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Background: Drug utilization studies have become a useful tool to facilitate rational use of drugs. A very few studies provides information on drug use patterns in children. Objectives: To evaluate drug utilization and associated cost of treatment in the paediatric outpatient and inpatient department of a university teaching hospital in north India...
Citations
... Unnecessary medicines may be prescribed, such as high doses of multivitamins to patients without nutritional problems or antibiotics to patients without evidence of bacterial disease. For the use of medicines to be reasonable, they must be effective, safe, prescribed for the right therapeutic indication, in the right dosage, in the right formulation, easily available and at a reasonable cost [34]. ...
Over the past 100 years, medical care for animal diseases has evolved significantly. The purpose of this paper is to review the rational use of veterinary medicines and their current status in Ethiopia. Veterinary drugs are used rationally or irrationally in the livestock sector for therapeutic, prophylactic, and growth-promoting drugs, food preservation and processing, stress control in slaughterhouses prior to slaughter, and reproductive control. Rational use of drugs is the use of the right drug, in the right amount, at the right cost, and at the right time. Irrational use of veterinary drugs is a major problem when used in food-producing animals. Reasons for irrational drug use include poor communication between owners and professionals, inadequate training and education of veterinary graduates, demands from owners, and lack of diagnostic equipment. Irrational use of drugs can negatively impact public health, including: decreased quality of drug therapy leading to increased mortality and morbidity; increased risk of undesirable effects (emergence of drug resistance and side effects); waste of resources leading to decreased availability of other important drugs; increased costs; adverse, sometimes increased, in some cases lethal, effects, and so on. To promote the rational use of drugs, WHO has announced 12 core interventions. In Ethiopian veterinary clinics, there were problems with correct diagnosis, low prescriber education levels, the presence of a small number of essential drugs, the absence of a standard veterinary drug list, and inappropriate drug use leading to irrational drug use. Therefore, attention should be paid to proper diagnosis, educational status of prescribers, different types of drugs, and meeting all the customs of the national veterinary drug lists and guidelines..
... Some studies have reported optimal or near-optimal averages (1.8-2) [7,10], but our findings align with the values observed in studies elsewhere (2.4-4.1) [2,11,12]. Polypharmacy, or the use of multiple medications, can lead to drug interactions, increased risk of adverse effects, medication errors, and higher healthcare expenses. In low-income countries like Afghanistan, the increased healthcare costs associated with prescribing more drugs per patient encounter pose challenges [13]. ...
... Nevertheless, our findings suggest that prescribers may not fully appreciate the importance of generic drugs. Additionally, pharmaceutical companies' marketing efforts may influence the preference for brand-name drugs in our country [11,16,17]. ...
... The overuse of antibiotics, as observed in our study (84%), contributes to antimicrobial resistance. Unfortunately, our figure exceeds both the WHO standard and the rates reported in similar studies worldwide [2,11,12,14,16,18], except for one study in Jordan (85%) [19]. This overprescribing can fuel antimicrobial resistance, a significant therapeutic challenge. ...
Background
The global issue of irrational drug use, particularly concerning pediatric patients, is a significant concern. Notably, there has been a lack of studies assessing rational drug prescribing for pediatric patients within Afghanistan's healthcare system. This investigation aimed to address this gap by examining drug prescribing patterns at the Indira Gandhi Pediatric Health Institute (IPHI) in Kabul, Afghanistan.
Methods
A prospective cross-sectional analysis was conducted to evaluate the prevailing drug prescribing practices at the outpatient department of IPHI in Kabul, Afghanistan. A systematic random sampling method was employed to select 600 outpatient prescriptions from the institute, following the World Health Organization (WHO) guidelines for investigating drug utilization in healthcare facilities.
Results
The average age of patients was 4 years, and the average number of drugs per prescription was 2.9. Notably, 84% of prescriptions included one or more antibiotics, surpassing the WHO standard of <30%. Furthermore, 67% of the prescribed drugs were listed on Afghanistan's national essential drugs list (EDL), falling below the standard value of 100%. Only 35.1% of the prescribed drugs were in generic form, also lower than the recommended 100%. Moreover, 5.7% of all prescriptions included injections, the ideal value is <20%. The most frequently prescribed drug groups were anti-microbials (25.7%), followed by non-steroidal anti-inflammatory drugs (NSAIDs), (21.4%), gastrointestinal drugs (17.3%), and vitamins (7.8%).
Conclusion
The study's findings indicate that, on average, a higher number of drugs were prescribed per patient visit at IPHI compared to recommended standards. Additionally, there was a lower utilization of generic drugs and drugs from Afghanistan's national essential drugs list (EDL), with an over-prescription of antibiotics.
... Polypharmacy is an important component of irrational prescribing. It implies the use of many drugs in one prescription or the prescription of too many medications for a particular patient with associated risk of drug interactions and adverse drug reactions (13,16). It is known that the number and severity of adverse medication reactions are directly related to the number of drugs administered (17). ...
... Similar results have been obtained in other studies in Nigeria and Pakistan (6,19). The use of high number of drugs which may have been influenced by factors like financial incentives to prescribers by medical sales representatives and/or inadequate therapeutic training of prescribers can lead to high risk of drug interactions, adverse effects and high medication cost to the patients (15,16). ...
... The percentage of drugs prescribed by generic name in the two hospitals was lower than the approved standard of 100 % (10,12,18). Factors responsible for prescribing with brand names include promotional activities by companies, pressures from company representatives, lack of continuing education and training on rational prescribing principles and non-familiarity with generic names by most prescribers (7,14,16,22). ...
Rationality analysis of the prescribing pattern of antibiotics for pediatric patients can help to point towards irrationality and can make a consensus among physicians for rational prescribing. This study was aimed at identifying the antibiotic prescription survey in pediatric outpatient prescriptions. This study was carried out in two hospitals namely; Usmanu Danfodiyo University Teaching Hospital, Sokoto, and General Hospital Katsina Nigeria during the period of October to December 2019. A total of 600 prescriptions cumulatively were used as a sample and were selected using the convenience sampling technique. For data collection, a self-designed data collection sheet was used. WHO / INRUD prescribing indicators were used for the analysis of prescription patterns. A total of 600 prescriptions (364 from UDUTHS and 236 from GHKS) were selected and used for the study. Most of the patients admitted to the two selected hospitals were male. The patient’s ages varied from a few months to 12 years, with the majority aged 4 years or less (61.0%) of age. From the 600 prescriptions evaluated, 1564 drugs (912 from UDUTHS and 652 GHKS) were prescribed. The average number of drugs per encounter in UDUTHS and GHKS were 3.0±0.4 and 3.2±0.7 respectively. The percentages of encounters with an antibiotic prescribed in both hospitals were similar: 32.1% for UDUTHS and 31.1% for GHKS. Most antibiotics were targeted at respiratory tract infections Roxithromycin 126 (21.0%) was the most frequently prescribed antibiotic and was prescribed by the proprietary name. This study has revealed inappropriate drug prescriptions in the pediatric outpatient in these hospitals. These include the low rate of prescriptions in generic names; extensive polypharmacy; and inappropriate prescription of antibiotics which could lead to drug-drug interaction and adverse drug reaction is also evident in these hospitals.
... Among different antibiotic groups, 85 % (n=285) of the prescription was contributed by cephalosporin, penicillin group (ampicillin, amoxycillin and amoxycillin-clavulanate) and azithromycin. 30.95% (n=13), 25% (n=5) and 80% (n=12) had received either oral or parenteral antibiotics respectively, also 46.6% (n=96), 58.62% (n=85), 28.42% (n=27), 59.52% (n=25), 80% (n=16) and 0% respectively did not required antibiotic because they had non-bacterial cause for their illness. ...
... 27 This pattern of antibiotic varies from country to country like it is 81.3% in Sudan, 71.1% in Nigeria, and 81.1% India. [28][29][30] Such resistance to drugs is seen not only with bacteria, it is seen with all categories of microbes that includes virus, rickettsia, chlamydia, fungus and parasites. 31 Development of superbugs is basically due to presence of resistant microbial genes and non-judicial use of antimicrobial drugs. ...
Resistance to antimicrobial drugs is a global threat now. It creates burden on the health system financially and also increases the morbidity rate in pediatric age group attributed to infectious disease. To overcome this issue, it is inevitable to have pre-set guidelines for the pediatricians at the institution level. The current study was done to have an understanding of the antibiotic use among the pediatric patients admitted in the hospital. The study has also envisaged the pattern of antibiotics use among these children. An observational study was conducted among patients admitted to the inpatient paediatric department of a referral centre of Bihar, India during the period from April 2019 to March 2020. A total of 557 children were included in our study. Out of them, majority belonged to the age group of <5 years. Overall, 60% have received antibiotic in any form. Study participants were categorized based on the predefined criteria, requiring antibiotic, can be given antibiotics and antibiotics not required are 12.93%, 38.78% and 48.29%, respectively. Patients with respiratory, gastrointestinal and systemic infections comprised the majority of the cases. Antibiotic use was most commonly among those with respiratory and systemic infectious disease. Among the prescribed antibiotics, cephalosporin, penicillin group and azithromycin constitute more than 90% of the prescriptions. Irrational use of antibiotic is a threat to the health care system, that poses monetary loss to the system and the creates microbial resistance. World health Organization has recommended to have a strict surveillance system for all the hospitals to overcome this problem.
... This is where such prescription pattern monitoring studies have important role to play. Prescription patterns explain the quality and quantity of drugs being recommended, give insight into recent trends among physicians/surgeons, and quantify the extent of adherence to WHO indicators like standard treatment regimens, overuse /underuse of recommended antibiotics, usage of drugs from essential medicine list, etc. 11 As WHO is promoting implementation of these indicators in developing countries, and it has successfully done so in 30 + such countries 7 , very limited number of data is available from our country regarding adherence to WHO Indicators. Therefore our study along with other such studies can provide a source of useful information in this regard to assess the prescription and hospital indicators. ...
Background: Medicines play a crucial role in the healthcare delivery of a hospital. The appropriate use of medicines gives us assessment of the quality of health services being provided in a particular region. Aim: To evaluate the prescribing practices and antibiotic utilization patterns so that the extent of irrational use can be assessed by comparing them with published ideal values set by WHO. Study design: Retrospective, cross-sectional study. Place and duration of study: Teaching Hospital of Faisalabad: Independent University Hospital (IUH), from Jan 2018 to June/July 2018. Methodology: 200 cases were selected through systematic random sampling from medicine/surgery wards and pharmacy registers. The standard World Health Organization prescribing indicators and AWaRe categorization of antibiotics were used to assess the prescribing practices of physicians/surgeons. Published ideal standards for each of the indicators were compared with study findings to identify extent of irrational drug use. Results: Most of the facility indicators were met with. The Drug and Therapeutic Committee (DTC) was functional. The Standard treatment guideline booklets (STGs) and Essential Drugs List (EDL) of the hospital were available. 88% of the key drugs listed in EDL were available in stock. The expenditure on antibiotics compared to total medicines was 17%. Regarding prescribing indicators: the average number of drugs prescribed per encounter was 6 (optimal value 1.6–1.8). Average no of antibiotic per prescription amounted to almost 1 (0.925). % prescriptions with an antibiotic amounted to 72% (optimal value 20-26.8%).72% antibiotics were prescribed from the EDL formulary of the hospital (optimal value 100%). Conclusion: Regarding compliance with prescribing indicators and AWaRe categorization of antibiotics by WHO, significant deviation was observed. Education and training of physicians according to WHO parameters is required to ensure rational prescribing. Keywords: Prescription pattern, WHO Prescribing Indicators, AWaRe Categorization
... Table 2 shows the total number of medicines/prescriptions per health facility. (2), respectively [4][5][6][7][8]. ...
... Our finding is lower than the WHO standard (100%). However, studies carried out elsewhere found that the percentage of drugs prescribed by the generic name was 2.6% in India, 49.3% in Sudan, and 68.9% in Nigeria [8,6,7]; our values fall in this range. Inadequate generic prescribing could lead to increased health care costs, and the problem of bioequivalence; therefore, it is required to promote the prescribing of generic drugs [9]. ...
... On the other hand, this finding is in range with studies carried out in Sudan (81.3%), Nigeria (71.1%), and India (81.1%) [6][7][8]. Overuse of antibiotics can lead to the emergence of antimicrobial resistance, which does not respond to the conventional antibiotics available at present [9]. Similarly, the percentage of prescriptions with injections prescribed was 6% in 001 health facility, 32% in 002 health facility, and 19.5% in 003 health facility. ...
Background: Irrational medicine use is a global problem. It can lead to increased morbidity and mortality and increased costs of drug therapy, thus imposing an adverse impact on the overall quality of the pharmaceutical care system. Objective: To evaluate drug use practices based on WHO core drug use indicators at pediatric health facilities of Kabul, Afghanistan.Methods: A cross-sectional study was conducted at outpatient departments of the three pediatric health facilities at samples that were collected using a systematic random sampling method. The sample size included 600 outpatient prescriptions. Data were evaluated as per the WHO guidelines.Results: On average 2.795, 2.745, and 4.2 drugs per prescription were prescribed in 001, 002, and 003 health facilities respectively (WHO standard is 1.6-1.8). 37.03% of drugs in 001, 42.62% in 002, and 42.64% of drugs in 003 were prescribed by the generic name (WHO standard is 100%). Antibiotics were prescribed in 79% prescriptions of the 001, 88% of the 002, and 52% of the 003 health facilities (WHO standard value is 20-26.8%). Injections were prescribed in 6% of the 001, 32% of the 002, and 19.5% of the 003 prescriptions (WHO standard is 13.4-24.1%). 65.47% of drugs in 001, 67.94% of drugs in 002, and 73.1% of drugs in 003 health facilities were prescribed from the Afghanistan national essential medicines list (WHO standard is 100%).Conclusion: Most of the core drug use indicators were not met with WHO standards in these pediatric health facilities. However, in 001 and 003 health facilities the prescribing patterns may be more complex because they are tertiary health care centers.
... [13] Inconclusive diagnosis or pressure on physicians to prescribe drugs for minor symptoms leads to an increased risk of adverse effects, drug interactions, administration errors, development of antimicrobial resistance, and increased cost. [14] In addition, treatment of patients with multiple conditions was also instrumental in polypharmacy. In contrast to our study, the average number of drugs in Sudan and Nigeria were observed at 2.0 and 2.6, respectively. ...
Background:
The irrational use of antibiotics is a global issue and it can lead to morbidity, mortality, and increased health care costs. Hence, proper use of antibiotics is imperative and should be included in the pharmaceutical care plan.
Objective:
The objective of this study was to evaluate the prescribing pattern of antibiotics for children using WHO core prescribing indicators.
Materials and methods:
A prospective, observational study was carried for 6 months in the pediatric department at a tertiary care hospital, Pune. The WHO prescribing indicators were used to evaluate the prescriptions, and the ideal WHO range was considered as a determining factor for rational prescription.
Results:
A total of 302 patients were included in the study, with a mean patient age of 4.92 ± 4 years. The average number of drugs per encounter was 6.12 (WHO standard is less than 2). The percentage of antibiotics prescribed was 26.3% with an average of 1.63 antibiotics per prescription. Of the 493 antibiotics, 85.59% were injectable which is higher than the WHO standard of 13.4-24.1%. A near-optimal value of 99.59% antibiotics was prescribed from the hospital formulary which is similar to WHO standards, and the antibiotics prescribed with generic names were 25.76%. The most common class of antibiotics prescribed were cephalosporins and penicillins.
Conclusion:
Polypharmacy, high injectable use, and non-adherence to generic prescription were common in our tertiary care center. Continuous audits, training, and new treatment protocols are recommended.
... 34.11%). [12] With regard to age stratification, majority of the students were in the age group of 2-11 years and is in deviation to the previous study where 29.8% of the pediatric patients were in the age group of 1 month to 12 months. [12] In the present study, on an average, 3.96 medicines were prescribed and is in agreement to earlier reports. ...
... [12] With regard to age stratification, majority of the students were in the age group of 2-11 years and is in deviation to the previous study where 29.8% of the pediatric patients were in the age group of 1 month to 12 months. [12] In the present study, on an average, 3.96 medicines were prescribed and is in agreement to earlier reports. [13][14][15] With regard to treatment details of pediatric patients who were treated on OP basis, the results suggest that 1.75 medicines were prescribed and numerically lesser than that reported in an earlier study. ...
... The antibiotics, cephalosporins (72.6%), were the most commonly used, followed by penicillin (22.2%), aminoglycosides (11.3%), azithromycin (9.7%), and metronidazole (9.7%) and is not in agreement to earlier reports. [19,21,22] Among the other group of drugs in IPs, nutritional preparations (62.9%) were the most commonly prescribed, followed by cough and cold preparations (45.2%), gastrointestinal drugs (36%), antimalarials (18.5%), and corticosteroids (6.5%) and similar to the observations of Akhtar et al. [12] On the contrary, among OPs, the respiratory drugs (58%), antipyretics (52%), antibiotics (18%), GIT drugs (14.8%), and nutritional preparations (5.68%) were other category of drugs prescribed. These observations are not in agreement to the previous reports of Torvi and Dambal, [18] who observed antimicrobials to be the most commonly prescribed drug. ...
... Several studies have been conducted regarding medicine use in children, including those conducted in the early 2000s [1,[10][11][12][13][14][15][16][17]. Most of the studies analyzed drug prescriptions from healthcare settings, including pediatric wards, outpatient clinics, or community pharmacies. ...
Background
Rational medication use for treatment is mandatory, particularly in children as they are vulnerable to possible hazards of drugs. Understanding the medication use pattern is of importance to identify the problems of drug therapy and to improve the appropriate use of medication among this population.
Methods
A post-hoc study of the RV3-BB Phase IIb trial to children aged 0–18 months which was conducted in Indonesia during January 2013 to July 2016. Any concomitant medication use and health events among 1621 trial participants during the 18 months of follow-up were documented. Information on medication use included the frequency, formulation, indication, duration of usage, number of regimens, medication types, and therapeutic classes.
Results
The majority of participants (N = 1333/1621; 82.2%) used at least one non-antibiotic medication for treatment during the 18-month observation period. A total of 7586 medication uses were recorded, mostly in oral formulation (90.5%). Of all illnesses recorded, 24.7% were treated with a single drug regimen of non-antibiotic medication. The most common therapeutic classes used were analgesics/antipyretics (30.1%), antihistamines for systemic use (17.4%), cough and cold preparations (13.5%), vitamins (8.6%), and antidiarrheals (6.6%). The main medication types used were paracetamol (29.9%), chlorpheniramine (16.8%), guaifenesin (8.9%), zinc (4.6%), and ambroxol (4.1%). Respiratory system disorder was the most common reason for medication use (51.9%), followed by gastrointestinal disorders (19.2%), pyrexia (16.9%), and skin disorders (7.0%).
Conclusion
A large number of children were exposed to at least one medication during their early life, including those where evidence of efficacy and safety in a pediatric population is lacking. This supports the need for further research on pediatric drug therapy to improve the appropriate use of medication in this population.
... study done by Nazima et al. 15 In other studies, average number of drugs per encounter were 5.69 (inpatients), 5.61 (outpatients+inpatients), 2.7 (outpatients+inpatients), 2.35 (outpatients). 14, [16][17][18] About three fourth (74.41 %) prescribed drugs were from NLEM. ...
Background: Drug utilization study is essential, as safe and effective therapeutic regimen in paediatric population is challenging. Pattern of use of drugs in pediatrics vary as compared to adults, also there is limited data available. The objective of this study was to study drug utilization pattern in pediatric patients attending pediatric outpatient department of Maindarkar pediatric hospital, Latur.Methods: A cross sectional study was carried out for a period of six months from September 2019 to February 2020, by analysing a total 1000 prescriptions of patients who had visited the OPD of Maindarkar pediatric hospital. Prescriptions were selected by simple random sampling method.Results: In our study, out of the total of 1000 prescriptions, 244 (24.4%) were of neonates, 556 (55.6%) were of infants (1 month to 1 year) and 200 (20%) were of children above 1 year. 547 (54.7%) prescriptions were of male patients and 453 (45.3%) were of female patients. The most frequent classes of drugs prescribed were nonsteroidal anti-inflammatory drugs 704 (70.4%), followed by drugs used for respiratory disorders 655 (65.5%) and supplements (60%). Antimicrobials were prescribed in 498 (49.8%) prescriptions. The average number of drugs per prescription was 2.45. About two third of all the prescribed drugs (74.41%) were from national essential medicine list. Most of the prescriptions had oral drug formulation 825 (82.5%) followed by inhalational 208 (20.8%) followed by injectables 150 (15%). All the drugs were prescribed by brand names.Conclusions: Our study helps health-care system to understand, interpret and improve prescribing, administration, to minimize adverse events and promote rational use of medicines.
