Irrational use of medicines fuels the emergence of drug-resistant microbes………

New Delhi :The irrational use of medicines fuel the emergence of drug-resistant microbes, increase treatment costs and expose patients to side effects of drugs they don’t need.

An audit of prescriptions has found that one in 10 medical prescriptions by doctors in some of the nation’s
top teaching hospitals has exposed patients to enhanced risks of increased drug costs, antimicrobial resistance.

Researchers who conducted the audit have found that 475 (9.9 per cent) of 4,838 prescriptions from 13 hospitals across India contained “unacceptable deviations” from standard treatment guidelines (STGs) that could potentially expose patients to such risks.
Among the 4,838 prescriptions, the researchers found 2,667 (55 per cent) adhered to STGs and another 1,698 (35 per cent) contained acceptable deviations from STGs but did not pose any additional risks or costs to patients.

According to the recent study published in the Indian Journal of Medical Research it is important to capture real-life examples of inappropriate prescriptions and their potential consequences and use such examples to improve prescribing practices.
As per the study, it identified pantoprazole, azithromycin, amoxicillin- clavulanate, serratiopeptidase and trypsin among the most common inappropriately prescribed medicines.

Pantoprazole is used for gastroesophageal reflux disorder or stomach ulcers, amoxicillin- clavulanate and azithromycin are antibiotics, and trypsin and serratiopeptidase are prescribed to fight inflammation.

The researchers of the study classified prescriptions as containing unacceptable deviations if they listed a medicine, dose, frequency, or duration inconsistent with STGs and could expose patients to enhanced risks of lack of response, extra treatment cost, adverse drug reaction, or antimicrobial resistance.
The ICMR and the Union health ministry have published STGs for many common health disorders. In the absence of ICMR STGs for specific disorders, the researchers compared prescriptions with treatment guidelines from national or international professional medical bodies.

Upper respiratory tract infections (URTIs), high blood pressure, osteoarthritis, diabetes, and malaria were the top five health disorders with unacceptable deviations in their prescriptions .

For instance, 35 prescriptions for URTIs listed combinations of medicines intended for gastric disorders (rabeprazole+ domperidone) and asthma or bronchial illness (montelukast+ levocetirizine). Both these combinations would increase the treatment cost but may not be needed by patients.

The study has corroborated anecdotal suggestions that doctors often prescribe medicines to address anticipated side effects of other drugs that the patients require.

The researchers have cited 54 prescriptions that included the anti-ulcer agent pantoprazole — alongside antibiotics or anti-hypertension medications, even though it wasn’t required.

For conducting the above mentioned study clinical pharmacologists worked alongside physicians in each participating hospital to evaluate the prescriptions, intercepting patients exiting the hospitals’ outpatient departments across different medical specialities.

The hospitals that participated in this study are KEM Hospital, Mumbai, All India Institute of Medical Sciences, New Delhi; Safdarjung Hospital, New Delhi; the Institute of Postgraduate Medical Education and Research, Calcutta; Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry; and Christian Medical College, Vellore, among other hospitals in Ahmedabad, Baroda, Bhopal, Ludhiana, and Noida._ _______________________________________________________

*Dr. Naresh Purohit-MD, DNB, DIH, MHA, MRCP(UK), is an Epidemiologist, Advisor-National Communicable Disease Control Program of Govt. of India, Madhya Pradesh and several state organizations.)

Dr.  Purohit is also Principal Investigator for the Association of Studies For Kidney Care.