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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.