European Journal of Cardiovascular Medicine

Study of prescriptions reveals the drug utilization pattern in a given hospital at a given time. This information may then be compared with data from other hospitals to look for variations. The data may also be compared with earlier studies to look for any changes in the pattern of drug use over the years.

Drug utilization research is an important tool to analyze the use of drugs with special emphasis on medical, social and economic consequences in a society.¹ Many hurdles in pharmacotherapy such as adverse drug reactions and drug interactions can be reduced by periodic evaluation of drug utilization patterns.²

Drug utilization studies are continuing programmes that review, analyze and interpret the pattern of drug use.³ These studies are also helpful to suggest modifications, if necessary, in the prescribing behavior of medical practitioners to make medical care rational and cost effective.⁴

This study was conducted to observe and analyze the prescribing pattern of drugs for the in-patients in the general medicine department of a teaching hospital.

This was a prospective observational study conducted at Department of Pharmacology, in association with Department of general medicine of a tertiary care teaching hospital Santosh Medical College & Hospital, Ghaziabad. A total of 234 prescriptions were analyzed. In-patients of general medicine department, of both sex and any age were included in this study. Data was collected from the case sheets of the patients and documented in a predesigned case record form. Demographic data like age and sex were noted. The clinical data comprising diagnosis, name of the drugs and their route of administration were recorded.

The data thus obtained was analyzed to arrive at the WHO core prescribing indicators and patient indicators as mentioned below.

WHO core prescribing indicators:

1. Average number of drugs per prescription
2. Percentage of drugs prescribed by generic names
3. Number of prescriptions with an antibiotic
4. Number of prescriptions with an injection
5. Number of drugs prescribed from the national list of essential medicines (NLEM)

Patient indicators:

1. Total number of male and female patients
2. Average age of male and female patients The national list of essential medicines⁵ 2015 (India) was accessed on 23 September 2016 from the website: http://cdsco.nic.in/WriteReadData/NLEM2015/NLEM,%202015.pdf

Table 1: Prescribing indicators.

Table 2: WHO core indicators assessing drug prescription

This study showed a large percentage of drugs given by injection (45.67%) (Table 1). The number of drugs per prescription varied from a minimum of 3 to a maximum of 13. Most of the prescriptions (88.46%) had one or more antimicrobials (Table 2). Cefoperazone+sulbactam combination was the most commonly prescribed among the antimicrobials (Table 5). Metronidazole, doxycycline, ofloxacin, amoxicillin+clavulanate and ceftriaxone were the other commonly prescribed antimicrobials. Paracetamol was found in 65 prescriptions. It was prescribed to reduce fever and also to reduce pain.

Table 3: Patient indicator

Table 4: Drug classes commonly prescribed.

Table 5: Frequency of prescription of drugs.

Gastroprotective agents such as pantoprazole, sucralfate and ranitidine were found in almost every prescription (Table 5). This study has shown that racecadotril, an enkephalinase inhibitor, is being increasingly used as an anti-diarrheal drug. Among the cardiovascular drugs, metoprolol and carvedilol were the frequently prescribed beta-blockers. Hypolipidemic drug atorvastatin was found in 33 prescriptions. Anti-platelet agents including aspirin and clopidogrel were found in 37 out of the 234 prescriptions studied (Table 5). Telmisartan followed by amlodipine were the commonly prescribed anti-hypertensives.

Diuretics, vitamins, laxatives, anti-diabetic agents and corticosteroids were the other commonly prescribed drugs in this study (Table 5). The detailed results are shown in the tables below.

Pantoprazole was found in most (88%) of the prescriptions (Table 5). This could be to prevent stress ulcers in acute illnesses and to reduce gastric irritation by drugs. Ondansetron was the second most frequent drug prescribed, even in the absence of vomiting/nausea. This was probably to prevent vomiting due to gastric irritation by drugs. However, further analysis and debate are needed to see whether the frequent use of these drugs is rational.

Antimicrobials were the commonest class of drugs prescribed in this study (Table 2, Table 4). This is similar to the data from other studies.^6,7 Among the antimicrobials, third generation cephalosporins were most commonly prescribed. Other studies^6,8,9,10 had similar findings. Cefoperazone plus sulbactam combination was the most frequent. Other antimicrobials frequently used in this study were metronidazole, doxycycline, ofloxacin and amoxicillin+ clavulanate (Table 5).

Assessment of WHO core indicators of drug prescription (Table 2) showed that all the prescriptions in this study had injectable drugs. This is understandable as the present study included only inpatients. The number of drugs prescribed from the national list of essential medicines (NLEM) was 75.97% which is a positive trend.

Only 3% of the drugs were prescribed by generic names. This highlights the need for a sustained campaign to make doctors prescribe more of generic drugs.

 Prescription of pantoprazole and ondansetron was found to be very frequent in this study. Antimicrobials were found in most of the prescriptions. Cephalosporins, metronidazole, doxycycline, ofloxacin and amoxicillin+clavulanate accounted for most of the antimicrobials.

All the prescriptions in this study had injectable drugs. Three-fourths of the drugs were from the national list of essential medicines (NLEM). Generic drugs need to be prescribed more.

1. World Health Organization. Introduction to drug utilization research. Oslo: World Health Organization; 2003.
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