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Rational Use of Drugs

Haryana State Health Resource Centre. Rational Use of Drugs. Pharmaceutical Management Cycle. PRESCRIPTION LEVEL Use of Cap Amoxi + Clox - combination is irrational (Reasons-same class, no increase in spectrum and dose schedule is different)

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Rational Use of Drugs

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  1. Haryana State Health Resource Centre Rational Use of Drugs

  2. Pharmaceutical Management Cycle

  3. PRESCRIPTION LEVEL Use of Cap Amoxi+ Clox- combination is irrational (Reasons-same class, no increase in spectrum and dose schedule is different) Annual Consumption in 2010-11 is Rs 49.66 Lacs (5th largest ). Ciplox 500mg is the topmost Antibiotic (Rs74.6 lacs) on verge of developing resistance. Levoflox should not be used indiscriminately in chest infections as it is a 2nd line ATT Instances of irrational use

  4. DISPENSING LEVEL Use of Tinidazole 300mg is used while 500mg has nil consumption (Taken from monthly drug consumption report) (300mg is inadequate dose for adult patients) Substitution of doctor’s prescription Substitution of Nimuslide with Diclofinac/Brufen which can cause Angiodema in prone patients Instances of irrational use

  5. PATIENT LEVEL Iron causes gastric irritation and change in stool color Metronidazole causes taste alteration This can reduce compliance and may lead to incomplete treatment Simply giving information of common side effects can improve compliance and better treatment outcome Instances of irrational use

  6. Poly pharmacy Misuse of antibiotics Overuse of injections Under-use of drugs for chronic illnesses like HT, Epilepsy, Depression, BA,COPD Examples of Irrational Use

  7. Problems: • Ineffective treatment • Increased financial burden • Wastage of resources • Side effects of drugs leading to increase in disease burden • Drug resistance especially antibiotic resistance (public health problem) • e.g. Amoxicillin & Cloxacillin (as described earlier) Why Rational Use of Medicines?

  8. The rational use of medicines requires that patients receive medicines 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 the community (WHO 1988) What is Rational Use of Medicines?

  9. Essential Medicine List (EML) Drug Formulary Standard Treatment Guidelines Trainings to doctors and paramedical staff Prescription Audit Drug Utilization Studies TOOLS TO PROMOTE RDU

  10. Preparation of Standard Treatment Guidelines (STGs) • Updating the Essential Medical List based on the STGs • Preparation of Drug Formulary • Prescription Audit & Drug use studies STEPS TOWARDS RDU

  11. “Systematically developed statements to help practitioners or prescribers make decision about appropriate treatments for specific clinical conditions.” Standard Treatment Guidelines

  12. Pt Level : Optimal drug treatment • Prescriber Level: Guidance to prescribers • Policy Level: • Revision of EML • Demand estimation • Per capita consumption  • Budget allocations • Rationalize Procurement of drugs Advantages of STGs

  13. Workshop was held on RDU & STGs • Specialists from each specialty from all distt. • Sensitized about need of RDU & STGs • STGs of Haryana state based on local disease profile • Formation of a State Level Committee headed by The DGHS is being formed. • Civil Surgeons should ensure maximum feed back to this committee so that STG is a made with participation of all as full participation will help in proper implementation Drafting of STG

  14. A tool for monitoring and evaluation of drug management system Availability & Use of drugs Rational / irrational Why ,Why, Why, Why, Why to get to the bottom Not fault finding exercise Hand holding at each level (Prescriber, dispenser and patient) Prescription Audit

  15. THANK YOU

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