The concept of personal drugs in the undergraduate pharmacology practical curriculum

Abstract

I have read the thought provoking research letter by Dr Parmar and Jadav on The concept of personal drugs in the undergraduate pharmacology practical curriculum.[1] I have the following comments to share with the readership of the IJP. The concept of P-drug for the undergraduate practical curriculum is a good instrument to promote the practice of rational therapeutics with the objective to promote use of cost effective, safe and suitable medicines. However, the concept needs to be utilized in its right perspective so that it does not leave enough to question its utility. In selecting a P-drug for acute amoebic dysentery so far as the drug group is concerned, nitroimidazoles may be the choice. However, choosing a drug among this group will require utilization of certain criteria. Therefore, using the criteria of efficacy, safety, suitability and affordability [Table 1], one may conclude that tinidazole is a better choice to be a P-drug (along with a luminal amoebicide-vide infra). This is because of its suitability i.e., once or twice daily intake) and comparable cost of a course of treatment (3 days for tinidazole v/s 7-10 days of metronidazole). The authors have ignored the suitability factor. It is one of the important criteria for selecting a P-drug. It not only includes patient-related conditions, which preclude the use of selected drug, but also the convenience of dosage form and dosage schedule.[2] Adherence to treatment is improved by creating a good doctor-patient relationship, giving necessary drug related information to the patient and most importantly, prescribing a few drugs with a simple dosage schedule (one or two times a day).[2] Table 1 Comparison of nitroimidazoles in acute amoebic dysentery[4] It is difficult to agree with the authors' proposition of ignoring the advice of clinical teachers in selecting P-drug. Medical teachers have gained expertise from long standing practice and medical students learn greatly from these experts. In fact they may provide vital information to the students about the use of existing drugs and this will help them a lot in selecting their own P-drugs. Furthermore, authors' recommendation of use of a luminal amoebicide AFTER a course of nitroimidazole is contrary to the text book recommendation of its concurrent use.[4,5] Is a P-drug concept different from the principle of choosing a ‘drug’ of choice? The drug of choice for roundworm infestation is selected by using same criteria [Table 2]. Table 2 Criteria of selection of a suitable antihelminthic agent[3–4] It is clear that albendazole is a drug of choice because of convenience of single dose, comparable efficacy, safety and cost. It can also be considered to be a P-drug for roundworm infestation.