Irrational Drug Use Research Articles

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

Background The advancement in drug development and availability of newer drugs has improved overall health services including decrease in mortality and hospital stay. Along, it has brought negative impacts such as polypharmacy and associated adverse drug reactions and antimicrobial resistance. Drug utilization research is an essential approach to understand the drug use pattern, identify the early signs of such irrational drug use and to improve quality of drug use.
 Objective To study the drug utilization pattern in the Ophthalmology Outpatient department (OPD) of Dhulikhel Hospital, Kathmandu University Hospital (DH-KUH).
 Method A descriptive, cross sectional study was conducted from March 2019 to August 2019 in patients attending OPD of Ophthalmology in Dhulikhel Hospital, Kathmandu University Hospital. Prescriptions of 311 patients were analyzed using World Health Organization (WHO) International Network of Rational Use of Drug (INRUD) and additional other indices. The descriptive data was presented in mean and standard deviation.
 Result The average number of drugs per prescription was 2.10±1.35. Out of total 311 prescriptions, drugs prescribed in generic name were 152 (23.30%). Total antibiotics encountered were 247 (37.90%) and total drugs prescribed from National Essential Medicine List (NEML) were 371 (56.90%). Antibiotics 247 (37.90%) were the most commonly prescribed drugs followed by lubricants 146 (22.40%).
 Conclusion Practice of polypharmacy was very high. Most of the drugs were prescribed in brand names and antibiotics were the most frequently used drugs.

Evaluating the effectiveness of drug and therapeutics committees (DTCs) in controlling irrational drug use: Aretrospective analysis.

This study aimed to explore methods to optimize the function of Drug and Therapeutics Committees (DTCs) in controlling irrational drug use. Clinical pharmacologists contribute their specific knowledge and skills to DTCs and help guide rational therapeutics. The DTC is the highest organization of hospital pharmacy management. From January 2016 to August 2021, the DTC promoted the optimization of clinical drug treatment schemes and reduced unreasonable drug use by improving the organizational framework, clarifying the division of functions, regularly monitoring drug use, organizing expert comments, scientific decision-making and functional intervention. During this time, we statistically analysed typical management cases, irrational drug use and drug cost to evaluate the effectiveness of the DTC's management. The DTC's intervention led to a significant reduction in prescribing errors (65.98%, p<0.05); the intervention acceptance rate increased by 16.37%; and the rate of problem resolution increased by 45.84% (p<0.05). The level of drug treatment was improved, and the proportion of patients' drug expenses was reduced. The DTC carried out a series of continuous improvement work that played a significant normative role in clinical drug use. Giving more power to the DTCs can significantly improve the level of drug treatment and reduce unreasonable drug use, which reduces unnecessary drug expenses.

The prevalence and factors associated with potentially inappropriate medication use in Chinese older outpatients with cancer with multimorbidity

BackgroundMultimorbidity and polypharmacy is a general problem in older patients; they increase the prevalence of potentially inappropriate medication (PIM) use. But PIM use in patients with cancer is less clear. This study aimed to examine the prevalence and the predictors of PIM use in Chinese older outpatients with cancer with multimorbidity in Chengdu based on the 2019 Beers Criteria. MethodsA cross-sectional study was conducted using electronic medical data from nine tertiary hospitals in Chengdu from January 2018 to December 2018. The 2019 AGS Beers Criteria were used to evaluate the PIM status of older outpatients with cancer (age ≥ 65 years), and multivariate logistic regression was used to identify the risk factors associated with PIM use. ResultsA total of 6160 cancer outpatient prescriptions were included in the study. The prevalence of PIM use based on the 2019 AGS Beers Criteria was 32.65%. The most frequently used PIMs in outpatients with cancer were benzodiazepines and benzodiazepine receptor agonist hypnotics, diuretics, tramadol, non-steroidal anti-inflammatory drugs, and glimepiride. Logistic regression demonstrated that age ≥ 80 (odds ratio [OR]: 1.238, 95% confidence interval [CI]: 1.071, 1.431, P = 0.004), more diseases (OR: 1.193, 95% CI: 1.017, 1.399, P = 0.03), polypharmacy (OR: 2.520, 95% CI: 2.169, 2.927, P<0.001), and irrational use of drugs (OR: 1.762, 95% CI: 1.408, 2.205, P<0.001) were positively associated with PIM use in older outpatients with cancer. ConclusionsThe prevalence of PIM use in Chinese older outpatients with cancer and multimorbidity is high in China. The increased prescription complexity caused by cancer will further increase the prevalence of PIM use. Research on interventions rationing PIM use in the older cancer population are necessary in the future.

Analysis of Pharmaceutical Intervention on Irrational Drug Use in Hospital by Pharmacy Department

Analysis of Pharmaceutical Intervention on Irrational Drug Use in Hospital by Pharmacy Department

Kesesuaian Resep ISPA Non Pneumonia dengan Kriteria Por Nasional di Puskesmas Kabupaten Sleman Yogyakarta

Pharmacists at the Puskesmas have a role in monitoring and fostering the Rational Use of Drugs (POR) to prevent and overcome the problems in drug administration. The high irrational use of drugs and the bad consequences of resistance is one of the reasons why this research needs to be done. The purpose of this study was to determine the suitability of prescribing non-pneumonia ARI drugs with the National POR indicator at the Sleman District Health Center, Yogyakarta. This research uses observational descriptive research with cross-sectional design. The research data obtained from non-pneumonia ARI prescriptions for the period January-June 2020. Data were analyzed descriptively by calculating the percentage rationality of prescribing non-pneumonia ARI drugs and their conformity with the National POR indicator. The results showed that during the study period, patients who visited the Puskesmas were dominated by women (56.45%) and the age group was 26-45 years (26.57%). From 8 Puskesmas in Sleman Regency, only 3 Puskesmas (37.5%) with non-pneumonia ARI prescriptions in each month that met the National POR criteria. This study concludes that not all puskesmas in Sleman Regency, Yogyakarta that included in the study meet the rationality standard for prescribing non-pneumonia ARI by the National POR criteria

Kesesuaian Resep ISPA Non Pneumonia dengan Kriteria Por Nasional di Puskesmas Kabupaten Sleman Yogyakarta

Pharmacists at the Puskesmas have a role in monitoring and fostering the Rational Use of Drugs (POR) to prevent and overcome the problems in drug administration. The high irrational use of drugs and the bad consequences of resistance is one of the reasons why this research needs to be done. The purpose of this study was to determine the suitability of prescribing non-pneumonia ARI drugs with the National POR indicator at the Sleman District Health Center, Yogyakarta. This research uses observational descriptive research with cross-sectional design. The research data obtained from non-pneumonia ARI prescriptions for the period January-June 2020. Data were analyzed descriptively by calculating the percentage rationality of prescribing non-pneumonia ARI drugs and their conformity with the National POR indicator. The results showed that during the study period, patients who visited the Puskesmas were dominated by women (56.45%) and the age group was 26-45 years (26.57%). From 8 Puskesmas in Sleman Regency, only 3 Puskesmas (37.5%) with non-pneumonia ARI prescriptions in each month that met the National POR criteria. This study concludes that not all puskesmas in Sleman Regency, Yogyakarta that included in the study meet the rationality standard for prescribing non-pneumonia ARI by the National POR criteria

Pengetahuan, Persepsi dan Sikap Tentang Obat Pada Siswa SMK Muhammadiyah Susukan Kabupaten Semarang

An irrational use of drug and drug abuse are some of the impacts of the low knowledge of the public about medicine, including vocational students. This study aimed to assess the knowledge, perceptions, and attitudes of Muhammadiyah Susukan high school (SMK) students about medicine. The research was conducted by using descriptive and analytical methods with cross sectional using a questionnaire instrument. This research was conducted in June 2020. Data were analyzed using univariate and bivariate analysis. The results obtained indicate that students' perceptions of drug safety are 76.7%, students have a positive attitude with drugs 91.7%, but have less knowledge (50.6%). The place where respondents live in the village has a close relationship with their level of the knowledge. There is a relationship between perception and attitude (P &lt;0.05) but there is no relationship between knowledge and perception (P&gt; 0.05), and between knowledge and attitude (P&gt; 0.05). Low levels of knowledge and perceptions can cause students to abuse drugs or use drugs that are not rational. So that efforts are needed to increase students' knowledge about medicine. Keywords: knowledge, perceptions, attitudes about medicine, students

Evaluation of irrational drug use of individuals over the age of 18 who applied to a university hospital.

Irrational drug use not only causes a delay in the treatment of patients, failure to achieve full well-being, drug interactions and side effects, drug resistance but also creates economic negativities such as waste of resources and unnecessary workload. This study aims to investigate the irrational drug use behaviors of individuals over the age of 18 who applied to a university hospital. This sectional study included 1247 people over the age of 18 who applied for Gazi University Health, Research and Application Center. A questionnaire was applied to the applicants by face-to-face interview technique. Logistic regression analysis was performed among the factors associated with the subcomponents of irrational drug use. Participants (20.1%) used medication without a doctor's prescription (self-medication), 3.4% did not comply with the recommended dose and duration for medications, 47.4% applied to the physician to prescribe the medication they wanted, 65% had medication for later use at home. It was determined that 24.1% of them used drugs without looking at the expiration date and 45.5% of them used drugs without reading the patient information leaflet. Among the risk groups identified for the different irrational drug use behaviors mentioned are the following: males, lower educational groups, housewives, not having social insurance, continuous drug users. Irrational drug use behaviors are still observed in society. The fact that the risk is higher in lower education groups is an example of the negative consequences of limited health literacy. The fact that different risk groups have been identified for different behaviors related to irrational drug use shows that intervention studies on this subject should be directed to specific groups. The effect of having social security reveals its connection with universal health coverage and rational drug use.

Appropriateness of drug usage in acute pediatric diarrhea – A prospective observational study

Background: Pediatric diarrhea is the 3rd foremost cause of childhood mortality all over the world. Although these are self-limiting diseases, irrational antibiotic use and polypharmacy are prevalent in their treatment. Antimicrobial therapy is recommended in bacterial diarrhea and severely malnourished children only. Inappropriate use of drugs for the treatment of acute diarrhea can be minimized by adhering to standard guidelines. Aims and Objectives: The objectives of this study were as follows: (1) To evaluate the appropriateness of drug treatment in Acute Pediatric Diarrhea and (2) to assess the appropriateness of antibiotic treatment in diarrhea based on modified Kunin’s criteria. Materials and Methods: A prospective observational study was conducted for 12 months at the pediatric inpatient unit of Bidar Institute of Medical Sciences teaching hospital, Bidar. Prescriptions of 400 cases of acute diarrhea were evaluated for the appropriateness of drug usage using Indian Academy of Pediatrics (IAP) guidelines and modified Kunin’s criteria. Results: Among the 400 acute diarrhea cases, majority were male (54.75%) and below 5 years (58.25%). Oral rehydration solution (ORS) was given to 337 patients and IV fluids to 324 cases. About 55.5% patients were prescribed antibiotics. In 75.67% prescriptions, the antibiotic use was not necessary (modified Kunin’s criteria category V). Only 12.5% prescriptions adhered to IAP guidelines (2006), which included ORS and Zinc. About 54.5% patients were prescribed probiotics and 80% were prescribed antiemetics (ondansetron), which is not appropriate as per guidelines. Conclusion: Majority of patients were prescribed ORS, but only few were given zinc as an adjunctive therapy. Thus, we found that adherence to IAP 2006 guidelines was very low in our setup. Based on our observations, we suggest that prescribers should make use of standard treatment guidelines and choose appropriate drugs and their formulations so that irrational use of drugs can be minimized.

Community pharmacists’ perception and exposure to drug promotion in Pakistan: a cross-sectional study

ObjectiveDrug promotion is a factor that promotes the irrational use of drugs and sometimes negatively influences the prescribing/dispensing pattern. So there was a need to assess the views about accepting...

Antibiotic-prescribing pattern in the outpatient departments using the WHO prescribing indicators and AWaRe assessment tool in a tertiary-care hospital in South India

Context:Rational drug use has a great role of influence in health care. The fact sheet given by the World Health Organization (WHO) shows that around 50% of the drugs are prescribed, dispensed, and sold inappropriately. One of the major consequences of irrational drug use in infections is antibiotic resistance.Aim:The present study aims to assess the antibiotic-prescribing pattern by auditing the prescriptions in a teaching hospital.Settings and Design:A prospective cross-sectional study was conducted in the pharmacy of a teaching hospital to evaluate the prescriptions of the outpatient department.Materials and Methods:The prescriptions used to treat symptoms suggestive of infections were taken into consideration. A total of 1,000 prescriptions were analyzed.Data Analysis:The data was analysed using Microsoft Excel.Results:A total of 2,536 drugs were prescribed. The average number of drugs per prescription was 2.5. The percentage of encounters with antibiotics prescribed was 17.5%. The percentage of encounters prescribed with a generic name and with drugs from the essential drug list was 87.5% and 65%, respectively. There were no injections prescribed. Amoxicillin and ciprofloxacin were the most common antibiotics prescribed. The duration of the treatment was mentioned in all the prescriptions.Conclusions:Our study shows that the percentage of antibiotic usage is within the WHO standard value. The average number of drugs per prescription was slightly higher than the WHO value. Steps should be taken to improve the generic prescribing by the physicians.

Assessment of drug use in primary health centers in Lagos State, Nigeria.

rational drug use prevents wastage of resources, loss of confidence in healthcare system and drug-related morbidity and mortality. This study aims to assess drug use in Primary Health Centers (PHCs) in Lagos State, Nigeria using the World Health Organization in collaboration with the International Network of Rational Use of Drugs core drug use indicators. the study was conducted between February to October 2021 as a comparative observational survey of selected PHCs. It included a retrospective and prospective cross-sectional design for prescribing and patient care indicators assessing 2640 prescriptions and clients respectively. Data were analyzed and presented as frequency with percentage or mean with standard deviation, as applicable. The performances of the types of PHCs were compared using two-sample t-test. A 2-tailed p-value < 0.05 was considered statistically significant. average number of drugs per prescription, drugs prescribed by the generic name, percentage of encounters with prescribed antibiotics and injections were 3.6 ± 0.9%, 76.5 ± 18.5%, 63.3 ± 19.1% and 21.1 ± 24.1% respectively with no significance difference between the comprehensive and basic PHCs. For all the facilities, the average consultation and dispensing times were 10.5 ± 6.0 minutes, 244.9 ± 179.2 seconds respectively. In this study, the percentage of patients' knowledge of the correct dosage was 72.4 ± 38.3%. There is statistically significant difference in availability of key drugs in stock between the comprehensive and basic PHCs (p-value 0.0001). irrational drug use practices exist in comprehensive and basic PHCs. There is a need to implement interventions aimed at strengthening good prescribing and patient-care practices across the PHCs in Lagos State.

Early Detection of Drug Resistant Enterobacteriaceae in Urinary Tract Infections using Chromogenic Agar Medium in a Tertiary Care Hospital, Kakinada, Andhra Pradesh, India

Introduction: The irrational and inappropriate use of beta lactam antimicrobial drugs has led to the advent of Extended Spectrum Beta-Lactamase (ESBL) resistant strains. ESBL producing Enterobacteriaceae strains are frequent causative agents both in community and in acquired nosocomial infections and Urinary Tract Infections (UTI). The phenotypic confirmatory tests rarely identify all ESBLs. Chrom ID (Chromogenic identification Media) ESBL – Bx (bioMerieux) is a completely new and innovative chromogenic medium designed specifically for the screening of ESBL producing Enterobacteria directly from urine samples. It is a ready to use selective media which is sensitive and specific for rapid and presumptive identification of ESBL producing Enterobacteriaceae. Aim: Early detection of ESBL producing Enterobacteriaceae directly from urine samples on chromogenic medium (Chrom ID- ESBL- Bx) and confirmation of ESBL producing Enterobacteria using Disc Potentiation Test (DPT). Materials and Methods: The present cross-sectional study was conducted in the Department of Microbiology, Rangaraya Medical College, Kakinada, Andhra Pradesh, India from November 2019 to March 2020 (five months duration). The study was done on 70 urine samples from patients with UTI. All samples were subjected to wet mount, inoculated directly for culture on Chrom ID ESBL- Bx agar and MacConkey agar. Antibiotic Susceptibility testing of ceftazidime and cefotaxime was done by Kirby-Bauer disc diffusion method and conformation of ESBL production by DPT using Clinical and Laboratory Standards Institute (CLSI) method. The Statistical Package for the Social Sciences (SPSS) Statistical package version (18.0) was used. Results: A total of 56 (80%) isolates were obtained from 70 urine samples, out of them 28 (50%) were Escherichia coli, 21 (37.5%) were Klebsiella spp., 7 (12.5%) were Proteus spp., 23 (82.14%) isolates of Escherichia coli, 15 (71.43%) of Klebsiella spp., 6 (85.71%) of Proteus spp., isolated were screened positive using Chrom ID ESBL-Bx agar. About 44 (78.57%) of total Enterobacteria (56) were screened for ESBL production. 20 (86.96%) of Escherichia coli, 11 (73.33%) of Klebsiella spp., and 5 (83.33%) of Proteus spp., that were screened positive using Chrom ID ESBL agar were confirmed (by DPT) as ESBL producers and 2 (16.6%) of total (12) isolates that were screened negative by Chrom ID ESBL agar were confirmed as ESBL producers when screened and confirmed by DPT. So sensitivity and specificity CHRO Magar was 94.73% and 55.5%. Conclusion: ESBL continues to become a serious public health threat. Results from present study showed that CHROMagar ESBL has a high sensitivity and a convenient method for making provisional diagnosis of drug resistant Enterobacterial infections in 24 hours. Chrom ID ESBL- Bx agar medium allows easy differentiation of different bacteria based on colony colouration.

Identification and Antifungal Drug Susceptibility Pattern of Candida auris in India.

Candida auris has turned up as a multidrug-resistant nosocomial agent with outbreaks reported worldwide. The present study was conducted to evaluate the antifungal drug susceptibility pattern of C. auris. Isolates of C. auris were obtained from clinically suspected cases of candidemia from January 2019 to June 2021. Identification was done with matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) and panfungal DNA polymerase chain reaction (PCR), followed by sequencing. Antifungal susceptibility testing was performed with broth microdilution method. Out of 50 isolates C. auris, 49 were identified by MALDI-TOF and one isolate was identified with panfungal DNA PCR followed by sequencing. For fluconazole, 84% (n = 42) isolates were found to be resistant and 16% (n = 8) isolates were susceptible (minimum inhibitory concentrations [MICs] range 0.5-16). Posaconazole exhibited potent activity, followed by itraconazole. For amphotericin B, only 6% (n = 3) isolates were resistant with MICs ≥2 μg/mL. Only 4% (n = 2) isolates exhibited resistance to caspofungin. No resistance was noted for micafungin and anidulafungin. One (2%) isolate was found to be panazole resistant. One (2%) isolate was resistant to fluconazole, amphotericin B, and caspofungin. Correct identification of C. auris can be obtained with the use of MALDI-TOF and sequencing methods. A small percentage of fluconazole-sensitive isolates are present. Although elevated MICs for amphotericin B and echinocandins are not generally observed, the possibility of resistance with the irrational use of these antifungal drugs cannot be denied. Pan azole-resistant and pan drug-resistant strains of C. auris are on rise.

Evaluation of the integrated model of the rational drug use into the Bachelor of Nursing Science program in Thailand: A mixed-methods study.

Integration of rational drug use (RDU) into a nursing program to increase nurse graduates' RDU competencies is essential to solving the problem of irrational drug use. This study aimed to evaluate the integrated model of the RDU into the Bachelor of Nursing Science (BNS) program developed by the Thailand Nursing and Midwifery Council (TNMC). A mixed-methods study was designed using a sequential explanatory design. The whole population of 3,848 nurse educators and 9,249 nurse graduates from 86 nursing education institutions across Thailand in Academic Year 2018 were recruited for quantitative data collection. Fifty nurse educators selected as representatives of the nursing education institutions were recruited for qualitative data collection. Online questionnaires were sent to collect information regarding the context, input, process, and product relating to the model, while structured focus group guidelines were developed to obtain more details in assessing the model. The data were analyzed using descriptive statistics and content analysis. The findings showed that the context and policy of utilizing the model to increase nurse graduates' RDU competencies were well accepted. The nurse educators' RDU competencies, the input of the model, were rated at a high level. The process of the model was implemented as guided at almost all nursing education institutions. The product of the model, the RDU competencies of the nurse graduates, was reported at a high level. The model of integrating the RDU into the BNS program developed by the TNMC was well performed and resulted in high RDU competencies of the nurse graduates. This integration model should be published and applied in nursing schools worldwide to enhance RDU competencies of nurse graduates.

Clinical pharmacology-real basis of effi cient and inoff ensive pharmacotherapy

Clinical pharmacology play an important role in ensuring effective and inofensive pharmacotherapy. The administration of a adjusted treatment according to the pharmacokinetic and pharmacodynamic peculiarities of the drug, as well as the patient’s condition is indispensable. The rational use of medicines would increase the patient’s quality of life, as well as has important financial and public health benefits. Excessive, unreasonable prescription of drugs, polypharmacy, misuse of drugs, including expensive and unnecessary are the most common problems of irrational drug use. Many efforts have been made to improve drug use, but few evaluations have been carried out in this area. Identifying the problems that lead to irrational drug use and awareness of the importance of clinical pharmacology could ensure safe and effective pharmacotherapy.

Assessment of Antibiotic Prescription Pattern Using who Prescribing Indicators and Aware Categorization of Antibiotics

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

INFLUENCE OF IRRATIONAL PRESCRIPTION OF ANTIBACTERIAL THERAPY ON THE PROGNOSIS OF TREATMENT AND SURVIVAL IN PATIENTS WITH COVID-19

IIntroduction. The COVID-19 pandemic became a major challenge for healthcare systems around the world. The development and improvement of basic treatments for coronavirus patients is important to improve public health and improve quality of life after recovery. The aim of the study: to determine the frequency and structure of prescribing antibacterial drugs in the prehospital and hospital stages, used in patients with COVID-19. Assess the relationship between irrational use of antibacterial drugs with the length of hospital stay of patients with coronavirus disease, the risk of transfer to the intensive care unit (ICU) and mortality. Materials and methods: Statistical, retrospective analysis of 400 case histories of patients with COVID-19 who were treated at the Municipal Non-Profit Enterprise «Kyiv City Clinical Hospital №17» (KNP «KMKL#17») for the period from September 2020 to November 2021 with severe coronavirus disease. Results: 400 medical charts were selected for the study, which were divided into two groups according to the purpose of antibacterial therapy. Of the group of patients who received pre-hospital antibacterial therapy (200 people), indications for its appointment had only 7 % of patients. Among the group receiving antibacterial drugs there is a prolongation of the length of stay in the hospital, the risk of transfer to ICU increases. There is also higher risk of mortality in patients of group 1 (14,5 %), compared with group 2 (8 %), whose antibacterial drugs were not prescribed at the prehospital stage. Conclusion: as a result of the study it was found that patients who were unreasonably prescribed antibacterial therapy prolongs the period of general hospitalization by 2.3 ± 0.8 days, increasing the need for transfer of patients due to deterioration to ICU by an average of 13 %, increase in the incidence of antibiotic-associated diarrhea by 7-8 %, and there is a tendency to increase mortality from COVID-19. Antibacterial drugs should be used only on the basis of indications in the case of proven bacterial co-infection (superinfection) or reasonable suspicion of it in patients with respiratory disease caused by SARS-CoV-2 and in no case should be prophylactic.

Study on the Influence of Pharmaceutical Management on Rational Drug Use under Chinese Health Strategy

In order to better promote the implementation of the healthy China strategy and the innovation of public hospital system management, we can explore a modern public hospital management system that can meet the needs of the people in the new era from the aspects of medical service supply mode, collaborative governance design of public hospitals and internal management system of public hospitals. In this paper, 300 prescriptions in our hospital before and after May, 2020 were selected as research objects, and were randomly divided into two groups, one group was the control group (300 cases) without pharmaceutical management, and the other group was the observation group (300 cases) with pharmaceutical management. Then, the drug satisfaction, irrational drug use and inappropriate drug use of the two groups were compared. The results showed that the satisfaction of medication in the observation group was significantly better than that in the control group, and the irrational and inappropriate medication was lower than that in the control group, with statistical differences (P &lt;0.05). It shows that the implementation of pharmaceutical management measures under the strategy of Healthy China can effectively improve patients' satisfaction with medication and prevent irrational medication.

Ayurveda approaches to COVID-19 in 2 wave: Lessons learned from practice

Ayurveda is a live traditional system of medicine with an unbreakable practice since 3000 years. Its principles and its approaches including oral administration of preventive drugs, herbs, formulae, decoction, indoor herbal medicine for fumigation, etc. were recommended for effective prevention and treatment whenever the emergent of new diseases. This paper highlights the patho-physiology of Corona as per Ayurveda, Clinical staging, preventive and curative approaches as learned time to time. and Anu taila nasya have excellent practice evidences for prevention of Covid-19 in 1 wave of corona. Sajeevani app developed by AYUSH to study the AYUSH practices. AYUSH -64 is an evidence-based treatment to cure mild to moderate COVID infection developed by Central Council for Research in Ayurveda Sciences. The second wave of COVID-19 is more tragedy than 1 wave and its impact on health care systems of our nation is devastating and unprecedented. National campaign for AYUSH-64 started and it is recommended in National Clinical Management Protocol based on Ayurveda and Yoga which is vetted by National Task Force on COVID management for COVID-19 Patients in Home Isolation. All Institute of Ayurveda released list of medicines for management of various symptoms of Covid. General public have more trusted upon Ayurveda practitioners as controversies of addition and deletion of steroid and antiviral in modern treatment protocol. The horror of Black (Mucormycosis) and white (Candiditis) fungus infection due to irrational use of immunosuppressive drugs confused the general people. More numbers of Covid patients received AYUSH-64 in 2 wave. Ayurveda Practice requires sound knowledge of Yukti Pramana(Logic and self judgement) by discerning clinical for better outcome irrespective of evidences and guidelines. We all are learning the pathogenesis of different mutants of Covid. Ayurveda approaches reduced the complication and progression of disease. This review will provide basic understanding Ayurveda for covid care.