FARMAKO EPIDEMIOLOGI

Drugs withdrawn from the market

Trovafloxacin, 19981998-2001, 14 cases of acute liver failure and six deaths Cerivastatin, 2001, 52 death (Fatal rhabdomyolisis and renal failure) Efalizumab, 2009, increased risk progressive leukoencephalopathy Rofecoxib (Vioxx), 2004, increased risk of myocardial infarction Rosiglitazone (avandia), 2010 (Europe (Europe) ) increased risk of heart attacks and death

Harus melakukan keputusan terapi

Ketidakyakinan terhadap value dari masing-masing opsi

Variasi terapi

WHO report (May 2010)

all medicines are prescribed, dispensed or sold inappropriately half of all patients fail to take medicines correctly

Overuse Underuse Misuse

IRRATIONAL USE OF DRUGS

Polypharmacy Incorrect drug(s) for specific indication(s): Steroid for sore throat Dose, route, frequency of treatment course: antibiotics for 3 days treatment Risk > benefit : corticosteroid for pharyngitis Expensive prescribing : cephalosporin for ARI

INAPROPRIATE USE OF DRUGS

1. No treatment is required 2. Wrong indications 3. Risk of adverse event > efficacy 4. Incorrect frequency & route of treatment 5. Expensive 6. Limited evidence of efficacy & safety 7. Affect patient perceptions on treatment

Rational use of medicine

Diagnosis

Follow up

Indication Drug(s)

Appropriate

Patients Information

Dose Dos e, route, treatment course

Many Factors Influence Use of Medicines

Prior KnowledgeIntrinsic

Information
Influence of Drug Industry

Scientific Information

Habits Social & Cultural Factors

Workload & Staffing

Treatment Choices
Infrastructure

Societal
Economic & Legal Factors Authority & Supervision

Workplac e

Relationships With Peers

Workgrou p