“An Overview of Prescription Pattern of Antibiotic among the Different Specialist

A DISSERTATION SUBMITTED TO THE DEPARTMENT OF PHARMACY, DAFFODIL INTERNATIONAL UNIVERSITY IN PARTIAL FULFILLMENT OF. SAIFUL ISLAM in the Department of Pharmacy, Daffodil International University, has been accepted as satisfactory for the partial fulfillment of the requirements for the degree of Master of Pharmacy. The authentic record of original research work was conducted by MD. SAIFUL ISLAM, ID M.Pharm of the Department of Pharmacy, Faculty of Allied Health Science, Daffodil International University, stated here that the project report titled “A Review of Prescription Pattern of Antibiotics among the Various Specialist Doctors in Faridpur City”, by submitted by me to the Department of Pharmacy, Daffodil International University in partial fulfillment of the requirement for the degree of Master of Pharmacy is a true and authentic record of original research work carried out by me under the supervision and guidance of MD.

MIZANUR RAHMAN, Adjunct Faculty, Department of Pharmacy, Daffodil International University and it has not formed the basis of any other degree/diploma or other similar title for any candidate for any other academic award anywhere before. I would like to extend my sincere regards and deep gratitude to my honorable supervisor Md Mizanur Rahman, Adjunct Faculty, Department of Pharmacy, Daffodil International University.

DISCUSSION

ABSTRACT

INTRODUCTION

Health Care System in Bangladesh
Disease Pattern in Bangladesh
Prescription pattern in Bangladesh
Standard prescribing indicators
Rational use of drugs
Irrational use of drugs

Impact of Irrational use of Drugs
Reasons for irrational use of drug 1. Lack of information –

It has long been stated and reaffirmed that the prescription section is the heart of the medication store. This is true, but it is not only the heart of the medication store; it is also the backbone of retail pharmacy [1]. In Bangladesh, most of the country's population lives in rural areas, while the bulk of wellness professionals work in urban focus.

The World Bank estimates that Bangladesh ranks first in the world in the number of children suffering from malnutrition. There are differences between drug regulatory authorities and pharmaceutical companies in the interpretation of data regarding drug safety and indications.

Figure 1: Rational use of drug (Juxtaglomerular, 2014)

Poor conversation between patient & health professional –

Faulty and inadequate education and training of medical graduates – During training period writing a prescription dependency on diagnostic aid, rather

Lack of diagnostic facilities –

Patient demand –

Defective drug supply system and ineffective drug regulation –

Pharmaceutical promotional activities –

Patients and community level irrational use of drugs –
Antibiotics

Mechanism of action of different antibiotics
Rational use of antibiotic
Consequences of irrational use of Antibiotics
National policies to improve use of antibiotics
Issues related to irrational use antibiotic

Essential drugs and medicines

Essential drug list of Antibiotic Serial no Name of Drug

Aims of the study
Objectives of the study

Irrational use of medications can harm patients in terms of poor outcomes, unnecessary side effects, and waste of resources that patients often pay out of pocket. The irrational use of antibiotics is particularly serious because it contributes to antimicrobial resistance, which is rapidly increasing worldwide and causes significant morbidity and mortality and millions of dollars in additional health care costs annually [18]. One of our most cost-effective health care interventions is medicine, where the most effective therapeutic classes of drugs are antibiotics, and antibiotic use is only monitored in some low- and middle-income countries.

For the irrational use of antibiotics, there is now enough evidence of widespread along with under-implementation of effective interventions and policies to promote rational use of antibiotics [20]. First, the promotion of rational use of drugs and containing antimicrobial resistance, the health care systems of many nations are not. In contrast, the modern rich countries have invested in national monitoring of antibiotic use and to promote rational use of antibiotics conducting nationwide campaigns.

Fifth, while there is a lot of thought in the public sector on how to improve the use of medicines, very little thought is given at the national level on how to promote rational use, with the informal sectors and the private sector be involved, especially in countries that do not have the resources. to finance huge government bureaucracies [20]. Proper antibiotic treatment is now delayed, which increases the risk of complications and severity and forces the use of antibiotics to more vigorous and expensive use. This is increased antibiotic resistance due to inappropriate use of antibiotics (as antibiotics have little effect on viruses) [23].

Improving the use of medicines The Second International Conference noted that the continued irrational use of medicines and the implementation of interventions was relatively absent. Therefore, they recommended that to monitor drug use, countries should implement national programs and coordinate the implementation of interventions, targeting both the public and private sectors at multiple levels of the health care system, to improve antibiotic use. The WHO recommends encouraging the appropriate use of medicines, but it is clear that many countries are not implementing many basic policies. Although it may appear that between 2003 and 2007 the number of countries implementing policies increased, caution should be exercised in interpreting the figures, especially for the SEA region, as the sample is of very small size and different years in different countries was responded.

Careful selection of a limited number of essential medicines results in higher quality of care for patients, better management and use of medicines and more cost-effective use of healthcare resources. Clinical guidelines and lists of essential medicines can improve the availability and appropriate use of medicines within healthcare systems (WHO, 2012). Most countries have national lists and some also have provincial or state lists.

Figure 3: Mechanism of action of different antibiotics 1.7.2 Irrational uses of antibiotics

METHOD

Selection of the area
Sampling design
Inclusion Criteria
Study Population
Data processing and graphical representation
Materials

It refers to the technique of procedure that the researchers would employ in selecting items for the sample. In this study, prescriptions are collected from both outside and inside patients in the hospital. The information related to the prescription of medications for a specific condition of which a specific disease is recognized.

In my study, both pediatric and geriatric patients were included and the prescription that has a significant impact on. Finally, all the collected raw data is processed and presented to various aspects by MS-Excel.

RESULTS

Analyzing the prescriptions

Out of the total 250 prescriptions I found that 68% of the total prescription containing ENT disorder and the number of prescription 170 out of 250, 16% of the total prescription containing orthopedic disorder and the number of prescription 40 out of 250 and the rest of 40 prescription meaning 16% prescription of other disorders (Table 3). It was observed that the medication for all these common infections involved antibiotics along with other drugs.

Table 3: Proportion of prescription containing different diseases from the total 250 prescription

Frequency (%)

Generic name vs. brand name

Figure 6 below shows that drugs are mainly introduced under their brand names and constitute antibiotics because most of our doctors mentioned the brand name instead of the generic name when prescribing antibiotics. It was found that antibiotics such as Clavusef, Cefotil, Xiclav, Ceftid, Cef-3, Levox, Zemicef, Ximeceff, Amoxicillin, Levofloxacin, Cefradine, Tocef, etc. On the other hand, antibiotics including Beuflox-D (Ciprofloxacin) Eye/Ear In most ENT patients, drops were used simultaneously.

Percentage (%) of different generic of Antibiotic

DISCUSSION

A prescription given by a physician or physician is taken as an indication of the physician's or physician's attitude toward disease and the role of drugs in its treatment [30]. The central priority of the health care system is to provide the right medicines to patients. the right people at the right time [31]. The source of data for the present survey included prescriptions of patients suffering from orthopedic disorder, ENT related infectious diseases and others which were collected from Orthopaedics, ENT and other departments of hospitals in Faridpur city. The percentages of male and female patients were 62.80% and 37.20% as shown in (Table 2) where the majority of patients were male.

Similar results were obtained from the previous study which was conducted by Khan et al. The current observation noted that the medication for all common ENT infections, orthopedic disorders and other disorders involved antibiotics along with other drugs. The study reported that 73.60% prescription contained antibiotics, and almost all prescriptions (100%) contained antibiotics along with other drugs (Figure 9).

41.85% of cases contained a single antibiotic, 58.15% contained two antibiotics and no prescription contained more than two antibiotics, as shown in (Table 7). On the other hand, 78.80% of prescriptions contained antiulcer drugs, 47.20% contained NSAIDs, 38.40% contained vitamin/calcium/iron supplements, and 16.80% contained antihistamines (Table 6). Most prescribed medications were administered orally, which was found to be similar to previous research from 2015 evaluating 855 prescriptions by SRTR Government Medical, Maharashtra, India [46].

In our current study, most of the drugs (93%) were prescribed by brand name, which coincides with the report from a survey conducted in a previous study [ 46 , 47 ]. A total of 291 antibiotics were detected in 184 prescriptions, among which the most frequently prescribed antibiotics were those belonging to the β-lactam class (cefuroxime, cefixime). In addition, the prescription of cefixime 17.87%, ciprofloxacin 16.49%, levofloxacin 11.68%, flucloxacillin 9.62%, amoxicillin 7.90%, cefpodoxime 2.75%, cephradine 2.40% and other generic antibiotics 8.25% and Opsoninpharma Ltd 24.74%. % is the largest seller of antibiotics followed by Square pharmaceutical limited 19.24%, Popular pharmaceutical Ltd 18.21%, Beximco pharmaceutical limited 12.71%, Incepta pharmaceutical limited 8.59% and remaining 16.50% antibiotics prescribed by other a pharmaceutical company.

CONCLUSION

Risk perception of prescription drugs: report on a survey in Canada, Canadian Journal of Public Health, Vol. World Health Organization (2002) 'Promoting the rational use of medicines: core components: WHO policy perspectives on medicine. Research into the pattern and costs of drug use. Investigating drug use pattern and cost efficiency in Upazilla. Health efficiency in Upazilla healthcare complexes in Bangladesh.

Prescribing pattern of drug and antimicrobial preferences in the ENT department of the tertiary care SGM. Antimicrobial prescribing patterns in the otolaryngology department of a tertiary care teaching hospital. Patient usage pattern of antibacterial agents used in outpatient and inpatient ear, nose and throat departments of a university hospital in New Delhi, India.

A survey on prescribing of antibiotics for upper respiratory tract infections by general practitioners in rural areas of Assam. A Study of Prescription Patterns in Drug Treatment of Ear, Nose and Throat Infections in a Tertiary Hospital in Mangalore. Professional practice and perception towards the rational use of medicines according to the WHO methodology in the United Arab Emirates.

Pattern of drug use in the ear, nose and throat clinic of a rural tertiary care hospital. Antibiotic prescription for adults with upper respiratory tract infection and acute bronchitis at King Chulalongkorn Memorial Hospital, Thailand. A study of rationality and pattern of antimicrobial use in the ear, nose and throat clinic of a tertiary care hospital, Nanded.