The Pattern of Drug Use in Acute Fever by General Practitioners (GPs) in Pune City, India

Abstract

Objectives: 1) To determine the WHO Prescribing Core Drug Use (PCDU) indicators in the management of acute fever (of less than 2 weeks duration) of the MBBS (allopathic) and BAMS (ayurvedic) General Practitioners (GPs) in Pune city. 2) To verify the appropriateness of the treatment. and 3) To compare the above parameters of the MBBS and the BAMS practitioners. Methods:Pune city was divided in five zones, north, south, east, west and central. A list of doctors was obtained from the Indian Medical Association and it was divided zone wise. 2 MBBS and 2 BAMS GPs. were selected per zone. An informed consent was obtained from the GPs. The sample size was 20 encounters per GP. The patients of all ages and both sexes, who suffered from fever of less than 2 weeks duration, were included in the study. The indicators which were studied were 1) the WHO Prescribing Core Drug Use indicators and 2) the complimentary drug use indicators for the appropriateness of the treatment. Results:1) The age, sex and diagnosis wise distribution of the patients was comparable in both the groups. 2) Among the WHO PCDU indicators, a highly significant difference was observed in the average number of drugs which was prescribed, the antibiotic usage and in the injections which were prescribed among the MBBS and the BAMS GPs 3) The use of the drugs from EDL and that of the generic drugs were comparable in both the groups.4) A marked irrationality was found in the injectable antimicrobials by the BAMS GPs.5) The selection of the antimicrobials was inappropriate in 64.14% and 17.5% of the encounters which were made by the BAMS and the MBBS GPs respectively. Conclusion:Among the BAMS GPs: the WHO prescribing core drug use indicators were all significantly abnormal and the percentage of the inappropriate prescriptions was alarmingly high (92%). Among the MBBS GPs:There was more use of the antimicrobials but the proportion of the inappropriate prescriptions was less (42%).

Antibiotic prescription practices in primary care in low- and middle-income countries: A systematic review and meta-analysis

“…Among the 21 studies that reported the total number of patients attending a certain facility at the time of data collection [27,28,30,32,36,38,39 [46,57]. We could not identify any specific pattern in the distribution of antibiotic prescription rates across levels of country income, partly due to small sample sizes.…”

“…In most cases, the authors made their judgment based on national and/or international guidelines for treatment of key conditions. Among the 9 studies that assessed the rationality of antibiotic prescriptions [36,39,46,53,55,62,64,65,67], the proportion judged inappropriate ranged widely, reflecting the significant differences in study designs as well as in the sets of criteria that were adopted to determine the outcome ( Table 2). The lowest level of inappropriate prescription (7.9%; 95% CI: 4.6%-12.5%) was reported in a study conducted in Zambia that included 537 children aged <5 years presenting with an acute respiratory syndrome, of whom 37.6% (95% CI: 33.5%-41.9%) were given antibiotics [39].…”

Perceptions of Antibiotic Use and Resistance: Are Antibiotics the Dentists’ Anxiolytics?

“…In such cases, antibiotic prescription is nonetheless still perceived as being essential. A parallel can be drawn with general medicine: for example, the use of antibiotics by doctors in case of a fever [ 12 ] seems comparable to the use of antibiotics by dentists in case of exacerbated pain [ 13 ].…”

Disease proportions and drug prescribing pattern observed in a free health camp organized at Dhorphirdi Village Development Committee of Western Nepal

“…A combination of nimesulide and paracetamol was found to be the most preferred drugs by physician for fever. Patients who were prescribed with NSAIDs also received drugs to prevent gastritis [ 10 ]. Vitamins and supplements were also found to be widely prescribed medication.…”