Rational Prescribing Research Articles

Evaluating drug use patterns among paediatric outpatients in Burundi.

Rational prescribing is key to optimising therapeutic outcomes and avoiding risks associated with irrational use of medicines. Using WHO drug use indicators, this study evaluated drug use patterns among paediatric outpatient encounters at Primary Healthcare Centers (PHCs) in Bujumbura Mairie, Republic of Burundi. Descriptive cross-sectional research assessed paediatric medicine use in 20 PHCs. From 8 February to 7 April 2023, 800 randomly selected paediatric encounters' 2022-year data were retrospectively collected. Data for specific facility indicators were prospectively collected. SPSS 23 was used to analyse data. 800 outpatient child encounters were analysed, 48.4% female and 51.6% male. The mean number of medicines per encounter was 2.4(±0.99). The injection rate was 9.9%. Overall, 78.8% of generics and 85.2% of essential medicines were prescribed. Results show drug prescribing differences between private and government PHCs (p < 0.001). All PHCs studied had no standard treatment guidelines (STGs), while 50% had an essential medicine list (EML) and 85% of key medicines were available. Poor prescribing practices were found indicating the need for interventions to promote good drug use practices. A large study at a national scale is required to provide a more comprehensive understanding of the overall drug use practices.

Positive Attitude Towards Personal Drug Selection among Undergraduate Medical Students of a Medical College.

Personal drug exercise helps in the selection of drugs depending on the criteria- safety, efficacy, suitability and cost. Undergraduate medical students are the future practitioners-in-training and should focus more on rational prescribing. This study aimed to find out the prevalence of positive attitudes towards personal drug selection among undergraduate medical students of a medical college. This is a descriptive cross-sectional study conducted among second and third-year medical students after obtaining ethical approval from the Institutional Review Committee. Data was collected from 1 December 2022 to 30 May 2023. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 132 medical students, 126 (95.45%) (91.90-99.01, 95% Confidence Interval) of the students showed a positive attitude toward P-drug selection. The prevalence of positive attitudes towards P-drug selection among medical students was found to be similar to other studies done in similar settings. medical students; medicine; perception; prevalence.

Medicine formulary writing for hospitals: A systematic review on development, approval, dissemination, and review

Background: A hospital formulary is a guiding manual developed to enhance the rational prescribing of medicines based on the local prevalence of diseases and hospital settings. This systematic review aimed to identify and evaluate the existing literature on hospital formulary development and management to ensure the availability of safe, cost-effective, quality, and efficacious medicines that all practitioners must use. Methods: A qualitative evidence and experience synthesis approach was chosen to create evidence on the development and use of hospital formulary. PubMed was the database used to search for similar reviews using Boolean operators. Results: Out of 1,347 potentially relevant literature and abstracts identified and screened, 25 publications were used in developing the hospital formulary. The hospital formulary should be developed and reviewed after using the current STG/NEMLIT to use updated medicine lists and indications. Medicines selected for the model are “medicines of choice.” The development of hospital formularies should be based on a comprehensive and transparent process that involves a multidisciplinary team of experts, a clear selection criterion, a reliable and updated source of information, and a regular evaluation of the clinical and economic outcomes. Conclusion: Hospital formularies promote the rational, safe use of medicines to improve the quality and efficiency of healthcare.

Management of bipolar disorder in South Africa: National Department of Health essential medicine selection and treatment algorithms

Background. Bipolar disorder (BD) is a severe mental illness associated with multimorbidity, psychosocial disability and significant public health issues. However, guideline heterogeneity clouds therapeutic decisions, particularly in relapse prevention. Polypharmacy and poor health outcomes are common. For low- and middle-income countries, deciding which medicines to procure and how to treat BD in an integrated manner remains elusive. Although South Africa (SA) is committed to universal health coverage, the estimated treatment gap for mental disorders in the public health sector is 91%. An Essential Medicines List (EML) enables equitable access to medicines, while Standard Treatment Guidelines (STGs) facilitate rational prescribing and quality care. Objectives. To describe the medicine selection process for the treatment of BD in the SA public health sector, and the treatment algorithms developed to guide integrated care. Methods. Evidence-based medicine principles, stakeholder consultation and consensus decision-making were used. The existing (2015) BD guideline and stakeholder comments were reviewed by a ministerially appointed expert review committee, following which a research question with eligibility criteria was formed, and rapid systematic evidence synthesis conducted. PubMed and Cochrane databases were searched for systematic reviews of randomised controlled trials and observational studies of acute and maintenance treatment in BD, with an additional PubMed search for primary research. Quality of the systematic reviews was appraised using the 11-item assessment of multiple systematic reviews. After costing to ensure affordability, final recommendations were made to the National EML Committee (NEMLC) using the strength of recommendation taxonomy classification. Following approval by the NEMLC, proposed medicines were incorporated into the 2019 National Department of Health Adult Hospital STGs. As the STGs are updated every 3 years, stakeholder input was sought in 2021 and 2023, with no changes to the medicine selection. Results. Seven systematic reviews and one observational study were included in the evidence synthesis. Six medicines were selected as essential for maintenance treatment: lithium, valproate, lamotrigine, olanzapine, quetiapine and clozapine. While risperidone and benzodiazepines were retained for acute mania, carbamazepine and fluoxetine were removed from acute depression. Treatment algorithms for predominantly manic and depressive courses of illness were constructed to encourage person-centred care, aiming for euthymia, individual functioning and relapse prevention. Conclusion. Evidence-based medicine principles enabled the NEMLC to select a range of essential medicines for the management of BD in a middle-income country. Local monitoring and evaluation are needed to inform future editions of the STGs and EML.

A Naturalistic, Non-interventional Investigation of the Clinical and Sociodemographic Characteristics and Prescription Patterns in Patients With Psychotic Disorders at a Tertiary Care Facility in South Asia.

This study aimed to evaluate the trends in the sociodemographic, clinical, and prescription characteristics of patients with psychotic illnesses seen in the outpatient psychiatry department of a tertiary care facility. Between March 2021 and April 2022, a cross-sectional, prospective, observational, naturalistic, non-interventional study was conducted. A total of two hundred prescriptions were analyzed. To assess the rationality of prescriptions, World Health Organization (WHO) indicators were also computed. With a range of 18 to 75 years, the cohort's mean age was 40.26 years, and its average disease duration was 10.75 years. Sixty-seven patients (68.5%) were diagnosed with schizophrenia. Of the 200 prescriptions that were analyzed, 13 antipsychotic prescriptions were written 343 times. Olanzapine was prescribed as an antipsychotic the most frequently (132, 66%), followed by clozapine (75, 37.5%). Haloperidol (41, 20.5%), trifluoperazine (3, 1.5%), loxapine (1, 0.5%), and flupenthixoldepot (1, 0.5%) were the most commonly prescribed typical antipsychotics. 91% (181/200) of patients received prescriptions for other drugs in addition to antipsychotics.Trihexyphenidyl (45%), escitalopram (30%), clonazepam (26.5%), sodium valproate (10%), propranolol (10.5%), and modafinil (9.5%) were the most frequently prescribed concurrent medicines.Forty-eight percent (95/200) of prescriptions demonstrated polypharmacy. Among patients, the frequency of antipsychotic prescriptions was 1 in 44% (88/200), 2 in 36.50% (73/200), 3 in 17% (34/200), 4 in 0.5% (1/200), and 5 again in 0.5% (1/200). Conclusions:On average, the cohort of the current study was young. The commonest diagnosis was mainly schizophrenia. Atypical antipsychotics accounted for the majority of antipsychotic prescriptions in the current study. In this study, a high prevalence of polypharmacy was noted.

Cutaneous Adverse Drug Reactions: Regional Experience of a Global Challenge.

Adverse drug reactions (ADR) are considered any harmful and unintended side effects associated with the use of a drug at the usual therapeutic dose, in which skin is involved in most cases. Therefore, the availability of epidemiological information on reactions, reaction patterns, and their causative drugs can be helpful in timely diagnosis and necessary measures, such as caution in prescribing causative drugs to prevent these types of reactions. In this retrospective descriptive study, the archived files of patients with dermatoses due to ADR referred to Taleghani University Hospital, Urmia, Iran, during 2015-2020 were studied. Patterns and frequency of skin reactions, demographic data, and the frequency of chronic comorbidities were identified. A total of 50 patients with drug-induced skin rash were found, of which 14 were male (28%) and 36 were female (72%). Skin rashes were most frequently found in patients aged 31-40 years. In 76% of patients, there was at least one chronic underlying disease. The most common reaction pattern was maculopapular rash (44%), and the most common causative drugs were antiepileptic drugs (34%) and antibiotics (22%). Mortality was found in 4 cases, which was due to antibiotics and antiepileptic drugs that caused toxic SJS/TEN and erythroderma. The hospital stays were highest in SJS and lowest in a maculopapular rash. Knowledge about the epidemiology and the frequency of adverse drug reactions may be helpful in increasing the awareness of physicians for correct and rational drug prescriptions, which can reduce unnecessary hospital referrals and treatment costs.

Antibiotic Prescribing in Dental Medicine-Best Practices for Successful Implementation.

With rising rates of antimicrobial resistance throughout the world, it is time to revisit antibiotic prescribing policies and practices, and dentistry is an important area for focused intervention, as it accounts for up to 15% of all antimicrobial prescriptions. In this narrative review, we have analyzed the current state of the knowledge, attitudes, and practice regarding antimicrobial use among dental professionals, and we have identified a set of seven recurring themes that drive inappropriate antibiotic prescribing in dental medicine. These include: 1. Prescribing antibiotics to delay or avoid dental treatment. 2. Overlooking the 5Ds-dental treatment (source control), dental condition (indication), drug (antibiotic choice), dose, and duration. 3. Relying on education from the distant past and on previous experience. 4. The heterogeneity of (too many) guideline recommendations leads to confusion and over-prescribing. 5. Decreased access to guideline information in private practice. 6. Psychological factors such as pressure to prescribe, comfort prescribing and the weekend effect, and 7. Feeling removed from antimicrobial resistance and externalizing responsibility. Based on the existing knowledge, we propose a framework based on four key pillars for focused intervention: 1. Education. 2. Internalizing responsibility. 3. Recognizing recurring counter-productive practices, and 4. Addressing recurring counter-productive practices. This framework can be applied in different dental settings to ensure best practices for the successful implementation of rational antimicrobial prescribing.

Comparative Analysis of Outpatient Antibiotic Prescribing in Early Life: A Population-Based Study Across Birth Cohorts in Denmark and Germany.

Comparing antibiotic prescribing between countries can provide important insights into potential needs of improving antibiotic stewardship programs. We aimed to compare outpatient antibiotic prescribing in early life between children born in Denmark and Germany. Using the Danish nationwide healthcare registries and a German claims database (GePaRD, ~ 20% population coverage), we included children born between 2004 and 2016, and followed them regarding outpatient antibiotic prescriptions until end of enrollment or the end of 2018. We then determined the median time to first antibiotic prescription. Based on all prescriptions in the first 2years of life, we calculated the rate of antibiotic treatment episodes and for the children's first prescriptions in this period, we determined established quality indicators. All analyses were stratified by birth year and country. In the 2016 birth cohorts, the median time to first antibiotic prescription was ~ 21months in Denmark and ~ 28 in Germany; the rate of antibiotic treatment episodes per 1000 person-years was 537 in Denmark and 433 in Germany; the percentage of prescribed antibiotics with higher concerns regarding side effects and/or resistance potential was 6.2% in Denmark and 44.2% in Germany. In the 2016 birth cohorts, the age at first antibiotic prescription was 50-59% higher compared to the 2004 birth cohorts; the rate of antibiotic treatment episodes was 43-44% lower. Infants in Denmark received antibiotics markedly earlier and more frequently than in Germany, while quality indicators of antibiotic prescribing were more favorable in Denmark. Although both countries experienced positive changes towards more rational antibiotic prescribing in early life, our findings suggest potential for further improvement. This particularly applies to prescribing antibiotics with a lower potential for side effects and/or resistance in Germany.

Prescribing pattern of antidepressants among patients with depression in a Mental Hospital of Nepal

Background: Depression is one of the major mental disorders and on the verge of emergence. Study on rational prescription of antidepressants is important since their inappropriate use may lead to precipitation of depressive symptoms. Objective: To study prescribing pattern of antidepressants among patients diagnosed with depression and observe its concordance with recommended guidelines. Methods: This retrospective study was conducted in Mental Hospital Patan, Nepal. All the patients (≥18 years) diagnosed with depression and prescribed at least one antidepressant were enrolled. Records of patients were selected on a daily registration basis from 2018/01/15 to 2018/05/14. Data collection form was designed to record details of eligible patients from the hospital. Statistical Package for the Social Sciences (SPSS) version 21 was used for data analysis. Results: A total of 114 records were reviewed. More than half of patients (51.8%) were female. Patients in between age group of 18-27 years were maximum in number (25.4%). It was observed that Selective Serotonin Reuptake Inhibitors SSRIs (74%) were the most commonly prescribed antidepressant (escitalopram (33.33%) and fluoxetine (33.33%). The most frequently prescribed dosages for fluoxetine fell within American Psychiatry Association (APA) and Centers for Medicare &amp; Medicaid Services (CMS) guidelines and specified in the Antidepressant Treatment History Form (ATHF); other antidepressants were found to be prescribed at lower than recommended doses. Conclusion: Prescribed doses for antidepressants were found to be lower than that recommended by the available guidelines. More studies on understanding the prescribing pattern of antidepressants and literacy among the public on their rational use needs to be conducted in Nepal.

Knowledge, attitude and practices related to drug prescription among postgraduate medical students: A cross sectional study

Pharmacology, being both the basic and applied science of drugs, forms the backbone of rational therapeutics. With an emphasis on learning the facts of medications, traditional pharmacology teaching is mostly teacher-centred. The erroneous prescribing that can result from inadequate understanding can cost a great deal of money and lives. The aim of the present study was to assess doctors' prescription knowledge, attitudes, and practices.The information was gathered from postgraduate students (residents) using questionnaires about their undergraduate training in clinical pharmacology and therapeutics, prescribing practices, frequently used drug information sources, and any perceived shortcomings in their undergraduate clinical pharmacology teaching. There was a calculation of descriptive statistics and a chi-square test.Among the 149 responses, 86 (57.71%) of them were male and 63 (42.28%) were female. Only 33 (22.1%) participants knew the components of a prescription, and 135 (90.6%) participants were aware that prescription writing was taught in their undergraduate course. Around 41 (27.5%) participants were aware of the concept of P drugs. Among them, 89 (59.73%) residents had good knowledge of prescriptions. Only 35 (23.5%) strongly agreed, and 113 (75.8%) agreed that undergraduate pharmacology training taught them to prescribe safely. About 83 (55.7%) participants disagreed, 33 (22.1%) strongly disagreed, and only 10 (6.7%) agreed that undergraduate pharmacology teaching should be improved. According to the patient's needs, 146 (98%) participants were prescribed additional vitamins and irons. Around 52 (34.9%) participants reported having difficulty prescribing during their internship rotation. Among them, 77 (51.67%) residents had good practice of prescription.A majority of postgraduate students believed that additional training should be provided on writing rational prescriptions to make them more confident in their prescribing practices.

Prescribing pattern of antibacterials as per dosage forms in various disease conditions at a rural tertiary care hospital

Background: The dosage form is useful in providing body to the drug, protecting the active ingredient of the drug and makes drug suitable for administration in a variety of ways. Selection of a suitable dosage form with appropriate route of administration in a particular infectious disease is an important aspect of rational prescribing. Aims and Objectives: For promoting the rational prescribing, the present study aims to estimate the pattern of antibacterial utilization in accordance with dosage forms in various disease conditions. Materials and Methods: A cross-sectional study was carried out which included 800 patients/prescription selected by simple random sampling technique. The study was conducted in OPD patients of SHKM, GMC, Nuh, Haryana for 12 months. Data analysis was done by using SPSS version 20. Results: Based on inclusion criteria, 800 patients were included for the study among 2105 screened patients. In our study, females (50.3%) out-numbered the male patients (49.8%). It was found that maximum antibacterials were prescribed in tablet form (74.6%), 13.7% were in drops form, followed by syrup (5.4%) and the remaining dosage forms (capsule, cream, gel, injection, ointment, and powder) were &lt;6.3%. A total of 23.9% of the patients were suffering from respiratory infections, 23.6% were suffering from ear, nose, and throat infections, followed by genitourinary infections (10.6%). Conclusion: With the help of dosage forms and disease frequency patterns observed in this particular region, prescribers can improve and develop rational prescribing guidelines.

Prevalence and prescribers’ knowledge of psychotropic polypharmacy in the Bono, Bono East, and Ahafo Regions, Ghana

The use of psychotropic medications for treating simple and complex psychological and emotional problems is common and relevant among prescribers. This, therefore, come with the tendency to prescribe many medications to a patient on a single visit due to varied reasons. The study, therefore, sought to ascertain the prevalence and prescribers' knowledge of psychotropic polypharmacy. A quantitative, descriptive study was conducted using a simple random approach to select and review the prescription records (both regular and prn basis) of three hundred and nine (309) patients’ folders retrospectively within seven (7) mental health units across the study area to ascertain the prevalence of Psychotropic Polypharmacy (PP). Fifty-eight (58) prescribers were selected using probability method (simple random) to respond to the study questionnaire. Psychotropic Polypharmacy was prevalent (66.0 %) in the study area with antipsychotic polypharmacy (74.0 %) being the common form with the co-prescription of chlorpromazine (CPZ) + haloperidol (70.0 %) being frequent. This was more predominant among male patients (78.0 %) than female patients (22.0 %). Prescribers had high (82.8 %) knowledge of Psychotropic Polypharmacy and the majority (68.9 %) disagreed that the practice of Psychotropic Polypharmacy should be promoted. The continuous training of prescribers (i.e. mental health officers) on rational prescriptions would help reduce the prevalence of Psychotropic Polypharmacy.

Neuroscience-Based Nomenclature (NbN): the Portuguese version of the new classification for psychopharmacological drugs.

Neuroscience-Based Nomenclature (NbN) is a proposal to provide a nomenclature based on neuroscience and pharmacology instead of the old disease-based classification. NbN is based on the mechanism of action and pharmacological target and aims to assist in rational prescription, reduce stigma, and increase treatment adherence. Currently, NbN is endorsed by many psychiatric associations, adopted by several relevant journals, and included in major psychiatry textbooks. Therefore, it is important that NbN is known to psychiatrists.

An observational study of drug utilization pattern in patients with diabetes mellitus in tertiary care hospital

Background: Diabetes will be the 7th leading cause of death by 2030 as per the World Health Organization (WHO). Encouraging the populace to use drugs rationally is the main goal of research on drug usage. Aims and Objectives: The objective of this study is to determine drug utilization pattern among patients with diabetes mellitus using the WHO Core Indicators in a tertiary care hospital, Indore. Materials and Methods: A prospective and observational study was done in the Department of Pharmacology along with the Department of Medicine in MGM Medical College and Hospital, Indore. After taking informed consent from diabetic patients visiting the outpatient department, their demographic details and prescriptions were recorded in case record form and analyzed using WHO core indicators. Results: In our study, total prescription assessed was 123. The total drugs prescribed were 652, out of which a total of 278 were anti-diabetic drugs. The average number of drugs per encounter = 5.3. Percentage of drugs prescribed by generic name = 92.4%. Percentage of encounters with an antibiotic prescribed = 10.5%. Percentage of encounters with an injection prescribed = 34.9%. The percentage of drugs prescribed from the essential drugs list (2015) = 72.3%. Conclusion: Prescribing pattern of antidiabetic drugs vary a little from the WHO standards. Rational prescription should be encouraged and such studies should be done regularly for periodic auditing of prescription.

Preoperativna procena rizika u pedijatrijskoj anesteziji

In general pediatric surgical population, the incidence of perioperative 30-day mortality is low. A child's physical status at the time of elective surgery and the presence of comorbidities can notably impact the perioperative risk. In order to provide quality care, preoperative evaluation should be undertaken in a timely and thorough manner. In preoperative period, it is highly important to be able to identify the patients who are at a higher risk, with the premise that early identification of these patients will allow for additional care to be provided, thereby minimizing possible complications. The main objectives of adequate preoperative assessment are to evaluate patients' readiness for the procedure, optimize patients' health status before surgery, reduce surgical morbidity, and help patients regain their usual functions postoperatively. Routine prescription of additional tests in children should be replaced by selective and rational prescriptions, based on the patients' history and performed clinical evaluation. Surgical and anesthetic complications can have adverse effects on patients' health, and they have also been proven to be associated with increased inpatient and postoperative costs. Each member of the surgical team plays a vital role in the safe care of pediatric patients. Well known risk factors for critical events in the perioperative period in pediatric population are as follows: ASA physical status, age, emergency surgery, and the existence of an underlying disease. This review highlights potential risks encountered in children and directs preoperative assessment towards selecting essential tests based on identified individual risk factors.

Evaluation of cardiovascular drugs in medical intensive care unit patients: A prospective observational study

Background: Nowadays, due to various factors such as stress, the number of patients suffering from cardiovascular disease particularly acute attacks of myocardial infarction (MI) and other CVS conditions is increasing. As the number of patients with CVS disease increases, the evaluation of various CVS drugs used in intensive care unit plays a very important role in improving the rationality of prescription as well as the quality of treatment. Aims and Objectives: The aims and objectives are to study the various cardiovascular drugs prescribed for patients admitted in the medical intensive care unit of a tertiary care teaching hospital, Udaipur, Rajasthan. Materials and Methods: It was a prospective and observational study conducted from August 2021 to March 2023. The required data were obtained from the patient’s prescription after obtaining consent. The prior permission was obtained from the institutional ethics committee of the college. Results: Nine hundred and thirty-six patients who fulfilled the inclusion criteria were studied. Among 936, 217 patients suffered from CVS disorders. 916 CVS drugs including antihypertensive drugs were prescribed for patients. Diabetes (26.40%) is the most common comorbidity found. Around 50.23% of patients were of MI. Noradrenaline (10.89%), atorvastatin (1.089%), furosemide (9.83%), and aspirin (6.30%) were the most commonly prescribed medications among inotropes, hypolipidemic, diuretics, and anti-platelet groups, respectively. Conclusion: After studying the various aspects, it was concluded that the cardiovascular health of the people in general is at stake of risk which may be due to lifestyle, stress, etc. The pharmaco-epidemiological studies should be conducted so that rational prescribing practices can be promoted.

Evaluation of the rational prescription of linezolid, the prevalence of thrombocytopenia and major drug interactions in patients with cardiovascular diseases: are there any cautions?

The present study evaluated the rational prescription of linezolid, the prevalence of thrombocytopenia, and major drug interactions in patients with cardiovascular diseases. We conducted a retrospective cross-sectional study on linezolid-treated patients at Shahid Chamran Heart Hospital in Isfahan from March 21, 2021, to March 20, 2022. Our research involved 132 patients who received linezolid. We reported 43.18% of linezolid prescriptions as irrational. Linezolid-induced thrombocytopenia is more common than previous studies, with a prevalence of 47.9%. We found a significant relationship between thrombocytopenia and the concomitant use of aspirin. The duration of treatment was identified as predicting factor for linezolid-induced thrombocytopenia. Moreover, the prevalence of interactions in the X and D categories was determined. Serotonergic and catecholamine medications were associated with 56.1% and 47.7% medication interactions, respectively. Our study found a high prevalence of linezolid-induced thrombocytopenia among patients with cardiovascular diseases. Based on this study, physicians should focus more closely on prescribing linezolid to patients with cardiovascular diseases. In addition to following rational antibiotic use, this susceptible group is also at an elevated risk of side effects (thrombocytopenia) and medication interactions.

Prescription pattern of antibiotics in dermatology: A Profile from a tertiary care teaching hospital, Kerala

Background: Antibiotics are commonly used in dermatology for infectious and inflammatory diseases. A study on the pattern of prescriptions will help in establishing fundamental data to enhance the utilization pattern of medications, elevate the standard of treatment, and enable prescribers to identify issues associated with drug usage, including adverse drug reactions, antibiotic resistance, drug interactions, and polypharmacy. Aim and Objective: The aim of the study was to describe the prescription pattern of antibiotics given to inpatients with dermatological disorders. Materials and Methods: This was a record-based descriptive study where the case records of 240 inpatients of the dermatology department of a tertiary care teaching hospital during the period from January 2019 to January 2022 were studied. The demographic profile, pattern of skin diseases reported, and pattern in antibiotic drugs usage were recorded with the help of a predesigned pro forma. Results: The mean age of the study population was 52.04 ± 16.91 years with male to female ratio 2.62:1. The most common skin disease diagnosed was Psoriasis (17.91%). Out of the 518 antibiotics prescribed to the patients in the study, the most preferred route of antibiotic administration was oral (48.84%). The most common oral antibiotic was cloxacillin (37.94%) while the most common parenteral antibiotic prescribed was cefotaxime (83%). Fusidic acid (78%) and mupirocin (16%) were commonly prescribed among the topical antibiotics. Amoxicillin-clavulanic acid combination (76%) was commonly prescribed among the fixed drug combinations. Among the topical antibiotics, 8.78% were prescribed as fixed-dose combination with steroids. Antibiotics (29%) constitute the major class of drugs among prescriptions followed by steroids (14%) and antacids (11%). Most of the prescribed antibiotics belonged to the Access group of antibiotics according to AWaRe classification of antibiotics (63.2%). Conclusion: The most common class of antibiotics prescribed was beta-lactam group of antibiotics. The study will help in formulating guidelines for rational prescription of antibiotics with special reference to dermatological cases and create awareness among physicians for effective therapeutic outcome. This will avoid the burden of antimicrobial resistance and pave pathway for the strengthening of economy.

Clinical Audit of Drug Prescription for Skin Disorders in Dermatology OPD at A Tertiary Care Centre

Introduction: Clinical audits are part of continuous quality improvement process that focus on specific issues or aspects of health care and clinical practice. There is growing concern about inappropriate drug utilization and prescribing habits of practitioners at all levels of health services. The cost of irrational use of medicines is enormous in terms of scarce resources and risk of adverse drug reactions. There is a paucity of data regarding prescription practices particularly in the dermatology department, so present audit was conducted. Materials and Methodology: This prospective prescription audit was carried out in Skin OPD of tertiary care centre amongst 100 prescriptions for duration of two months from November to December 2022. Demographic details and details of medications were recorded in a prestructured proforma and statistical analysis was done using descriptive studies. Results: In the current audit, 100 prescriptions were reviewed of which maximum prescriptions (33%) had a total of 3 drugs prescribed followed by 5 drugs in 22% of the prescriptions. Almost half, 45% prescriptions had 2 topical drugs and total 36% prescriptions had 2 systemic drugs given. In topical medications, 41% had moisturizers, 33% had antifungals. In systemic medications, 65% were anti-histaminic, 28% were antifungals. The frequency, strength, brand name and generic name were mentioned for topical and systemic drugs in 96% and 97% respectively .Total 14% of the prescriptions had FDCs. The average cost of prescription was Indian rupees 374.38. Discussion: Rational prescription writing is a talent that is learned via practise. Irrational prescriptions unnecessarily increase cost and duration of treatment. Drug interactions, medication resistance, and adverse drug reactions are also brought on by such activities which raises patient’s mortality, morbidity, and financial burden. Conclusion: This audit serves the purpose of evaluating prescriptions and further motivating such regular checks to improve patient outcomes.

Pharmacoepidemiology of drugs in glaucoma patients with comorbidities like hypertension and diabetes mellitus type 2 in Pakistan

Purpose: To evaluate the prescription pattern and utilization of drugs used by glaucoma patients with comorbidities including hypertension and diabetes mellitus type 2. Methods: This study was conducted at Al-Shifa trust eye hospital, Rawalpindi Pakistan from April 2021 to October 2021. Data regarding patient demographics, disease profile, medications &amp; side effects were recorded. Percent utilization of total ophthalmic, antiglaucoma, antihypertensive, and antidiabetic drugs was calculated. Comparative utilization of antiglaucoma drugs in hypertensive and diabetic patients and in pre and post-visit to glaucoma specialists was also calculated. Results: Out of 876 glaucoma patients, majority had primary open-angle glaucoma, 58.3 were males, &gt;50 belonged to the 50-70 years age group, and 27 and 18.8 were hypertensive and diabetic respectively. In the majority of cases, 1 or 2 eye drugs were prescribed and mostly in the topical dosage form. Fixed dose combinations (33.39) mainly were prescribed in all groups and Dorzolamide + Timolol was given in almost 80 of the time. Prostaglandin analogs (29.09) were 2nd most prescribed drugs. Beta-blockers were the least prescribed in all groups. Burning of the eyes was the most common side effect of ophthalmic drugs (28). Systemic beta-blockers were most commonly utilized by hypertensive patients while sulfonylureas by diabetic patients. No prominent change was noted in pre- and post-visit utilization of antiglaucoma drugs except brinzolamide. Conclusion: This study highlights the need for rational prescribing of antiglaucoma drugs in multimorbid patients and the importance of creating awareness of pharmacological actions, drug interactions, and side effects among physicians.