Appropriate Use Of Drugs Research Articles

Study of Drug Prescribing Pattern in Pediatric Outpatient Department at a Tertiary Care Teaching Hospital

Background: Infants and children suffer from frequent but usually non serious illnesses and are more vulnerable to various adverse events related to drugs and poor understanding of instructions on prescription by the patient or caretakers were likely to cause medication error. The correct identification of an illness and its management with medications is a vital aspect of patient care, especially for paediatric population. So, prescribing pattern studies are very helpful in promoting the appropriate use of drugs in population. Objectives: It aims to obtain data on the current prescribing pattern in pediatric OPD at a tertiary care teaching hospital with ultimate goal to promote appropriate use of drugs. Methods: This study was conducted in 62 pediatric patients of either sex visiting Pediatric out-patient department over a period of three months at NMCH and RC, Raichur, Karnataka. Results: Prescription analysis showed that the average number of drugs per prescription was 3.32. Drugs were mostly prescribed by brand name (98.06%), Injections (4.83%) were least prescribed, drugs prescribed from Essential Drug List was 48.54%. Antibiotics were most prescribed class of drugs (33.9%). Conclusion: The study concludes that polypharmacy was slightly seen in prescriptions. Diagnosis of the patient was recorded for most of the prescriptions. There is need to conduct many such studies at regular interval as it is useful for auditing large number of prescriptions to find out early signals of the irrational drug use. Our study evaluated drug use pattern only from the outpatients hence prescription pattern may vary among inpatients.
 Keywords: Prescribing pattern, Infants, WHO core prescribing indicators, Polypharmacy, Generic name

Singapore Advanced Cardiac Life Support Guidelines 2021.

Advanced cardiac life support (ACLS) emphasises the use of advanced airway management and ventilation, circulatory support and the appropriate use of drugs in resuscitation, as well as the identification of reversible causes of cardiac arrest. Extracorporeal cardiopulmonary resuscitation and organ donation, as well as special circumstances including drowning, pulmonary embolism and pregnancy are addressed. Resuscitation does not end with ACLS but must continue in post-resuscitation care. ACLS also covers the recognition and management of unstable pre-arrest tachy- and bradydysrhythmias that may deteriorate further.

Drug Utilization Study in Ophthalmology Outpatient Department of a Tertiary Care Teaching Hospital

Abstract: Background: World Health Organization (WHO) has defined drug utilization in 1977 as marketing, distribution, prescription and use of drugs in a society with special emphasis on the resultant medical and social consequences. It should be evaluated periodically to increase the therapeutic efficacy and decrease adverse effects. Objectives: The aim of study is obtain data on the current prescribing pattern and drug utilisation trend of ophthalmologist in a tertiary care teaching hospital with ultimate goal to promote appropriate use of drugs. Methods: This prospective interventional study was conducted in 272 patients of either sex visiting Ophthalmology outpatient department over a period of six months at NMCH and RC, Raichur, Karnataka. The data collected from data collection form was analysed with the help of WHO prescribing indicators and evaluated using descriptive statistics. Results: Prescription analysis showed that the average number of drugs per prescription was 2.45. Drugs were mostly prescribed by brand name (98.5%), Eye drops (69%) were most prescribed dosage form, Injections (0.75%) were least prescribed, drugs prescribed from Essential Drug List was 50.9%. Antibiotics were most prescribed class of drugs (49.62%). Dosage form, frequency and duration of therapy were recorded in 100%, 95.5% and 84% of prescriptions. Conclusion: Polypharmacy was slightly seen in prescriptions. Antibiotics were highly used. The most commonly prescribed dosage form was eye drops. Half of drugs were prescribed from Essential drug list (EDL). Physicians preferred branded drugs rather than generic drugs. Diagnosis of the patient was not recorded for most of the prescriptions. Key words: Drug utilization evaluation, WHO core drug prescribing indicators, Polypharmacy, Generic name, Ophthalmology.

Community pharmacists' views on their current role and future opportunities for antibiotic stewardship: a French qualitative study.

BackgroundDifferent healthcare professionals should contribute to antibiotic stewardship (ABS) activities. Involvement of community pharmacists (CPs) has been little explored worldwide to date.ObjectivesTo explore French CPs’ views on ABS and antibiotic resistance, their role and current practices, and future opportunities for ABS.MethodsA qualitative study using semi-structured face-to-face individual interviews was performed from May to October 2019 among CPs from north-eastern France. Transcripts of the interviews were analysed using a thematic analysis.ResultsTwenty-seven interviews were conducted. Most participants had a clear understanding of antibiotic resistance and ABS. They considered themselves as ‘guardians of the appropriate use of drugs’ but often failed to fulfil this mission because of difficult relationships with physicians. Their current ABS practices are: (i) counselling patients about the antibiotic treatment; and (ii) reporting to the prescriber when they identify contraindications/drug interactions. Concerning their potential increased involvement in ABS, CPs felt they could perform more rapid diagnostic testing for sore throat; they were divided on the possibility for them to change the antibiotic prescription made by a physician and were mainly against the possibility of initiating an antibiotic prescription. The idea of systematically collecting unused antibiotics was perceived well by CPs, while unit dose delivery was not.ConclusionsFrench community pharmacists are willing to become more involved in ABS activities. Collaboration and trust between pharmacists and prescribers should however be improved.

Assessment of Drug Utilisation Evaluation of Cephalosporins in A Tertiary Care Hospital

Drug Use Analysis (DUR) or Drug Use Assessment (DUE) is known as an important quality management method for evaluating and improving substance use and patient care. It is an ongoing, systematic method to examine the pattern of drug administration in a number of clinical environments, with recommendations or defined criteria to facilitate the acceptable and efficient use of drugs. The DUE can be organized for evaluation and to improve the method of prescribing or dispensing the medication according to acceptable indications, dosage, drug reactions, therapeutic efficacy and cost-effectiveness. The aim of this study to evaluate the drug utilization pattern of cephalosporins. A retrospective study was performed for a period of 2 months among the hospitalized patients who received cephalosporins for different indications in which 100 patients were enrolled. Inappropriate use of drug therapy has been found in phase 1 (pre- intervention) and interventions have been conducted to rationalize the appropriate use of drugs in terms of indication, dose, dose length, individualized dosage modification, which has been strengthened in phase 2 by providing effective guidance on the application of DUE and interventions.

DRUG UTILIZATION AND PRESCRIBING PATTERN ANALYSIS IN ORTHOPAEDIC OUTPATIENT DEPARTMENT OF TERTIARY CARE HOSPITAL

Objective: The objective of conducting prescribing pattern study is to monitor, evaluate, and if necessary, recommend modifications in the prescribing behavior of medical practitioners. Hence, this study was conducted to analyze the drug utilization and prescribing pattern of drugs in orthopedic outpatient department (OPD).
 Methods: This prospective observational study was conducted in the orthopedic OPD of tertiary care hospital for a period of 3 months. Data were obtained from the prescriptions through one-to-one interviews and recorded in a separately designed case report form.
 Results: Out of the 260 patients enrolled in the study, 181 were female and 79 were male. The patients between the ages of 50 and 60 years constituted the higher number with a mean age of 52.2 years. The total number of drugs prescribed in the analyzed prescriptions was 1012 which includes orthopedic drugs as well as drugs prescribed to treat various comorbidities. The World Health organization drug prescribing indicators were used to assess the appropriate use of drugs.
 Conclusion: Our study concludes that drug utilization and prescribing quality should be improved by promoting medical education on current updates. The periodic audit should be conducted by a clinical pharmacist to reduce an error in the prescription as well as to check the compliance of prescription with standard treatment guidelines for rationalizing the therapy.

Appropriateness and Pattern of Antibiotic Prescription in Pediatric Patients at Adigart General Hospital, Tigray, Ethiopia.

Background Inappropriate and unnecessary use of antibiotics can increase morbidity, mortality, medical expenses or patient cost, and microbial antibiotic resistance. However, in developing countries like Ethiopia, information regarding appropriateness of antibiotic prescribing pattern to guide improvement strategies is scant. Objective The aim of this study was to assess appropriateness and pattern of antibiotic prescription in pediatric patients at pediatric ward of Adigrat General Hospital. Methods Hospital-based retrospective cross-sectional study was conducted to assess the antibiotic prescribing pattern in pediatric inpatient and outpatient ward of Adigrat General Hospital from December 1, 2018 to April 30, 2019. Data was collected by using structured data collection checklist, and the systematic random sampling technique was employed to enroll the required sample size during the study period. Appropriateness of drug use in pediatrics was evaluated using Ethiopian Standard Treatment guideline and WHO pediatric guideline. Result A total of 692 pediatric patients' medical charts were reviewed. The median age of patients on antibiotics was 3.26 years (IQR: 2-4). Majority (49.13%) of the patients were hospitalized for 5-9 days. SCAP (195), tonsillitis (114), and cellulitis (99) were most frequently encountered pediatric diseases. Penicillins (37.86%) followed by cephalosporins (31.79%) antibiotics were the most prescribed antibiotics in pediatric wards. This study also showed that ceftriaxone and ceftriaxone+amoxicillin were the most frequently used single and combination antibiotics, respectively. The prescribing practices were not stick to WHO core indicators and standards. Inappropriate prescription of antibiotics was observed in 28.3% of patients. Advanced age of children, children aged between 6 to 10 years (AOR = 3.225; CI = 1.080 − 9.630; P = .036) and 11-18 years (AOR = 18.691; CI = 5.156 − 67.756; P = .000), was the independent determinant of inappropriate drug use. Conclusion Inappropriate antibiotic prescribing was encountered in 28.3% of children. The rate of generic prescription was not in line with WHO recommendation. Advanced age of children was the independent factor for inappropriate use of antibiotics.

Causality assessment between reported fatal cerebral haemorrhage and suspected drugs: developing a new algorithm based on the analysis of the Japanese Adverse Event Report (JADER) database and literature review.

Cerebral haemorrhage is a life-threatening event with various causes including adverse drug reactions (ADRs). Several methods have been proposed for the causality assessment of ADRs, but none specific for cerebral haemorrhage. The purpose of this study was to develop an algorithm for causality assessment between drugs and fatal cerebral haemorrhage, based on the analysis of data from the Japanese Adverse Drug Event Report (JADER) database and literature review. All fatal ADRs reported in the JADER database between April 2004 and March 2020 were searched, and literature on drug-related cerebral haemorrhage or general causality assessment was reviewed to summarise the information on causality between cerebral haemorrhage and ADRs. Of the 50,095 cases identified in the JADER database, cerebral haemorrhage was the fifth most reported cause of fatal ADRs, but the causality of >80% of the events was published as 'Unassessable'. The literature review identified articles on drug-related cerebral haemorrhage and causality assessment methods in general. Based on these articles, information on five categories (temporal relationship, previous knowledge about the relationship between drug action and ADRs, alternative aetiological candidate, appropriateness of drug use, and the relationship between death and ADRs) was determined for causality assessment between a suspected drug and fatal cerebral haemorrhage; a new algorithm was created using this information. In this study, the information considered necessary for causality assessment between drugs and fatal cerebral haemorrhage was reviewed and an assessment algorithm was developed. Future studies are needed to validate the usefulness of this method.

Prevalence of Some Opportunistic Infections (OIs) and Co-infections among HIV-Infected Persons in Port Harcourt, Nigeria

Aim: HIV/AIDS continues to spread globally and remains a worldwide pandemic. Opportunistic infections (OIs) occur more and are severe in people living with HIV who have weakened immune systems, and co-infection is another major challenge because it affects the rate to which the disease progress to AIDS. In the present study, a total of 100 HIV positive patients were recruited and evaluated for the presence of common opportunistic infections (OIs) and co-infections among HIV-infected individuals in Port Harcourt, Nigeria.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Prime Medical Consultants in Port Harcourt, Nigeria, between June 2012 and July 2015.
 Methods: A total of 100 HIV-infected individuals were recruited for this study (ages 1 to 70 years, 62 males and 38 females). Samples of blood, sputum, high vaginal swabs (HVS) and scrapped lesion from the mouth of the patients were collected. Blood samples were re-screened for the presence of HIV antibodies and HBsAg using the Determine HIV-1/2 (Alere), HIV ½ Stat-Pak (Chembio), HIV-1/2/P24/O ELISA kit and HBsAg one Ultra ELISA kit (Dia.Pro) following the respective manufacturer's instructions. The Ziehl-Neelsen sputum smear microscopy method was used for identifying tuberculosis (TB). Microscopical examination was done on HVS samples and lesions scrapings from the mouth to observe for Candida. Chi-square test was used to establish relationships between demographic factors and prevalence, and significance level was set at P ≤ 0.05.
 Results: Of the 100 HIV positive patients, suspected case were 32.0% of TB, 28.0% of oral thrush and vaginosis, and 19.0% of hepatitis. The results of the laboratory analysis further showed that tuberculosis was the most common OI among others. Overall prevalence was 22.0% for TB, 11.0% for Candida albicans (oral thrush), 28.9% for Candida albicans (vaginosis) and 4.0% for HBV. Higher prevalence of TB was observed in the age groups 41 years & above (35.7%, P=0.14) and in males (22.6%, P=0.86). As for Candida albicans, the higher prevalence was found in age groups 21-40 years (19.1%, P=0.03) and in females only (28.9%), and higher prevalence of HBV was found in age groups 41 years & above (9.1%, P=0.78) and in females (5.3%, P=0.61). None of the variables (age and sex) evaluated in this study was statistically associated (P>0.05) with TB, Candida and HBV prevalence.
 Conclusion: The study has also shown that some opportunistic infections (candidiasis and Tuberculosis) and coinfections with HBV is prevalent among HIV infected individuals and this could largely be due to a compromised immune system as a result of the viral activities in the host cell. There is need therefore to routinely check for OIs and co-infections especially in the case of an immunocompromised individual. It is also imperative to note that the appropriate use of drugs against these OIs may be one of the strategies to extend the life span of AIDS patients. This will help to monitor how the disease progresses and its complications.

Analysis and improvement measures of telephone drug consultation in a specialized hospital of obstetrics and gynaecology in China.

What is known and objectiveDrug consultation is an important part of pharmaceutical care offered by clinical pharmacists. We explored the characteristics of telephone drug consultations in an obstetrics and gynaecology speciality hospital to provide a reference as to how to improve drug consultation and pharmaceutical care.MethodsWe retrospectively analysed records of telephone consultations regarding medication use between 2014 and 2019 in our hospital. Any consultation cases with incomplete records were excluded from our analysis. Of the 1353 consultation cases included in our study, we further classified them into different categories based on the content of the consultations, the type of medications being inquired about, and the groups of people who sought medication guidance. Pareto analysis was performed to separate the main issues the callers were concerned about from the more minor concerns.Results and discussionThe medication issues that prompted the caller to consult with our clinical pharmacists could be divided into 12 categories, among which the main issues concerned usage and dosage, choice of drug variety, drug incompatibility (drug mixture in infusion bag or tube), adjustment of the treatment plan, and skin tests (cumulative percentage 76.3%). The minor issues involved medication use during pregnancy and lactation and adverse reactions. The top three types of drugs that callers asked about were antimicrobials (600 cases, 44.4%), anti‐tumour drugs (151 cases, 11.2%) and reproductive system drugs (111 cases, 8.2%). The callers could be divided into four groups as follows: doctors (865 cases, 63.9%), nurses (280 cases, 20.7%), patients (116 cases, 8.6%) and other medical professionals (92 cases, 6.8%).What is new and conclusionUsage and dosage, choice of drug variety, drug incompatibility, adjustment of treatment plan and skin tests represented the main issues for telephone drug consultations in our hospital. Doctors and nurses were most likely to consult clinical pharmacists regarding these issues. Improved drug consultation services are needed to allow more patients to have access to advice from pharmacists. Such access would better enable pharmacists to fulfil their roles in advising the appropriate use of drugs to ensure better patient care and medication compliance.

ANALYSING ANTIDEPRESSANT USE IN DEPRESSION OUTPATIENTS AT DA NANG PSYCHIATRIC HOSPITAL

Background: Depression is a common psychiatric disorder worldwide as well as Vietnam, greatly affecting the quality of life and threatening patient lives due to the high risk of suicide. Early treatment and appropriate use of drugs will help improve the effectiveness of treatment and reduce the burden on public health. Objectives: To analyze antidepressant use and level of drug interactions encountered in depression outpatient. Materials and methods: 252 depression outpatients at Da Nang Psychiatric Hospital, cross-sectional description method. Results: The multivalent treatment regimen was initiated on admission in 92.1% of cases, SSRI group accounted for the highest proportion (45.6%), followed by TeCA, TCA and SNRI, at 37.9%; 16.2% and 0.3% respectively. In the SSRI group, Fluoxetin was administered for 110/166 cases (66.3%); followed by Sertralin 31.9%; Fluvoxamin and Escitalopram accounted for only 1.2% and 0.6%, respectively. Out of 480 times using supportive medicine group, the highest percentage of patients using antipsychotic drugs (51.0%), including: Olanzapine, Sulpiride,... The number of patients being administered rational drug was 223/252 cases (88.5%). The results of drug interactions are largely severe. Conclusions: Antidepressants indicated in accordance with the recommendation accounnted for a high proportion and drug interactions appear in prescriptions at a high rate (50.8%) and are mostly severe. Key words: Depression, antidepressants, antidepressants use, drug interaction

KAJIAN PERESEPAN OBAT ANTIHISTAMIN PADA PASIEN RAWAT JALAN DI SALAH SATU RUMAH SAKIT DI BANDUNG

Histamine is one of the factors that cause acute and chronic disorders, so it is necessary to investigate further the mechanism of antihistamines in the treatment of allergic diseases. Antihistamines are substances that can reduce or block the effects of histamine on the body by blocking histamine receptors. Antihistamines are one of the drugs that are often prescribed to children to the elderly. Thus the application of therapy in medicine is needed to ensure the use of appropriate drugs to prevent the occurrence of medication errors so that the goal of therapeutic effectiveness can be achieved. The purpose of this study was to determine the prescribing pattern of antihistamine drugs and assess the accuracy of the administration of antihistamines based on dose accuracy and potential drug interactions. Prescribing studies of this drug are descriptive quantitative and qualitative by using data sources in the form of patient prescription sheets taken retrospectively. The results of quantitative research data show that patients 57.23% were female, the highest age was 55-59 years old 12.26%, the most widely used drug was setirizine 72.48%, dose accuracy 89.60% and more doses 10.40%, the potential for drug interactions occurred in 27.83%, The drug that has the most potential for interaction is setirizine with theophylline.

Drug utilization and expenditure of anticancer drugs for breast cancer

PurposeDrug utilization studies have proven to be an effective tool in the evaluation of rational drug use in different health care systems, including oncology. The drug utilization studies were used in many institutes to ensure the safe, effective and appropriate use of drugs being prescribed. The main aim of this study was to assess the utilization pattern of anticancer drugs in breast cancer patients. MethodA retrospective cross-sectional observational study was carried out at King Saud University Medical City (KSUMC) for 1 year from January 2016 to December 2016. All female patients diagnosed with breast cancer during this year were included in the study. ResultsA total of 101 patients were included in this study. Most patients received an average of three anticancer drugs. The most commonly prescribed medication was fluorouracil, epirubicin, and cyclophosphamide (FEC) regimen, which was used in 81% of patients. Combinations of FEC + docetaxel and FEC + docetaxel + trastuzumab were received by43% and 23% of patients, respectively. Docetaxel was the most commonly used drug in neoadjuvant setting, whereas letrozole and trastuzumab were prescribed more frequently in hormonal and targeted therapies, respectively. The total drug expenditure on anticancer therapy was approximately 3.8 million Saudi Riyals (S.R), with adjuvant therapy constituting over half of the total spending. In neoadjuvant settings, the spending cost for hormonal therapy was the highest. The condition of most breast cancer patients was improved during the study period, whereas only 29% of the included patients progressed. ConclusionFEC was the most common regimen used in this study, consistent with the National Comprehensive Cancer Network (NCCN) guideline recommendation. Our results indicated that adherence to a clinical guideline and recommended medication regimens improved patient outcomes. Our finding indicate how analyzing drug utilization pattern could benefit institutions in managing inventory and efficiently using health care resources.

Pattern of Drugs Use in Selected Paediatric Diseases in Outpatients Departments of Public and Private Teaching Hospitals in Bangladesh

Background & objective: Appropriate use of drugs are important in any diseases in any population. It is particularly so in children. To evaluate whether drugs are properly utilized in terms of efficacy, safety, convenience and economic aspects at all levels in the chain of drug use, periodic studies addressing the utilization of drugs in different health care setting are essential. Various drug utilization studies have been carried out all over the world but there are limited studies addressing drug use patterns in pediatric population in Bangladesh. The present study is one such step to evaluate the pattern of drug use in different pediatric diseases among patients attending at pediatric out-patient department (OPD) in two selected medical college hospitals.
 Methods: This cross-sectional study was conducted in the paediatric OPD of two tertiary care hospitals, Sir Salimullah Medical College & Mitford Hospital (SSMC & MH) (a public hospital), Dhaka and Dhaka National Medical College (DNMC) & Hospital (a private hospital). A total of 600 children (300 from each of the two Medical College Hospitals) were selected as study subjects. Three hundred prescriptions audited in SSMC & MH contained a total 946 drugs and 300 prescriptions audited in DNMC contained 990 drugs in total. Patients got admitted during out-patient department visit were excluded from the study. The age and sex of the patients and medications use-related variables like dose, frequency, duration and route of administration of the drugs were noted. Pattern of drug use in the hospitals for pediatric population was evaluated.
 Results: The study subjects of the two tertiary hospitals were almost identical in terms of age and sex (p = 0.181 and p = 0.369 respectively). Use of three drugs per encounter was commonly observed in both the hospitals. Around one-third of the prescriptions contained four drugs. Prescription of five drugs was rare in both the hospitals. Prescription with two drugs was higher in SSMC & MH than that in DNMC Hospital (p = 0.043). Majority of the prescriptions from SSMC (83.1%) contained drugs within essential drug list (EDL) compared to that from DNMC (73%) (p< 0.001). The highest prescribing drug was antibiotic, both in SSMC (22.7%) and DNMC (23.2%) (p = 0.417) followed by analgesic (18% in SSMC and 17.7% in DNMC), anti-diarrhoeal. The less commonly used drugs were gastric acid suppressant, antispasmodic, anthelmintic, antiemetic, while rarely prescribed drugs were antihistamines, antiasthmatic and nasal drops. Pattern of drugs prescribed in two hospitals were similar (p > 0.05).
 Conclusion: The study concluded that the rate of antibiotics prescribed in both public and private hospitals is higher. Further studies teaching hospitals etc. are required for the monitoring of drug utilization pattern and formulation of Standard Treatment Guidelines (STG) for the physicians is essential.
 Ibrahim Card Med J 2019; 9 (1&2): 54-59

Evaluation of Drug Use Pattern in Emergency Department of Dilchora Referral Hospital, Dire Dawa, Ethiopia.

Background Drug use evaluation is a system of continuous, systematic, criteria-based drug evaluation that ensures the appropriate use of drugs. Rationalization of drug therapy in emergency medicine would be useful in managing the broad array of conditions that present for emergency care. High-quality drug utilization is associated with the use of a relatively limited number of essential medicines. The World Health Organization developed core drug use indicators for conducting drug utilization studies in healthcare setting. WHO core drug use indicators including prescribing indicators, patient care indicators, and health facility indicators are used nowadays. Objective The aim of this study was to evaluate the drug use pattern in the Emergency Department of Dilchora Referral Hospital, Dire Dawa, Ethiopia, 2018. Methods A retrospective cross-sectional descriptive study was conducted in the emergency department (ED) of Dilchora Referral Hospital from July 20 to August 19, 2018, using structured data collection format. Result Out of 344 prescriptions analyzed, a total of 753 medications were prescribed. The average number of drugs per prescription was 2.19. Of drugs prescribed, 685 (90.97%) were in their generic names. Antibiotics were prescribed in 95 (27.62%) of encounters, and injections were prescribed in 154 (44.77%) of encounters. Among 753 medications prescribed, the name and strength of drugs are indicated in 100% and 95.22%, respectively. 679 (90.17%) of drugs were prescribed from the essential drug list of Ethiopia. Conclusion The findings of this study revealed that the drug utilization pattern was not optimal in accordance with the standard values of WHO prescribing indicators. Some of the prescribing indicators like overprescribing of antibiotics and injections were a problem. Therefore, it is very imperative for the concerned stakeholders and healthcare providers to work toward ensuring drug use according to the standard.

A pragmatic controlled trial to improve the appropriate prescription of drugs in adult outpatients: design and rationale of the EDU.RE.DRUG study

Abstract Introduction: Pharmacological intervention is an important component of patient care. However, drugs are often inappropriately used. It is necessary for countries to implement strategies to improve the rational use of drugs, including independent information for healthcare professionals and the public, which must be supported by well-trained staff. The primary objectives of the EDU.RE.DRUG (Effectiveness of informative and/or educational interventions aimed at improving the appropriate use of drugs designed for general practitioners and their patients) study are the retrospective evaluation of rates of appropriate prescribing indicators (APIs) and the assessment of the effectiveness of informative and/or educational interventions addressed to general practitioners (GPs) and their patients, aimed at improving prescribing quality and promoting proper drug use. Methods and analysis: This is a prospective, multicentre, open-label, parallel-arm, controlled, pragmatic trial directed to GPs and their patients in two Italian regions (Campania and Lombardy). The study data are retrieved from administrative databases (Demographic, Pharmacy-refill, and Hospitalization databases) containing healthcare information of all beneficiaries of the National Health Service in the Local Health Units (LHUs) involved. According to LHU, the GPs/patients will be assigned to one of the following four intervention arms: (1) intervention on GPs and patients; (2) intervention on GPs; (3) intervention on patients; and (4) no intervention (control). The intervention designed for GPs consists of reports regarding the status of their patients according to the APIs determined at baseline and in two on-line Continuous Medical Education (CME) courses. The intervention designed for patients consists in flyers and posters distributed in GPs ambulatories and community pharmacies, focusing on correct drug use. A set of indicators (such as potential drug–drug interactions, unnecessary duplicate prescriptions, and inappropriate prescriptions in the elderly), adapted to the Italian setting, has been defined to determine inappropriate prescription at baseline and after the intervention phase. The primary outcome was a composite API. Ethics and dissemination: The study was approved by the Ethics Committee of the University of Milan on 7th June 2017 (code 15/17). The investigators will communicate trial results to stakeholders, collaborators, and participants via appropriate presentations and publications. Registration details: NCT04030468. EudraCT number 2017-002622-21

What to Do with Epicardial Coronary Artery Abnormalities That do not Result in Myocardial Ischemia?

When epicardial arteries with minimal CAD do not limit flow are found at coronary angiography, all cardiologists agree that aggressive risk factor modification and use of appropriate drugs are warranted. Some consider plaque sealing of minor coronary lesions with balloon angioplasty to prevent future infarction. Others believe that a coronary lesion that does not cause ischemia should not have the plaque sealed but should have FFR and the non-ischemia producing stenosis should be treated with aggressive risk factor modification (DEFER study). Evidence based data e.g. DEFER, relates to populations, not the individual. Thus these data provide guidelines, which are suggestions for decision making. The weight of evidence favors angioplasty/stent for epicardial vessels that result in myocardial ischemia. Sealing of non flow limiting plaques with angioplasty must await further information derived from invasive and non invasive studies.

A prospective observational study on drug utilization pattern in medical intensive care unit of a tertiary medical care hospital

Background: Drug utilization research is a part of Pharmacoepidemiology defined by the WHO as the study of marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic consequences. Conducting periodic studies of pattern of drug use in our hospital setting is essential to critically analyse the current hospital drug policies and to make recommendations based on various guidelines to improve upon the current drug usage pattern. Aims and objectives of the study was to generate data on the drug utilization pattern in Medical ICU and to monitor antimicrobial usage in MICU.Methods: Patients who were admitted in medical ICU of Hassan institute of Medical Sciences were recruited based on inclusion-exclusion criteria. The study was conducted over a period of 3 months from April 2018 to June 2018. The demographic and clinical treatment data of patients were collected. The prescriptions were assessed as per the WHO indicators.Results: Common causes of admission were suicidal poisoning, snake bite, viral thrombocytopenia, myocardial infarction and stroke. The average duration of stay was 5.74 days and average number of drugs/patient was 5.26. Pantoprazole, Ranitidine, Ceftriaxone, Atropine, Pralidoxime, ASV, Ondansetron, and N-acetylcysteine were commonly prescribed drugs. 42.4% of drugs were prescribed by generic names and 84.2% of the drugs were prescribed from Essential Medicine List.Conclusions: This study will provide database to address prescription protocols and guide appropriate use of drugs in the ICU setting.

Analysis of Adverse Reactions Caused by Potentially Inappropriate Prescriptions and Related Medical Costs That Are Avoidable Using the Beers Criteria: The Japanese Version and Guidelines for Medical Treatment and Its Safety in the Elderly 2015.

We conducted a retrospective study to investigate adverse drug reactions and associated medical costs among elderly individuals that could be avoided if pharmacotherapy was performed in accordance with the Beers Criteria: the Japanese Version (BCJV) and Guidelines for Medical Treatment and Its Safety in the Elderly 2015 (GL2015). Patients aged at least 65 years who were either hospitalized at Gifu Municipal Hospital between October 1 and November 30, 2014 (n = 1236) or had outpatient examinations at Gifu Municipal Hospital on October 1-2, 2014 (n = 980) were included in the study. The outcomes measured were usage rates of drugs listed in the BCJV and GL2015, incidence rates of adverse drug reactions, and additional costs incurred per patient due to adverse reactions. Among the inpatients, usage rates of drugs listed in the BCJV and GL2015 were 24.0 and 72.4%, respectively, and adverse reactions to these drugs occurred at rates of 3.0 and 8.2%, respectively. Among the outpatients, while the usage rates were 26.2% (BCJV) and 59.9% (GL2015), the incidence rates of adverse reactions were 4.7% (BCJV) and 3.9% (GL2015). The additional costs incurred due to adverse drug reactions ranged from 12713-163925 yen per patient. Our results demonstrate that appropriate use of drugs based on the BCJV and GL2015 can help prevent adverse reactions; this would reduce the overall medical costs.

DRUG UTILIZATION PATTERN IN PAEDIATRIC PATIENTS IN A SECONDARY CARE HOSPITAL

Objective: The study was carried out to generate research on drug utilization pattern in paediatric patients in government headquarters hospital, Tiruppur, Tamilnadu, India using world health organization (WHO) and international network for rational use of drugs (INRUD) core indicator.
 Methods: The core prescribing indicators of the world health organization was used to assess the appropriate use of drugs. Index of rational drug prescribing (IRDP) developed by Zhang and Zhi was also used to find out the performance of a health care system in terms of drug utilization.
 Results: Out of 859 drugs in 200 cases the highest prescribed drug class is antibiotics 304(35.39%) and the majority of drugs were administered in injectable form 412(47.94%). It was analysed that a majority of prescriptions 117(58.5%) were discharged in between 4-7 d. 161(80.5%) patients were dismissed after completion of treatment. On analysing world health organization (WHO) prescribing core indicators, the average number of drugs per prescription was 4.29 which is higher than double the average number (i.e., 2). This indicates poly-pharmacy practice. 97.78% of drugs were prescribed were the generic name and percentage of encounters with antibiotic prescribed was 90.5% which is thrice greater than world health organization (WHO) standard<30%. Prescribing of injections is not within the world health organization (WHO) recommended range<20% and it was far higher showing 97.5% which is essential for paediatric inpatients. The prescribing practice in paediatric ward is in complete adherence to national essential drug list (EDL) or formulary. The mean value of the index of rational drug prescribing (IRDP) obtained was 3.09 which is very similar to that of optimal value world health organization (WHO).
 Conclusion: Prescription by generic name, prescribing drugs from essential drug list (EDL) and free government supply are encouraging findings in this hospital. The result shows poly-pharmacy and overuse of antibiotics are the areas to be concerned. The better clinical outcome shows rational prescribing is practised well.