A drug utilisation pattern in non-dialysis patients of diabetic nephropathy in a government-run tertiary care hospital in South-Asia.

OBJECTIVES: The objective of the present study was to evaluate the Drug utilisation pattern in patients of diabetic nephropathy (stage 1-4) in a tertiary care hospital in South-Asia. METHODS: A cross-sectional observational study was conducted in the nephrology out-patient-department of a tertiary care hospital in South-Asia. WHO core prescribing, dispensing, and patient care indicators were evaluated, and adverse drug reactions (ADRs) encountered by the patients were analysed for causality, severity, preventability, and outcome. RESULTS: The most commonly prescribed antidiabetics in diabetic nephropathy patients were insulin (17.42%), followed by metformin (4.66%). Current drugs of choice SGLT-2 inhibitors were prescribed in a lesser frequency than expected. Loop diuretics and calcium channel blockers (CCBs) were the preferred antihypertensives. The use of ACE inhibitors (1.26%) and ARBs (3.45%) for hypertension was restricted to Stage 1 and 2 nephropathy. The patients were on 6.47 drugs on average. 30.70% of drugs were prescribed by generic names, 59.07% of the drugs were prescribed from the national essential drugs list and 34.03% of the prescribed drugs were supplied by the hospital. CTCAE grade 1 (68.60%) and grade 2 (22.09%) ADR severity was the highest. CONCLUSIONS: Prescribing patterns in patients of diabetic nephropathy were adapted from relevant medical evidence, affordability and availability of the drugs. Generic prescribing, availability of drugs and ADR preventability in the hospital have a broad scope for improvement.

Past, present and future perspectives of therapeutic drug monitoring in India.

Therapeutic drug monitoring (TDM) is the clinical practice of performing drug assays and interpreting results to maintain constant therapeutic concentrations in patients' bloodstream. Conventional TDM was started way back in the 1960s and served to optimise pharmacotherapy by maximising therapeutic efficacy by evaluating efficacy failure and monitoring drug compliance, while minimising adverse events, in drugs with a narrow therapeutic range. Currently, the scope of TDM has been extended to additional indications which are of importance to India. Apart from the conventional indications, TDM can also help combat drug resistance amongst patients treated with antimicrobials, including anti-tubercular drugs and critically ill patients with compromised pharmacokinetics. TDM is also indicated for patients on antiretroviral drugs under specific clinical scenarios and is of high importance to India. Target concentration intervention (TCI) and apriori TDM (by merging TDM with pharmacogenomics) are emerging fields explored in developed nations. The authors sought to assess the evolution of TDM in India and evaluate the potential impact of newer indications in rationalising pharmacotherapy. In the mid-1980s, TDM was presented to India. Despite showing some initial progress, its use is limited to conventional indications. Its utility is also challenged by cost and higher reliance on conventional prescribing practices. However, the newer indications such as antimicrobial resistance, tuberculosis and HIV, with their high prevalence in developing nations, present an opportunity for the growth of TDM in these countries. Indian clinician's awareness and buoyant demands alongside expert contributions from clinical pharmacologists could widen its scope.

Awareness about rational use of medicines among fresh Bachelor of Medicine and Bachelor of Surgery graduates.

CONTEXT: Fresh Bachelor of Medicine and Bachelor of Surgery graduates (FMGs) are responsible for the majority of prescription errors and irrational use of medicines. Little research has explored their knowledge on rational prescribing practices. AIMS: The present study aimed to evaluate the awareness of rational use of medicines (RUMs) among the FMGs. SETTINGS AND DESIGN: A multicentric, cross-sectional, and questionnaire-based study was conducted among 308 FMGs during the internship orientation program. SUBJECTS AND METHODS: The structured and prevalidated questionnaire consisted of 35 statements on important aspects of RUM. STATISTICAL ANALYSIS USED: Data were analyzed using SPSS version 24.0 at 95% level of significance with Fisher's exact test. RESULTS: Nearly 31% of FMGs did not know that the generic drugs are equally efficacious as branded drugs whereas 53% were in support of pregnant female should not consume any drug. Nearly 58% of FMGs were confused about deciding the dose in children and 18% were in favor of using antibiotics in common cold. Almost 55% of FMGs were disagree for adjusting the dose of antidiabetic drugs by patient depending on the meal taken whereas 12% were not aware of the importance of compliance of antihypertensive drugs and 40% were supporting the safety of fruits in chronic renal disease. The FMG from government colleges answered more correctly than that of the private colleges. CONCLUSIONS: The awareness of RUM among FMG is not satisfactory, and also there is a gap in its implementation. Thus, they should be supervised during the initial phase of their medical practice.

Evaluation of rationality of promotional drug literature using World Health Organization guidelines.

OBJECTIVES: The study was aimed to evaluate collected drug promotional brochures for accuracy, consistency, and validity of the information presented in it, using World Health Organization (WHO) criteria for ethical medicinal drug promotion. Drug promotional brochures were evaluated for the type of claims and pictorial content presented in it and for references cited in support of these claims. MATERIAL AND METHODS: This observational, cross-sectional study was conducted in the outpatient department of Government Medical College and Hospital, Nagpur, India. In addition to the fulfillment of "WHO criteria, 1988," we examined 513 promotional brochures for the type of claims and pictorial content presented in it and references quoted in support of claims to check their retrievability, type, and authenticity. RESULTS: None of the promotional literature fulfilled all WHO criteria. Majority (92%) brochures claimed about the efficacy of product, and a few about safety (37.8%). Out of 1003 references given in support of various claims, 84.4% were from journals and only 28.5% were validly presented researches. Brochures presenting irrelevant pictures were 41.3%, whereas brief prescription information (BPI) of the promoted drug was given only by 8.8% brochures. CONCLUSION: Pharmaceutical industries did not follow the WHO guidelines while promoting their products, thus aiming to satisfying their commercial motive rather than fulfill the educational aspect of promotion.

Comparison of safety, efficacy, and cost effectiveness of benzyl benzoate, permethrin, and ivermectin in patients of scabies.

OBJECTIVE: To compare three treatment modalities in scabies for safety, efficacy, and economy in a local population of Nagpur. MATERIALS AND METHODS: This was a prospective, randomized, comparative clinical trial conducted in 103 participants, randomly allocated to three groups. First group received benzyl benzoate (BB) 25% lotion, second group received permethrin 5% cream, whereas third group received tablet ivermectin 200 mug/kg as a single dose. The participants were recalled after one week for follow-up evaluation. If there were no signs of cure, the same intervention was repeated. The participants were followed up for two weeks for cure rate, adverse drug reaction (ADR) monitoring, and postintervention observation. The follow-up was stopped after two weeks. STATISTICS: Fischer's exact test using Graph pad Instat v 3.05. RESULTS: Ivermectin showed 100% cure rate after two weeks of treatment. Permethrin decreased pruritus by 76% at the end of one week and had significantly better cure rate than ivermectin. At the end of two weeks treatment, this finding was reversed, that is, cure rate in ivermectin group was 100%. For cost-effectiveness analysis, treatment regimens were formulated hypothetically for comparison from Markov population tree for decision analysis. It was found that BB and ivermectin each consecutively for two weeks were most cost effective regimens giving complete cure in four weeks, while ivermectin was the fastest regimen giving the same results in two weeks. CONCLUSION: Benzyl benzoate as first line intervention and ivermectin in the remaining gave best cost-effective results in the study patients of scabies.