Prescription Audit Research Articles

Drug utilization pattern in an intensive care unit of a teaching hospital in South India

Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively. Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics.Background: Polypharmacy and inappropriate usage of antibiotics are common in an Intensive Care Unit (ICU) which may increase morbidity, mortality, antimicrobial resistance and treatment cost. Hence, drug utilization research is crucial for measuring drug consumption using DDD/100 bed-days formula proposed by the WHO that would possibly be useful while formulating a comprehensive antibiotic policy for the institution and guide for future inter-hospital or institutional comparisons. Therefore, in this study, we proposed to evaluate the drug utilization patterns in the ICU.Methods: A prospective observational study was conducted for 3 months from June 2018 to August 2018, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, the utilization of different classes of drugs (WHO-ATC classification) as well as individual drugs were recorded.Results:One hundred and twelve patient’s data were evaluated. About 90% patients were prescribed with antiulcer medications during their ICU stay followed by antibiotics in more than 89% patients. Azithromycin, levofloxacin, metronidazole, ofloxacin, ceftriaxone and amoxicillin/clavulanic acid were maximally utilized antibiotics with 24, 16.43, 14.27, 13.89, 12.22 and 10.97 DDD/100 bed-days respectively.Conclusions: Antiulcer medications were most commonly prescribed followed by antibiotics during ICU stay. Average numbers of drugs prescribed per patients were high. Regular prescription audit and modification of antibiotic policy is required to curtail the polypharmacy and inappropriate use of antibiotics. Keywords: Antibiotics, Daily defined doses, Drug utilization, Intensive care unit

Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States

To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients. To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies. This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA's national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month and the study period was January 1, 2011, to December 31, 2017. State legal intervention mandating naloxone coprescription. Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated. The rate of naloxone dispensing increased after implementation of legal mandates for naloxone coprescription. An estimated 88 naloxone prescriptions per 100 000 were dispensed in Virginia and 111 prescriptions per 100 000 were dispensed in Vermont during the first full month the legal requirement was effective. In comparison, 16 naloxone prescriptions per 100 000 were dispensed in the 10 states (including the District of Columbia) with the highest opioid overdose death rates and 6 prescriptions per 100 000 were dispensed in the 39 remaining states. The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22-49.35). Implementation of the naloxone coprescription mandate was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates, holding all other variables constant. Among covariates, naloxone access laws (IRR, 1.37; 1.05-1.78), opioid overdose death rates (IRR, 1.06; 95% CI, 1.04-1.08), the percentage of naloxone prescriptions paid by third-party payers (IRR 1.009; 1.008-1.010), and time (IRR, 1.06; 95% CI, 1.05-1.07) were significantly associated with naloxone prescription dispensing. These study findings suggest that legally mandated naloxone prescription for those at risk for opioid overdose may be associated with substantial increases in naloxone dispensing and further reduction in opioid-related harm.

Study of Drug Utilization Pattern in Acne Vulgaris in Skin Outpatient Department in Tertiary Health Care Centre

Background: Acne vulgaris is common skin disorder which dermatologists come across in day to day practice. Drug utilization studies are very useful to explore role of drugs in the society. It involves prescription, distribution, marketing and use of drugs and its different consequences like medical and socio-economic. Aims and Objective: To obtain information of drug prescription pattern in acne vulgaris in skin outpatient department and to evaluate pattern of prescription using World Health Organization (WHO) drug use prescribing indicators. Material and Methods: This was cross sectional observational study conducted by department of pharmacology in dermatology OPD in medical college and tertiary care centre from August 2015 to December 2017. During study period total 414 prescriptions of acne patients were analysed. Results: Out of 414 patients 226 (54.59%) were females and 188 (45.41 %) were males with male to female ratio was 1:1.20. Majority of patients belonged to 21-25 years (38.90%) followed by 15-20 (36.48%), 26-30 (18.59%), 31-35 (4.59%) and 36-40 (1.44%) with Mean age of 22.74 years. Grade II (52.66 %) consists of the majority of patients while others Grade I (35.27%), grade III (10.14%) and grade IV (1.93%). Monotherapy was prescribed in 35.26% cases and polytherapy in 64.74% cases. A total number of 950 drugs were prescribed out of them 306 (32.21%) were oral and 644 (67.79%) were topical, percentage of total fixed dose combination of topical preparations were 4%. Average number of drugs per prescription were 2.29. All drugs prescribed by prescribers are in brand names 76% (722 out of 950) of drugs were prescribed from national essential medicines list (NELM, 2015) and 19th WHO list of essential medicines, April 2015. Conclusion: Percentage of drugs prescribed in this study from National List of Essential Medicines (NLEM) was satisfactory but shows complete use of Non-Generic (Branded) drugs. The prescription audit or the drug utilization studies can be used as further basis for the prescribers. Periodic drug audits must be conducted to reduce errors, make prescription rationalize and for effective management of acne vulgaris.

Digoxin Use and Associated Adverse Events Among Older Adults

BackgroundOver the past 2 decades, guidelines for digoxin use have changed significantly. However, little is known about the national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over this time period. MethodsTo describe digoxin prescription trends, we conducted a population-level, cohort study using data from IQVIA, Inc.’s National Prescription Audit (2007-2014) for patients aged ≥65 years. Further, in a national cohort of Medicare fee-for-service beneficiaries aged ≥65 years in the United States, we assessed temporal trends of hospitalizations associated with digoxin toxicity and the outcomes of these hospitalizations between 1999 and 2013. ResultsFrom 2007 through 2014, the number of digoxin prescriptions dispensed decreased by 46.4%; from 8,099,856 to 4,343,735. From 1999 through 2013, the rate of hospitalizations with a principal or secondary diagnosis of digoxin toxicity decreased from 15 to 2 per 100,000 person-years among Medicare fee-for-service beneficiaries. In-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity decreased significantly among Medicare fee-for-service beneficiaries; from 6.0% (95% confidence interval [CI], 5.2-6.8) to 3.7% (95% CI, 2.2-5.7) and from 14.0% (95% CI, 13.0-15.2) to 10.1% (95% CI, 7.6-13.0), respectively. Rates of 30-day readmission for digoxin toxicity decreased from 23.5% (95% CI, 22.1-24.9) in 1999 to 21.7% (95% CI, 18.0-25.4) in 2013 (P < .05). ConclusionWhile digoxin prescriptions have decreased, it is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. These findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.

Clinical audit of drug prescriptions in Nigeria: An urgent and lifesaving need

A prescription is a legal document that should be carefully prepared. One of the duties of care which a doctor owes a patient is to write a drug prescription clearly, and failure to do so is negligence. One primary cause of medication error is lack of regular drug auditing and provision of necessary feedback after the process. In Nigeria, only a few studies have been done to audit prescriptions in some hospitals. There is a need to develop a standard prescription policy for use in hospitals in Nigeria that will help in reducing medication errors.

A retrospective audit of antibiotic prescriptions in a Lebanese Hospital

Despite the frequent alarms that have been published about the adverse effects of antibiotic use and misuse, physicians prescribe to patients approximately fifty percent of unnecessary antimicrobials. In an attempt to decrease the emergence of antimicrobial resistance and increase awareness, a team approach is required to address this prescribing phenomenon in a feasible manner. &#x0D; A retrospective study was done at a one-hundred-forty-bed hospital with a representative sample size of 368 patients. Patient data was collected and analyzed by a stewardship team. The overall antibiotic inappropriate rate was 45.8%, which is relatively high and consistent with the findings of other studies mentioned in the literature.&#x0D; This study aimed to provide baseline epidemiological data on the use of antibiotics in a Lebanese hospital and has revealed several notable patterns of antibiotic prescribing practices among Lebanese physicians such as the use of antimicrobial drugs example penicillin was consistently high. Strong correlations were identified between the type of attending physician and antibiotic appropriateness. These findings will be important in constructing an antimicrobial stewardship program to reduce antibiotic misuse.

Prescription audit and drug utilization pattern in outpatients of psychiatry department of tertiary care teaching hospital: an observational study

Background: The domain of psychiatric illnesses is grossly underrepresented in the current health care scenario especially due to overreliance on mortality rather than the morbidity or dysfunction. The field of psycho-pharmacology is witnessing constant development and introduction of new drugs for which holistic utilization, effectiveness, and side effects studies are the need of the hour. In addition, inappropriate use of drugs poses a potential hazard to patients. Our current study aims at studying the morbidity pattern of various psychiatric ailments and focuses on the prescribing trends of psychotropic drugs.Methods: A prospective observational study was conducted in psychiatry out-patient department of a tertiary care hospital for a period of 12 months. Prescription pattern of psychotropic drugs was analyzed using predesigned format. Prescriptions were collected from OPD and hospital pharmacy. Prescriptions were analysed as per WHO indicators for prescriptions. Descriptive statistics were used for analysis.Results: Depression was found to be the most common psychiatric disorder encountered (32.6%). Average number of psychotropic drugs prescribed per patient 2.45±1.013. Antidepressants along with BZD were the most frequently prescribed psychotropic drugs in various psychiatric disorders. Among the total of 2445 psychotropic drugs prescribed, 99.98% were oral formulations. Psychotropic fixed dose combinations were present in 1.68% of the prescriptions. Only 28% of medicines were prescribed by generic names. Utilization of drugs from the WHO’s 18th list of essential medicines of India was 29%. PDD of risperidone was 1.57mg in schizophrenia. Escitalopram, resperidone and propranolol were the most commonly prescribed drugs for mood disorders, schizophrenia and anxiety respectively.Conclusions: The concomitant use of two psychotropic drugs was the preferred therapy. FDC of anti-cholinergics with both typical and atypical antipsychotics were used. Benzodiazepins were significant part of therapy.

Analysis of the impact of antimicrobial management and rational use of antibiotics

ObjectiveThe scientific antimicrobial management strategy (AMS) was used to standardise the clinical use of antibiotics and optimise the anti-infection treatment protocol.MethodsBy formulating antibiotic use indicators and policy interventions, carrying out...

A drug utilization study to evaluate effectiveness of risk minimization measures for trimetazidine in France, Hungary, Romania and Spain.

The approved indication for trimetazidine (TMZ) was restricted to "add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled by or intolerant to first-line antianginal therapies" in 2012 by the Committee for Medicinal Products for Human Use (CHMP). TMZ was no longer indicated for ophthalmology and otolaryngology (ENT) indications. This drug utilization study analysed actual utilization of TMZ before and after the restriction on its indications to evaluate the effectiveness of risk minimization measures (RMM). This was a multi-national, cross-sectional, non-interventional drug utilization study using European databases: IMS Prescribing Insights (PI) for France and Spain, National Diagnostic Index (NDI) for Romania and National Prescription Audit (NPA) for Hungary. TMZ prescriptions issued by Ear-Nose-Throat (ENT) specialists, ophthalmologists, cardiologists and General Physicians (GPs)/others were analysed during the 24-month period before (reference period) and after RMM implementation (assessment period). During the assessment period, most of the TMZ prescriptions for ENT and ophthalmology indications (un-authorized indications) were made by GPs/others followed by ENT specialists, ophthalmologists and cardiologists in most of the countries. The proportion of TMZ prescriptions for ENT or ophthalmological indications after the restrictions on indication was reduced in Hungary (by 0.4%) and Spain (by 11.8%), remained the same in Romania and increased in France (by 3.7%). This study showed that a significant proportion of TMZ prescriptions was off-label for ENT or ophthalmological indications following the RMM implementation. More effective RMM strategies are required to reduce off-label prescriptions of TMZ.

Audit of intravenous fluid prescription in patients receiving premix parenteral nutrition

Patients receiving off the shelf premix bags of parenteral nutrition (PN) may require additional fluid and electrolytes to meet their daily requirements. This frequently occurs when energy requirements are low, such as during periods of refeeding risk, as smaller volume bags are used.

A prescription audit using the World Health Organization-recommended core drug use indicators in a rural hospital of Delhi.

INTRODUCTION:The inappropriate use of drugs is a global health problem, especially in developing country like India. Irrational prescriptions have an ill effect on health as well as health-care expenditure. Prescription auditing is an important tool to improve the quality of prescriptions, which in turn improves the quality of health care provided. The present study was conducted to investigate the rational use of drugs for completeness, legibility, and against the World Health Organization (WHO)-recommended core drug use indicators.MATERIALS AND METHODS:A cross-sectional, outpatient department-based study was carried out in a rural hospital of Delhi wherein 120 prescriptions were randomly sampled, irrespective of patient characteristics and diagnosis over a period of 1 month. All the prescriptions were analyzed for general details, medical components, and WHO core drug use indicators. The data obtained were summed up and presented as descriptive statistics using the Microsoft Excel and were analyzed using SPSS version 16.RESULTS:All the prescriptions had general details mentioned in it. The diagnosis was mentioned in 64.2% of prescriptions, and 85.8% of drugs were prescribed by generic name. An average of 3.02 drugs per encounter was prescribed. The average consultation time and dispensing time were 2.8 min and 1.2 min, respectively. Only half of the patients had correct knowledge of dose.CONCLUSIONS:Our study highlights the need to train our prescribing doctors on writing rational prescriptions for quality improvement.

Study on Steroid Utilization Patterns in General Medicine Department

Background: Corticosteroids are of great value in treating a wide spectrum of inflammatory conditions as they provide rapid symptomatic relief, especially in the short term. These highly efficacious drugs are mostly used for the treatment of various autoimmune, respiratory, and dermatological conditions. The frequent use of steroids for their palliative effects often leads to its misuse in medicine practice. Periodic monitoring of the drug utilization pattern is one of the methods to analyse the rationality of drug use and has been an effective tool to constitute guidelines for improving the utilization pattern. Aim and objectives: to study the prescribing patterns of steroids in general medicine department, to study the prescribing and administration related factors. Methodology: A prospective observational study was carried out in 324 In-patients from the general medicine department of the hospital during eight months period and subjected to statistical analysis. Results: Out of 324 patients, 207 (63.9%) were males, and 117 (36.1%) were females. More than half of the study population (53.1 %) belonged to the elderly age group of 51-70 years. Social habits of the patients revealed that 105 patients were smokers, 149 patients consumed alcohol. 154 (47.5%) of the patients were teetotallers and non-smokers. Almost 38.8% of reasons were related to respiratory tract infection for which steroid prescription was found to be common. Out of 324 cases common morbidities were COPD (34.9%), asthma(17.0%), broncho pneumonia (16.0%), other pulmonary diseases (8.6%). Other reasons included severe allergic reactions (7.7%), allergic conditions (7.4%), tuberculosis (4.9), dermatological Diseases (2.5%) and septic shock (0.9%), etc. budesonide was the most prescribed steroidal drug for 214 (66%) patients followed by hydrocortisone 56 (17.30%), prednisolone 29 (9%) and so on. Conclusion: It may be concluded that clinical pharmacist can play an important role in the prescription audit and safety assessment of steroid medications in hospital settings, including corticosteroids. The commonly used corticosteroids were budesonide and frequently used in respiratory diseases like COPD and Asthma.

Prescription Audit, Drug Utilization Pattern and Adverse Drug Reaction Monitoring in Outpatients of Orthopedics Department of Tertiary Care Teaching Hospital: A Pilot Study

Background: The domain of orthopedic illnesses is grossly underrepresented in the current healthcare scenario especially due to overreliance on mortality rather than the morbidity or dysfunction. Continuous introduction of new drugs in the field of pharmacology requires holistic utilization, effectiveness, and side-effects studies. In addition, inappropriate use of drugs poses a risk of adverse drug reactions (ADRs). Our study aims to analyze the prescription pattern in outpatient department of orthopedics at a tertiary care hospital of Delhi. Methodology: The study was carried out in 210 patients who attended the orthopedics outpatient department for a period of 3 months. Patient demographic details, duration of illness, comorbid conditions, drugs prescribed, ADRs, and usage of complementary and alternative medicine were used to analyze the pattern of drug use. Results: In our study, we observed that vitamins and mineral preparations (20%) was the most commonly prescribed class of drugs followed by nonsteroidal antiinflammatory drugs (11.42%). Polypharmacy was seen in most of the prescriptions (60.95%), but 100% of the drugs were from Essential Medicine List of Government of National Capital Territory, Delhi. About 75% of the prescriptions were prescribed by generic names. ADRs were reported in 30 patients and majority of them were mild in nature (96%). Complementary and alternative medicine was used by 13.3% of the study patients. Conclusion: Majority of the drugs were prescribed by generic names and were essential medicines. Trend of polypharmacy was noted. Injudicious use of multivitamins and calcium was seen. Nonsteroidal antiinflammatory drugs were a significant part of therapy. ADRs reported were generally mild in severity and involved gastrointestinal tract. Need of the hour is to conduct frequent prescription audits to inculcate good prescribing practices.

Prescription audit study from a tertiary care private hospital in Kolkata, India

Introduction: Prescription writing is an important aspect of safe medication practices. Prescriptions should adhere to best practices mentioned in the World Health Organization guidelines and the National Accreditation Board for Hospitals and Healthcare Providers guidelines. Aim: Evidence about prescription audit study conducted in developing countries like India is scarce, especially from the Eastern part of the country. Hence, the current prescription audit study was conducted in a tertiary care private hospital in Eastern India in the city of Kolkata. Materials and Methods: This study presents an assessment of the quality of prescribing practice in a tertiary care private hospital in Kolkata. Six thousand four hundred and six medicine cards (6406) of inpatients were prospectively analyzed for the duration of 6 months. Results: The audit revealed that only 69.24% of medicine cards had captured drug allergy, 99.53% had mentioned the route of administration, 99.85% had dose strength, 99.89% had mentioned the frequency of dose, and only 75.35% had mentioned the indication/diagnosis of patients. Surprisingly, 90.75% of medicine cards had an error-prone abbreviation which was an issue of major concern. Conclusions: The audit report was shared with the clinicians every month along with regular training of good prescribing practices, which improved the quality of prescribing practice. Regular prescription audit followed by dedicated clinical pharmacology team along with constant communication with clinicians can improve the quality of prescriptions in long run.

Topic Modelling for Medical Prescription Fraud and Abuse Detection

SummaryMedical prescription fraud and abuse have been a pressing issue in the USA, resulting in large financial losses and adverse effects on human health. The size and complexity of the healthcare systems as well as the cost of medical audits make use of statistical methods necessary to generate investigative leads in prescription audits. We analyse prescriber–drug associations by utilizing the real world Medicare part D prescription data from New Hampshire. In particular, we propose the use of topic models to group drugs with respect to the billing patterns and exhibit the potential aberrant behaviours while using medical specialities as a covariate. The prescription patterns of the providers are retrieved with an emphasis on opioids and aggregated into distance-based measures which are visualized by concentration functions. This output can enable healthcare auditors to identify leads for audits of providers prescribing medically unnecessary drugs.

Prescription auditing based on World Health Organization (WHO) prescribing indicators: A case of Dilla University referral hospital

Introduction: Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community. The issues of irrational use of medicines is global and that a global approach coordinated by WHO with more vigorous implementation of leadership and evidence based advocacy of rational use of medicine is essential&#x0D; Materials and Methods: Cross-sectional descriptive and quantitative study was conducted at Dilla University Referral Hospital to determine the current prescribing practices. 1440 prescription were selected using systematic random sampling and reviewed retrospectively for a 2-year period from from September 01/2016 to August 31/ 2018 using prescriptions and Prescription registry.&#x0D; Results: The average number of drugs prescribed per prescription was 1.813 ranging from 1 and 6. 1437(99.79%), 1287(89.38%), 1392 (96.67%), 1428 (99.17%) and 0(0%) of the analyzed prescriptions had name of the patient, date, medical record number, age and address of the patients respectively. Antibiotic and injection was prescribed in 842(58.47%) and 94(6.53%) of encounters respectively. The Percentage of drugs prescribed by generic name and from an essential drug list was 85.33% (n=2227) and 97.43% (n=2543), respectively. Of the total 2610 drugs, 2431(93.14%) drugs were actually dispensed.&#x0D; Conclusion: Polypharmacy, percentage of encounters with with injection and percentage of drugs from essential drug list was within acceptable range. The prescribing practice for antibiotics and generic medicines shows significant deviation from WHO.&#x0D; Keywords: Prescription auditing, WHO prescribing indicators, Dilla University Referral Hospital.

Trends in Opioid Prescribing Among Hemodialysis Patients, 2007–2014

Background: Hemodialysis (HD) patients frequently experience pain. Previous studies of HD patients suggest increased opioid prescribing through 2010. It remains unclear if this trend continued after 2010 or declined with national trends. Methods: Longitudinal cohort study of 484,745 HD patients in the United States Renal Data System/Medicare data. We used Poisson/negative binomial regression to estimate annual incidence rates of opioid prescribing between 2007 and 2014. We compared prescribing rates with the general US population using IQVIA’s National Prescription Audit data. Outcomes included the following: percent of HD patients receiving an opioid prescription, rate of opioid prescriptions, quantity, days supply, morphine milligram equivalents (MME) dispensed per 100 person-days, and prescriptions per person. Results: In 2007, 62.4% of HD patients received an opioid prescription. This increased to 63.2% in 2010 then declined to 53.7% by 2014. Opioid quantity peaked in 2011 at 73.5 pills per 100 person-days and declined to 62.6 pills per 100 person-days in 2014. MME peaked between 2010 and 2012 then declined through 2014. In 2014, MME rates were 1.8-fold higher among non-Hispanic patients and 1.6-fold higher among low-income patients. HD patients received 3.2-fold more opioid prescriptions per person compared to the general US population and were primarily prescribed oxycodone and hydrocodone. Between 2012 and 2014, HD patients experienced greater declines in opioid prescriptions per person (18.2%) compared to the general US population (7.1%). Conclusion: Opioid prescribing among HD patients declined between 2012 and 2014. However, HD patients continue receiving substantially more opioids than the general US population.

The use of ATC/DDD WHO 2016 and Prescription audit study in the Dermatology OPD of a tertiary care hospital in Jharkhand

Background: To study the prescribing patterns, rationale of drug usage and use of anatomical, therapeutic, chemical (ATC) and defined daily dosage (DDD) classification for the monitoring of drug utilization in the dermatology department of a tertiary care hospital.Methods: A retrospective, observational study was conducted in out-patients department of dermatology at RIMS, Ranchi over a period of two months. Rationale of drug usage was assessed by analysing the prescriptions. Defined daily dosage/1000 patients/day of the commonly used medications was compared to the defined daily dosage by World Health Organization in 2016. Data was analysed by statistical tools. Most of the results were expressed in percentages.Results: The prescriptions were rational in most of the cases. Emphasis was more towards the branded drugs. Polypharmacy was evident in many of the prescriptions. The number of DDD/1000 patients/day in cases of antifungals was more than the WHO DDD and less than the WHO DDD in case of antihistaminics.Conclusions: The number of drugs per prescription must be rationalized so as to avoid polypharmacy. The drugs should be prescribed by their generic names also along with the brand names. Generic medicines should be available in the hospital pharmacy so that a more cost-effective treatment can be assured. CMEs and stewardship programs for health care professionals regarding rational drug usage should be organized.

The impact of prescriptions audit and feedback for antibiotic use in rural clinics: interrupted time series with segmented regression analysis

BackgroundProblems of irrational antibiotic use by prescribers are ongoing and have escalated following reductions in the cost of essential drugs policy. In an attempt to improve prescribing practices for village doctors and rational use of essential drugs, a program designed to audit and monitor drug use was established. However, the effects of the program to control antibiotic resistance and changing the village doctors’ prescribing behaviors remain largely unknown. This study measured the effect of the program on levels of antibiotic use.MethodData was collected covering a 22-month period, before, during and after the program was implemented in rural clinics. Segmented regression analysis with interrupted time series (ITS) data was used to examine whether there had been a significant interaction with the onset of the program in September 2011 and levels of antibiotic use from November 2010 to August 2012. Both serial and 12-month lag autocorrelations were controlled for.ResultsA noticeable drop about 6.15% per month (95% CI: -13.36%; 1.06%, P = 0.089) for the antibiotic use in outpatients, which is lower of effect size assuming that the program has the immediate impact of the program were captured for the immediate effect of the program. Meanwhile, levels of antibiotic use would have continued to decrease by 1.12% per month (P = 0.034) as they did in the absence of the program.ConclusionThe central finding was that the prescription audit and feedback program was associated with significant decreases (P = 0.034) in antibiotic use after its implementation.

The use and misuse of antibiotics in dentistry: A scoping review

BackgroundTo describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review. Types of Studies ReviewedThe authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Management’s critical appraisal of a survey checklist. ResultsThe authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons. Conclusions and Practical ImplicationsConsidering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.