Prof. Beena Rani Goel
How are we different from Quacks? Does our training distinguish us? Or is it because we use science in our clinical practice? How much are we influenced by the medical representatives in our prescribing habits? Ask these questions to yourself and search for honest answers.
As dentists we commonly prescribe antibiotics and analgesics. How often are we aware why we prescribe a particular antibiotic or painkiller? How much are we contributing to the problem of antibiotic resistance? Have you ever asked yourself whether your children be able to fight their infections in the future with so many resistant bacteria around?
There are 15,000 registered pharmaceutical manufacturers in India, producing medicines worth Rs. 20,000 million yearly. This industry employs about 3 million people in research, production, distribution and marketing, and yet only 22% of the Indian population have access to modern medicines. By some estimate, about 100,000 brands of drugs are sold in the country, large number of drugs in Indian market is either irrational or harmful. Pharma companies dictate what a doctor will prescribe, and for how long.
To address these and many other issues global movement on Rational Use of Medicines has been gaining momentum spearheaded by World Health Organisation. (http://www.who.int/medicines/areas/rational_use/en/index.html)
What is Rational Use of Medicines?
Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own requirement, for an adequate period of time, and at lowest cost to them and their community (WHO 1985).
In other words we should ensure that there is :
Appropriate indication. The decision to prescribe drug(s) is entirely based on medical rationale and that drug therapy is an effective and safe treatment
Appropriate drug. The selection of drugs is based on efficacy, safety, suitability and cost considerations.
Appropriate patient. No contra-indications exist and the likelihood of adverse reactions is minimal, and the drug is acceptable to the patient.
Appropriate information. Patients should be provided with relevant, accurate, important and clear information regarding his or her condition and the medication(s) that are prescribed.
Appropriate monitoring. The anticipated and unexpected effects of medications should be appropriately monitored.
Common Problems:
- The number of drugs per prescription is often more than needed, with an average of 2.4 up to 10 drugs, while generally one or two drugs should be sufficient.
- Wrong drug for a specific condition.
- Drugs of doubtful efficacy.
- Drugs of uncertain safety status.
- Use of drugs in wrong dosage and duration.
I have come across patients who have been prescribed antibiotics for periods up to two weeks. A study recently published in BMJ (June 10,2006) found that even some cases of pneumonia a potentially life-threatening disease could be treated with a three-day course of antibiotics, rather than the conventional 7- to 10-day treatment. In light of this we have to justify if we prescribe for more than 3 days in dental problems.
In a study done at a dental school it was found that most of the interns/students are prescribing without application of their knowledge.
We have a responsibility to prescribe rationally and also to educate our patients and public that they should not indulge in self medication and take medicines as per the instructions given by their doctor. An excellent presentation for consumer education can be seen at www.healthmantra.com/chen/
Mindless prescriptions cause great harm to patients in long term. Painkillers can produce long lasting gastric problems. Antibiotics disturb the delicate balance of bacterial flora of GI tract and this can have far reaching consequence on patients general wellbeing and long life. As such irreversible damage can occur by patients taking certain antibiotics and force patients into filing a Levaquin lawsuit or another malpractice suit in an attempt to ease the pain caused to their loved ones.
In case of analgesics we need to know which one will be appropriate for patients needs so that he will get relief from his pain. In case of antibiotics we should choose a proper antibiotic which will take care of his condition and assist his body in early resolution of his ailment. We should also know exactly in which circumstances/ medical conditions preventive prophylactic cover is needed. In next part of the article we shall see what are the guidelines that should dictate our prescriptions.