Evaluation of prescribing patterns using WHO core drug use indicators in a pediatric hospital of Kabul Afghanistan: A prospective cross-sectional study.

Background: The global issue of irrational drug use, particularly concerning pediatric patients, is a significant concern. Notably, there has been a lack of studies assessing rational drug prescribing for pediatric patients within Afghanistan's healthcare system. This investigation aimed to address this gap by examining drug prescribing patterns at the Indira Gandhi Pediatric Health Institute (IPHI) in Kabul, Afghanistan. Methods: A prospective cross-sectional analysis was conducted to evaluate the prevailing drug prescribing practices at the outpatient department of IPHI in Kabul, Afghanistan. A systematic random sampling method was employed to select 600 outpatient prescriptions from the institute, following the World Health Organization (WHO) guidelines for investigating drug utilization in healthcare facilities. Results: The average age of patients was 4 years, and the average number of drugs per prescription was 2.9. Notably, 84% of prescriptions included one or more antibiotics, surpassing the WHO standard of <30%. Furthermore, 67% of the prescribed drugs were listed on Afghanistan's national essential drugs list (EDL), falling below the standard value of 100%. Only 35.1% of the prescribed drugs were in generic form, also lower than the recommended 100%. Moreover, 5.7% of all prescriptions included injections, the ideal value is <20%. The most frequently prescribed drug groups were anti-microbials (25.7%), followed by non-steroidal anti-inflammatory drugs (NSAIDs), (21.4%), gastrointestinal drugs (17.3%), and vitamins (7.8%). Conclusion: The study's findings indicate that, on average, a higher number of drugs were prescribed per patient visit at IPHI compared to recommended standards. Additionally, there was a lower utilization of generic drugs and drugs from Afghanistan's national essential drugs list (EDL), with an over-prescription of antibiotics.

Prevalence and Correlates of Polypharmacy, and Drug Utilization Pattern in a Semi-urban Population: Results from the Pars Cohort Study.

BACKGROUND: Although polypharmacy is considered a major predictor of irrational use of drugs, little is known about polypharmacy in developing regions. We aimed to indicate the prevalence and correlates of polypharmacy and to determine the medication profile at the population level in southern Iran. METHODS: In this cross-sectional study, we analyzed data from participants of the Pars Cohort Study (PCS) (aged above 40 years, N=9269). Polypharmacy was defined as using five or more medications concurrently. A Poisson multivariable model was applied to estimate the adjusted prevalence ratios (APRs) of various risk factors. The Anatomical Therapeutic Chemical (ATC) classification system was used for classifying medications. RESULTS: Prevalence of polypharmacy was 10.4%, (95% CI: 9.75; 11.08) and it was higher among females (15.0%), older adults (age≥65 years) (16.0%), and individuals with more than two chronic conditions (31%). Being female, educated, married, and not having a low socio-economic class were independently associated with a higher likelihood of polypharmacy. The most prevalent medications among female participants were sex hormones and modulators of the genital system (58.4%), drugs for acid-related disorders (14.6%), and anti-anemic preparations (13.6%,). On the other hand, males were using acid-related disorders (14.6%), anti-inflammatory and anti-rheumatic products (7.8%), and beta-blocking agents (6.3%). CONCLUSION: The prevalence of polypharmacy in our sample was relatively low, especially among males. Cardiovascular drugs, acid suppressants, hormonal contraceptives, and anti-anemic preparations are drug classes with the highest contribution to polypharmacy.

A Cross-Sectional Study on Self-Medication Prevalence and Usage Patterns: An Alarming Concept Among the Saudi Population.

BACKGROUND: Self-medication (SM) has many potential drawbacks, including toxicity, drug resistance, severe adverse effects, drug interactions, drug abuse, and drug dependence, but it is still widely used for a variety of reasons, including time and money savings, symptom prevention or treatment of minor illnesses, a lack of access to doctors, etc. This study aimed to describe and analyse the usage of antibiotics without a prescription, self-medication practises, and patterns of using them among Saudis. MATERIALS AND METHODS: In 13 provinces of Saudi Arabia, a community-based cross-sectional study was done. After gaining consent, data were gathered from 420 adults during face-to-face interviews using a questionnaire. SPSS was used to analyse the data once it had been entered into Microsoft Excel (Microsoft® Corp., Redmond, WA). RESULTS: Regarding self-medication, among 208 participants, there was a male predominance and among upper lower class with respect to socioeconomic status. The self-medication rate was found to be higher among graduates and professionals with respect to education and occupation. Self-medication was discovered to be more prevalent among metropolitan residents. The majority of those who started using self-medication got their knowledge from various advertisements. The most frequent symptom of self-medication was fever, followed by a common cold. The most commonly used medication was paracetamol, followed by cough syrups. Weight loss advertisements influence participants the most for self-medication, followed by hair loss and diabetes. TV advertisements have the highest influence on people practising self-medication. CONCLUSION: The study calls for greater knowledge of the impacts of antibiotic self-medication, which can be accomplished through efficient measures including behaviour change communication and encouraging more research into its causes and effects.

Evaluation of irrational drug use of individuals over the age of 18 who applied to a university hospital.

BACKGROUND: Irrational drug use not only causes a delay in the treatment of patients, failure to achieve full well-being, drug interactions and side effects, drug resistance but also creates economic negativities such as waste of resources and unnecessary workload. This study aims to investigate the irrational drug use behaviors of individuals over the age of 18 who applied to a university hospital. METHODS: This sectional study included 1247 people over the age of 18 who applied for Gazi University Health, Research and Application Center. A questionnaire was applied to the applicants by face-to-face interview technique. Logistic regression analysis was performed among the factors associated with the subcomponents of irrational drug use. RESULTS: Participants (20.1%) used medication without a doctor's prescription (self-medication), 3.4% did not comply with the recommended dose and duration for medications, 47.4% applied to the physician to prescribe the medication they wanted, 65% had medication for later use at home. It was determined that 24.1% of them used drugs without looking at the expiration date and 45.5% of them used drugs without reading the patient information leaflet. Among the risk groups identified for the different irrational drug use behaviors mentioned are the following: males, lower educational groups, housewives, not having social insurance, continuous drug users. DISCUSSION: Irrational drug use behaviors are still observed in society. The fact that the risk is higher in lower education groups is an example of the negative consequences of limited health literacy. The fact that different risk groups have been identified for different behaviors related to irrational drug use shows that intervention studies on this subject should be directed to specific groups. The effect of having social security reveals its connection with universal health coverage and rational drug use.

Evaluation of Drug Use Pattern in Pediatric Outpatient Clinics in a Tertiary Teaching Hospital Using WHO Drug-Prescribing Indicators.

Purpose: The main aim of the study is to assess physicians' prescribing patterns using the World Health Organization (WHO) prescribing indicators among pediatric outpatient clinics, and to identify areas in need of intervention regarding the rational use of medicines among pediatric outpatients in Jordan. Methods: This is a descriptive observational cross-sectional study that was conducted at the outpatient pediatric clinics at Jordan University Hospital (JUH). During the study period, prescriptions were collected over a period of two months. Prescribing patterns were assessed using the five WHO drug prescribing indicators. Results: A total of 1011 prescriptions/encounters were assessed. More than half of the encounters were for male patients (n= 595, 58.9%), and the median age of patients was eight years (IQR = 7.9). The average number of drugs prescribed per encounter was 1.8 ± 1.3; however, a specific individual clinic, the respiratory clinic, witnessed an average of 2.1 drugs prescribed per encounter. All of the prescribed drugs were prescribed by generic name (100%). Only 47.7% of the drugs were from the essential drug list of the JUH. Overall, antibiotics were prescribed in 19.5% of the encounters, but at higher rates in some clinics such as respiratory clinics (50.8%). Injectables were prescribed in 9.5% of the 1011 encounters; however, they were prescribed at higher rates in endocrinology and neurology clinics, in 44.8% and 31.3% of encounters, respectively. Conclusion: This study revealed some adequate prescribing habits with an optimal prescribing pattern of generics and number of drugs per encounter among pediatric patients. However, the prescribing patterns of the essential drug list, antibiotics, and injectables, in specific clinics, failed to meet WHO standards. The findings of this study shed light on the need to establish national strategies to improve prescribing practices among the pediatric population.

Are antibiotic prescription practices in Eastern Uganda concordant with the national standard treatment guidelines? A cross-sectional retrospective study.

OBJECTIVES: This study aimed to evaluate the antibiotic prescription patterns of health workers in Eastern Uganda and more specifically whether they are in accordance with the Ugandan standard treatment guidelines and other indicators of appropriate antimicrobial prescription. METHODS: Patient data were obtained from the health management information system of the outpatient department registers of Soroti and Mbale Regional Referral Hospitals from 2016-2018. RESULTS: The prevalence of non-adherence to treatment guidelines when prescribing antibiotics was 82.6% (95% CI 81.4-83.7%). Guidelines were more likely to be adhered to when prescribing antibiotics for individuals aged 13-19 years compared with their counterparts aged 0-12 years [adjusted odds ratio (aOR) = 0.55, 95% CI 0.40-0.74]. When prescribing antibiotics for males, health workers were twice as likely not to adhere to guidelines compared with when prescribing for females (aOR = 2.09, 95% CI 1.61-2.72). When prescribing cephalosporins and nitroimidazoles, health workers were likely not to adhere to guidelines compared with when prescribing penicillin (cephalosporins, aOR = 1.92, 95% CI 1.28-2.86; nitroimidazoles, aOR = 1.70, 95% CI 1.09-2.65). Health workers were most likely not to follow guidelines when prescribing antibiotics in combination (two antibiotics, aOR = 1.27, 95% CI 1.03-1.56). CONCLUSION: Non-adherence to treatment guidelines for an indicated diagnosis and inappropriate antibiotic prescription are significantly prevalent in Eastern Uganda. Health workers were more likely not to follow guidelines when prescribing for males, children up to 12 years of age and when prescribing cephalosporins, nitroimidazoles or double antibiotic combinations.

Analysis of the Antimicrobial Market in Pakistan: Is It Really Necessary Such a Vast Offering of "Watch" Antimicrobials?

Understanding antimicrobials (AM) on offer in a pharmaceutical market, with a particular reference to drugs categorized as "Watch" active ingredients, is one of the important first steps to prevent their potentially inappropriate use. The March 2019 data of all AM containing registered brands and presentations currently being sold in the country for the J01 Anatomical Therapeutic Chemical (ATC) subgroup from IQVIA Pakistan was used. Each AM was categorized as "Access," "Watch," or "Reserve," according to the WHO AWaRe classification. There were 59 single chemical entities and 14 combinations with 1869 brands and 4648 presentations. The WHO Essential Medicines List included 35 J01 AM while an additional 38 single and combination AM with 425 brands and 977 presentations were present in the country. Looking at the whole list of marketed AM, 8 of the 10 AM with more than 60 brands were classified as "Watch", offering 962 brands and 2418 presentations. Most AM marketed in Pakistan, of which there are an excessive number of brands, belong to the "Watch" AWaRe category. The higher the number of brands, the higher the marketing pressure on prescribers and pharmacists will be which implies more potential confusion. One vital step to rationalize the use of AM lies in reviewing their market offer.

Herbal Fixed Dose Combinations in Nepal: Growing Concerns in a Developing Country.

Herbal medicines are mostly prepared as a combination therapy that has been used since therapeutic was first practiced. Combination products, also known as Fixed Dose Combinations (FDCs) of herbal remedies are in widespread use in Nepal. Herbal FDCs are in common practice because it is believed to have better adherence, less side effects and easy accessibility. Nevertheless, combination products possess greater risk of adverse effects, increases costs associated with treatments and leads to an ineffective dosages. Herbal FDCs are used extensively in Nepal although the rationality beyond the use of these combinations is still unidentified and at times are questionable. Legislations governing the use of herbal medicines is lacking in Nepal. Many herbal FDCs are not supported by any scientific data and test for the presence of ingredients mentioned in the package insert/container label is always difficult. A FDC of herbal products must be based on clear criteria that guarantee consumer safety and appropriate indications. These criteria helps to protect the consumers or patients from the misleading claims and risk associated with the use of unjustifiable combination of herbal substances. Strict monitoring from the regulatory body and the public awareness on the cost as well as advantages and disadvantages of herbal FDCs is urgently required.

Difference in described indications of medicines among drug information sources in India: An issue urgently to be addressed.

BACKGROUND: Drug information can be obtained from various sources such as National Formularies, drug package inserts (PI), other sources such as Monthly Index of Medical Specialities (MIMS), Current Index of Medical Specialities, and the information available with the regulators. Any variation in the information available in different sources can promote irrational drug use. In this study, we assessed this variation in a sample of commonly used drugs. MATERIALS AND METHODS: Fifty commonly used drugs were analyzed for any variation (both quantitative and qualitative) in information on indications as mentioned in commonly used drug information sources such as Central Drugs and Standards Control Organization (CDSCO) website, National Formulary of India (NFI), MIMS, and PI of medicines. RESULTS: We observed a variation in average number of indications per drugs given in CDSCO (2.2 ± 0.25), NFI (3.51 ± 0.42), MIMS (2.98 ± 0.29), and PI (3.18 ± 3.52). The CDSCO and NFI did not contain information about indication for 10 and 17 drugs, respectively, while MIMS and PI contained information about all the selected drugs. A subset analysis was done for 24 such drugs which were mentioned in all the four sources and it was found that NFI had listed the maximum number of indications per drug (3.79 ± 0.53), followed by PI (3.08 ± 0.44), MIMS (3.04 ± 0.51), and CDSCO website (2.66 ± 0.37) and this difference was found to be statistically significant (P = 0.02). We also observed some gross qualitative variation regarding drug information given in different sources. CONCLUSION: Variation exists in the quantity and quality of information available on indications about drugs available in various sources. Necessary steps need to be taken to harmonize drug information available across various sources so as to provide reliable and uniform drug information thereby promoting rational drug use.