Assessment of prescribing pattern of drugs and completeness of prescriptions as per the World Health Organization prescribing indicators in various Indian tertiary care centers: A multicentric study by Rational Use of Medicines Centers-Indian Council of Medical Research network under National Virtual Centre Clinical Pharmacology activity.

OBJECTIVE: The rational use of medicines as per the World Health Organization (WHO) should be practiced globally. However, data regarding the completeness of the prescriptions and their rational use is lacking from developing countries like India. Thus, the aim of this study was to assess the prescribing patterns of drugs and completeness of prescriptions as per WHO core drug use and complementary indicators to provide real-life examples for the Indian Council of Medical Research (ICMR) online prescribing skill course for medical graduates. METHODS: Prescriptions of the patients, fulfilling inclusion criteria, attending Outpatient Departments of various specialties of tertiary care hospitals, were collected by thirteen ICMR Rational use of medicines centers located in tertiary care hospitals, throughout India. Prescriptions were evaluated for rational use of medicines according to the WHO guidelines and for appropriateness as per standard treatment guidelines using a common protocol approved by local Ethics committees. RESULTS: Among 4838 prescriptions, an average of about three drugs (3.34) was prescribed to the patients per prescription. Polypharmacy was noted in 83.05% of prescriptions. Generic drugs were prescribed in 47.58% of the prescriptions. Further, antimicrobials were prescribed in 17.63% of the prescriptions and only 4.98% of prescriptions were with injectables. During the prescription evaluation, 38.65% of the prescriptions were incomplete due to multiple omissions such as dose, duration, and formulation. CONCLUSION: Most of the parameters in the present study were out of the range of WHO-recommended prescribing indicators. Therefore, effective intervention program, like training, for the promotion of rational drug use practice was recommended to improve the prescribing pattern of drugs and the quality of prescriptions all over the country.

Comparison of a stabilized stannous fluoride/sodium hexametaphosphate dentifrice and a zinc citrate dentifrice on plaque formation measured by digital plaque imaging (DPIA) with white light illumination.

OBJECTIVES: The objectives of this study were to verify use of a white light-illuminated adaptation of an established digital plaque image analysis (DPIA) technique to measure changes in plaque levels, and to compare the antiplaque efficacy of a 0.454% stannous fluoride/sodium hexametaphosphate dentifrice (SnF2/SHMP) and a 0.76% sodium monofluorophosphate/zinc citrate (ZnCit/SMFP) dentifrice using the white light DPIA system. METHODS: White Light DPIA Qualification--17 subjects were enrolled in the study. The following four images were captured on different days: a) non-disclosed morning plaque; b) disclosed morning plaque; c)just-brushed plaque; and d) post-prophylaxis plaque levels. Comparative Dentifrice Assessment-Following the qualification study, 21 subjects were enrolled in the dentifrice assessment. During Phase I (two weeks acclimatization phase), subjects used a standardized oral hygiene regimen twice per day, consisting of a sodium fluoride dentifrice and a standard flat-profile manual toothbrush. In Phase II (two-week treatment phase), subjects were randomized to one of two treatment groups: SnF2/SHMP dentifrice (Crest Pro-Health) or the ZnCit/SMFP formulation (Viadent). During each phase, plaque levels were assessed in the morning prior to the morning tooth brushing (a.m.), post-brushing in the morning (p.b.), and in the afternoon (p.m.). RESULTS: White Light DPIA Qualification--All 17 subjects completed the trial. The white light modification of DPIA successfully distinguished known variations in plaque coverage. Mean plaque coverage of the 12 anterior facial surfaces, as determined by the system for the four images, was: a) 0.07%; b) 11.44%; c) 4.99%; and d) 2.16%. Comparative Dentifrice Assessment-All 21 subjects completed the study. The SnF2/SHMP dentifrice provided a statistically significant 25% lower a.m. pre-brushing plaque level (p = 0.0385) versus ZnCit/SMFP. SnF2/SHMP also showed a directional 23% lower p.m. plaque (p = 0.09) level, and 15% less (p = 0.10) post-brushing plaque compared to ZnCit/SMFP. CONCLUSION: The white light DPIA system was shown to be a sensitive method to measure changes in plaque levels. Using this system, a SnF2/SHMP dentifrice was found to be significantly more effective than a ZnCit/SMFP dentifrice in the prevention of overnight plaque growth.

Drug prescribing in children in a North Indian referral hospital.

Ojective- Pattern of drug use in an ambulatory paediatric patients in a tertiary care hospital in Northern India was studied.Methods- Prescribing patterns were studied prospectively, using drug use indicators developed by WHO/International Network for Rational Utilization of Drugs (INRUD).Results- The most frequent diagnosis was seizure disorder (26.9%) and antiepileptics were the most often prescribed drugs (24.6); followed by vitamin and mineral supplements (20.1%), and cough/cold preparations (16%). Use of vitamin and mineral supplements was disproportionately high (20.1%) when compared to the number of cases of anaemia (2.3% and malnutrition (2.6%). The average number of drugs per encounter (1.32), percentage of encounters with an antibiotic (6.1%) or injection (0.2%) prescribed, were all within the acceptable range. The percentage of drugs prescribed by generic name was too low, at 11.2%.Conclusion- Barring the frequent use of supplements and low rate of generic prescribing, prescribing trends were found to be rational in other aspects in the study population. Copyright (c) 2000 John Wiley & Sons, Ltd.

Adverse drug reactions among inpatients in a north Indian referral hospital.

BACKGROUND: Monitoring spontaneous adverse drug reactions is one of the epidemiological methods for assessing the safety of drugs in a hospital setting. METHODS: Data on adverse drug reactions (ADRs) were collected over a 3-year period among inpatients in a north Indian referral hospital using the spontaneous ADR monitoring system. RESULTS: A total of 317 ADRs were reported. Cutaneous reactions (38.8%) and gastrointestinal disturbances (28.4%) made up a large proportion of reported ADRs. Antimicrobial agents, including those used for antituberculosis therapy, were responsible for 47.3% of the events. Radiocontrast dyes, and antineoplastic and psychoactive agents were the other important drugs causing ADRs. No age- or sex-related differences were found in the overall rate of ADRs, though toxic epidermal necrolysis was more frequent in the elderly. CONCLUSION: The pattern of ADRs and drugs involved were largely similar to those reported in the western literature.

Prescribing patterns and cost of antihypertensive drugs in an internal medicine clinic.

BACKGROUND: Antihypertensive agents are selected primarily for their ability to prevent morbidity and mortality related to hypertension. METHODS AND RESULTS: Prescribing trends and the cost of antihypertensive drugs were studied in 300 patients attending an internal medicine clinic. Beta-blockers were the most frequently used group of drugs (46.7%), followed by calcium-channel antagonists (34.3%) and angiotensin-converting enzyme inhibitors (30%). Diuretics were used in only 13.2% of the prescriptions. Atenolol (36%), amlodipine (29.3%) and enalapril (19%) were the most frequently used individual drugs. Propranolol, furosemide, amlodipine and atenolol were the least expensive drugs used, with annual drug acquisition costs of Rs 80, 102, 182 and 318, respectively. Benazepril (Rs 1778), diltiazem SR (Rs 1777), lisinopril (Rs 1660), prazosin (Rs 1416) and losartan (Rs 1365) were the most expensive drugs in terms of annual drug acquisition costs. CONCLUSIONS: The results of our study emphasize the need to encourage frequent use of diuretics. Since the costs of different antihypertensives vary considerably, newer and relatively expensive antihypertensives should be prescribed only when clearly indicated.

Adverse drug reactions to fluoroquinolones at a tertiary care hospital in northern India.

Use of fluoroquinolones has increased considerably in the last 5-6 years in our hospitals. With a view to ascertain their safety and the type of adverse drug reactions (ADRs) in our population, spontaneous reports were collected and analysed to ciprofloxacin (the most prescribed fluoroquinolone in our hospital) over a period of three and a half years. The pattern of reactions were rash in 18, severe reactions like Steven Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in 4, gastritis and diarrhoea in 3, shivering and rigors in 2, hemorrhagic purpuric spots in 2 and oedema of eye and lids with topical application in 1 patient. Most cases recovered on stoppage of the drug and symptomatic treatment. However, one case of SJS and one of TEN proved fatal. Care needs to be exercised in their use and they do not appear to be innocuous to severe and disturbing ADRs.

Cutaneous adverse reactions in in-patients in a tertiary care hospital.

Cutaneous reactions were monitored by spontaneous adverse reaction monitoring system among inpatients in Nehru Hospital, over a period of 3 1/2 years. A total of 379 adverse drug reactions were reported during this period, of which 144 (40%) were cutaneous reactions. Maculopapular rashes (50% of cutaneous reactions), and urticaria (21.5%) were the most common eruption. Stevens-Johnson syndrome (13.9%) and toxic epidermal necrolysis (TEN 4.9%) were the serious cutaneous reactions. There were 4 fatal cutaneous reactions (all due to TEN). Antimicrobials (caused 56.9% reactions), radiocontrast dyes (14.6% reactions) and antiepileptics (15.3% reactions) were the most prominent drugs responsible for these eruptions.

Use of cold medications for upper respiratory tract infections in children.

Prescribing practices in the treatment of upper respiratory tract infections (URTI) in children were studied, with particular emphasis on overuse of antibiotics, combination cold medications, and off-label use of medicines in children. Prescriptions with the diagnosis of URTI were studied over a period of 5 months in a general pediatric clinic. Out of 224 prescriptions scrutinized, a cold medication was prescribed in 88.4% of cases and 50.9% prescriptions contained a combination preparation. Antihistamines (50.9%), alpha-adrenoceptor agonist decongestants (50.0%) and opioid anti-tussives (24.5%) were the common ingredients of cold medications. Antihistamines (35.7%) were also used alone. Of the children 18.2% were receiving a drug contraindicated or not recommended in their age group. Antibiotics were prescribed in only 8.5% of cases, and for appropriate indications, reflecting a more restrained use of antibiotics.