Rational Use of Medicines

Dr. Harpreet KaurM.O. HSHRC

2

save lives

improve quality

of life

Can be dangerous:

ADR and medication

errors

Expensive

Misused and abused

Why worry about medicines

• The rational use of medicines requires that patients receive medicines appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and the community

(WHO 1988)

What is Rational Use of Medicines?

Why Rational Use of Medicines?

• Ineffective treatment• Increased financial burden• Wastage of resources• Adverse effects of drugs• Antibiotic resistance (public health problem) • e.g. Amoxicillin & Cloxacillin

Examples of Irrational Use

• Poly pharmacy • Overuse of injections • Under-use of drugs for chronic

illnesses like GAN, HT, CAD, BA,COPD Depression, Epilepsy…..

• Misuse of antibiotics

ANTIMICROBIAL RESISTANCE

World without antibiotics

Discovery of antimicrobials is probably the most important

milestone in the history of medicine

“Magic bullets and miracle drugs”

“Antibiotics kill microbes”

But if used inappropriately

“Microbes kill the drugs”

Need of Antibiotic

Discovery

MisuseResistance

Ineffective

List of contributors to the problem

• Qualified physicians and dentists,

• Paramedical staff

• Government authorities

• Pharmaceutical companies

• Unqualified general practitioners

• Patients

Physicians

• Misconceptions about prescription

Newer, Costly and Branded drugs are

better

Fixed-dose combinations are better

• Overuse antimicrobials• No knowledge of local resistance patterns• Abt. Prescription on patient demand

Paramedical staff

• Access to antimicrobials

• Inadequate knowledge of using them

rationally

• Self medication

• Peer treatments

“In Delhi, no prescription was presented for one-fifth

of the antibiotics purchased recently”

Unqualified practitioners

A major percentage of drug prescriptions come from private sector

Large numberNot adequately trained

? Rational prescribing

Patients

Noncompliance/ Over compliance

Self medication

Request for antibiotic prescriptions

Multiple consultations

Lack of awareness

Addressing the problem

“Rational use of antibiotics”

5 Rs

Right drug

Right patient

Right time

Right dose and dosage form

Right duration of time

Levels need to be addressed

• Policy makers/ Govt.

• Prescription

• Dispensing/ Administration of drug

• Patient

Health professionals

Culture senstivity test

Emperical therapy Definitive

therapy

Fast diagnostic methodsUp-to-date information about drugs

thru CMEsProblem-based training in pharmaco-

therapy in undergraduate curriculum

Public

Public education campaigns

Importance of compliance

Danger of self medication

Not to request for antibiotic

prescriptions

Public “Misuse of drugs other than

antibiotics i.e. analgesics,

corticosteroids etc. is going to harm

the person himself only”

But

“Misuse of antibiotics is harmful for

the whole community including their

near and dear ones also.”

Prescription Audit

• 55 out of 94: Analgesics

• 51 out of 94: Antibiotics

• 9 out of 51 Combination of

antibiotics

• 2 out of 9 (Amoxicillin with

Ciprofloxacin)

3 yr male child with Hb 6.2 gm/dl

• Syp. Iron • 2ml – 2ml

• Syp Albendazole• 2 tsf Hs Stat

• Syp Abof NZ (Ofloxacin & Nitazoxanide)

• 1-1

• Syp Cyclopam• ½ tsf sos

6 months child• c/o cough for 1 month• o/e afebrile , quite , calm

• Syp Cotrimoxazole • Tab Cetirizine

• 1/4 BD

• Tab Ofloxacin• 1/4 BD

• Syp PCM

Primary infertility

• Cap Doxy• 1 BD

• Tab TZ• 1 BD

• Tab Dicyclomine• 1 TDS

• Clomiphene Citrate is missing

45 years male Hypertention

• c/o weakness and palpitation• B.P. 170/100

• Tab Atenolol 50 mg OD• ORS solution

Case of abd pain with vomiting age 27 years male

1. Tab Buscopan 1 TID2. Tab Ranitidine 150mg BD3. Tab Perinorm 1 TID4. Digene 2 tsf QID5. Tab Metrogyl 1 TID

Drugs in Supply• Ciprofloxacin + Tinidazole ( 4th in

budget consumption)– Bacterial resistance to fluoroquinolones is major

concern

• Cap Amoxycillin (250 mg)+ Cloxacillin (250mg) ( 5th in budget consumption)– No increase in spectrum of action is achieved.– Dose of each component is less– Amoxicillin TDS & Cloxacillin QID

• Cap Tetracycline ( Relatively safe Doxycycline in EML)

Drugs in Supply• Cap Ampicillin – Amoxicillin with favorable side effect profile

in EML

• Inj. Cefotaxime Sodium , Ceftriaxone + Sulbactum , Cefoparazone,Cefotaxime Sodium + Sulbactum• a no. of higher generation cephalosporins

adding in cephalosporins in EML

• Cefuroxime Axetil – Many strains are resistant

Prescription WritingIs

An Art

Each one is Important

• Drug • Strength• Dose• Frequency of administration• Duration of treatment• Non Pharmacological measures • Special Instructions

Selection of Drug

Wheather the pharmacological treatment required or Not

Selection of Drug

• Is dental pain due to – nerve exposure – Inflammation– Infection

• Gastritis : PPI/Ranitidine • Rhinitis: only decongestant / steroid nasal

spray• Constipation : stool softener/Irritant • Cough: Cough suppressant/bronchodilator • HT & BA (Atenolol & Salbutamol)

Strength of Drug

• Strength (esp. Children,

Pharmacist decide)

• Dose ( Suboptimal, Overdose)

Frequency of administration

• Not given importance

• Report of death of a patient who took MTX daily instead of weekly prescribed for RA

Duration of treatment

• Analgesics, Antibiotics, Steroids

• Antianaemics

• Initially abt should be given for

…………days.

• What is duration of treatment in mild,

moderate and severe anaemia?

Non Pharmacological measures

• Warm saline water gargles in gingivitis

• Cold sponging in high fever

• Salt restricted diet in HT

• Plenty of fluids in UTI

• Gargles and steam inhalation in URC

• Normal saline in nasal blockade in infants

Special Instructions

• Bad taste with Metronidazole• Iron utensils for cooking• PPI, • NSAID, • Iron & Calcium • Dark colored stool with Iron

Special Instructions

• Gastritis (avoid tea, spicy food ,fried & natural antacids water milk)

• Scabicidal agents • PID (Abstinence & Tt. of partner

even if asymptomatic)• Alklanizer in UTI• MTP Pill • Antidepressants

Conclusion

• Health is considered a basic human right. • Drug use is the end of the therapeutic consultation.• Drugs are different from other CONSUMER PRODUCTS.

• USE THEM CAREFULLY & RATIONALLY • Health professionals have a responsibility to ensure

that the right drug is prescribed, dispensed and taken.

THANK YOU