Outpatient prescribing trends, rational use of medicine and impact of prescription audit with feedback at a tertiary care centre in India.

BACKGROUND: Rational use of medicines (RUM) is highly desired worldwide yet many shortcomings are found. This study aims to evaluate prescription pattern and RUM using World Health Organisation (WHO) prescribing indicators. The impact of audit and feedback has also been studied, along with comparison with published data. METHODS: A cross-sectional observational study was conducted in the outpatient department setting of a tertiary care centre in central India. Data were collected from 2719 prescriptions across different departments from hospital pharmacies from 2016 to 2018 at different time periods. The data was analysed using WHO core prescribing indicators. RESULTS: Average number of drugs per prescription was found to be 2.53 ± 1.23 (WHO optimal value ≤ 2). The mean values of prescribing indicators for antibiotics (19.82% vs. ≤ 30%) and injection prescribing (1.98% vs. ≤10%) were within optimal values. Generic prescribing (15.96% vs. 100%) and prescribing from National List of Essential Medicines (NLEM; 37.37% vs. 100%) were found to be significantly lesser. Annual audit and feedback showed improvement in generic prescribing and prescribing from NLEM, but the other trends continued to be similar. CONCLUSION: While use of antibiotics and injections among outpatients was found to be rational, there is scope of improvement in most domains that can be addressed with appropriate interventions.

Evaluation of an outpatient department (OPD)-based prescribing pattern of fixed-dose combinations in a tertiary care institute in Central India.

Background Fixed-dose combinations (FDCs) are being widely prescribed for the treatment of various disorders in India. However, not all FDCs are rational. To know the awareness of physicians in prescribing rational FDCs was the need of the hour in order to assess the prescribing trends and rationality of FDCs. Eventually, this will help to formulate the guideline for rational use of FDCs. Methods This was a prospective observational study conducted in All India Institute of Medical Sciences Bhopal, MP, India. Prescriptions were collected over a period of 2 months by the convenience sampling method from hospital pharmacy. The data were subjected to descriptive analysis using Microsoft Excel and Graph Pad Prism. Results were expressed in mean ± standard deviation (SD), percentages and 95% confidence interval. Results A total of 2496 drugs were prescribed in 1008 prescriptions, of which 945 (37.82%) were FDCs with an average of 0.93 ± 0.94 (mean ± SD) per prescription. Of 945, 67 (7.09%) were included in National List of Essential Medicine 2015 considered as rational. The number of prescriptions containing one or more FDCs was 629 (62.40%). FDCs were more frequently prescribed to male patients (54.92%) and in the age group of 18-30 years (33.44%). FDCs containing a proton pump inhibitor were prescribed most frequently (16.29%) followed by nonsteroidal anti-inflammatory drugs (13.96%) and multivitamins (7.83%). Conclusions Prescribing irrational FDCs was very common, and hence there is an obvious need to update our prescribers about the irrationality of FDC and motivate them to develop a habit of rational prescribing.

Evaluation of the effect of piperine per se on blood glucose level in alloxan-induced diabetic mice.

Abstract: Diabetes mellitus is a metabolic disorder and emerging pandemic of the 21st century. Piperine, the chief alkaloid present in Piper nigrum (black pepper), has a wide array of uses in alternative and complementary therapies. The effect of piperine on blood glucose level was studied in alloxan-induced diabetic mice in acute and subacute study models. Piperine was isolated from the fruits of Piper nigrum crude extract. Diabetes was induced using alloxan in albino mice which were then randomly divided into 5 groups (n = 6). In acute study, drugs were administered orally as: control (2% gum acacia, 10 mL/kg), standard (metformin 150 mg/kg), P10 (piperine 10 mg/kg), P20 (piperine 20 mg/kg) and P40 (piperine 40 mg/kg). Drug intervention for subacute study consisted of once daily oral administration for 14 days of 2% gum acacia 10 mL/kg, metformin 250 mg/kg, and piperine 5, 10 and 20 mg/kg, respectively, in the control, standard and P5, P10, P20 groups. Blood glucose levels were estimated before and at 1, 2, 3 and 4 h post dosing, respectively, in the acute study and on day 7 and 14 in the subacute study. Results of acute study showed that at 2 h post-dosing piperine at high dose of 40 mg/kg showed significant rise in blood glucose level (p < 0.05) in comparison to control group. In contrast, a significant blood glucose lowering effect was seen with piperine at dose of 20 mg/kg on day 14 (p < 0.05) in the subacute study. In summary, we suggest that subacute administration of piperine has statistically significant antihyperglycemic activity while acutely it raises blood glucose at high doses. Further investigations are needed to consider it as prospective anti-diabetic agent at appropriate dosage.