Prescribed Daily Dose Research Articles

Antidepressant prescription patterns and polypharmacy in outpatient psychiatry: a cross-sectional study.

Background and aim: Prescription patterns of antidepressants have changed over the years with a shift towards newer antidepressants with better tolerability and safety. Polypharmacy is common in psychiatry settings. The study aimed to evaluate the antidepressant drug prescription pattern and polypharmacy in a psychiatry outpatient setting. Investigations: This prospective observational study was conducted in a psychiatric outpatient clinic. The medication use data of eligible patients were collected. In addition, the rationale of antidepressant medication prescription, the defined daily dosage (DDD), the prescribed daily dose (PDD), and the PDD to DDD ratio were assessed. The assessment of prescription polypharmacy was conducted utilizing the framework provided by the National Association of State Mental Health Program Directors. Results: Data from 131 patients was analyzed. Major depressive disorder (32.8%) was the most common disorder for which antidepressants were prescribed. The majority, 91 (69.4%), received monotherapy. Selective serotonin reuptake inhibitors were the most frequently prescribed drugs in 69 (52.7%). Mirtazapine was the most frequently 32(24.4%) prescribed drug. Escitalopram and mirtazapine were the most commonly prescribed combination therapy (4.6%). Antipsychotic medications (37.4%) were the most widely co-prescribed medications, along with antidepressants. The PDD to DDD ratio was less than 1 for mirtazapine and imipramine; they were ≥1 for others. Psychiatric polypharmacy was documented in 87.1% of prescriptions. The total polypharmacy was not significantly (p>0.05) associated with demographic, illness, and treatment-related variables. Conclusion: Selective serotonin reuptake inhibitors were the most commonly prescribed antidepressants, monotherapy, and combination therapy. A substantial amount of patients received concomitant administration of antidepressants or psychotropic drugs, warranting careful monitoring.

A point prevalence survey and monitoring indicator research on the second batch of national key monitoring and rational use drugs.

With the remarkable effect of controlling the increase in drug costs by the first batch of National Key Monitoring and Rational Use Drugs (first NKMRUDs), the National Health Commission of the People's Republic of China releases the second NKMRUDs to further strengthen the reasonable use of drugs. Unfortunately, the second NKMRUDs include some drugs of National Volume-based Procurement and National Essential Medicines, which challenges the management of pharmaceutical affairs on the three kinds of drugs. The main objective of this study was to investigate the prevalence of the second NKMRUDs and explore their monitoring indicators. An adapted WHO methodology for point prevalence surveys was conducted for the second NKMRUDs. For the monitoring indicators, we sought to explore whether the defined daily dose (DDD) and days of therapy (DOT) can be suitable for the second NKMRUDs through comparing differences between DDD and DOT with the prescribed daily dose (PDD). Among the 935 included patients, 29.20% of the patients received at least one of the second NKMRUDs. A total of 273 patients were administered with 487 times of the second NKMRUDs. Among them, 162 , 62 , and 49 patients were receiving one, two, and three or more agents, respectively. The most commonly prescribed second NKMRUDs were compound amino acids, budesonide, and ceftazidime. The total DDDs and DOTs of the second NKMRUDs were 3360.68 and 1819.80, respectively, with the PDDs of 1865.26. The deviations (80.17%) of DDDs from PDDs were significantly greater than those (-2.44%) of DOTs. The prevalence of the second NKMRUDs was obtained by using the adapted PPS methodology at a tertiary university hospital. The DOT indicator is found to more accurately reflect actual consumption than the DDD indicator for second NKMRUDs. It is recommended to use the DOT indicator to monitor second NKMRUDs.

Long-Term Physical Activity Effectively Reduces the Consumption of Antihypertensive Drugs: A Randomized Controlled Trial.

Although physical activity (PA) has been shown to enhance hypertension control, the impact of exercise on the potential decrease of the use of antihypertensive medications remains inadequately researched. The aim was to assess the impact of a two-year PA on the medication requirements of individuals with hypertension. A clinical trial was conducted, involving 130 participants with essential hypertension who took at least one antihypertensive medication. Participants were randomly assigned to either a control group (CG n = 65) or an experimental group (EG n = 65) that underwent a 24-month supervised PA program based on a combination of aerobic and resistance training. The antihypertensive drug load for each participant was determined by adding the ratios of the prescribed daily dose (PDD) to the defined daily dose (DDD) for all antihypertensive medications taken by the participants. The outcome measures were evaluated at 0, 6, 12, 18, and 24 months. A total of 76 participants completed the 24-month assessment, and RM-ANOVA revealed a significantly lower antihypertensive drug load in the EG compared to the CG at 18 (p < 0.017) and 24 months (p < 0.003). A long-term PA program can decrease the antihypertensive drug load in older adults with essential hypertension. The trend of improvement regarding the EG drug load intake and the trend of CG drug load increase, although not significant over time, results in a significant difference between the groups at 18 months and an even greater difference at 24 months. This trend certifies the protective value of PA against the aging process and its related health risk factors.

Prescribed daily-dose-based metrics of oral antibiotic use for hospitalized children in Japan.

Defined daily-dose (DDD)-based metrics are frequently used to measure antibiotic consumption. However, they are unsuitable for the pediatric population because they are defined using the maintenance dose for 70-kg adults. Moreover, children have large body weight variations. We assessed the prescribed daily dose (PDD) and PDD-based metrics of oral antibiotics for children to develop an alternative to DDD-based metrics in Japan. We performed observational study using data from the Japanese administrative claims database between April 2018 and March 2019. Of 453,001 patients (aged 1 month-15 years), 564,326 admissions to 1,159 hospitals were included. We showed the median PDD (mg/day and mg/kg/day) and PDD-based metrics for 8 antibiotics for each age category (1 month to <1 year old and 1-6, 7-12, and 13-15 years old). We also assessed the relationship between PDD-based metrics and days of therapy (DOT)-based metrics using a scatter plot and correlation. In total, 86,389 patients (19.1%) were prescribed oral antibiotics; amoxicillin, macrolides, and third-generation cephalosporins were the most common. The PDD (mg/day) for each antibiotic increased with age to 7-12 years old, when an adult dose was reached. The PDD (mg/kg/day) decreased with age to 13-15 years old, due to increasing body weight. The relationship between PDD per 1,000 patient days and DOT per 1,000 patient days differed depending on the antibiotic. PDD-based metrics stratified by age could characterize antibiotic consumption, even with body-weight variations. Therefore, PDD-based metrics, in addition to DOT-based metrics, are helpful benchmarks for antibiotic use in children.

DRUG UTILIZATION EVALUATION OF MACROLIDES IN ENT OUTPATIENT DEPARTMENT IN TEACHING HOSPITAL PUNJAB, PAKISTAN.

Background: A major danger to the health care system is the rise in antibiotic resistance. The aim of current Study is to evaluate the comparison defined daily dose (DDD) and prescribed daily dose (PDD) of macrolide and to evaluate the prescribing pattern of the drug, either it met the standards or not. Methodology: Quantitative, retrospective study was carried out to measure the use of antibiotics specifically macrolide antibiotics in ENT outdoor department of teaching hospital Punjab, Pakistan. Study research from August 2021 to October 2021, the patient who was reported in OPD of ENT department during study period of 3 month retrospectively. Results: Total 438 prescriptions were collected and reviewed to evaluate the prescribing pattern of macrolides in outdoor patients of ENT department. Out of 438 prescriptions only in one prescription 10 antibiotics was prescribe (polypharmacy) and in 19(4.3%) prescriptions only one antibiotic is prescribed. Drug prescribed by their generic were 438(100). Encounter with antibiotics 95%. All drug were prescribed from essential drug list (EDL). Azithromycin was the most commonly prescribed drug in ENT department, followed by clarithromycin. Conclusion: Control bacterial resistance is become challenge to our health care system, major portion of our population is become resistance to majority classes of antibiotic if this practice will continue in future, it became difficult to control or treat infectious diseases. Irrational use of drugs, over prescribing of antibiotics and brand prescribing were observing during the study. Lack of knowledge and non-adherence to the prescribing indicators are the major factors that contribute towards the irrational drug prescribing that ultimately leads towards the antibiotics resistance.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient’s demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Compliance with the DPP-4 inhibitors dose adjustment recommendations based on renal function in a population database

ObjectiveTo examine the prescription pattern of the different dipeptidyl peptidase-4 inhibitors (DPP4is), depending on the estimated glomerular filtration rate (eGFR) under real-world clinical practice conditions. MethodThis was a descriptive, observational study using a population database (SIDIAP Catalonia). Subjects diagnosed with T2DM with kidney function assessed and on active treatment with DPP4is were enrolled. Patients were included at the time of the measurement of eGFR (CKD-epi) and were monitored for 6 months after enrolment.For each subject, the prescribed daily dose (PDD) of DPP4i, the theoretical dose according to the degree of renal failure established by the recommendations in the summary of product characteristics (DDD-adj), and the PDR ratio (PDD/DDD-adj) were estimated. A subject was considered overtreated if his/her RDR was greater than 1.2 (>20%). ResultsThe study sample consisted of 72,135 subjects with a mean age of 69.7 (±11.6) years and 55.9% males. The proportion of patients overtreated varied depending on the type of DPP4i and the renal function stage. Overall, overdosage was recorded in 7.15% of all DPP4i treatments. In advanced stages (IIIb, IV, and V), overdosage was much higher (36.8% for all DPP4is, and 58.7% if linagliptin is excluded). DiscussionUnder real-world clinical practice conditions, more than one third of T2DM patients with advanced renal failure were overdosed with DPP4is because the doses were not adequately adjusted to the glomerular filtration rate of each patient.

Prescription patterns and dosages of antiepileptic drugs in prevalent patients with epilepsy in Taiwan: A nationwide retrospective cross-sectional study

ObjectiveTo evaluate the prescription patterns and prescribed daily dose (PDD)/defined daily dose (DDD) ratios of antiepileptic drugs (AEDs) in prevalent patients with epilepsy in Taiwan. Materials and methodsA nationwide retrospective cross-sectional study was conducted for prevalent patients with epilepsy in 2016 using the Taiwanese National Health Insurance Research Database. The prescription records of AEDs of all prevalent patients with epilepsy were retrieved. The mean PDDs and PDD/DDD ratios of AEDs in adult patients were obtained to evaluate dosing adequacy. A chi-square test and two-sample t test were used to analyze the differences in AED prescription patterns and dosages, respectively, among patients with different ages, sexes, comorbidities, and therapeutic approaches. ResultsA total of 118,937 prevalent patients with epilepsy were enrolled. The predominant therapeutic approach was monotherapy, especially in the elder adults, accounting for 82.9% of elder adult patients with epilepsy. The proportion of AED monotherapy was higher in patients with dementia (78.9%) and stroke (80.6%). The top three antiepileptic monotherapies were valproic acid (28.7%), levetiracetam (19.1%), and phenytoin (16.9%); however, oxcarbazepine (22.8%) was substituted for carbamazepine (3.9%) as monotherapy for patients aged 0–17 years. Among adult patients with epilepsy, the PDD/DDD ratio of each AED in monotherapy was less than 1.00. The mean PDD of each AED was higher in polytherapy than in monotherapy (p < 0.01), except for lacosamide. The mean PDDs of all evaluated AEDs in monotherapy were lower in elder adult patients than in younger adult patients, most of which reached statistical significance (p < 0.001). ConclusionsIn Taiwan, valproic acid was the most prescribed AED for prevalent patients with epilepsy. The mean PDDs of most AEDs were lower than the DDDs developed by the World Health Organization.

A drug utilization study of antiepileptic drugs uses in a tertiary care teaching hospital of India

Background: Epilepsy is a disorder characterized by repeated seizures due to the disorder of the neurons. Epilepsy needs life-long medical therapy. It is managed by polytherapy. Drug utilization studies help to determine rational combinations of drug use in epilepsy. Aims and objectives of the study were to analyses the drug utilization pattern of anti-epileptics and common types of epileptic seizures and to determine the safety of antiepileptic drugs (AEDs).Methods: It was a prospective, cross-sectional, observational study. Patients attending neurology epilepsy OPD with h/o seizures and taking at least one antiepileptic were recruited. Data was collected by taking demographic details including brief history of disease, clinical examination and reviewing OPD prescription. Details were recorded in case record form.Results: We recruited 102 participants (57 male and 45 females) of mean age 29.68±10.52. Mean age of onset of epilepsy was 18.9±10.5 years. Among them 77 (75.4%) were diagnosed as generalized tonic clonic seizures and 18 (17.6%) were diagnosed as focal seizures. Monotherapy was given in 31 (30.3%) patients while polytherapy was given in 71 (69.7%) patients. Valproic acid was most commonly used monotherapy (12 patients). No fixed drug combinations were used. Clobazam in 55 (53.9%) patients and valproic acid in 53 (51.9%) patients were prescribed. The other AEDs prescribed were lamotrigine, oxcarbazepine, carbamazepine, lacosamide, zincosamide, perampanel, and phenytoin. All antiepileptics were prescribed in brand name. The prescribed daily dose (PDD) was less than defined daily dose (DDD) as per anatomical therapeutic chemical (ATC) classification. Two adverse effects were reported during study period. They were mood change and blurring of vision in two different patients.Conclusions: The PDD was less than DDD as per ATC classification. Awareness should be created among neurologists to prescribe more generic drugs because of their cost effectiveness. Studies are needed with larger sample size to analyze the drug utilization patterns which helps in the planning of reduction of expenditure for the patient without compromising efficacy.

Drug Utilization Study of Antidiabetic Drugs in Patients Attending Geriatric Outpatient Department at a Tertiary Care Hospital.

IntroductionDiabetes has increased in prevalence from 108 million individuals in 1980 to 463 million individuals in 2021. As people's life expectancies have risen, it's become increasingly necessary to be worried about diseases that affect the elderly. To focus and manage these diseases effectively, the illumination of current knowledge about the pattern of anti-diabetic drug utilization in the elderly is important. As a result, it is necessary to evaluate the pattern of anti-diabetic medication use among diabetes patients of the geriatric age group and determine if there is room for improvement in light of current knowledge. With this information, we intend to provide feedback and suggestions for the health care providers. This research aimed to study and analyze the drug utilization of antidiabetic medications in patients attending the geriatric outpatient department.MethodsThe data of 600 patients visiting the geriatric outpatient department from January 1, 2016 to September 30, 2017 were collected from the electronic medical record (EMR) database. The protocol was designed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Subjects were grouped according to gender, age, drug combination use, and underlying co-morbidities. Indicators of drug usage and the total number of drugs prescribed and prescription patterns were analyzed. Then, the recorded data were classified according to the anatomical therapeutic chemical (ATC) - daily defined dose (DDD) classification. Prescribed daily dose (PDD) values and PDD/DDD ratio of antidiabetic drugs prescribed to a sample of patients (n=600) were calculated. Cost analysis of the prescribed drugs was analyzed and the cost index for each drug is described.ResultsA total of 600 diabetic patients (286 males) were recruited in the study. In the study, the average age of participants was 69.30±11.34 years. The most common comorbidity associated with diabetes mellitus (DM) was hypertension followed by hypertension along with chronic heart disease. Glibenclamide and pioglitazone (thiazolidenediones) had PDD/DDD ratio equal to 1. The ratios for glimepiride (sulfonylurea), metformin (biguanides), sitagliptin (sodium-glucose cotransporter 2 inhibitor), insulin glargine, insulin lispro, insulin aspart, were 1.85, 1.29, 1.66, 1.63, 1.42, and 1.21, respectively, whereas the premixed insulin had a ratio of 0.83. The average cost per prescription was USD 3.36 and around 87.72% of the cost per prescription was due to the prescribed antidiabetics. Metformin + glibenclamide was the most commonly prescribed combination followed by metformin + glimepiride.ConclusionOn the whole, the principles of rational prescription were followed in accordance with the different WHO drug usage indicators. Many of the drugs prescribed by generic name were supplied from hospital pharmacy thus reducing the burden to some extent.

Cumplimiento de las recomendaciones de ajuste de la dosis de inhibidores DPP4 según la función renal en una base de datos poblacional

ObjectiveTo examine the prescription pattern of the different dipeptidyl peptidase-4 inhibitors (DPP4is), depending on the estimated glomerular filtration rate (eGFR) under real-world clinical practice conditions. MethodThis was a descriptive, observational study using a population database (SIDIAP Catalonia). Subjects diagnosed with T2DM with kidney function assessed and on active treatment with DPP4is were enrolled. Patients were included at the time of the measurement of eGFR (CKD-EPI) and were monitored for 6 months after enrolment.For each subject, the prescribed daily dose (PDD) of DPP4i, the theoretical dose according to the degree of renal failure established by the recommendations in the summary of product characteristics (DDD-adj), and the PDR ratio (PDD/DDD-adj) were estimated. A subject was considered overtreated if his/her RDR was greater than 1.2 (>20%). ResultsThe study sample consisted of 72,135 subjects with a mean age of 69.7 (±11.6) years and 55.9% males. The proportion of patients overtreated varied depending on the type of DPP4i and the renal function stage. Overall, overdosage was recorded in 7.15% of all DPP4i treatments. In advanced stages (IIIb, IV and V), overdosage was much higher (36.8% for all DPP4is, and 58.7% if linagliptin is excluded). DiscussionUnder real-world clinical practice conditions, more than one third of T2DM patients with advanced renal failure were overdosed with DPP4is because the doses were not adequately adjusted to the glomerular filtration rate of each patient.

Risk indicators in tapentadol use: opportunities to improve outcomes with a personal pharmaceutical care approach in community pharmacies

Opioids have historically been the pharmacological choice in the treatment of moderate to severe pain of oncological and chronic origin but they have also become a growing and controversial tool in the treatment of non-oncological pain that requires a risk/ benefit evaluation. The present study focuses on the opioid tapentadol, the newest opioid considered highly effective in treating cancer and non-cancer pain. According to the WHO Collaborating Center for Drugs Statistics Methodology, the stated Tapendatol Defined Daily Dose (DDD) for oral administration is 400 mg but the prescribed doses range from 100 mg/day in patients without previous opioid treatments up to a maximum of 600 mg/ day. However, the DDD is a unit of measurement that does not have to reflect the prescribed daily dose (PDD) because therapeutic doses usually differ from DDDs by taking into account individual patient considerations and pharmacokinetic conditions. This retrospective observational study in a community pharmacy on the island of Tenerife (Canary Islands, Spain) is based on the 471 dispensations of opioids for the year 2020, of which 213 correspond to tapentadol (45.2%). In 2020, among the 62 patients using opioids, 58% (36) were treated with tapentadol. For both genders, the predominant age range among tapentadol users is over 61 years, accounting for 70% of the sample (50% women and 20% men). Regarding the origin of the prescription of tapentadol, 68% of the prescriptions were originated in Primary Care services and only 14% were prescribed at a Hospital. Recorded tapentadol PDDs range from 25 mg/day to 500 mg/day but the most prescribed PDD in both women (22%) and men (11%) was 100 mg/day. When studying the polymedication of tapentadol users we observed that 36% of them are also treated with benzodiazepines (34% women and 2% men), 34% also use SSRI antidepressants (32% women and 2% men), 15 % take antiepileptic drugs (13% women and 2% men) and 8% receive TCA antidepressants. The tapentadol dispensing was also recorded in synergy with other major opioids. Thus, 3.2% of patients (women over 61 years of age) receive a combination of oral tapentadol (150 mg and 200 mg) and oral sublingual fentanyl (0.13 mg - 0.4 mg/day). Therefore, the authors believe that in any pharmaceutical care intervention on opioids treatment users, especially dispensing and follow up, is an ideal time to promote a safer user of Tapentadol and to detect and to avoid potential drug related problems (DRP) and negative medicine outcomes (NMO).

Implications of a defined daily dose fixed database for drug utilization research studies: The case of statins in Portugal.

Given the discrepancies between PDDs (prescribed daily doses) and DDDs (defined daily doses), we aimed to assess the extent of error in the results of an 18-year population-level study on statin utilization in Portugal. The Portuguese regulatory agency provided data for the period 2000-2018 on statin dispensing (C10AA). The DDDs were gathered from the ATC/DDD database. DDDs were calculated by the DDD year-by-year approach (DDDYEAR ) and by the DDD last-year approach (DDDLAST ). PDDs were calculated according to the year-by-year approach (PDDYEAR ). Statin annual utilization rates per 1000 inhabitants per day were also calculated. Percent errors were calculated for PDDYEAR and DDDYEAR units. The DDDYEAR approach revealed decreases in the consumption of atorvastatin, fluvastatin, lovastatin, pravastatin and simvastatin in 2009, when their DDD was modified. Conversely, the results from both DDDLAST and PDDYEAR approaches indicated gradual changes in the actual consumption of all statins in Portugal. Before 2009, atorvastatin, pravastatin and simvastatin utilization was greatly overestimated by DDDYEAR /1000 inhabitants/day. The average dose of lovastatin prescribed in the past 18years (20mg) was below the assigned DDDs during the study period, varying from 30mg to 45mg. Conversely, the PDD for fluvastatin was above the DDD values (ranging from 40mg in 2000 to 70mg in 2016). For atorvastatin, pravastatin and simvastatin, national PDDs were above the assigned DDD until the DDD modification in 2009. A more dynamic system, based on national and annually updated DDDs, should be able to reduce discrepancies between DDDs and PDDs and the bias in utilization studies.

Adherence and persistence analysis in patients treated with double antiplatelet therapy (DAPT) at two years in real life

IntroductionDouble antiplatelet therapy (DAPT) is indicated for the treatment of coronary artery diseases (CAD). The optimal duration of therapy with DAPT continues to be a subject of debate in the scientific community. To improve adherence to DAPT, the FDC (fixed dose combination) of Acetylsalicylic acid (ASA) and clopidogrel was developed into a single pill instead of two separate pills thus facilitating the dosage and administration of the therapy and increasing compliance. The aim of this study was to assess adherence and persistence over a period of two years in patients treated with DAPT composed of: ASA/clopidogrel, ASA/prasugrel, ASA/ticagrelor and FDC with ASA and clopidogrel in real life and to assess whether the use of ASA and clopidogrel FDC is associated with improved adherence. Materials and MethodsIn the following retrospective pharmacological-observational non-interventional study, all patients treated with DAPT in the Hospital of Pescara from January 2010 to October 2019 were considered. Persistence to treatment is defined as the duration of time from initiation to discontinuation of treatment. Adherence was calculated as the ratio between Received Daily Dose (RDD) and Prescribed Daily Dose (PDD). Results277 patients treated with ASA/clopidogrel, 77 patients treated with ASA/prasugrel, 57 patients treated with ASA/ticagrelor and 108 patients treated with FDC of ASA/clopidogrel were analysed. Persistence curves at two years showed a statistically significant difference (p < 0.001). Adherence to therapy was optimal with an absolute value at two years of 0.96. Adherence was better in patients treated with ASA/prasugrel with a value of 0.98 and with 97 % of patients with an adherence value greater than or equal to 0.8, while, it was worse in patients treated with FDC ASA/clopidogrel with an absolute value of 0.94 and with 88 % of patients with an optimal adherence value. No statistically significant difference was found between the ASA/clopidogrel FDC in comparison to each component taken as a separate pill (p = 0.0752). ConclusionDAPT along with ASA/clopidogrel showed a statistically significant better persistence than ASA/ticagrelor and ASA/prasugrel. Whereas, to our knowledge and as per the current literature no statistically significant differences were found, in terms of adherence in real life, between the use of ASA/Clopidogrel FDC and the use of two different pills.

Evaluation of anti-microbial usage using world health organization-anatomical therapeutic chemical methodology in tertiary care teaching hospital of Central India: A cross-sectional study

Antimicrobial agents are the most common group of drugs prescribed, especially in inpatients, as well as contribute highest in the drug-related expenses. To gather an overview regarding the utilization pattern of antimicrobials among hospitalized patients, this retrospective study was conducted for the patients admitted in 2019. The present study was conducted at All India Institute of Medical Sciences Raipur, wherein the 600 medical records (50*12) of different departments for the year 2019 were chosen randomly for evaluation. Information regarding the number of beds, occupancy, demography, strength, route, and amount of drug that prescribed was noted for each month. Antimicrobial utilization was performed using the World Health Organization Anatomical Therapeutic Chemical/Defined Daily Dose (DDD) methodology. Antimicrobial drugs which were prescribed at least 5% of patients were evaluated in detail, and their prescribed daily dose (PDD) and anti-microbial consumption index was calculated and compared with their defined-daily dose. Monthly consumption of antimicrobials was noted and summed to get consumption for the whole year. Most of the records encountered while collecting data were of female patients, with an overall mean age of 42.4 years. Moreover, the records were largely from the patients who were admitted in either of the surgical departments. For the in-patients with an average duration of hospitalization of 6.56 days, the mean number of antimicrobials prescribed per prescription was observed to be 1.41. Highest consumption units were of ceftriaxone in 2019. The PDD of azithromycin and piperacillin + tazobactam was different from their DDD. For majority of antimicrobials, the calculated PDD was close to their DDD. The consumption was noted to be disproportionately higher in the 4 months of 2019 (September–December). Moreover, ceftriaxone was found to be prescribed routinely in the clinical practice.

Assessment of drug utilization pattern and adverse drug monitoring among patients on antipsychotic drugs in a tertiary care hospital of Bihar: An observational and prospective study

Objective: There is increasing trend among psychiatrists to use newer psychotropic medications in their practice. Assessing the pattern of prescription and setting standards according to it should become part of clinical practice. Keeping this in mind, present study was planned to highlight the utilization pattern, comparing it with other studies and assess safety outcomes. Materials and Methods: This was an observational and prospective study. One hundred forty-three (n=143) prescriptions were analysed and were followed up for 12 months. Patient on psychotropic drugs were screened for suspected Adverse Drug Reactions (ADRs) and were reported to AMC (Adverse Drug Reaction Monitoring Centre), Department of Pharmacology. Result: Total 514 drugs were prescribed in 143 prescriptions. Total number of antipsychotic drugs prescribed was 375. The average number of antipsychotic drugs per prescription was 2.62. Among Antipsychotics atypical antipsychotics (64.52%) were prescribed more than typical antipsychotics (39.02%). Most commonly reported ADR was weight gain (28.38%) followed by sedation (14.19%), tremor (12.16%) and akathisia (10.81%). 6.08% of ADRs were Gastrointestinal side effects. Weight gain was found exclusively in atypical antipsychotics while tremor and akathisia were found mostly in typical ones. Conclusion: Polypharmacy was avoided in prescriptions. Atypical antipsychotics were prescribed more than typical ones with olanzapine having highest percent drug utilisation. But this trend is increasing burden of obesity and metabolic syndrome in old age populations. The study results strongly suggest the need for healthcare team to focus on assessing and reporting suspected ADRs for enhancing the quality of monitoring and managing ADRs. Keywords: Antipsychotic drugs, Adverse drug reactions (ADRs), Prescribed daily dose (PDD), Defined daily dose (DDD), Prescription.

Prevalence of Antibiotics Prescription and Assessment of Prescribed Daily Dose in Outpatients from Mexico City.

Pharmacoepidemiological research about antibiotics is supported by the World Health Organization (WHO), but data regarding antibiotic prevalence based on actual prescriptions and dosing patterns are insufficient. The aims were: (i) To estimate the prevalence and prescribed daily dose (PDD) of antibiotics in outpatients from Mexico City and (ii) to compare the PDD against the defined daily dose (DDD), as established by the WHO. The study included 685 prescriptions of antibiotics selected randomly from five geographical zones of Mexico City. Drug, dose, frequency, and duration of treatment were obtained from each prescription. PDD values of each antibiotic drug were calculated as the average of the daily doses. Sub-use and overuse were determined by the ratio PDD/DDD for each prescription. The most prescribed antibiotics to outpatients from Mexico City included six pharmacological groups: quinolones (28%), penicillins (23%), cephalosporins (17%), macrolides (10%), lincosamides (9%), and sulfonamides (4%). Both overuse and sub-use were high (55% and 63%, respectively). In conclusion, most of the antibiotics with a high prevalence of prescription also had a high rate of either sub-use or overuse, with prescribed doses that significantly differ with their corresponding DDD. The dosing variation has important clinical implications since it denotes low prescription control.

PND125 PREGABALIN PRESCRIBING IN PRIVATE HEALTHCARE SETTINGS IN SOUTH AFRICA WITH SPECIFIC FOCUS ON DOSAGES

Pregabalin is registered in South Africa for post-herpetic neuralgia and painful diabetic polyneuropathy in adults. The primary aim of the study was to analyse the prescribing patterns and cost of pregabalin with the focus on dosages. A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2018. All products in ATC group N03AX16 were analysed. A total of 726 patients (54.41% males) were prescribed 1888 pregabalin products. The average age of patients was 50.38 (SD=13.59) years. Two trade name products were prescribed (the originator and one generic), and both were available in capsules in strengths of 25 mg, 75 mg and 150 mg. The originator accounted for 72.83% of prescription volume. The 75 mg capsules of the originator product was prescribed the most (44.92% of prescriptions), followed by the 25 mg capsule of the originator. The average Prescribed Daily Dose (PDD) was 73.44 mg. Most prescriptions were dispensed by pharmacies (57.10%), followed by hospitals (32.10%). Smaller quantities were prescribed in hospitals. If only pharmacy prescriptions were considered, the average PDD of pregabalin in the 464 patients was 89.36 (SD= 67.38) mg. The most popular specific PDD was 75 mg, followed by 150 mg. Pregabalin is used for different indications, also often off-label. Similarly, a wide variation of dosages were prescribed. In pharmacies, a PDD of 75 mg was the most popular dose. The importance of accurate diagnosis codes in electronic databases to enable dosage linking cannot be overemphasised.

Adalimumab and etanercept adherence, persistence and switch in the treatment of psoriatic arthritis: 10-year real-life analysis

ABSTRACT Objectives: The objective of this study was to calculate adherence, persistence and 10-year switches in patients with PsA, by comparing adalimumab and etanercept in real life. Methods: The authors conducted a retrospective, observational, pharmacological and non-interventional study taking into consideration the dispensations of the study drugs at the Hospital Pharmacy, from 1 January 2007 to 31 December 2018. In the study, the authors considered adalimumab and etanercept. The authors calculated adherence to treatment through the relationship between received daily dose (RDD) and prescribed daily dose (PDD), and calculated persistence to treatment as the difference in days between the first and last dispensation. Results: The authors enrolled 113 patients, 60 treated with adalimumab and 53 with etanercept. Adherence levels were 0.83 for adalimumab and 0.84 for etanercept. Switches occurred in 42% of adalimumab and in 47% of etanercept prescriptions. Conclusion: In the treatment of PsA, persistence and switches are a problem for patients who cannot follow a consistent therapy over time, for clinicians who have to manage therapy suspension and changes, and for the National Health System that must procure and pay for a high number of drugs without information on their real value in terms of efficacy and safety of use.

A Prospective Study on Usage Pattern of Corticosteroids in a Tertiary Care Hospital

Rational use of corticosteroids is very essential for improving patient safety on long term use. The present study aimed to study the prescribing usage pattern of corticosteroids in a tertiary care hospital. A prospective observational study was conducted in the department of dermatology, gynecology and general medicine in a tertiary care teaching hospital for the period of 6 months (August-February). All patients receiving any category of Steroid therapy were included and the prescribing and tapering pattern of steroids were reviewed. Prescribing pattern was observed and analysed in 132 participants during the study period. Cases were collected from the departments of Dermatology, General Medicine, Pediatrics and Gynecology in Gandhi Hospital, Secunderabad. All the prescriptions containing steroids were included in this study and the parameters evaluated were gender distribution, age of the patients, types of steroids according to the route of administration, number of prescribed daily dose (PDD) where compared with defined daily dose (DDD). In the collected 132 cases, 162 times corticosteroids were prescribed. The steroid utilization was found to be more in female patients, the maximum number of cases with corticosteroids was found in Dermatology department (39.4%). Particularly Injection Dexamethasone (24.7%) and Tablet Prednisolone (24.7%) are mostly prescribed. Most drugs were prescribed rationally although some factors like improper history,drug administration time and tapering were deviating away from rationality. Although most of the drugs were prescribed rationally, involvement of a Clinical pharmacist in patient care can help in more rational prescribing along with prevention and early detection of ADRs which can directly promote drug safety and better patient outcomes.