A market survey was conducted to analyze the rational use of antibiotics among pediatric patients. Commonly used antibiotics in pediatrics include amoxicillin, azithromycin, albuterol, and others. The survey found that 40% of 50 prescriptions contained irrational antibiotic use, with 30% posing mild risks and 50% posing severe health risks. Examples of irrational combinations observed included ampicillin with cloxacillin. The survey results suggest the need to promote more rational antibiotic prescribing practices among pediatricians.

1. TITLE
TO CARRY OUT COMPARATIVE STUDY ON
RATIONALE USE OF ANTIBIOTICS AMONG
PEDIATRIC PATIENTS BY MARKET SURVEY
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3. CONTENTS
• RATIONALE OF PROJECT
• COMMONLY USED ANTIBIOTICS IN PEDIATRICS
• USE OF ANTIBIOTICS IN VARIOUS DISORDERS
• DOSING GUIDELINES OF PEDIATRICS AS PER USFDA
• MARKET SURVEY FORM
• MARKET SURVEY CONDUCTED

4. • IRRATIONAL
• SOME OF CATEGORIES OF IRRATIONAL DRUG COMBINATIONS
• MARKET SURVEY
• LIST OF COMMONLY USED IRRATIONAL DRUGS WHICH WERE
OBSERVED UNDER SURVEY
• COMBINATIONS THAT ARE APPROVED IN NATIONAL ESSENTIAL
DRUG LIST
• CONCLUSION

5. RATIONALE OF PROJECT
• In the present era, the pharmaceutical industry is growing enormously and
number of drugs are available for treatment of a specific disease or condition.
• Determination of rationality of the prescribed drugs in the specific condition.
• Determination of rationality of the dosing frequency.
• It has been scientifically proved that antibiotics prescribed in pediatric
patients may lead to severe consequences, as their intestinal flora is not well
developed to mark the effect of drug.
• There are many antibiotics, which are safe as well as effective in adults but
may cause serious adverse effects in pediatrics. E.G. Ofloxacin is an antibiotic
used to treat numerous infections in children but is having lesser safety in
children, still it is among one of the highly used drugs in pediatrics in india.

6. COMMONLY USED ANTIBIOTICS
IN PEDIATRICS
• Amoxicillin
• Azithromycin
• Albuterol
• Clavulanate
• Cefdinir
• Penicillin
• Cephalexin

7. USE OF ANTIBIOTICS IN
VARIOUS DISORDERS
S.NO. DRUG DISEASE DOSE
1. Amoxicillin Pneumonia 500mg(cap)
2. Azithromycin Ear infection 200mg(tab)
3. Cefdinir Sinus infection 300mg(cap.)
4. Cefixime UTI 100mg(tab.)
5. Cefadroxil Impetigo 500mg(cap.)

8. DOSING GUIDELINES OF PEDIATRICS
AS PER USFDA
Antibiotic (generic name
/brand name)
Daily oral dose Dosage interval Dosage form
Amoxicillin (amoxil) 50mg/kg/day
90mg/kg/day
Every 8 or 12 hours 125 and 250mg/5 ml
susp.
250 and 500mg cap.
125and250mg chew.tab.
Amoxicillin-clavulanate
potassium(clavulin)
40-50mg/kg/day Every 8 hours 125 and 250mg/5 ml
susp.
250 and 500mg tab.
Azitthromycin(zithromax) 10mg/kg/day
5mg/kg/day*4days
Every 24 hours 100 and 200mg/5ml susp.
250mg tab.
Cefprozil(cefzil) 30mg/kg/day Every12 hours 125 and 250mg/5 ml
susp.
250 and 500mg tab.

9. Antibiotic (generic name/
brand name)
Daily oral dose Dosage interval Dosage form
Metronidazole(flagyl) 30mg/kg/day Every 6 0r 8 hours 250mg tab.
Pencillin v (pen-vee) 25-50mg/kg/day Every 6hours
Every 12 hours
125,180,250and 300mg/5ml
susp.
300mg tab.
Trimethoprim-sulfamethoxa
zole(septra)
8-12mg/kg/day Every 12 hours 40mg/5ml susp.
20,80,160mg tab.
Vancomycin(vancocin) 40mg/kg/day Every 6 hours 125 and 250mg cap.

10. MARKET SURVEY FORM

11. MARKET SURVEY CONDUCTED
• In this Project market survey was conducted for pediatric patient
prescriptions containing antibiotics, In which 50 forms were Filled
by taking the patients prescriptions and different kinds of
Irrationalities were observed. The irrationalities can be omitted.
• Sometimes there is a irrational use of drug is carried out
intentionally because sometimes it is a only method of treatment.

12. The rationality of a fixed dose combination is the most controversial and
debated issue in today’s clinical practice. Irrational Drug Combinations or
Fixed Dose Combinations (FDCs) are combinations of two or more active
drugs in a single form. Combination drugs increase the risk of side
effects, lead to an Ineffective dosage and liability to abuse and may also
needlessly increase the cost. Drug combinations make it more difficult to
find the causative agent responsible for the adverse reactions. In many
cases their stability is doubtful, reducing the efficacy of many
preparations. The Fifteenth WHO model list of essential medicines
contains only 25 approved fixed dose combinations, whereas in some
Countries, There Are innumerable examples of Irrational Drug
Combinations, which are easily available and can be bought even
without a prescription.
IRRATIONAL

13. TYPES OF IRRATIONALITIES
IRRATIONALITIES
NON-AVOIDABLE
NO-
ALTERNATIVE
PSEUDO
IRRATIONALITY
AVOIDABLE

14. AVOIDABLE IRRATIONALITY
Avoidable irrationality can be defined as the irrationality which can
be avoided by taking any other drug. The irrationality can be
avoided by using a another substitute which is safer for the health
of the patient.
Avoidable irrationality can be avoided by changes in
the diet , and daily life habbits.

15. Non-avoidable irrationality can be defined as the
irrationality which can not be avoided . The effects of this
type of irrationality are severe and can’t be ignored.
Non-avoidable
irrationality can be treated 90% with the help of drugs.
NON-AVOIDABLE IRRATIONAL
ITY

16. SOME OF CATEGORIES OF IRRATIONAL
DRUG COMBINATIONS
• Ampicillin + Cloxacillin
Ampicillin is effective against Gram negative bacilli but Cloxacillin is an
Anti-staphylococcal penicillin and not effective against Gram negative bacilli.
Mixed Gram negative and Staphylococcal (Gram positive) infection rarely
coexists So, in a patient with a single infection, one of the drugs of the
combination would be useless. In addition to the cost of therapy it would
add to adverse side effects and resistance of bacteria to the drug. On the
other hand the combination would reduce the dose of effective drug to the
half and the patient would need longer course of therapy.

17. • Antibacterial + Antiamoebic
Ciprofloxacin+Metronidazole, Norfloxacin + Tinidazole and Ofloxacin
+ Ornidazole are such commonly available fixed dose drug
combinations. In bacterial diarrhoea only anti-bacterial drug is
effective and antiamoebic drug is useless. Similarly, in intestinal
amoebiasis only antiamoebic drug is effective while antibacterial
drug is useless. Amoebiasis and bacterial diarrhoea rarely coexist.
The therapy should be based on the diagnosis to reduce the cost of
treatment since in a given case, only one drug of the combination
would be effective and the other one would be useless.

18. • H2 Blocker (Ranitidine) + Antispasmodic
Drug (Dicyclomine)
The pain of peptic ulcer is due to high level of gastric acid but
not due to spasm of smooth muscles and will subside only
with reduction in gastric acid in stomach by use of H2 blocker
(Ranitidine) or proton pump inhibitor drugs (Omeprazole,
Pantoprazole or Lansoprazole). So there is no justification in
combining H2 blocker (Ranitidine) with antispasmodic drug
(Dicyclomine).

19. • Domperidone + Proton Pump Inhibitors
Omeprazole, pantoprazole and lansoprazole are proton pump
inhibitors. Proton pump inhibitors reduce gastric acid
production in peptic diseases and give symptomatic relief. The
combination of these drugs with antiemetic drug
(domperidone) is an irrational drug combination as peptic
ulcer is not always associated with vomiting. Even in gastro-
esophageal reflux disease (GERD), the domperidone is less
effective as compared to metoclopramide, so combining
proton pump inhibitors with domperidone seems to be an
irrational choice.

20. CMARKET SURVEY
• TThe market survey was conducted and the drug percentage (%) of
irrationality was observed.From the survey it was observed
that the irrationale of drug can be of two types .
• MILD
• SEVERE
Mild are those conditions which can be ignored and severe
one’s can not be under seeened.
The total no. Of forms conducted during survey
is 50, under which 40 are found to be irrational.Out of which 25 are under
severe category and 15 are under mild category.

21. PERCENTAGE OF DRUGS UNDER
MILD CONDITIONS
• MMild conditions can be avoided or can be ignored
because they will not cause any hazardous effect to
the patient.
No. Of forms filled which are under the mild
conditions are 15 and there percentage is carried out
15/50 = 0.3
0.3*100 = 30.0%

22. PERCENTAGE OF DRUGS UNDER
SEVERE CONDITIONS
Severe conditions cannot be avoided as they can lead to
death of a the patient.
• Various drugs substitution can be used to cure the
conditions.
• Out of total no. Of forms filled the forms lies under this
category are 25 and there percentage is carried out.
25/50 = 0.5
0.5*100 = 50.0%

23. LIST OF COMMONLY USED
IRRATIONAL DRUGS WHICH WERE
OBSERVED UNDER SURVEY
S.NO. DRUGS
PREFERENCE
OF
USAGE
1. TETRACYCLINE 10%
2. METRONIDAZOLE 20%
3. OFLOXACIN 32%
4. NITROFURANTOIN 9%
5. PENICILLIN 26%
6. CLATHIROMYCIN 50%
7. CEFTRIAXONE 49.3%

24. COMBINATIONS THAT ARE APPROVED IN
NATIONAL ESSENTIAL DRUG LIST
S.No Combination Therapeutic category
1. Isoniazid + Rifampicin Antitubercular
2. Benzoic acid+ salicylic acid Antifungal
3. Sulfamethoxazole+
Trimethoprim
Antibacterial

25. Market survey was conducted among 50 pediatric patients about rationa
le use of antibiotics. It has been observed that antibiotics are prescribed
enormously among pediatric patients even where they are not required.
Out of 50 prescriptions 30% of prescriptions contain irrational antibiotics
which may lead to mild consequences and 50% of prescriptions contain
irrational antibiotics which may lead to severe consequences.
CONCLUSION

26. ONGOING:
Review paper entitled as “Prescription Pattern
of Antibiotics Among Pediatrics Patients”.
Project Report Submission
PENDING WORK

27. REFERENCES
• www.drugs.com/amoxicillin
• www.rxlist.com
• www.medicinenet.com
• www.webmed.com/drugs
• www.pdrhealth.com
• www.everydayhealth.com

28. THANKS……
JJATIN SING
LA