RATIONAL AND IRRATIONAL USE OF DRUGS

What is rational use of drugs ?

What does rational means ?

WHO definition of RUD is :

"Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community"

These requirements will be fulfilled if the process of prescribing is appropriately followed.

This includes :

* Steps in defining patients problems (or diagnosis).

* In defining effective and safe treatments (drugs and non drugs)

* In selecting appropriate drugs, dosage and duration.

* In writing a prescription.

* In giving patients adequate information.

* In planning to evaluate treatment responses.

The rational prescribing should meet the following criteria:

* Appropriate indications:

The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment.

* Appropriate Drug:

The selection of drugs is based on efficacy, safety, suitability and cost considerations.

* Appropriate Patient:

No contraindications exist and the likelihood of adverse reaction is minimal, and the drug is acceptable to the patient.

* Appropriate Information:

Patients should be provided with relevant, accurate, important and clear information regarding his or her conditions and the medication(s) that are prescribed.

* Appropriate Monitoring:

The anticipated and unexpected effects of medications should be appropriately monitored.

Unfortunately, in real practice, prescribing patterns do not always conform to these criteria and can be classified as "inappropriate" or "irrational" prescribing. Irrational Prescribing can be regarded as "pathological" prescribing, where the above mentioned criteria are not fulfilled.

Irrational Prescribing

Common patterns of irrational prescribing may be manifested in the following forms :

* The use of drugs, when no drug therapy is indicated.

Eg. Antibiotics for viral URI infections.

* The use of a wrong drug for a specific condition requiring drug therapy.

Eg. Tetracyclines in child hood diarrhoea requiring ORS.

* The use of drugs with doubtful / unproven efficacy.

Eg. The use of antimotility agents in acute diarrhoea.

* The use of drugs of uncertain safety status

Eg. The use of Baralgan etc.

* Failure to provide available, safe and effective drugs

Eg. Failure the vaccinate against measles, tetanus, etc.

Failure to prescribe ORS for acute diarrhoea.

* The use of correct drug with incorrect administration, dosage and duration.

Eg. The use of IV metronidazole, when oral or suppository formulations would be appropriate.

* The use of unnecessary expensive drugs

Eg. The use of third generation, broad - spectrum antimicrobial, when a first line, narrow spectrum agent is indicated.

Some examples of commonly encountered, inappropriate prescribing practices in many health care settings include :

* Over use of antibiotics and antidiarrhoeals for non specific childhood diarrhoea.

* Indiscriminate use of injections.

* Multiple drug prescriptions.

* Excessive use of antibiotics for treating minor ARI.

* Minerals and tonics for malnutrition.

Factors underlying the Irrational use of Drugs

There are many different factors which affect the irrational use of drugs, which can be categorised as those deriving from the following factors :

* Patients - Drug misinformation

- Misleading beliefs

- Patient demands / expectations.

* Prescribers - Lack of education and training

- Inappropriate role models

- Lack of objective drug information

- Generalization of limited experiences

- misleading beliefs about drugs

efficiency

* Work place - heavy patient load.

- Pressure to prescribe.

- Lack of adequate lab capacity

- Insufficient staffing.

* Drug supply - unreliable suppliers

system - Drug shortages

- Expired drugs supplied

* Drug Regulation- Non-essential drugs available.

- Non-formal prescribers.

- Lack of regulation enforcement.

* Industry - Promotional activities

- Misleading claims.

All these factors are affected by various attitudes that are prevailing among the prescribers and consumers. In some areas the use of injections remains high due to the false assumption of the prescribers that injections will improve patients satisfaction and that they are always expected by the patients. In some countries, the frequent use of injections is declining because of the fear of AIDS.

Impact of Irrational use of Drugs

This can be seen in many ways :

* Reduction in the quality of drug therapy leading to increased morbidity and mortality.

* Waste of resources leading to reduced availability of other vital drugs and increased costs.

* Increased risk of unwanted effects such as adverse drug reactions and the emergence of drug resistance.

* Psychosocial impact, such as when patients come to believe that there is "a pill for every ill", which may cause an apparent increased demand for drugs.