Literature review :
Lourdu jafrin , Venkata Naveen Kumar .P, Udaya laxmi .T Jayapriya. B et.al performed a 2 months cross-sectional, Unicentric observational study titled “drug utilization pattern of geriatric patients in the medical department of tertiary care hospital” and it was published in international journal of pharmacy and life sciences in 2013. This research has shown the chronic nature of diseases affecting the geriatric population most commonly the respiratory diseases and rightly increasing the trend of deriphyllin drug utilization.
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Vandana A badar, Sanjay Kumar. B navale performed a prospective study for a period of 6 months from may 2010 – dec 2010 titled “study of prescribing pattern of anti microbial agents in medicine ICU of a teaching hospital in central India” and was published in JAPI , April 2012.the main objective of the study is to evaluate the utilization of anti- microbials. They found that infection was the major reason for the usage of anti – microbial therapy .Author revealed that the drug cefotaxime was most commonly used in MICU by about 32% followed by metronidazole 24% , ampicillin 17- 29%. Study also showed the rationality of drug usage by about 30% which was evaluated by analysing the prescriptions. From this study authors concluded that the medical fraternity needs to understand the importance of antibiotics. An international programme may be a useful initiative to reduce antibiotic use.
Prakash katakam , Abdul baset A. Elfituri, Zaidoon H. Ramadoan , Osama g. Abadi performed a cross- sectional retrospective study for a period of 15 months in Libya titled “ A retrospective study on antibiotic use in different clinical departments of a teaching hospital in zawiya , Libya” and it was published in Ibnosina journal of medicine and biomedical sciences in 2012. An interesting observation was that increase in the antibiotic consumption which was expressed as DDD/ 10000 inhabitants / day especially AMOX (Amoxicillin+ Clavulanicacid) had been observed from 2008-2009 when compared to other antibiotics rightly for the indication of respiratory diseases. Study reveals that out of 100 subjects only 6 have undergone microbial culture investigations. From this study authors conclude that before initiation of the treatment, a vital need for microbial investigation is essential.
Jeevangi. SR, Patil. RB, Manjunath et al. performed a 15 months prospective cross-sectional study in Gulbarga titled “ drug utilization study in a trauma care unit of a tertiary care hospital “ and it was published in journal of clinical and diagnostic research in 2010. In his study the author used the who drug use indicator i.e.., prescribing indicator which can be known by calculating the average number of drugs per encounter and observed that newer anti- microbial and proton pump inhibitors are prescribed more. The study reveals that poly pharmacy was found to be high and the generic is low. An increase in the number of drugs per prescription in the TCU was gradually increased from the day of admission when compared to previous records. The study concluded that usage of drugs in TCU were in accordance with standard treatment guidelines. Hence the authors reveals that by the results of the study there is a considerable scope for improving the prescribing habits according to rational drug use.
Sahar I, Al. Niemat, Diana T.bloukh, Manal D. Al. Harasis et.al performed a retrospective study for a period of 3 months from May 2007- July 2007 in 5 hospital centres in KHMC titled” drug use evaluation of antibiotics prescribed in a Jordanian hospital out- patient and emergency clinics using who prescribing indicators” and it was published in Saudi med J 2008. The authors used the who prescribing indicators for the evaluation of prescriptions taken from the out patients settings. The study reveals that the share of antibiotics was more when compared with the total number of encounters surveyed. Also states that the antibiotic categories rightly penicillins( especially amoxicillin) and quinolones ( especially ciprofloxacil, norfloxacin) were prescribed. He authors conclude that the prescribing pattern of antibiotics was very high . so requirement of continuing medical education programme may be needed.
Hillary o. Odo, Sunday o.Olotu , Imafidon o.Agbonile, Peter o.esan , Bawa o. James performed a retrospective descriptive study from a review of out- patient prescriptions between sept 2007and Aug 2012 in a regional psychiatric hospital, Nigeria” and it was published in Archives of pharmacy practice in 2013. DDD/ 1000 inhabitants/day was calculated to evaluate the pattern of drug utilization. The results of the study showed that the drug Halopridol accounted the highest drug utilization with a DDD /100inhabitants / day of 5 followed by amitriptylline, benhexol , trifluperazine. The authors concluded that the prescribing pattern of antibiotics were not in accordance with the who guidelines and observation of polypharmacy either haloperidol accounts more often.
Praveen KG, Arun K performed a prospective study for a period of 6 months in a tertiary care hospital titled “ drug utilization and evaluation of HMG- co A reductase inhibitors in tertiary care hospital “ and it was published in Indian journal of pharmacy practice in 2013. The study used the methodology of DDD/12 bed days to evaluate the drug utilization of statins. Present study shown that statins are more prescribed for various indications like primary and secondary prevention of cardiovascular and cerebrovascular complications, dyslipidemia and hypertriglyceridemia. The authors from the study concluded that dosage units for atorvastatin were nearer to the who recommended dose where as variation is observed in case of simvastatin and rosuvastatin.
Sutharson L, Hariharan R.S, Vamsadhara C performed a 4 months prospective cross- sectional study in a tertiary hospital , Chennai titled “ drug utilization study in a diabetalogy out –patient setting of a tertiary hospital” and it was published in Indian journal of pharmacology in 2003. Who drug use indicators and DDD were used in the methodology to evaluate the drug utilization. The study reveals that more utilization of sulfonyl ureas was observed when compared to biguanides. The authors concluded that the total number of drugs prescribed in generic is high and incidence of polypharmacy is low. Hence some of the interventional measures may be vital in promoting the patient education and knowledge .
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James M Hutchinson, David M Patrick , Fawziah Marra et al . presented a paper titled “ measurement of antibiotic consumption: A Practical guide to the use of the ATC and DDD system methodology in Canada “ and it was published in Can J Infect Dis in 2004. The presented paper provides a practical advice on the use of ATC and DDD classification system for evaluating the prescribing pattern of antibiotics. The authors concluded that initiation of drug utilization documentation procedure may stimulate interest in measurement and display of antibiotic consumption.
Hamdi Sozen, Ibak gonen, Ayse Sozen et al. Performed a point prevalence study on july 19 , 2011 in a general hospital , turkey titled “ Application of ATC and DDD methodology to evaluate antibiotic use in a general hospital in turkey “ and it was published in Annals of clinical microbiology and anti microbials in 2013. The results of the study showed that the rational use of antibiotics were identified with appropriate indication for prophylaxis and treatment. The authors concluded that the hospitals should implement their own principles of antibiotic use to decrease the microbial resistance and economic consequences too.
Mahendra K Patel , Manish J Barvaliya , Tejas K patel , CB Tripathi performed a retrospective study between 2008 and dec2010 in takhtsinhji general hospital , Bhavnagar, Gujarat, India titled “ drug utilization pattern in critical care unit in a tertiary care teaching hospital in india” and it was published in International Journal of critical illness and injury science in 2013. The case papers were analyzed for demographic variables, indications, duration of critical care unit stay and usage of anti – microbials were evaluated based on culture report. In the study DDD/100 bed days were calculated to evaluate the drug utilization and also cost of the drugs from Indian drug review (2010). The study results showed DDD/100 bed days was more in case of total drug utilization in the anti- microbials which were prescribed without culture report , more economic burden is seen in expired patients and incidence of polypharmacy is a major problem in ccu.
Shankar PR, upadhyay DK, Subish P, Bhandari RB, Das B performed an observational study from a period of June2005-May 2006 in a teaching hospital in western Nepal titled “ Drug utilization among older patients in a teaching hospital in western hospital” and it was published in Singapore Med J in 2010. The author uses the drug use indicator DDD/ 100 bed days. For the evaluation of drug use in the hospital. In the present study basic demographic information of older patients , microbial report, drug utilization pattern and cost of the drugs were included. The study reveals that average number of drugs consumed by each patient was tends to be high i.e.., (7.73). The authors concluded that incidence of parenteral formulations arises a common problem. Authors also suggested that there must be an initiation of guidelines for the usage of drugs in elderly patients.
Khavane.K, Addepalli.V, Bhusare.K,Payghan S.A, Patweakar.S,Kate.V performed a 6 months prospective study at the saifee hospital , charni road , Mumbai titled “ prescribing patterns of antibiotics and sensitivity patterns of micro –organisms towards different antibiotics in multi disciplinary health care hospital “ and it was published in International Journal of pharmaceutical and biological archives in 2010. The study was carried over by collecting the patient demographic details, antibiotic information, microbial culture sensitivity test .The present study showed the process of interpretation of results. The authors concluded that there must be requirement of formulation of a policy for antibiotic use, obtaining the culture and sensitivity reports must be quickened, avoidance of continued or over usage of antibiotic for a longer period of time.
Patil P.H, Kuchake V.G, KumarAjay, Dighore Pitambar,Surana S.J performed a 5 months prospective study in inpatient department of tertiary care hospital titled “ evaluation of drug utilization especially anti- microbial agents in inpatient department of tertiary care hospital “ and it was published in International Journal of community pharmacy in 2009.In the present study patient demographic information, antibiotic consumption for empirical and surgical prophylaxis , microbial culture reports were included and the data were analyzed in a simple percentage manner. Based on the results authors concluded that more number of prescriptions containing antibiotics were observed and there are no gold standard methods for the usage of antibiotics. Authors also suggested that an antibiotic order form must be prepared and implemented for achieving the rational use of drug .
Ulla-Maija Rautakorpi, Soija Huikko, Pekka Honkanen et.al.. performed a 5 year follow up study titled “ The anti- microbial treatment strategies (MIKSTRA) program: A 5yr follow up of infection – specific antibiotic use in primary health care and the effect of implantation of treatment guidelines ”and it published in clinical infectious diseases in 2006. In the present study data were collected from various health care centres and the national guidelines were published during the study period. Initiation of interventional programmes were done by the local trainers. Based on the results concluded that because of multifaceted intervention, a qualitative improvement in the drug use is observed.
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