiratory distress (27%). About 34% of the patients did not comply with the prescription and 75% did not take regular physical exercise. Stress (49%) and insomnia (41%) were common among the patients. Polypharmacy was observed in 69% of the patients and an average of 5.5 drugs was given to them. Losartan potassium was the mostly prescribed (31%) drugs followed by esomeprazole (20%) and multivitamins (17%). Unnecessary drug use problem can be prevented by the rational prescribing of drugs by the practitioners. Any medications without therapeutic benefit, goal or indication should be avoided during prescribing for geriatric patients. This study reveals the prescription trends, and indicates possible areas of improvement in prescribing practice.
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The present study was undertaken to evaluate the format, prescribing pattern and rationality of prescriptions of the patients attending Dermatology Out Patient Department of a tertiary care hospital for a period of one year. A total of 5,355 prescriptions were analyzed in which 17,459 drugs were prescribed with an average of 3.26 drugs per prescription. The patient's name and age was mentioned in all the prescriptions while superscription, dosage form, duration of therapy and prescriber's identity was written in 95.4%, 100%, 80.7% and 23.5% prescriptions respectively. Out of all drugs, 15.4% were from National Essential Drug List of India. Antihistamines (16.9%) were the most common group of drugs used, followed by corticosteroids (15.3%). Most of the drugs were given by topical route (60.2%). Dosage and dose schedule of drugs was written for 91.2% and 94.7% drugs respectively. The study showed a tendency towards polypharmacy and prescribing by proprietary names.