Rational Drug Use

By Dr Herbert Kayiga

Definition

Rational use means prescribing right drug, in adequate dose for the sufficient duration & appropriate to the clinical needs of the patient at lowest cost

WHO: The rational use of drugs requires that patients receive medications 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 their community

Definition

Correct drug Appropriate indication Appropriate drug considering efficacy, safety, suitability for the patient, and cost Appropriate dosage, administration, duration

No contraindications Correct dispensing, including appropriate information for patients Patient adherence to treatment

Global Problem

Irrational use of medicines is a major problem worldwide.

WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly.

Global Problem

The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards.

Examples of irrational use of medicines include:1. use of too many medicines per patient ("poly-

pharmacy"); 2. inappropriate use of antimicrobials, 3. often in inadequate dosage, 4. over-use of injections when oral formulations would

be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication, often of prescription-only medicines; non-adherence to dosing regimes

Global Problem

5. over-use of injections when oral formulations would be more appropriate;

6. failure to prescribe in accordance with clinical guidelines

7. inappropriate self-medication, often of prescription-only medicines

8. non-adherence to dosing regimen

Why rational Drug Use

Drug explosion Efforts to prevent the development of resistance Growing awareness

Increased cost of the treatment Consumer protection Act. (CPA)

Reasons for Irrational Use of Drugs

Lack of information Faulty & inadequate training & education of

medical graduates Role models Teachers or seniors Lack of diagnostic

facilities Uncertainty of diagnosis medicine for all possible causes Demand from the patient

Reasons For Irrational Drug Use

Prompt and quick action Patient load Promotional activities of pharmaceutical

industries Poor communication between health

professional & patient Drug promotion exaggerated claim by companies Defective drug supply system &

ineffective drug regulation

Hazards Of Irrational Drug Use

Ineffective & unsafe treatment over-treatment of mild illness inadequate treatment of serious illness Exacerbation or prolongation of illness Distress & harm to patient Increase the cost of treatment

Hazards Of Irrational Drug Use

Increased drug resistance – misuse of anti-infective drugs Increased Adverse Drug Events Increased morbidity and mortality Loss of patients confidence to doctor

Overuse and misuse of Antimicrobial Drugs

resistance Malaria choroquine resistance Tuberculosis primary multi-

drug resistance Gonorrhea penicillin resistance in N.

gonorrhea Pneumonia and bacterial meningitis

penicillin resistance in S. pneumonia Diarrhea: shigellosis resistance

Absolute Irrational Use of Drugs

Injudicious use of antimicrobials: Antibiotics in Viral fever and diarrhea Unnecessary combinations:Tinidazole

and ciprofloxacin in diarrhoeal diseasesUse of drugs not related to diagnosis Incorrect route Incorrect dosing

Absolute Irrational Use of Drugs

under or overdose Incorrect duration prolong or short term use Unnecessary use of expensive

medicines Unsafe use of corticosteroids Polypharmacy

Steps of Rational Drug Use

1. Identify the patient’s problem based on symptoms & recognize the need for action

2. Diagnosis of the disease (define the diagnosis)

3. List possible intervention or treatment (drug or no drug). Identify the drug

4. Start the treatment by writing an accurate & complete prescription e.g. name of drugs with dosage forms, dosage schedule & total duration of the treatment

 

Steps of Rational Drug Use

5. Given proper information instruction & warning regarding the treatment given

e.g. side effects (ADR), dosage schedule dangers/risk of stopping the therapy

suddenly

Steps of Rational Drug Use

6. Monitor the treatment to check, if the particular treatment has solved the patient’s problem.

Passive monitoring done by the patient himself.

Explain him what to do if the treatment is not effective or if too many side effect occurs

Active monitoring - done by physician and he make an appointment to check the response of the treatment

Instruction to the Patients

Effects of the Drug Adverse effects Instructions Precautions to be taken

Warning (Disulfiram Reaction): Symptoms: flushing of the skin

accelerated heart rate shortness of breathe nausea, vomiting, throbbing headache visual disturbance mental confusion, postural fainting and circulatory collapse

12 Key interventions to promote more rational Use by WHO

Establishment of a multidisciplinary national body to coordinate policies on medicine use

Use of clinical guidelines Development and use of national essential medicines list Establishment of drug and therapeutics committees in

districts and hospitals Inclusion of problem-based pharmacotherapy training in

undergraduate curricula Continuing in-service medical education as a licensure

requirement

12 Key interventions to promote more rational Use by WHO

Supervision, audit and feedback Use of independent information on medicines Public education about medicines Avoidance of perverse financial incentives Use of appropriate and enforced regulation Sufficient government expenditure to ensure

availability of medicines and staff.

THANK YOU