Background: Rational drug use (RDU) generally covers appropriate prescribing, appropriate dispensing and appropriate patient use of medicines for the diagnosis, prevention, mitigation and treatment of diseases. To enhance RDU, the patient should receive medicines appropriate to their heath care conditions, at optimum doses and sufficient time, as well as at the cost that the individual and the community can afford. This study aimed to review systematically the rational drug use to increase service quality in developing countries. Subjects and Method: A systematic review was conducted by searching the following databases included PubMed, Proquest and Garuda which published articles in last ten years. The keywords for this review included rational drug use, irrational drug use, drug use pattern, WHO indicator, hospital, developing country, and cross sectional. The inclusion criteria were review, systematic review, clinical review and guidelines. After review process 13 articles were included in this review. Results: The average prescription was varying in several development countries included India, Ethiopia, Jordan, Pakistan, Indonesia, and Sri Lanka. The highest average prescription generic drug was in Ethiopia (90.61%) and lowest was in India (25.37%). The average prescription antibiotics highest was in Ethiopia (58.1%) and lowest was in Indonesia (36%). The percentage of injection prescriptions that exceed WHO recommendations occurs in Ethiopia (38.1%). Percentage of compliance with the List of Essential Medicines highest was in India (74.3%), and Sri Lanka (100%). Prescriptions were adequately labeled highest was in Pakistan (100%) otherwise lowest was in Ethiopia (45.4%). Patients know about the dosage of the prescription highest was in Ethiopia (78.8%) and Pakistan (61.6%). All of the hospitals included in the study used the national drug list, formulary and standard treatment guidelines but none of them had their own drug list or guideline. Conclusion: Rational drug use in several countries is slightly above the WHO recommendation. An intervention strategy includes managerial, educational, regulatory and economical strategies should be designed to solve the problem on the health care system in general.
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