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 ("polypharmacy"); 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 selfmedication, often of prescription-only medicines; nonadherence 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 multidrug 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 diseases  Use 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. 2. 3. 4.

Identify the patients problem based on symptoms & recognize the need for action Diagnosis of the disease (define the diagnosis) List possible intervention or treatment (drug or no drug). Identify the drug 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 patients 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.

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