The document outlines the principles of responsible drug use, emphasizing safe, effective, and cost-effective prescribing practices tailored to patient needs and healthcare contexts. It discusses the significance of essential drug lists, appropriate procurement, and continuous education for healthcare professionals to mitigate irrational drug use, which can lead to adverse health outcomes and increased costs. Additionally, it provides guidelines for monitoring drug use patterns and ensuring that antibiotics and other medications are used judiciously based on evidence and patient-specific factors.

2.  It is defined as the use of an appropriate,
efficacious, safe and cost effective drug given
for the right indication in the right dose and
formulation, at right intervals and for the right
duration of time.

3.  Adoption of the essential drug concept
 Training of health professional in RDU
 Development of Evidence-based clinical
guidelines
Unbiased and independent drug information,
continuing education of the health professionals,
consumer education and regulatory strategies are
also vital to promote RDU

4. Irrational drug use leads to
 Ineffective and unsafe drug treatment
 Worsening or prolonging of illness
 Adverse drug reactions
Inappropriate treatment also increases the costs to
the patient, government or insurance system.
Widespread antibiotic resistance is partly due to
the irrational use of antibiotics.

5.  Prescribing drugs of no proven value
 Prescribing empirically
 Unnecessary prescribing for self-limiting
conditions
 Overdosing and under dosing
 Prescribing costly drugs and formulations
when cheaper drugs are available
 Using injectable when oral drugs would suffice
 Using ‘available’/ ‘favoured’ drugs when
stocks of ideal drugs are not available.

6.  WHO has defined essential drugs as those that
satisfy the healthcare needs of the majority of
the populations.
 These must be available at all times in adequate
amounts and in appropriate dosage forms.
 The first WHO model list of essential drugs
was published in 1975.
 Indian government published its first National
Essential Drug list(EDL) in 1996.
 It is believed that only about 250 drugs are
essential to treat majority of diseases in the
country.

7.  Pattern of prevalent diseases
 Treatment facilities
 Training and experiences of available
personnel
 Safety, efficacy, cost
 Ease of administration
 Storage conditions
 Patient acceptability

8.  Guidelines for establishing an EDL include
provision of unbiased scientific information on
a drug, which looks at benefit/risk ratios, and
cost of treatment.
 A list of essential drugs does not imply that
other drugs are not useful, but simply that in a
given situation these drugs are the most
needed for the healthcare of the majority of the
populations.

9.  Fixed-dose combinations should not be
encouraged in an EDL, unless there is clear
evidence of therapeutic benefits as in the case of
oral contraceptive agents and co-trimoxazole.
 Selection of essential drug is a continuing process,
which should take into account changes in disease
prevalence, as well as new advances in
pharmacological and pharmaceutical knowledge .

10.  Drug procurement
four strategic objectives of pharmaceutical
procurement
1.Procure the most cost-effective drugs in the
right quantities
2.Select reliable suppliers of high quality
products
3.Ensure timely delivery
4.Achieve the lowest possible total cost
Every attempt should be made to prevent ‘crash
purchases’

11.  Inventory control
Monitoring of drug stocks and minimizing ‘out-of-
stock’ situations can be achieved by good
inventory control.
The use of drug formulary or drug list to restrict
the number and brands of drugs stocked will be
helpful.
Drugs with overdue expiry dates should not be
dispensed or stored.

12.  Information and education
• Introduction of new drug
• Drug policy changes in the hospital
• Availability of drugs
• Drug related problems
 Pharmaceutical care
It aims to optimize the patients health related
quality of life and achieve positive and cost
effective clinical outcomes.

13.  Process of diagnosis and prescribing are complex
 There is no single method for estimating the
appropriateness of drug treatment in all settings
 In 1993 WHO identified a number of objective
measures , or indicators , which can be used to describe
drug use pattern in a country, region or individual
health facility.
 This can be used to describe or monitor treatment
practices, to compare prescribing behavior in different
areas or facilities, and to assess the impact of an
intervention designed to improve drug use.

14. Prescribing indicator
 Average number of drugs per prescription
 Percentage of drugs prescribed by generic
name
 Percentage of encounters with an antibiotic
prescribed
 Percentage of encounters with an injections
prescribed
 Percentage of drugs prescribed from an
essential drug list or formulary

15. Patient care indicators
 Average consultation time
 Average dispensing time
 Percentage of drugs actually dispensed
 Percentage of drugs adequately labelled
 Patient’s knowledge of correct dosages
Facility indicators
 Availability of copy of essential drug lists or
formulary
 Availability of key drugs

16. Complementary indicators
 Percentage of patients treated without drugs
 Average drug cost per encounter
 Percentage of drug costs spent on antibiotics
 Percentage of drugs costs spent on injections
 Prescriptions in accordance with treatment
guidelines
 Percentage of patients satisfied with the care
they received
 Percentage of health facilities with access to
impartial information

17.  Regulatory factors
 Prescriber factors
 Patient factors

18.  Define the patient’s problem(diagnosis), then specify
the therapeutic objective for this problem
 Decide whether a drug is needed to achieve your
therapeutic objective. Use drugs only when indicated,
and when the potential benefits of drug therapy
outweigh the potential risks
 If a drug therapy is indicated , consider the various
treatment alternatives. Choose a drug of proven
efficacy and safety. The drug must also be suitable for
the individual patient, and be affordable

19.  Choose a dose which is suitable for the individual
patient. Careful dose adjustment is required for
children, the elderly, and patients with renal or
hepatic impairment.
 Avoid using more than one drug of the same
chemical class at the same time.
 Inform the patient.
 Monitor the effects of treatment
 If the treatment has not been effective try and
identify why
 Continue treatment only if the original therapeutic
objectives is still relevant.

20.  Use antibiotics only when indicated
 Where appropriate, specimen for gram stain ,
culture and sensitivity testing should be obtained
before commencing antibiotics
 When an antibiotics is indicated, the choice of
agents should be based on factors such as
spectrum of activity in relation to known or
suspected causative organism, safety , previous
clinical response, cost, ease of use and the potential
for selection of resistant organism.

21.  An adequate dose and duration of treatment is
essential for all antibiotics
 A history of allergy or other adverse effect to
the drug under consideration should always be
sought
 Prophylactic use of antibiotics should be
restricted
 Empirical antibiotic therapy should be based,
where possible, on local epidemiological data
on potential pathogens and their patterns of
sensitivity

22.  Antibiotic therapy directed at specific
organisms should include the most effective,
least toxic and narrowest spectrum agent
available.
 Oral therapy should be used in preference to
parenteral therapy whenever clinically
possible.
 Antimicrobial combinations should only be
used where indicated

23.  Topical antibiotics should be restricted to few
proven indications
 Reserve new antibiotics