Drug utilization pattern in the treatment of acute diarrhea in children aged 1–12 years

Background: Pediatric diarrhea is the second most common cause of childhood mortality globally. Despite being self-limiting, polypharmacy is rampant in their treatment. The adherence of practitioners to the recommended guidelines can be assessed by drug utilization studies. Aim and Objectives: The aim of the study was to assess the drug utilization pattern of acute diarrhea management in children. Materials and Methods: A prospective observational study was undertaken for 12 months at pediatric inpatient unit of BRIMS, Bidar. Prescriptions of 400 cases of acute diarrhea in children of either gender aged 1?12 years were evaluated for the pattern of drugs prescribing using the WHO core indicators. Results: The study showed male preponderance with 54.75% being males. Every prescription, on an average had five drugs for diarrheal management. About 43.5% prescriptions had at least two antibiotics. Out of a total of 2237 drugs prescribed, 1392 (62.2%) drugs were prescribed as injections. About 78.5% medicines were selected from the National List of Essential Medicines (NLEM), 2015 and 87.12% drugs were from the hospital formulary. Drugs were categorized as per ATC/DDD system using the WHO reference DDDs and ATC codes website. PDD to DDD ratio of majority of drugs was 0.99. Conclusion: We observed polypharmacy in practice for diarrheal illness in our study. Accentuation on evidence-based management and adherence to the treatment guidelines may help in improved and rational drug use in children.

The use of ATC/DDD WHO 2016 and Prescription audit study in the Dermatology OPD of a tertiary care hospital in Jharkhand

Background: To study the prescribing patterns, rationale of drug usage and use of anatomical, therapeutic, chemical (ATC) and defined daily dosage (DDD) classification for the monitoring of drug utilization in the dermatology department of a tertiary care hospital.Methods: A retrospective, observational study was conducted in out-patients department of dermatology at RIMS, Ranchi over a period of two months. Rationale of drug usage was assessed by analysing the prescriptions. Defined daily dosage/1000 patients/day of the commonly used medications was compared to the defined daily dosage by World Health Organization in 2016. Data was analysed by statistical tools. Most of the results were expressed in percentages.Results: The prescriptions were rational in most of the cases. Emphasis was more towards the branded drugs. Polypharmacy was evident in many of the prescriptions. The number of DDD/1000 patients/day in cases of antifungals was more than the WHO DDD and less than the WHO DDD in case of antihistaminics.Conclusions: The number of drugs per prescription must be rationalized so as to avoid polypharmacy. The drugs should be prescribed by their generic names also along with the brand names. Generic medicines should be available in the hospital pharmacy so that a more cost-effective treatment can be assured. CMEs and stewardship programs for health care professionals regarding rational drug usage should be organized.

Drug utilization pattern and physician adherence to treatment guidelines in inpatients with urinary tract infection

Background: Mainstay of management in urinary tract infection (UTI) is antibiotics and it is seen in recent years that antibiotic resistance is increasing. However, very few treatment guidelines exist for UTI and often treating physicians may not adhere to these guidelines. Aims: Current study was undertaken to analyze antimicrobial prescription pattern and utilization, and check for physician adherence to treatment guidelines in UTI.Methods: This retrospective, record-based study was carried out in a tertiary care hospital in inpatients with UTI. Tabulated data was analyzed using WHO core drug prescribing indicators and Anatomical Therapeutic Chemical/ Defined Daily Dose (ATC/DDD) index. Adherence to treatment guidelines was assessed using Indian Standard Treatment Guidelines for Urology. Data documented in SPSS software was analyzed using ?2-test and multinomial logistic regression.Results: Among 364 patients included in study, equal incidence of UTI was seen in both sexes (male to female ratio 1.02:1). Prolonged hospital stay (>7 days) was associated with elderly age group (OR=3.09, CI95% 1.83-5.21), complicated UTI (OR=8.11, CI95% 4.62-14.24), ESBL-producing E. coli (OR=3.07, CI95% 1.58-5.94), non-adherence to treatment guidelines (OR=8.65, CI95% 4.19-17.84), and presence of comorbid conditions like diabetes mellitus (OR=4.89, CI95% 3.05-7.82), benign prostatic hypertrophy (OR=2.76, CI95% 1.36-5.59) and utero-vaginal prolapse (OR=8.33, CI95% 2.28-30.45). Average number of drugs prescribed per encounter was 1.59, while drugs prescribed by generic name and from essential drug list were 98.1% and 70.69% respectively. Majority of prescriptions (87.6%) adhered to standard treatment guidelines. Prescribed daily dose (PDD) and defined daily dose (DDD) were equal for most antibiotics prescribed.Conclusions: Majority of prescriptions were adhering to treatment guidelines but the need to prescribe using generic name and from essential drug list should be emphasised upon.

Systematic review of drug utilization studies & the use of the drug classification system in the WHO-SEARO Region.

Background & objectives: Information available on drug consumption is inadequate in most low and middle income countries. This systematic review was conducted to analyse published work on drug utilization research/studies (DUR) in the SEARO region of WHO for study objectives, methodology, results and recommendations and to identify the need for improving DUR and the use of the ATC/DDD system. Methods: A literature search for DUR was carried out in biomedical databases (PubMed, Scirus, Scopus and Google Scholar) up to May 2012. Publications were selected if those were in the English language, describing DUR or prescription practices, and study conducted in the WHO-SEARO countries. Results: A total of 318 publications were included in the review. Of these, 67 per cent were from India and 13 per cent were from Thailand. Majority of the publications were hospital based; only 16 per cent were community based. The ATC/DDD system was used in only 20 per cent of the publications, of which 73 per cent publications used DDD indicators. Several publications focused on antibiotics (31%). Publications that recommended the need for a policy or intervention to improve prescription practices/rational drug use amounted to 35 per cent. Interpretation & conclusions: Drug utilization studies using ATC/DDD system need to be promoted and carried out on an ongoing basis. DUR is important for rational use of drugs. Its relevance to policy making and resource allocation needs to be emphasized.

What is ATC/DDD ? / 薬剤疫学

The Anatomical Therapeutic Chemical (ATC) classification system and the Defined Daily Dose (DDD) as a measuring unit was developed along with an increased concern about drug utilization studies in Europe in the 1960s. Its use was recommended by the WHO Regional Office of Europe on 1981, then by the WHO Headquarters in Geneva in 1996. It is maintained by the WHO Collaborating Centre on Drug Statistics Methodology in Olso (http://www.whocc.no/) and widely used in Europe. However, it is rarely used in other parts of the world. This paper aims to inform the Japanese public about the ATC/ DDD system towards a more rational use of drugs in Japan. It attempts to answer the five Ws on ATC/ DDD, i.e., “What is ATC/DDD?”; “Why is ATC/DDD used?”; “When was ATC/DDD established?”; “Who decide ATC/DDD and how?”; and “Where is ATC/DDD used?”