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Study of antimicrobial prescribing pattern in a tertiary care teaching hospital at Dehradun, Uttarakhand, India - A tool to teach clinical pharmacology to MBBS students

Mirza Atif Beg, Shalu Bawa, Shaktibala Dutta, Mohammad Anjoom, Subhash Vishal.

Background: Due to increasing resistance to a majority of antimicrobials, it becomes very necessary to teach undergraduate students, the future prescribers, about the judicious and rational use of antimicrobial drugs. The objective of this study was to impart the basic clinical skills to undergraduate MBBS students which will form an integral component of practising rational therapeutics.
Methods: A total no of 737 cases were followed up by the 5th semester 2nd Professional MBBS students in the Department of Pharmacology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS), Dehradun from June 2013 to July 2015. Patients were analysed on various WHO drug use indicators like drug formulations, drugs prescribed per prescription, Fixed dose Combinations (FDCs), drugs prescribed from National List of Essential Medicines (NLEM) and drugs prescribed by generic names.
Results: A total of 737 prescriptions were analysed. Male: Female ratio was 1.74:1 (63.50%:36.50%). Majority of the patients 218 (29.58%) were in 16-30 years age group. A total of 1205 antimicrobials were prescribed. 304 (25.23%) cephalosporins were most frequent followed by 184(15.27%) penicillins, 176(14.61%) antitubercular drugs, 163(13.53%) nitroimidazoles, 143 (11.87%) fluoroquinolones, 102 (8.46%) aminoglycosides, 29 (2.41%) macrolides, 19 (1.58%) tetracyclines, 12 (1%) carbapenems, 11 (0.91%) antimalarials, 11 (0.91%) antihelminthics, 6 (0.50%) glycopeptides, 4 (0.33%) lincosamides and 41 (3.41%) miscellaneous antimicrobials. Most frequently prescribed antimicrobial was Ceftriaxone which was given in 97 (8.05 %) patients. A total of 424 (35.19%) oral antimicrobials, 777 (64.48%) injectable antimicrobials and 04 (0.33%) local/topical antimicrobial drugs were prescribed. 5.13 drugs per prescription and 1.64 antimicrobials per prescription were prescribed. 2100 (55.56%) drugs were prescribed from National List of Essential Medicine 2015 (NLEM 2015). 1177 (97.68%) antimicrobials were prescribed from NLEM. 1110 (92.12%) antimicrobials were prescribed by brand names. A total of 342 (28.38%); fixed dose combinations of antimicrobials were prescribed.
Conclusions: Majority of the prescriptions revealed poly-pharmacy and a very high percentage of drugs were prescribed by their respective brand names. It is only by observing drug utilization patterns, current trends and common errors in prescriptions can be highlighted and rational prescription of antimicrobials can be taught to MBBS students.

Key words: Antimicrobials, Prescribing pattern, WHO drug use indicators, Rational prescription

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