It is very important to incorporate clinically relevant practicals into the undergraduate pharmacology practical (UGPP) curriculum. Various medical colleges in the state of Gujarat have included clinical practicals in their UGPP curriculum. [2] Rai has recommended the inclusion of the 'P-drug' concept in the UGPP curriculum. The conference of experts on the rational use of drugs, convened by the World Health Organization in Nairobi in 1985, stated that: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community." This goal can be achieved by acquiring knowledge of the principles of rational drug usage during undergraduate training. This correspondence emphasizes the importance of this concept. » What is a P-drug? The drugs you are going to prescribe regularly and with which you will become familiar are called P(ersonal)-drugs. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. Due to varying availability and cost of drugs, different national formularies and essential drug lists, medical culture and individual interpretation of information, P-drugs differ from country to country and between doctors. There are four reasons that indicate why a P-drug should never be the one that has been suggested or dictated by clinical teachers, senior colleagues or by sales representatives: a) the latest and the most expensive drug is not necessarily the best, the safest or the most cost-effective, b) by developing one's own set of P-drugs, one can learn to handle pharmacological concepts and drug-related data in an effective manner, c) by compiling one's own set of P-drugs, one can prescribe alternatives when the P-drug cannot be used and d) one has the final responsibility for his / her patient's well being, which he / she cannot pass on to others. While physicians can and should draw on expert opinion and consensus guidelines, they should always think for themselves. » Example for selecting a P-drug for acute amoebic dysentery Top Amoebiasis is one of the common infections encountered in clinical practice and it is relatively easy to understand the pathophysiology as well as the treatment of amoebiasis. Therefore, we have selected the example of acute amoebic dysentery and analyzed it in consultation with standard textbooks of pharmacology.

1. Drug formulary
Hospital research analysis
Drug Prescribing Pattern in Surgical Wards of
a TeachingHospital in India
2016
MOHAMMAD YASER HUSSAIN
APOLLOHOSPITALS
1/1/2016

2. Irrational use of medicines is widespread throughout the world. The main problems include the
unnecessary prescription of drugs, particularly antimicrobials and injections. To investigate the
situation in surgery wards, the present study was undertaken. Ninety six prescriptions were
collected prospectively from post-operative patients admitted in surgery wards of the JN Medical
College Hospital, AMU, Aligarh, and subjected for analysis according to the WHO/INRUD
Indicators. VEN method was also applied to ascertain quality of drug procurement. It was
revealed that the proportion of drugs from Essential Medicines List (EML) was 61.4%, while no
drug was prescribed by generic name. Groups of drugs most commonly prescribed by general
surgeons were antibiotics (93%), analgesics (60%), antacids (43%) and antiemetics (10%). The
most extensively prescribed drugs from each of the above groups were injections Ceftriaxone
and Amikacin, tablets Voveron, Pantoprazole and Metoclopromide, respectively. The average
number of drugs prescribed per patient and cost per day per prescription was 4.8 and 246.1 INR,
respectively. Average number of antibiotics prescribed per prescription was 2.2 and the average
number of injections per prescriptions was 2.3. The results showed that the pattern of drug
prescribing is not based on WHO criteria for rational use of drugs. The system is not at all
evidence-based. It is thus necessary to make surgeons aware about good prescribing habit by
following 5 steps of the WHO Program on Rational use of Drugs (RUD).
Introduction
Rational use of medicines requires that patients receive medications appropriate to their clinical
needs, in doses that meet their own requirements, for an adequate period of time and at the
lowest cost to them and their community. The irrational use of drugs is a major problem of
present day medical practice and its consequences include ineffective treatment, unnecessary
prescription of drugs – particularly antimicrobials and injections, development of resistance to
antibiotics, adverse effects and economic burden on patients and the society. In spite of extensive
programs on rational use of drugs and the Emergency Medicine List (EML) of WHO, which are
being promoted by various national and international agencies working on health sector,
irrational prescription is still a common practice.
Irrational drug combinations, banned drugs and withdrawn drugs are still being prescribed by
both qualified physicians and quacks. There is a need of mass awareness amongst physicians and
consumers about the concept of essential medicines, advantages of generic drugs prescription
and use of rational combinations. This study was undertaken to audit the pattern of drug
prescribing by surgeons to postoperative patients.
Materials and methods
Ninety six prescriptions of postoperative patients admitted in the General Surgical wards of the
Jawaharlal Nehru Medical College Hospital, Aligarh, were collected prospectively between
March 2007 and May 2007. These were analyzed according to the WHO/INRUD indicators1 for
Number of drugs per prescription,
Number of antibiotics per prescription,
Number of drugs prescribed by generic name.
Number of drugs prescribed from the WHO Model List of Essential Medicines (EML) and
Number of injections per prescription.
The cost per prescription was also studied. Moreover, the commonly prescribed groups of drugs
were also looked into. Vital, Essential and Non-Essential (VEN) Method1 was also applied for
the above study to ascertain the quality of drug procurement. This information was compiled,
scored and analyzed in consultation with a surgeon using WHO guidelines.
Results

3. Among the studied prescriptions, the most common groups of drugs (Figure 1) prescribed by
surgeons were antibiotics (93%), analgesics (60%), antacids (43%) and antiemetics (10%). The
most extensively prescribed drugs from each of the above groups were Injections Ceftriaxone
and Amikacin, Tablets Voveron, Pantoprazole and Metoclopromide, respectively. Since these
were postoperative patients, no vital drug was prescribed. The average number of drugs
prescribed per prescription was 4.8±1.5 (antibiotics per prescription was 2.3±0.7 and injections
per prescription was 2.3±2.1). Since there is no hospital formulary, the prescription of drugs was
studied from the WHO Model List of Essential Medicines (EML). Only 62.2±18.1% of drugs
were prescribed from the EML. None of the drugs was prescribed by generic name. The average
cost incurred by the patient was 246.1±86.3 INR per day.
Fig 1. Groups of drugs commonly prescribed and percentage of prescriptions containing
them in postoperative wards.
IJPD_005_002a_02_fig_0001.jpg
Discussion
The review showed that the pattern of drug prescribing was not based on WHO criteria for
rational use of drugs. The prescribing system was not at all evidence-based. The proportion of
drugs prescribed from EML was low with an average prevalence of more than 2 broad spectrum
antibiotics given unnecessarily along with extensive use of other drugs, with no drug prescribed
by generic name. An interesting observation pertaining to the choice of antibiotic prophylaxis in
surgery was the use of Ceftriaxone with Amikacin in majority of cases despite the awareness of
similar gram negative coverage inherent in this combination. The most commonly prescribed
analgesic was the NSAID, Diclofenac, although the suitability of NSAIDS for relief of
postoperative pain remains controversial3. Also, proton-pump-inhibitors were prescribed too
often. Routine polypharmacy leads to economic burden on patients and society and makes
healthcare unaffordable to the common Indian masses. It is, thus, necessary to make surgeons
aware about the use of drugs from EMLs, importance of prescribing drugs with generic names
and, for patients’ point of view, the vital factor of costbenefit. Also there is a clear need for the
development of prescribing guidelines and educational initiatives to encourage the rational and
appropriate use of drugs in surgery4,5.
Improvement through continuing education (CME) is desired on part of prescribes to ensure a
good standard of care and avoid practices that may increase antimicrobial resistance. Drug
information services including side effects and drug interactions for professionals and consumers
at the hospital are highly desirable. There is need of CMEs based on Good Clinical Practices
(GCP) and Standard Treatment Guidelines (STG). These should be followed by drug utilization
studies and feedback to the surgeons regarding prescribing behavior since the use of feedback
has been shown to have a a significantly favorable impact on surgeons’ compliance with hospital
guidelines, especially on antimicrobial prescribing.6,7 Similarly, it has been seen that a
standardised process of education, assessment and standardised guidelines on postoperative pain
management lead to significant reduction in postoperative pain, nausea, vomiting, as well as
postoperative complications.8 Every institution must have a Drugs and Therapeutic Committee.
Conclusion
Results indicate that there is scope for improving prescribing habits among the fraternity and
minimizing the use of antimicrobial agents. For rational prescribing of drugs, there is a need of
mass awareness amongst surgeons about good prescribing habit by following five steps of WHO
Program on Rational Use of Drugs (RUD).