Indications For Prescription Research Articles

Quality indicators for appropriate antibiotic prescribing in urinary tract infections in children

BackgroundThe aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece.MethodsThe UTIs-specific quality indicators were informed by a review of the existing literature. Quality indicators were selected to describe the overall antibiotics use, prescribing patterns and UTIs clinical management regarding treatment and prophylaxis in a cohort of children admitted with a UTI. Microbiological, clinical and prescribing data about dosing, duration and route of administration were collected from the patients’ electronic health records.ResultsTwelve quality indicators were adapted or developed for prescribing in childhood UTIs. A broad variety of antibiotics were prescribed for UTIs, with a drug utilization (DU) 90% rate of 6 and 9 different antibiotics for febrile and afebrile UTIs, respectively. Despite the low incidence of multi-drug resistant UTIs in the study period (9/261, 3.4%), broad-spectrum antibiotics were prescribed in 33.5% (164/490) of prescriptions. A total of 62.8% (164/261) of patients were started on empiric combined therapies, while opportunities to de-escalate were missed in 37.8% (62/164) of them. One quarter (67/261, 25.7%) of patients did not fulfil the criteria for receiving treatment, while nearly half of those prescribed prophylaxis (82/175, 46.9%) could have avoided having a prophylaxis prescription.ConclusionsOur study identified substantial gaps for improvement in antimicrobial prescribing for UTIs in children. The application of the proposed quality indicators could help to limit unnecessary antibiotics use in children with UTI.

Prescription Audit for WHO Prescribing Indicators and Prescription Errors in a Tertiary Care Teaching Hospital

ABSTRACT Aim: Our study aimed to audit prescriptions for the prescription indicators given by WHO and to analyze prescription errors, evaluating the frequency and types of prescription errors. Methodology: Prospective study was done in Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, under Pharmacology Department in October 2020. The prescriptions from all the OPD (outpatient departments) were collected from the pharmacy store. Prescriptions for the follow-up medication and devoid of medicine were excluded from the study. Results: Total of 1451 errors were found from 400 collected prescriptions, out of which 324 (22.3%) were errors of omission and 145 (10.0%) were errors of commission related to drugs whereas 982 (67.7%) were the error of omission other than drug details. A total of 1257 drugs were prescribed making an average of 3.14 drugs per prescription, out of which 28.72% drugs were prescribed by generic name. About 34.0% of patients were prescribed antibiotics and 2.25% of patients were prescribed injectable drugs. All the drugs were prescribed from the National Essential Drug List (NEDL). Conclusion: The prescription audit showed that there is a need to train prescribing doctors as per the standard MMC and NMC guidelines for rational prescription writing to minimize the chance of major errors like not writing the dose of the drug, not writing it in capital letters, drug-related instructions, diagnosis and so on. The prescription audit should be carried out at regular intervals to improve prescription writing skills to establish a better healthcare system.

Empiric antibiotic selection for community-acquired pneumonia in US hospitals, 2013–2020

Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic prescribing in hospitalized patients. Professional societies’ clinical guidelines recommend specific antibiotics for empiric treatment of CAP based on clinical factors. Manual assessments of appropriateness are time-consuming and are often conducted on a smaller scale. We evaluated empiric antibiotic selection among a large cohort of adults hospitalized with CAP using electronic health records. Methods: In this study, we used the PINC-AI healthcare database to define a cohort of adults hospitalized with CAP from 2013 to 2020. CAP was identified by International Classification of Diseases (ICD) diagnosis codes. Exclusions were applied to identify uncomplicated CAP (Fig. 1). Treatment was only evaluated if a chest radiograph or computerized tomography (CT) scan was charged during the first 2 days of hospitalization, otherwise it was considered an inadequate CAP evaluation. Administrative billing data were used to identify antibiotics charged within the first 2 days of hospitalization. Empiric guideline-recommended treatment was determined based on 2019 CAP guidelines and more recent studies. Patients who received nonrecommended treatment were evaluated for antibiotic allergies in the current hospitalization or methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in the year prior or on admission using International Classification of Disease, Tenth Revision (ICD-10) diagnosis codes. Results: We identified 4.47 million adult hospitalizations with CAP from 2013 to 2020; 32% (1.43 million) were included in this analysis (Fig. 1). Among discharges with adequate CAP evaluation (1.37 million), 59.7% received recommended antibiotics in the first 2 days of hospitalization, ranging from 62.6% in 2013 to 57.5% in 2019. Overall, 34.8% of our study population received a nonrecommended antibiotic without documentation of an antibiotic allergy or MRSA colonization (2013: 32.5%; 2018: 36.7%) (Fig. 2). Most patients in our study population received >1 antibiotic (92.3%) in the first 2 days of hospitalization. The most common antibiotics among patients receiving recommended treatment were ceftriaxone (74.2% of patients receiving recommended treatment), azithromycin (67.2%), and levofloxacin (31.8%) (Fig. 3a). The most common nonrecommended antibiotics were vancomycin (57.2% of patients receiving nonrecommended treatment), piperacillin-tazobactam (48.1%), and cefepime (25.7%) (Fig. 3b). From 2013 to 2020, cefepime charges consistently increased among CAP patients treated with nonrecommended antibiotics, whereas levofloxacin charges consistently decreased among CAP patients treated with only recommended antibiotics. Conclusions: Approximately one-third of patients with uncomplicated CAP received nonrecommended empiric antibiotics, and from 2013 to 2020 that proportion increased by 9%. Additional strategies are needed to help identify opportunities to optimize antibiotic selection among patients with CAP.Disclosures: None

High prevalence of antibiotic use in a tertiary-care hospital in Sierra Leone: We need to handle antibiotics with care

Background: Antimicrobial resistance (AMR) is a global public health concern that has the potential to reverse decades of progress aimed at decreasing morbidity and mortality attributed to infectious diseases. In 2019, ~5 million deaths were associated with AMR, of which 1.2 million were attributed to antibacterial-resistant infections. Healthcare facilities where antimicrobials are frequently used are high-risk settings for the selection and spread of resistant bacteria, and they further contribute to the increase in the burden of AMR. We have documented the prevalence and indication of antibiotic use in a tertiary-care referral hospital in Freetown, Sierra Leone. Methods: This point-prevalence survey was conducted at Connaught hospital, a tertiary-care hospital in Sierra Leone, in November 2021. The hospital offers a range of medical and surgical services through 25 units and has 16 wards with >300 beds. Data on patient-level antibiotic use, including indications for use, were extracted from medical records using WHO point-prevalence survey (PPS) forms that had been pretested and validated. Data collection was conducted in all the wards over a 10-day period by trained healthcare personnel. On the day of the survey, only the medical records of patients on admission before 8:00 a.m. on that day were included in the study. Data entry, cleaning, and analysis were conducted using the WHO PPS platform. Ethical approval was obtained. Results: In total, 87 patient records were included in the survey. Most (71%) were women, and the average age was 30.6 years. The prevalence of antibiotic use was 66%, and the average number of antibiotics prescribed to patients since admission was 2. The 5 most prescribed antibiotics were metronidazole, ceftriaxone, amoxicillin and clavulanic acid, ampicillin and cloxacillin, and azithromycin. The parenteral route of drug administration was the mainstay. The most frequent indications for antibiotic prescription were community-acquired infection and surgical prophylaxis. Blood-culture requests were not ordered before the initiation of antibiotic treatment. Conclusions: This study was the first study to be conducted in Connaught hospital using the WHO PPS methodology. The survey reports a high prevalence (60%) of antibiotic use, and most treatment was done empirically. This finding is contrary to the WHO recommendation of <30% antibiotic use. This high prevalence of antibiotic use has the potential to increase the burden of AMR in the country. Therefore, there is an urgent need to strengthen Connaught hospital’s antibiotic stewardship program.Disclosures: None

PRESCRIPTION PATTERN OF ANTIEPILEPTIC DRUGS IN CHILDREN WITH EPILEPSY: A CROSS-SECTIONAL STUDY

Objective: To evaluate the pattern of prescription of antiepileptic drugs (AED) in children with epilepsy attending a tertiary care hospital in North India. Methods: An observational cross-sectional study was conducted for a duration of 1 year. Data on demographic variables including age, gender, type of epilepsy, and prescription of all AEDs and their different combinations were collected from the patients of epilepsy coming to the Department of Pediatrics, Rajindra Hospital attached to Government Medical College, Patiala, Punjab, India and analyzed using WHO core prescription indicators. Results: Out of 100 prescriptions analyzed, 55% of patients were males and 45% were females. The mean age of patients was 8.65 years (±3.80). Generalized epilepsy (78%) was the most commonly diagnosed epilepsy. 92% of patients were prescribed monotherapy, while polytherapy was used in 8% of patients. Valproate was the most common drug used in monotherapy (44.56%), followed by phenytoin (21.74%) and phenobarbitone (15.22%). In polytherapy, the most common combination used was valproate with clobazam (62.5%). 96.6% of prescriptions were based on the National List of Essential Medicines (NLEM), 2022. Conclusion: Monotherapy was the preferred modality of treatment in our hospital. Conventional drugs were favored in monotherapy, while benzodiazepines and newer drugs were more commonly used as an add-on drugs in polytherapy. Valproate was the most commonly used AED in monotherapy as well as polytherapy.

Hospital admission after primary care consultation for community-onset lower urinary tract infection: a cohort study of risks and predictors using linked data.

Urinary tract infections (UTIs) are a common indication for antibiotic prescriptions, reductions in which would reduce antimicrobial resistance (AMR). Risk stratification of patients allows reductions to be made safely. To identify risk factors for hospital admission following UTI, to inform targeted antibiotic stewardship. Retrospective cohort study of East London primary care patients. Hospital admission outcomes following primary care consultation for UTI were analysed using linked data from primary care, secondary care, and microbiology, from 1 April 2012 to 31 March 2017. The outcomes analysed were urinary infection-related hospital admission (UHA) and all-cause hospital admission (AHA) within 30 days of UTI in primary care. Odds ratios between specific variables (demographic characteristics, prior antibiotic exposure, and comorbidities) and the outcomes were predicted using generalised estimating equations, and fitted to a final multivariable model including all variables with a P-value <0.1 on univariable analysis. Of the 169 524 episodes of UTI, UHA occurred in 1336 cases (0.8%, 95% confidence interval [CI] = 0.7 to 0.8) and AHA in 6516 cases (3.8%, 95% CI = 3.8 to 3.9). On multivariable analysis, increased odds of UHA were seen in patients aged 55-74 years (adjusted odds ratio [AOR] 1.49) and ≥75 years (AOR 3.24), relative to adults aged 16-34 years. Increased odds of UHA were also associated with chronic kidney disease (CKD; AOR 1.55), urinary catheters (AOR 2.01), prior antibiotics (AOR 1.38 for ≥3 courses), recurrent UTI (AOR 1.33), faecal incontinence (FI; AOR 1.47), and diabetes mellitus (DM; AOR 1.37). Urinary infection-related hospital admission after primary care consultation for community-onset lower UTI was rare; however, increased odds for UHA were observed for some patient groups. Efforts to reduce antibiotic prescribing for suspected UTI should focus on patients aged <55 years without risk factors for complicated UTI, recurrent UTI, DM, or FI.

Assessment of Prescribing Practices and Factors Related to Antibiotic Prescribing in Community Pharmacies.

Background and Objectives: Overprescribing of antibiotics is one of the important contributors of antimicrobial resistance globally. A high proportion of antibiotics prescribed in community settings are unnecessary or inappropriate. This study assesses the prescribing practices and factors related to antibiotic prescribing in community pharmacies in United Arab Emirates (UAE). Materials and Methods: A cross-sectional study utilizing a quantitative approach was carried out in the community pharmacies of Ras Al Khaimah (RAK), UAE. Six hundred and thirty prescription encounters from 21 randomly selected community pharmacies were investigated using World Health Organization (WHO) core prescribing indicators. Factors related to antibiotic prescribing were identified using logistic regression analyses. Results: In 630 prescription encounters, a total of 1814 drugs were prescribed. Out of these, the most commonly prescribed drug class was antibiotics (43.8% prescriptions) and the antibiotic was amoxicillin/clavulanic-acid (22.4%). The average number of drugs per prescription was 2.88, which was higher than the WHO recommended value of 1.6-1.8. In addition, more than half of the prescriptions (58.6%) had drugs by generic names and the majority of the drugs prescribed (83.8%) were from the essential drug list, which were lower than the optimal values of 100%. The majority of the antibiotics prescribed in the study were from the WHO's Access group antibiotics. Multivariable logistic regression analysis identified patient age (children-OR: 7.40, 95% CI: 2.32-23.62, p = 0.001 and adolescent-OR: 5.86, 95% CI: 1.57-21.86, p = 0.008), prescriber qualification as general practitioner (OR: 1.84, 95% CI:1.30-2.60, p = 0.001), and number of drugs per prescription (OR: 3.51, 95% CI: 1.98-6.21, p < 0.001) as independent factors associated with antibiotic prescribing. Conclusions: This study reveals considerable variations from the WHO recommendations for the different prescribing indicators in the community pharmacies of RAK, UAE. In addition, the study reports overprescribing of antibiotics in the community setting, indicating the need for interventions to promote rational use of antibiotics in a community setting.

Evaluation of prescription pattern of antifungal drugs in the dermatology department of a tertiary care teaching hospital

Background: In general, fungal infections are one of the contributors of disease burden in the community, but irrational use of antifungal drugs can result in unwanted adverse events or antifungal drugs resistance. The present study was designed to analyze the prescription pattern of antifungal drugs prescribed in the dermatology department of a tertiary care teaching hospital. Methods: After getting permission from the ethics committee, this prospective observational cross-sectional study was conducted by analysis of prescriptions of 900 voluntary participant patients over a period of seven months in the dermatology outpatient department of a tertiary care teaching hospital in western India. Prescribed medicines’ parameters were analyzed as per WHO/INRUD prescription indicators. Results: Overall 900 prescriptions were analyzed, and among them around 50% patients were having tinea corporis and tinea cruris, making it the most common fungal infection. The most commonly prescribed antifungals were Clotrimazole (34.59%), followed by Fluconazole (31.61%) and Luliconazole (23.52%). Percentage of drugs prescribed from the WHO model list of essential medicines was 71.22%. Average number of antifungal drugs per prescription was 2.83 ± 0.57%. Conclusions: This study indicates prescribing practices of anti-fungal drugs and supportive medicines at tertiary care hospital that can be further improved by promoting prescribing by generic names. Overall final list of essential medicines at district level, state level and national level may vary as compared to the WHO list for anti-fungal drugs and doctors can consider alternative drugs as per domestic resistant pattern.

The Pattern in the Utilization of the First-Choice Antibiotic among Dentists in the Republic of Kosovo: A Prospective Study

Abstract Objective Antibiotics are prescribed by dentists during dental treatments, depending on the diagnosis and severity of the disease. Appropriate indicators of the benefit of systematic and regular use of antibiotics in dentistry are limited, because a large number of dental and periodontal problems can be treated either by surgical intervention or by maintaining good oral hygiene. Improper use of antibiotics leads to antimicrobial resistance. In Kosovo, this problem is very evident and more studies are required to identify antibiotic prescribing patterns by health care workers. In this context, this study aims to investigate the issue of antibiotic use in dentistry. Materials and Methods This prospective study was conducted for 6 months and followed the dental practice of 80 dentists. Data were collected from 795 patient forms. Results After analysis, results showed that amoxicillin with clavulanic acid and amoxicillin alone were the most commonly prescribed antibiotics, each accounting for 35%. The most common indications for antibiotic prescription were dental and periodontal abscesses (24.9%), while 20.7% of antibiotics were prescribed for postextraction healing, pericoronitis (15%), chronic periodontitis (12.8%), and dry socket (11.5%). Conclusion These results suggest that the problem of inappropriate antibiotic prescribing is not only overprescribing but also the selection of inappropriate agents, especially amoxicillin with clavulanic acid, instead of amoxicillin alone.

Pharmacoepidemiological study of self-medication in adultsattending pharmacies in Tikrit city, Iraq

A cross-sectional study was conducted to determine the extent and pattern of self medication among adults, to identify their knowledge and practice concerning the purchased drug sand lo calculate prescribing and purchaser care indicators, Following. WHO methods, 30 pharmacies were randomly selected from Tikrit city, Iraq. Of 1000 clients interviewed al these pharmacies, 811 (81.1%) purchased self-medication; the commonest reason given was a belief thal the condition was minor. The most frequently dispensed drugs were those for the respiratory system, The mean number of drugs per encounter was 1.10, mean cost 1500 ID, and mean dispensing time 2.53 minutes. Purchasers’ knowledge and practice regarding the purchased drugs were poor.

A closed-loop audit of the prescription practice of topical antibiotics for acute infective conjunctivitis.

Objective: The implementation of guideline recommendations for antibiotics prescription for the management of patients with acute infective conjunctivitis (AIC) in primary care departments remains below par. Our objective was to assess the impact of clinical audit on adherence to evidence-based indications for prescription of antibiotic eye drops in patients diagnosed with AIC, in the setting of a primary care practice in western Greece. Methods: We conducted a retrospective audit to evaluate the current prescription practice of antibiotics for the management of AIC. Following evidence-based indications for the prescription of antibiotics in AIC through literature search, and in combination with discussion and collaboration with the primary care doctors of our department, we formulated and implemented guidelines for the management of AIC. We then performed a prospective re-audit to assess the management of patients with AIC after local implementation of the guidelines. Results: A total of 158 cases were audited in the first cycle before the introduction of the guidelines, from 15th June 2019 to 7th March 2020, and 26 cases after, from 10th March 2020 to 20th November 2020. The compliance with the guidelines regarding antibiotics prescription was significantly improved from 12.0% to 84.6% between the first and the second cycles of audit. Conclusions: In this study, with the local introduction of guidelines, clinical audit significantly improved the prescription practice of topical antibiotics in patients with AIC in a primary care department. Abbreviations: AIC = acute infective conjunctivitis.

New prolonged opioid consumption after major surgery in Sweden: a population-based retrospective cohort study

ObjectiveGiven that long-term opioid usage is an important problem worldwide and postsurgical pain is a common indication for opioid prescription, our primary objective was to describe the frequency of new...

Current Antibiotic Use Among Hospitals in the sub-Saharan Africa Region; Findings and Implications.

The rapid rise in antimicrobial resistance (AMR) globally, impacting on morbidity, mortality and costs with sub-Saharan African countries reporting the greatest burden is a concern. Instigation of antimicrobial stewardship programs (ASPs) can improve antibiotic use in hospitals and reduce AMR. Implementing ASPs requires knowledge of antibiotic utilization against agreed quality indicators with the data obtained from point prevalence surveys (PPS), hence the need to document antibiotic utilization patterns in sub-Saharan Africa. A narrative review to document current utilization patterns, challenges, indicators and ASPs across sub-Saharan Africa based on previous reviews by the authors, supplemented by the considerable knowledge and experience of the co-authors. Results from multiple PPS studies showed a high prevalence of antibiotic use among hospitals, mostly over 50%. Prevalence rates ranged from as low as 37.7% in South Africa to as high as 80.1% in Nigeria. There was also considerable prescribing of broad-spectrum antibiotics which could be due to lack of facilities within hospitals, alongside concerns with co-payments to perform microbiological tests, resulting in empiric prescribing. This is a concern alongside lack of guidelines or adherence to guidelines, which was as low as 4% in one study. Another concern was the high rates of extended prophylaxis to prevent surgical site infections (SSIs), with antibiotics often prescribed for longer than 24 hours, usually multiple doses. Several quality indicators have been used to evaluate antibiotic utilization providing exemplars for the future. Among the initiatives being instigated to improve antibiotic use, ASPs have proved effective. For ASPs to be successful objectives and indicators must be agreed, and regular audits undertaken. Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR.

Disease-Specific Quality Indicators for Outpatient Antibiotic Prescribing for Respiratory Infections (ESAC Quality Indicators) Applied to Point Prevalence Audit Surveys in General Practices in 13 European Countries.

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January-February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0-20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90-100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0-20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

Rational choice of antibiotic therapy in children with acute respiratory infections of the upper respiratory tract

Acute respiratory infections are leading in the structure of infectious pathology in children. Despite the high importance of viruses in the etiology of acute respiratory infections, the role of bacterial pathogens remains important. Features of the current course, high frequency of complications, unreasonable prescription of antibacterial drugs and the risk of developing drug-resistant forms of microorganisms require adherence to algorithms for the timely diagnosis of bacterial infections and the rational use of antibacterial drugs. In the article, on the example of the analysis of clinical cases, the main stages of diagnosis and algorithms for choosing the initial antibiotic therapy for acute respiratory infections of the upper respiratory tract in children in an outpatient setting are considered. In the first clinical case, the principles of differential diagnosis of viral and bacterial acute otitis media, the risks of adverse outcome are considered, the main indications for prescribing systemic antibiotic therapy in preschoolers are identified. The second clinical case demonstrates the algorithms for diagnosing bacterial sinusitis, the possible masks of the disease, and the selection of a starting antibacterial drug. The example of the third clinical case shows the etiological diversity of acute tonsillopharyngitis in children, defined indications for systemic antibacterial therapy. It has been noted that only streptococcal tonsillopharyngitis is the primary indication of antibacterial prescription. The features of initial therapy and the duration of the course of antibacterial drugs in children were determined.

Drugs Prescribing Trends in Three Polyclinics in Benghazi-Libya 2020

Background: There is an efforts made to improve drug prescribing practices in developing countries. The aim of present work was to comparing prescribing indicators, patient care, and missing information on prescriptions and identifying and assessing drug use patterns in three polyclinics in Benghazi city, Libya. Methods: In this descriptive cross section study a random sample of 1522 prescriptions were selected from three polyclinics include Ras-Ebida, Khalid Ibn-Elwalid and Al-Kish, over 4 months (July-October 2020). The data was collected through predesigned questionnaire. The prescriptions were analyzed for the following indicators: prescribing indicators, patient-care indicators and drug-use indicators. Results: A total of 1522 prescriptions (average = 507.3/clinic) were collected from the three polyclinics including 2329 prescribed (average = 1.4/prescription) items. Percentage of drugs prescribed with generic name was 0.0%, the percentage of prescriptions with antibiotics was 46.3%. The average of prescriptions of injections was 0.84. The average consultation time is 3.4 min and the average dispensing time was found to be 24 seconds. Major classes of drugs prescribed included analgesics, antibiotics, drugs used in medicine &amp; derma clinics, ophthalmic drugs, minerals &amp; vitamins, anti-inflammatory drugs, antihistaminic and antifungal drugs. The most prescribed analgesic was paracetamol (94.4%) and antibiotic was Augmentin (50.3%). In regarding prescribed drug in medicine clinics was found lisinopril (32.0%) and ophthalmic drug was cusicrom (36.8%). In addition, the majorities of prescribed vitamin were vitamin C (81.0%), for GIT drug was omeprazole (59.3%), and for dermatology was Fucidin (56.3%). While most prescribed anti-inflammatory was aspirin (52.4%), antihistaminic was loratidine (97.0%), for antifungal drug was flagyl (58.0%). Conclusion: Despite the efforts being made to improve prescribing habits and to rationalize the use of drugs, the obtained results confirm the deficiencies as reported earlier and suggest that methods of intervention should be initiated to improve prescribing trends in these polyclinics.

Prescription of cannabinoids in psychiatry: (how) do we cross that door?

AbstractCannabis policy liberalization has increased the availability of cannabis products for medical and recreational purposes, following a growing public demand. The large number of cannabinoid users reporting self-medication for several mental health-related problems and the limited medical indications for cannabis prescription have led to prescription dilemmas and confronted views between patients and clinicians. This discrepancy in perspectives grows together with a huge terminological confusion regarding medical cannabis, as some subjects use recreational products for medical purposes. In this session we will outline the current controversies of cannabis prescription in psychiatry and discuss how to deal with (il)legitimate patient needs and prescription barriers. Finally, we will discuss research approaches that could shed light on this controversial topic.Disclosure of InterestNone Declared

Prednisolone prescribing practices for dogs in Australia.

Although prednisolone is a routinely prescribed medication in dogs, there is a lack of information regarding prednisolone prescribing practices by veterinarians. This study aims to describe characteristics of dogs receiving prednisolone, disease processes treated, doses prescribed as well as to identify factors influencing the dose rate in Australia. The VetCompass Australia database was queried to identify dogs prescribed prednisolone between 1 July 2016 to 31 July 2018 (inclusive). A random sample of 2,000 dogs from this population were selected. Dog demographic data, prednisolone dose and indication for prescription were collated. Indicated dose for the condition treated was compared to prescribed dose. Multivariable linear regression was used to identify patient-level characteristics associated with prescribed prednisolone dose. A large and small breed dog cohort, treated for the same disease process, were compared for differences in dosing. Median age of dogs was 73 (range 2 to 247) months and median body weight was 17 (range 1.56 to 90) kg. Median prescribed prednisolone dose was 0.8 mg/kg/day, with most dogs receiving an anti-inflammatory dose (0.3-1 mg/kg/day, 58%). Prednisolone prescriptions were predominantly for diseases of the integument (n = 1645, 82%) followed by unknown indication and respiratory disease. A total of 152 dogs (8%) were prescribed immunosuppressive doses of prednisolone for conditions where an anti-inflammatory dose would be recommended. Increases in bodyweight were associated with lower doses on mg/kg scale but higher doses on a mg/m2 scale (p < 0.001). Overall, prednisolone was primarily used as an anti-inflammatory in this population, with some inappropriate use of immunosuppressive doses. Increasing bodyweight was associated with a small reduction in dose in mg/kg, suggesting that clinicians are adjusting prednisolone dose rates based on dog bodyweight.

Drug utilization study in the department of psychiatry

Psychiatry disorders are creating its own place in morbidity these days. Various factors like cost of drugs, local paradigms, etc, plays a critical role for selecting the appropriate therapy for a particular patient because usually they are chronic therapy. Keeping this in mind, we conducted a study to delineate the various drugs used in psychiatric disorders, to find discrepancies. Drug utilization studies are essential for correct use of drug. Our study identifies the problems that arise from drug usage in health care delivery system and highlights the current approaches to the rational use of drugs. A total of 518 patients’ data were collected during the period and analyzed for WHO recommended prescribing and complementary indicators. Study shows low incidence of poly pharmacy which is good as poly pharmacy is common in psychiatry and also use of injections was very low. Study shows that prescribing from WHO List of Essential Medicine was not as good as it accounted for only 21.3%. There is scope for improvement in case of medicines prescribed by generic name as none were prescribed by generic name. The average cost per prescription in our study was only 9.41 Indian rupees per day which is affordable by the majority of the patients.

A drug utilisation pattern in non-dialysis patients of diabetic nephropathy in a government-run tertiary care hospital in South-Asia.

The objective of the present study was to evaluate the Drug utilisation pattern in patients of diabetic nephropathy (stage 1-4) in a tertiary care hospital in South-Asia. A cross-sectional observational study was conducted in the nephrology out-patient-department of a tertiary care hospital in South-Asia. WHO core prescribing, dispensing, and patient care indicators were evaluated, and adverse drug reactions (ADRs) encountered by the patients were analysed for causality, severity, preventability, and outcome. The most commonly prescribed antidiabetics indiabetic nephropathy patients were insulin (17.42%), followed by metformin (4.66%). Current drugs of choice SGLT-2 inhibitors were prescribed in a lesser frequency than expected. Loop diuretics and calcium channel blockers (CCBs) were the preferred antihypertensives. The use of ACE inhibitors (1.26%) and ARBs (3.45%) for hypertension was restricted to Stage 1 and 2 nephropathy. The patients were on 6.47 drugs on average. 30.70% of drugs were prescribed by generic names, 59.07% of the drugs were prescribed from the national essential drugs list and34.03% of the prescribed drugs were supplied by the hospital. CTCAE grade 1 (68.60%) and grade 2 (22.09%) ADR severity was the highest. Prescribing patterns in patients of diabetic nephropathy were adapted from relevant medical evidence, affordability and availability of the drugs. Generic prescribing, availability of drugs and ADR preventability in the hospital have a broad scope for improvement.