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Rational Drug Therapy By: R C Dhakar, Dept of Pharmacy,

IEC Group of Institution, Gr Noida

RATIONAL DRUG THERAPY (RDT)

Rational drug use (RDU) means prescribing right drug, in

adequate dose for the sufficient duration & appropriate to the

clinical needs of the patient at lowest cost

Objectives of RDT/RDU:

correct drug

appropriate indication appropriate drug considering efficacy, safety, suitability

for the patient, and cost

appropriate dosage, administration, duration

no contraindications

correct dispensing with appropriate information for

patients

patient adherence to treatment

Reasons for Irrational Prescribing

1. Lack of training in clinical pharmacology and in basic

principles underlying rational drug use.

2. Lack of continuing education, supervision and critical review

of prescribing practices.

3. Promotional activities by pharmaceutical companies.

4. Desire for prestige.

5. Too many patients.

6. Uncertain diagnosis.

Barriers and Problems for RDT/RDU:

Problems of availability and affordability

Far too many products in the market

Unethical promotion of products

Irrational prescribing - quackery

Lack of diagnostic facility

Use of drugs when no drug therapy is needed

Use of wrong drugs

Use of drugs with doubtful efficacy

Use of drugs with uncertain safety status

Unnecessary use of injections and antibiotics

Incorrect administration, dosages, or duration

Lack of medicine literacy among people

Poor adherence

Inadequate or inappropriate dispensing

No clear strategy by the government

Types of Irrational Prescribing

Irrational drug prescribing can occur when the medication

prescribed is incorrect, inappropriate, excessive, unnecessary or

inadequate (WHO Draft, 1985). Accordingly, the types of

Irrational Prescribing are:

1. Incorrect prescribing

2. Inappropriate prescribing

3. Over prescribing

4. Multiple prescribing

5. Under prescribing

Following information are essential for RDT/RDU1. Basic pharmacology of a drug.

2. Indications for this drug's use.

3. Contra-indications to this drug's use.

4. Side effects of this drug.

5. Drug interactions.

6. Cost to the patient and community.

7. Dosage schedule.

8. What is the quality of the evidence provided about the risk/benefit ratio of this new drug compared to existing therapy?

9. What conclusions have independent experts reached about

the role of this new drug (e.g., review articles, editorials, etc.

Examples of Rational Combinations

_Amoxycillin + Clavulinic acid

Suicide inhibitors) - restore activity

_Ampicillin + Sulbactum

_Imipenem + Cilastatin

_Pyrimethamine + Sulfadoxine

_Sulfamethoxazole + trimethoprim

_ferrous salt + Folic acid

Strategies which help in RDT/RDU

Training for Providers

Undergraduate education

Continuing in-service medical education e.g.

seminars, workshops

Face-to-face persuasive outreach e.g.

academic detailing

Clinical supervision or consultation

Printed Materials

Clinical literature and newsletters

Formularies or therapeutics manuals

Persuasive print materials

Media-Based Approaches

Posters

Audio tapes, plays, Radio, television

10 national strategies to promote RDT/RDU:

1.Evidence-based standard treatment guidelines

2. Essential Drug Lists based on treatments of choice

3. Drug & Therapeutic Committees in hospitals

4. Problem-based training in pharmacotherapy

5. Continuing medical education as a licensure requirement

6. Independent drug information e.g bulletins, formularies

7. Supervision, audit and feedback8. Public education about drugs

9. Avoidance of perverse financial incentives

10. Appropriate and enforced drug regulation

Parameters that are linked to RDT/RDU are

Treatment guidelines

Essential Drug list

Perception of drug quality

Medical education and culture

Patient education

Prescriber monitoring

Incentives for providers and physicians

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Rational Drug Therapy By: R C Dhakar, Dept of Pharmacy,

IEC Group of Institution, Gr Noida

Dispensing rights for physicians

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