Padrão das prescrições odontológicas de antibióticos dispensados no Sistema Único de Saúde do estado de Minas Gerais / Standard of dental prescriptions for antibiotics dispensed in the systempublic oral health services in the state of Minas Gerais

Antibióticos, juntamente com analgésicos e anti-inflamatórios, são os medicamentos mais utilizados em odontologia. A prescrição de antibióticos por cirurgiões-dentistas acontece em todo o mundo, sendo que o uso adequado desses medicamentos pode resultar em falha terapêutica, aumento do risco de reações adversas e impacto econômico, além de ser a principal causa de resistência antimicrobiana. A literatura aponta que dor de origem dental raramente é causada por uma infecção bacteriana que requer medicação antibiótica e geralmente é melhor gerenciada com o uso de analgésicos e procedimentos odontológicos locais. Os resultados de pesquisas realizadas na Inglaterra e Canadá sugerem que as prescrições de antibióticos por cirurgiões-dentistas estão aumentando de forma alarmante. Sabe-se também que o padrão de prescrição de antibióticos pode ser influenciado por fatores clínicos e não clínicos. Nesse sentido, gerar informação sobre o consumo de antibióticos é essencial para que os países adotem medidas para a conscientização da população e profissionais de saúde sobre o uso apropriado desses medicamentos, monitorem o impacto das intervenções e aprimorem o processo de aquisição, prescrição e dispensação desses medicamentos. O objetivo deste estudo foi analisar a possível associação entre prescrições odontológicas de antibióticos no setor público de um estado do sudeste brasileiro, características dos serviços de saúde e características sociais municipais. O desenho do estudo foi do tipo ecológico, o ano analisado foi o de 2017 e os dados foram obtidos do banco de dados do Sistema Integrado de Gerenciamento da Assistência Farmacêutica. A variável desfecho do primeiro artigo dessa Tese de Doutorado foi o número de Doses Diárias Definidas (DDD) por 1.000 habitantes/ano dos municípios. A variável desfecho do segundo artigo foi a adesão dos municípios a um sistema de informação de prescrições odontológicas. O banco de dados foi analisado inicialmente no programa Excel versão 2016 (Microsoft, Seattle, USA) e posteriormente no programa SPSS versão 25.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). A técnica CART (Classification And Regression Tree) foi usada para determinar a influência das características sociais dos municípios (Índice de Desenvolvimento Humano, Índice Gini, proporção de população rural, proporção de famílias beneficiárias do Programa Bolsa Família, tipologia rural/urbana, ser ou não município sede de Centro de Especialidades Odontológicas, sede de Macrorregião e Microrregião de Saúde) e das características dos serviços de saúde bucal (cobertura de saúde bucal na Estratégia Saúde da Família e na Atenção Primária à Saúde, cobertura populacional de primeira consulta odontológica, número de cirurgiões-dentistas e de equipes de saúde bucal por 1000 habitantes e percentual de procedimentos odontológicos individuais preventivos e restauradores). Os antibióticos foram os medicamentos mais prescritos pelos cirurgiões-dentistas do setor público pesquisado, sendo as penicilinas o grupo mais prescrito. A média geral de DDD/1000hab/ano, para os 421 municípios pesquisados, foi de 96,54. Fatores de organização de serviços estiveram associados à aceitabilidade dos municípios ao sistema de vigilância analisado.Concluiu-se que fatores socioeconômicos e de organização dos serviços de saúde estiveram associados à utilização de antibióticos. Há necessidade de avanços na vigilância da prescrição de antibióticos nos serviços públicos de saúde bucal do estado de Minas Gerais.

Antibiotics, along with analgesics and anti-inflammatory drugs, are the most commonly used medications in dentistry. The prescription of antibiotics by dental surgeons happens all over the world, and the irrational use of these drugs can result in therapeutic failure, increased risk of adverse reactions and economic impact, besides being the main cause of antimicrobial resistance. The literature points out that pain of dental origin is rarely caused by a bacterial infection requiring antibiotic medication and is usually best managed with the use of analgesics and local dental procedures. The results of surveys conducted in England and Canada suggest that antibiotic prescriptions by dental surgeons are increasing alarmingly. It is also known that the pattern of antibiotic prescribing can be influenced by both clinical and nonclinical factors. In this sense, generating information on antibiotic consumption is essential for countries to adopt measures to raise awareness among the population and health professionals about the appropriate use of these drugs, monitor the impact of interventions, and improve the process of acquiring, prescribing, and dispensing these drugs. The aim of this study was to analyze the possible association between dental antibiotic prescriptions in the public sector of a southeastern Brazilian state, health services characteristics, and municipal social characteristics. The study design was of the ecological type, the year analyzed was 2017, and the data were obtained from the database of the Integrated Pharmaceutical Assistance Management System. The outcome variable of the first article of this PhD Thesis was the number of Defined Daily Doses (DDD) per 1,000 inhabitants/year of the municipalities. The outcome variable of the second article was the municipalities' adherence to a dental prescription information system. The database was analyzed initially in Excel version 2016 program (Microsoft, Seattle, USA) and later in SPSS version 25.0 program (IBM SPSS Statistics for Windows, Armonk, NY, USA). The CART (Classification And Regression Tree) technique was used to determine the influence of the social characteristics of the municipalities (Human Development Index, Gini Index, proportion of rural population, proportion of beneficiary families of the Bolsa Família Program, rural/urban typology, whether or not the municipality is the headquarters of a Dental Specialties Center, seat of a Health Macro-region and Microregion) and the characteristics of oral health services (oral health coverage in the Family Health Strategy and Primary Health Care, population coverage of first dental consultation, number of dentists and oral health teams per 1000 inhabitants, and percentage of individual preventive and restorative dental procedures). Antibiotics were the most prescribed drugs by dental surgeons in the public sector surveyed, with penicillins being the most prescribed group. The overall average of DDD/1000hab/year, for the 421 municipalities surveyed, was 96.54. It was concluded that socioeconomic factors and organization of health services were associated with the use of antibiotics. There is a need for advances in the surveillance of antibiotic prescribing in public oral health services in the state of Minas Gerais.

Prescription Auditing of Patients Admitted at Psychiatry ward of a Tertiary Care Hospital of Western UP

Introduction: The World Health Organization (WHO) proposed core-prescribing indicators for prescription audit and drug utilization studies. The focus of Indian studies has mainly been on the WHO core-prescribing indicators such as the range and number of drugs per prescription. Critical evaluation of prescriptions including rational auditing of prescriptions of patients admitted at Psychiatry Ward of Jawaharlal Nehru Medical College Hospital, A.M.U., Aligarh, from the period of 31/05/2013 to 30/05/2015. Materials and Methods: Permission for retrospective study to access medical records of the past 2 years of all patients admitted in the Psychiatry ward from 31/05/2013 to 30/05/2015 was obtained from the competent authority. Prescriptions of 44 patients (26 female, 18 male) were available in the Central Record Section during this period. The following parameters were taken to analyse and audit prescriptions as per WHO prescribing indicators: 1) Patient details, 2) Mention of diagnosis, legibility & spelling mistakes, 3) Details of the consultant, 4) Use of antibiotics/antipsychotics by various routes, 5) Provision of proper instructions to patients and 6) Additional parameters - Percentage of prescriptions with nutritional supplements and antacids. Results: Only 36% of prescriptions contained the full names of patients, while age, sex and address were present in 84.09% of the prescriptions. 100% prescriptions were found written with complete diagnosis and contained the signature of the concerned doctor. None of the prescription had the doctor’s contact number. A mean number of 3.18 drugs were written per prescription. All prescriptions were legible and 2.27% contained spelling mistakes. Insufficient instructions for both oral and injectable drugs were mentioned on all prescriptions. Conclusion: As per WHO laid guidelines, study related to drug use indicators are simple as a supervisory tool to assess prescribing patterns by individual doctors. These prescription studies provide scope to improvement in prescribing patterns and promotion of rational use of drug among practitioners.

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.

Prescription patterns of antihypertensive drugs in a tertiary care hospital in India.

Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India. Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with comorbidities were excluded from study. The data were analyzed to fi nd out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency. Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensinconverting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed. Conclusions: This study represents the current prescribing patterns for antihypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.