Antibacterial prescription and the associated factors among outpatients diagnosed with respiratory tract infections in Mbarara Municipality, Uganda

Background Respiratory tract infections (RTI) are the second most frequent diagnosis after Malaria amongst Outpatients in Uganda. Majority are Non pneumonia cough and flu which are self-limiting and often do not require antibacterials. However, antibiotics are continuously prescribed for these conditions and are a major contributor to antimicrobial resistance and wastage of health resources. Little is known about this problem in Uganda hence the impetus for the study. Objectives To determine the antibacterial prescribing rate and associated factors among RTI outpatients in Mbarara municipality Methodology This was a retrospective cross-sectional study on records of RTI outpatients from 1st April 2019 to 31st March 2020 (prior to the novel corona virus disease pandemic) in four selected public health facilities within Mbarara municipality. A pretested data caption tool was used to capture prescribing patterns using WHO/INRUD prescribing indicators. We used logistic regression to determine factors associated to antibacterial prescribing. Results A total of 780 encounters were studied with adults (18-59 years) forming the largest proportion of age categories at (337, 43.15%) and more females (444, 56.85%) than men (337, 43.15%). The antibacterial prescribing rate was 77.6% (606) with Amoxicillin the most prescribed 80.4% (503). The prescribing pattern showed an average of 2.47 (sd 0.72) drugs per encounter and the percentage of encounters with injection at 1.5% (24). Drugs prescribed by generic (1557, 79%) and drugs prescribed from essential medicine list (1650, 84%) both not conforming to WHO/INRUD standard; an indicator of possible irrational prescribing. Female gender (adjusted odds ratio [aOR] = 1.51, 95% confidence interval [CI]: (1.06–2.16); 18–59 years age group (aOR = 1.66, 95% CI: 1.09–2.33) and Individuals prescribed at least three drugs were significantly more likely to have an antibacterial prescribed (aOR= 2.72, 95% CI: 1.86–3.98). Conclusion The study found a high antibacterial prescribing rate especially among patients with URTI, polypharmacy and non-conformity to both essential medicine list and generic name prescribing. This prescribing pattern does not comply with rational drug use policy and needs to be addressed through antimicrobial stewardship interventions, prescriber education on rational drug use and carrying out more research to determine the appropriateness of antibacterial prescribed.

Morbidity profile and prescription audits using WHO core prescribing indicator in government hospitals of Province 1, Nepal

Background: Periodic assessment of morbidity and drug use at various levels of healthcare delivery system is important to recognize common prevalent morbidities and rationalize the use of medicines. The study was conducted to determine the common morbidities and audit prescription using WHO prescribing indicator in government operated tertiary hospitals of eastern Nepal. Methods: A cross-sectional study was carried out in government tertiary hospitals of Province 1, Nepal, from March 2019 to August 2019. For analysis, descriptive statistics were used. Prescribing characteristics were evaluated using recommended guidelines of the World Health Organization (WHO) prescribing indicators. Results: Six hundred prescriptions were analyzed. The most prevalent morbidity was endocrine, nutrition & metabolic diseases (21.5%) followed by diseases of the respiratory system (19.8%), circulatory system (17.6%), and digestive system (12.8%). The most frequently encountered individual disease entity were hypertension (18.7%), diabetes (15.5%), acid peptic disorders (14%). A total of 2072 drugs were prescribed with an average of 3.45 (± 1.39) drugs per consultation. About 30.2% of prescriptions encountered contain at least one antibiotics, whereas injectable were prescribed in 1.8%. Only 3.9% of total medicines were prescribed in generic name and 31.7% of drug prescribed were from essential medicine list. Conclusion: Among the prescriptions evaluated, diseases of the endocrine, respiratory, cardiovascular, and gastrointestinal systems were the most common morbidities. Polypharmacy was prevalent to some extent whereas prescribing in generic and essential medicine list was poor relative to standard WHO recommendations. However, the overall prescribing of antibiotics and injection were found to be satisfactory.

Assessing variation among the national essential medicines lists of 21 high-income countries: a cross-sectional study

ObjectiveEssential medicines lists have been created and used globally in countries that range from low-income to high-income status. The aim of this paper is to compare the essential medicines list of high-income countries with each other, the WHO’s Model List of Essential Medicines and the lists of countries of other income statuses.DesignHigh-income countries were defined by World Bank classification. High-income essential medicines lists were assessed for medicine inclusion and were compared with the subset of high-income countries, the WHO’s Model List and 137 national essential medicines lists. Medicine lists were obtained from the Global Essential Medicines database. Countries were subdivided by income status, and the groups’ most common medicines were compared. Select medicines and medicine classes were assessed for inclusion among high-income country lists.ResultsThe 21 high-income countries identified were most like each other when compared with other lists. They were more like upper middle-income countries and least like low-income countries. There was significant variability in the number of medicines on each list. Less than half (48%) of high-income countries included a newer diabetes medicines in their list. Most countries (71%) included naloxone while every country including at least one opioid medicine. More than half of the lists (52%) included a medicine that has been globally withdrawn or banned.ConclusionEssential medicines lists of high-income countries are similar to each other, but significant variations in essential medicine list composition and specifically the number of medications included were noted. Effective medicines were left off several countries’ lists, and globally recalled medicines were included on over half the lists. Comparing the essential medicines lists of countries within the same income status category can provide a useful subset of lists for policymakers and essential medicine list creators to use when creating or maintaining their lists.

A STUDY AIMED TO INCREASE THE KNOWLEDGE ABOUT THE FIXED DOSE COMBINATIONS (FDC'S) AND IRRATIONAL FDC'S AVIALABLE IN INDIA.

Fixed dose combinations(FDC's) is a combination of 2 or more than 2 drugs in a single dosage formulations, it should not be confused with concomitant drug therapy which refers to taking 2 or more than 2 drugs separately. Fixed dose combinations may be rational or irrational. In India there are more FDC's than single drugs and majority of those FDC's are irrational. Many of these irrational FDC's are widely prescribed. The WHO essential medicine list incorporates only 23 FDC's while as the National list of essential medicines(NLEM) of 2011 has only 12 FDC's.

Prescription Pattern Analysis of Type II Diabetes Mellitus Inpatients and Associated Co-Morbidities

Background: The present study was planned to assess the prescription pattern analysis of Type II Diabetes Mellitus and associated co-morbidities. As per WHO, the worldwide prevalence of DM will reach 366 million by 2030. Evaluating drug prescription pattern is a major aspect of patient care, which is used as a measure of the quality of care provided. Objectives: Primary objectives of the study were to highlight the current prescription pattern trends in patients having diabetes mellitus with or without other co-morbid conditions, to ensure safety and rational use of prescribed regimen. And the secondary objectives of the study were to analyse the demographic information of the enrolled patients and also to identify and analyse the prescriptions with polypharmacy. Materials and Methods: A prospective observational study was conducted to analyse the prescribing pattern of anti-diabetic drugs. The study incorporated 100 Type II DM inpatients having comorbid conditions. The study has been conducted with the help of WHO prescribing indicator scale. It is used to analyse drug class, generic and branded drugs, fixed dose combination and dosage form. Patient data was collected and medical data records were analysed daily till discharge from hospital. Results: It was found that most of the drugs have been prescribed are purely from Karnataka Essential Medicine list (KEML). And percentages of medicines prescribed on their generic name were 76%. About 51% of patients were treated only with oral hypoglycemic agents. Whereas, 38% were treated with Insulin and 11% were treated with both oral hypoglycemic agents and Insulin. Conclusion: Improved rational use of prescription by using Essential Medicine List (EML).And also ensured the appropriateness of prescription by using WHO scale. Several Adverse Drug Reactions (ADR)have been reported and which leads to improved prescription pattern. Keywords: Type II Diabetes Mellitus, Prescribing Indicator, Co-Morbidities.

An evaluation of fixed dose combinations and it’s practices at medicine department of tertiary care hospital, Nepal

<p class="abstract"><strong>Background:</strong> A large proportion of fixed dose combinations (FDCs) are manufactured and used widely in Nepal. This study aimed to evaluate the FDCs and its utilization in medicine department of tertiary care hospital.</p><p class="abstract"><strong>Methods:</strong> A cross-sectional study was conducted for 50 days among admitted patients in the medicine department of tertiary care hospital, Nepal. A predesigned form was used to collect the data at the time of patient discharge. Only the oral FDCs were selected for study.<strong> </strong>Microsoft Excel 2007 was used for statistical analysis and data were presented as number and percentage in tabulated and figure forms. </p><p class="abstract"><strong>Results:</strong> Oral FDCs were used in 27.08% of admitted patients. A total of 295 FDCs were prescribed in 208 patients with 44 FDC items in 58 different brand names. Categorically, the most commonly used FDCs were of analgesics (34.24%) followed by antibiotics (25.76%) and vitamin supplements (22.71%). The 27.27% of FDCs prescribed contain more than two active pharmaceutical ingredients (APIs) up to nine and the highest number of APIs were found in vitamin supplements. All FDCs were prescribed in the brand names. The very few 2.27% and 4.55% of FDCs were prescribed from the essential medicine list of Nepal and world health organization, respectively.</p><p class="abstract"><strong>Conclusions:</strong> The use of FDCs listed in essential medicine list was very poor. Similarly, generic prescribing was also zero. The regulatory body must study the rationality of FDC before production, marketing, importing, and utilization in hospital.</p>

Outpatient prescription audit in a tertiary care hospital at Puducherry

Background: Rational use of medicines promotes good health practices and prevents inappropriate use of medicines, polypharmacy, unnecessary use of antimicrobials, injections, and also encourages use of medicines from essential medicine list and dispensing by generic names. The aim of the study was to analyze the outpatient prescriptions of a tertiary care centre by utilizing World Health Organization (WHO) core drug use prescribing indicators.Methods: A retrospective observational study was conducted in a tertiary care health setup at Puducherry, South India. Outpatient prescriptions from all the major clinical departments were analyzed using WHO prescribing indicators and they were compared with some similar studies.Results: The average number of drugs per prescription was 2.74. The percentage of prescriptions with antibiotics was 20.33% and the percentage of prescriptions with injections was 0.16%. The percentage of drugs prescribed by generic names and from essential medicine list was 83.13% and 87.9 respectively. Further antibiotic utilization was found to be higher in the department of ENT (56.67%), respiratory medicine (45%) and surgery (40%). Percentage of drugs prescribed by generic names in pediatrics and respiratory medicine were found to be 67.88% and 65.27% and percentage of drugs prescribed from essential medicine list in dermatology was 69.62%.Conclusions: Prescription pattern followed in our Institute almost adheres to the guidelines laid down by the WHO. Moreover, it is also implied that a routine audit of this type should be done in health care setups to ensure that they adhere to the WHO guidelines for better health care.

Interpretation of the changes in 2018 National Essential Medicine List (NEML) from the specialists

On 25 October 2018, National Essential Medicine List (NEML) of China was formally published by National Health Commission and it has been executed since 1 November. The new NEML, which includes 685 drugs with more than 1110 kinds of dosage forms and more than 1810 kinds of specifications, further standardizes dosage forms and specifications of drugs. The new catalog not only increases the number of categories, but also optimizes the structure of the drug list. It highlights the need for basic drugs in aspects of common diseases, chronic diseases, serious diseases and public health. Besides, the normalization of dosage forms and specifications, and the persistence of emphasizing the combination of Western and Chinese medicine are both the characteristics of it. This news report is composed of several parts including brief introduction of NEML, the difference between NEML and National Directory of Health Insurance (NDHI) which is likely to be confused with NEML, the dissection of the change of medicine varieties, relevant policies and potential issues of NEML. We intend to give a comprehensive interpretation of NEML from different perspectives.