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Rewa Shinde. et al. / International Journal of Biological & Pharmaceutical Research. 2013; 4(7): 528-532.
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International Journal of Biological
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Pharmaceutical Research
Journal homepage: www.ijbpr.com
IJBPR
PRESCRIPTION ANALYSIS OF DRUGS PRESCRIBED FOR
CHILDREN IN PUNE, MAHARASHTRA, INDIA
Rewa Shinde, *Yogendra Keche1, Radha Yegnanarayan2, Pramatha Muley,
Shewta Rameshkumar, Animesh Sharma
MBBS student, Associate Professor1, Professor and Head2, Department of Pharmacology,
Smt Kashibai Navale Medical College and Hospital, Narhe Ambegaon, Pune, Maharashtra, India – 411041.
ABSTRACT
To analyze the drug pattern prescribed by SKNMC teaching hospital doctors and private doctors in Pune. II MBBS
students collected data from the prescriptions issued for children in paediatric OPD of Smt Kashibai Navale Medical College
and from prescriptions of issued for children by private hospitals at medical shops or in hospitals. Information about
demography, names of drugs with doses, frequency of administration, duration of therapy and diagnosis. Rationality of
prescribed drugs was assessed in accordance with WHO Model List of Essential Drugs for Children, 3 rd Edition, 2011. About
70 % drugs prescribed by teaching hospital for children were from WHO Model List. Significantly more number of rational
FDCs was prescribed by teaching hospital for children as compared to private hospitals. Antimicrobials, vitamins and minerals
and cough /cold preparations were commonly prescribed for children, but rational drugs were prescribed more by teaching
hospital. Significantly more number of rational antimicrobial FDCs was prescribed by teaching hospital. Antimicrobials were
commonly prescribed for respiratory tract ailments. Most of the drugs prescribed in children by private hospitals were not
according to WHO Model List of Essential Drugs for Children. Interventions to rectify over prescription of antimicrobials,
cough/cold FDCs are needed. Organizing regular workshop/ educational campaign for rational prescribing may help in this
regard.
Key Words: Prescription analysis of drugs for children, WHO Essential Drug List for children, Rational drug use in children.
INTRODUCTION
The prescribing behavior of physician depends
upon the input from patients, professional colleagues, and
academic literatures, commercial publicity, Government
regulations. However, the continuous monitoring of
prescriptions and drug utilization studies may help to
identify the problems involved in therapeutic decision and
promote the rational prescribing (Kastury N et al., 1999).
Surprisingly, even in the presence of regulatory
guidelines in the form of WHO model list of essential
Corresponding Author
Dr Yogendra Keche
Email: drynkeche@gmail.com
drugs for Children, 3rd edition, March 2011 which includes
total 271 medications and only 12 Fixed Dose
Combinations(FDCs) (WHO, 2011) and Indian Academy
of Pediatrics List of Essential Medicines for Children
which include 134 total drugs and 13 FDCs (Indian
Academy of Pediatrics, 2011), FDCs are also being used
widely for children in India. (Pandey et al., 2010) observed
poly-pharmacy and FDCs is being practiced in paediatric
population. (Karande et al., 2005) observed that teaching
hospital paediatricians prescribed the drug compliant to
WHO Model List of Essential Medicines for children. So
many countries like India may develop their own list for
children if studies on prescription analysis of drugs
prescribed for children are carried out. This study is not
only important for academicians, but it may create
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Rewa Shinde. et al. / International Journal of Biological & Pharmaceutical Research. 2013; 4(7): 528-532.
awareness among the prescribing practitioner for using
WHO or National Essential Drug Lists of their country as
guidelines for prescribing medication. Hence, this study
was planned to study the rational use of drugs in paediatric
population. This was done by analyzing the prescriptions
issued for children in Pune, Maharashtra, India.
Aims and Objectives
1. To analyze the drug pattern prescribed for children by
SKNMC teaching hospital doctors and private
practitioner.
2. To find out whether drugs are prescribed as per WHO
Model list for children 3rd Edition, 2011.
3. To find out groups of drugs and FDCs which are
commonly prescribed for children
4. To find out common diagnosis for the use of
commonly prescribed groups of drugs
MATERIALS AND METHODS
Study site
Data collected by II MBBS students of Smt.
Kashibai Navale Medical College and Hospital, Narhe
Ambegaon, Pune. (SKNMC) from:
1) Paediatric OPD or Wards of SKNMC (teaching hospital
doctors)
2) Prescriptions of private practitioner at hospitals (with
their prior permission verbally) or Prescriptions of private
practitioner at medical shops from areas like Kothrud,
Dhayari, Narhe, Pimpri Chinchwad areas (non teaching
hospitals)
Study design and sampling
It was a cross sectional observational study. The
students had been given an option to collect data from
private practitioner or from medical shops or hospital near
their residence.
Study tools
Data collection: Semi-structured questionnaire prepared
by Department of Pharmacology was used for data
collection.
Information obtained: Demography, Names of drugs with
doses prescribed by paediatricians, frequency of
administration, duration of therapy, diagnosis, adverse
effects to prescribed drug noted by parents during the
therapy.
Rationality assessment: was done in accordance with
WHO Model List of Essential Drugs for Children, 3rd
Edition, 2011.
Statistical analysis: Microsoft Excel and OpenEpi 2.3
version software was used for statistical analysis.Chi
square test was used for comparison between the two
groups.
RESULTS
Demographic characteristics of the study population
There is no significant difference in age and sex
distribution in both the groups (Table 1).
Drugs prescribed for children in SKNMC teaching and
private non teaching hospitals
SKNMC teaching hospital prescribed 61 % drugs
from WHO Model List of Essential Drugs for Children and
more number of FDCs from Model list of Essential drugs
(Table 2).
Drug groups prescribed for children in Pune
Cough /cold preparations prescribed significantly
more by private non teaching hospitals. Antimicrobials,
analgesics, GIT drugs, topical formulation prescribed by
teaching hospital for children were significantly more
compliant with WHO Model list of Essential Medicines for
Children as compared to non teaching practitioner (Table
3).
Drug groups of FDCs prescribed for children
Antimicrobials FDCs were significantly less
prescribed for children by teaching hospital doctors as
compared to non teaching hospital doctors. Cough / cold
FDCs were significantly less prescribed by teaching
hospital doctors (Table 4).
Different drug formulations prescribed for children in
Pune
Syrups forms of drugs were prescribed by 50 %
practitioners (Table 5).
Diagnosis for antimicrobial prescriptions
Respiratory tract infections, enteric fever, GIT
disorders were common diagnosis for prescription of
antimicrobials (Table 6).
Table 1. Demographic characteristics of the study population – No (%)
S.No.
Parameter
SKNMC teaching hospital
Private nonteaching hospital
Age (yrs)
41 (20.10)
22 (12.94)
0-1
1
106 (51.96)
117 (68.82)
2-5
57 (27.94)
31 (18.24)
6-12
Sex
2
131 (64.22)
106 (62.35)
Male
73 (35.78)
64 (37.65)
Female
P value
0.09
0.77
0.35
0.11
0.87
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Rewa Shinde. et al. / International Journal of Biological & Pharmaceutical Research. 2013; 4(7): 528-532.
Table 2. No (%) drugs prescribed for children in SKNMC teaching and private nonteaching hospitals
S.No.
Indicators
SKNMC - No (%)
Private - No (%)
1
Total prescriptions
204
170
2
Total drugs prescribed
431
379
3
Included in WHO Model list
263 (61.02)
106 (31.93)**
4
FDCs prescribed
139 (32.25)
97 (25.59)
5
Rational FDCs
55 (39.57)
35 (36.08)
6
FDCs in EML
45 (32.37)
23 (23.71)
7
Average number of drugs per prescription
2.11
2.22
**P< 0.01
Table 3. Drug groups prescribed for children by practitioners in Pune, Maharashtra, India
No (%) drugs
Drugs in EML (Children)-No (%)
S.No.
Drug class
SKNMC
Private
SKNMC
Private
teaching
Non teaching
teaching
Non teaching
1
163 (37.81)
144 (37.99)
142 (87.11)***
72 (50)
Antimicrobials
2
98 (22.74)
70 (18.47)
15 (15.31)*
5 (7.14)
Vitamins/minerals
Cough / cold
3
23 (5.34)
43 (11.35)*
0
0
preparations
4
58 (13.46)
45 (11.87)
42 (72.41)*
15 (33.33)
Analgesics
5
50 (11.60)
31 (8.18)
34 (68)***
10 (32.26)
GIT drugs
6
7
Topical preparations
Others
Total
*P<0.05, ***P< 0.001
21 (4.87)
20 (5.28)
13 (61.90)*
2 (10)
18 (4.18)
431 (100)
26(6.86)
379 (100)
14 (77.78)
263 (61.02)
17 (65.38)
121 (31.93)
Table 4. Drug groups of FDCs prescribed for children by practitioners- No (%)
No. of FDCs
Rational FDCs
S.No
FDCs drug class
SKNMC
Private
SKNMC
Private
teaching
nonteaching
teaching
nonteaching
34
36
30
1
Antimicrobials
30(88.23)
(24.46)*
(37.11)
(83.33)
44
20
5
3
2
Vitamins/minerals
(31.66)*
(20.62)
(11.36)
(15)
Cough / cold
17
16
3
0
0
preparations
(12.23)
(16.49)**
4
Analgesics
15 (10.79)
9 (9.28)
0
0
5
GIT drugs
7 (5.04)
2 (2.06)
2 (28.57)
1 (50)**
Topical
20
9
11
1
6
preparations
(14.39)
(9.28)
(55)***
(11.11)
2
5
7
Others
0
0
(1.44)*
(5.15)
Total
139(100)
97 (100)
55 (39.57)
35 (36.08)
*P<0.05, **P<0.01, ***P< 0.001
Table 5. Different drug formulations prescribed for children by practitioners
S.No.
Drug formulations
SKNMC teaching
1
Injections
99 (22.97)
2
Syrups
233 (54.06)
3
Tablets/ Capsules
74 (17.17)
4
Topical formulations
25 (5.80)
FDCs in EML (Children)
SKNMC
Private
teaching
nonteaching
14
7
(41.18)**
(23.33)
0
2 (10)**
0
0
0
0
6
(30)***
0
0
1 (5)
0
0
45 (32.37)
23 (23.71)
Private non teaching
56 (14.78)
194 (51.19)
82 (21.64)
47 (12.40)
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Table 6. Diagnosis for antimicrobial prescriptions
SKNMC teaching hospital
Malaria
Acute tonsillitis/ chronic tosillopharyngitis/ /follicular
tonsillitis/ laryngitis/ URTI
LRTI/ pnemonia
Acute otitis Media
Acute gastritis/ Acute gastroenteritis/ Colitis
Anemia due to worms/ Worm infestation
Conjuctivitis
Febrile convulsions
Enteric fever / enteric fever with toxemia
Asthmatic bronchitis
Ricketcial fever
Acute amoebiasis
Rt hand contusion
Viral fever
DISSCUSION
There is no significant difference in age and sex
distribution in both the groups. Teaching hospital
practitoners as compared to private practitioners had
prescribed more number of drugs and rational FDCs that
are compliant with WHO Model List of Essential
Medicines for Children. Similarly observed previously by
(Karande et al., 2005). Cough or cold preparations
prescribed significantly more by private non-teaching
hospitals practitioners. Antimicrobials, analgesics and GIT
drugs prescribed by teaching hospital doctors were
significantly more compliant with WHO Model list of
Essential Medicines for Children as compared to nonteaching hospitals doctors. In a previous study of Nigeria,
teaching hospital paediatricians were not prescribing drug
compliant to Nigerian national essential drug list and
suggested need of continuous medical education with focus
on rational drug use and evidence based medicines
(Oshikiya et al., 2006). Private practitioners rational
prescribing can be improved by : i) Face-to-face education
by organizing seminars ii) Workshops for rational
prescribing iii) Structured order forms iv) CMEsContinued medical education with credit points.v) Focused
educational campaigns is needed for improving rational
drug prescription (Bexell et al., 1996).
FDCs of antimicrobials, analgesics and cold/
cough prescribed more by private practitioners as
compared to teaching hospital doctors and also more FDCs
were not compliant with WHO Model List of Essential
Drugs for Children. In previous study conducted by
Department of Pharmacology, SKNMC & GH. (Pillay et
al., 2013) It was observed that polypharmacy and FDCs
were significantly more in private practitioner’s
prescriptions. This can be explained as SKNMC & GH has
its own dispensaries and dispense the drugs which are
included in WHO/ National Essential Drug Lists.
Private non teaching hospitals
Upper respiratory infection/ chronic cough/ respiratory infection/
Consolidation/ bronchopneumonia/ bronchitis
enteric fever with toxemia
Ricketssial fever
Gastroenteritis/ diarrhea/ bacillary dysentery
febrile convulsions with URTI
Malaria
fungal infection
Viral infection- cough, cold, fever
Roundworm infection/ Worm infestation
Scabies
Vitamins/Minerals FDCs were prescribed
commonly by both the groups. Vitamins/Minerals FDCs
many times only add to the expenditure bill of the patient
without giving any potential benefit (Shewade et al.,
1998). Vitamins and Minerals FDCs prescription should be
based on deficiency status of that individual patient. Indian
Academy of Pediatrics List for Essential Medicines for
Children of India, October 2011 had given place to
multivitamins and iron and folic acid FDCs (IAP list 2011)
whereas these FDCs are not included in WHO Model List
for Children (WHO EML for children, 2011).
Most of the antimicrobial FDCs prescribed for
children were rational. Wide range of use of FDCs is
leading to unnecessary drug use, ADRs and increased
expenditure on medicine by the parents. In a previous
study, prescription of cephalosporins, macrolides and not
approved drug for community acquired pneumonia like
quilolones was observed oftenly and recommended region
specific guidelines for antibiotic use in children (Borgnolo
et al., 1990).
Antibiotic are prescribed frequently for
respiratory tract ailments. Drug use for URTIs in children
should be based on clinical improvement, cost
effectiveness and reduction in potential risk of side effects
(Das et al., 2006). Prescription audit studies can be
repeatedly carried out to find out overuse of antimicrobials
and nutritional products (Prakash, 1989) and to find out
causes for over consumption of drugs that are outside the
WHO/ National Essential drug list as both the list, from
India’s point of view had included minimal number of
drugs.
CONCLUSION
Most of the drugs prescribed in children by
private practitioners are not according to WHO Model List
for Children. Interventions to rectify over prescription of
antimicrobials, cough/cold FDCs are needed. Making
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Rewa Shinde. et al. / International Journal of Biological & Pharmaceutical Research. 2013; 4(7): 528-532.
availability of WHO/National Essential Drug List for
children to all the practitioners and organizing regular
workshop/ educational campaign for rational prescribing
may help in this regard. There is need to develop region
specific guidelines for antibiotic use in children. Upper
respiratory tract infection drug use should be based on
rational
medication, clinical improvement,
effectiveness and decrease risk of adverse effects.
cost
CONFLICTING AND COMPETING INTERESTS
None to declare.
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