Transcript Rational Drug Use and medicine Safety

Rational Use of Medicines
Dr. Harpreet Kaur
M.O. HSHRC
Why worry about medicines
save lives
improve quality of
life
Can be dangerous: ADR
and medication errors
Expensive
Misused and abused
2
What is Rational Use of 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)
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
Ineffective
Resistance
Discovery
Misuse
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 number
Not 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 methods
Up-to-date information about drugs
thru CMEs
Problem-based training in pharmacotherapy 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.
2.
3.
4.
5.
Tab Buscopan 1 TID
Tab Ranitidine 150mg BD
Tab Perinorm 1 TID
Digene 2 tsf QID
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 Writing
Is
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.
THANK YOU
• 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.