ASSESSMENT OF PRESCRIBING, DISPENSING AND PACKAGING

www.wjpps.com Vol 9, Issue 9, 2020.

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Jamal et al. World Journal of Pharmacy and Pharmaceutical Sciences

ASSESSMENT OF PRESCRIBING, DISPENSING AND PACKAGING

PATTERNS OF ANTIBIOTICS IN TERTIARY CARE HOSPITAL

Ayesha Jamal1*, Parisa Peivand Kermani

1, Mahendra Kumar B. J.

2, Nisar Ahmed

3 and

Shahid Ashraf

1Pharm D Interns, Department of Pharmacy Practice, Farooqia College of Pharmacy, Mysore,

Karnataka, India.

2Professor and Head, Department of Pharmacy Practice, Farooqia College of Pharmacy,

Mysore, Karnataka, India.

3Assistant Professor, Department of Pharmacy Practice, Farooqia College of Pharmacy,

Mysore, Karnataka, India.

ABSTRACT

Introduction: A Study on "Assessment of Prescribing, Dispensing

And Packaging patterns of Antibiotics In Tertiary Care hospital" was

carried out to find out indiscriminate use, drug misuse, and Incorrect

prescribing of antibiotics that have resulted in drug- drug interaction,

sub-optimal therapy, poly-pharmacy, medication failure, non-

compliance, increased healthcare expenditure, multiple drug resistance

as well as financial pressure on households and communities and most

importantly increased occurrence of antibiotic resistance.

Methodology: A prospective, observational and descriptive research

was conducted for six months from Sept 2018 to Feb 2019 in the in-

patient Departments of General medicine, Obstetrics and gynecology,

Pediatrics, ICU and Surgery in CSI Holdsworth Memorial (Mission) hospital, a tertiary care

hospital in Mysore District and in community pharmacies in Mysore, with the aim to evaluate

the prescribing, dispensing and packaging patterns of antibiotics. The data on prescribing

pattern of antibiotics by physicians, patient’s demographic details, complaints, past medical

history, current medications along with their ADRs, dispensing pattern of antibiotics in

pharmacies by pharmacists, and packaging patterns of antibiotics by manufacturers was

collected. The Potential drug–drug interactions (DDIs) were identified using Medscape drug

interaction checker. The data was Analyzed utilizing MS EXCEL and MS WORD. Results:

WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

SJIF Impact Factor 7.632

Volume 9, Issue 9, 1892-1916 Research Article ISSN 2278 – 4357

Article Received on

01 July 2020,

Revised on 21 July 2020,

Accepted on 11 August 2020

DOI: 10.20959/wjpps20209-17063

*Corresponding Author

Ayesha Jamal

Pharm D Interns,

Department of Pharmacy

Practice, Farooqia College

of Pharmacy, Mysore,

Karnataka, India.


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This research features polypharmacy, overuse and inappropriate prescribing of antibiotics

without prior culture sensitivity in hospital situations. Distributing antibiotics without

prescription and by non-pharmacists are widespread in this sector. In the manufacturing

sector, we invariably figured dissimilarity among the measure of doses and frequency of

antibiotics prescribed by the physicians, when compared to the regular packaging sizes

available as approved by guidelines for the most typically prescribed antibiotics. The research

also indicates irrational use of antibiotics which may lead to antibiotic resistance.

Conclusion: Public attention, sensitization of physicians, pharmacists and manufacturers for

modification of prescribing, dispensing and packaging patterns of antibiotics is necessary for

rational use of antibiotics. Excellence in healthcare can be boosted by improving the

prescribing, dispensing and packaging pattern of antibiotics by physicians, pharmacists and

by manufacturers in healthcare system. Establishing ideas and evaluating the excellence of

care through performance analysis is the need of the hour in everyday hospital practice.

KEYWORDS: Pharmacist, Tertiary care hospital, prescribing patterns, dispensing patterns,

packaging patterns, irrational use.

INTRODUCTION

Antibiotics are certainly miracle drugs that have protected millions of lives either as

prophylaxis agents or as therapeutics agents.[1]

Unfortunately, indiscriminate usage, drug

misusage, and Incorrect prescribing of antibiotics have resulted in drug- drug interaction, sub-

optimal therapy, poly-pharmacy, medication failure, multiple drug resistance, non-

compliance, increased healthcare expense and financial burden on households and

communities and most importantly heightened occasion of antibiotic resistance.[2]

At first, antibiotic discovery were extremely successful; this implied that if drug resistance

developed, a new drug was always accessible to deal with the increasingly resistant bacteria.

But now this resistance is expanding and antibiotic advancement is holding up. The prudent

usage of antibiotics is therefore an important way to reduce antimicrobial resistance.[3]

Prescribing patterns of antibiotics indicate the clinical judgment of the clinicians. Examining

prescribing patterns keenly will help minimize adverse drug reactions and give expense-

effective medications.[4]

Thus antibiotic prescribing pattern has an important consequence on

the outcome of patient’s constraint. Hence, to withstand antimicrobial resistance,

interventions on improper antibiotic usage have to be analyzed occasionally so that

interventions can be enforced if essential to guarantee careful antibiotic usage. These signs


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for warning on the way of prescribers and pharmacists and the need for understanding of

methods that can be utilized by practitioners for perceiving drug medication issues.[5]

Today the WHO indexes abuse of antibiotics as one of the three biggest dangers to human

health. Widespread Incorrect usage of antibiotics has created intensifying resistance

pathogens, spoiling much of the improvement made against infectious organisms in the last

50 years. Clinicians and healthcare experts worldwide must vigorously attempt to strengthen

the potency, span and practical life of existing antibiotics. It is advisable for pharmacists to

examine the availability of a once-daily single tablet, fixed-dose combination of antibiotics to

decrease pill burden, boost adherence and reduce the expense and complexness of medication

regimen. The main reason we see 'antibiotic resistance' is because of the misuse of antibiotics

in a population that does not need antibiotics, for instance, in viral infections. "Deliberate

usage of antibiotics stimulates the spread of 'antibiotic resistance'; smart usage of antibiotics

is the key to repealing its spread".

Practical antibiotic prescription is essential to prevent multiple drug resistance, medication

failure, non-compliance and increased expense on medications. Incorrect usage of antibiotics

is allowing usage of an antibiotic when it is not really required. It is also providing the

appropriate antibiotic for an inaccurate interval, i.e., too long or too short at a time. In some

cases, the correct antibiotics can be provided in combination with medicines that interact with

the antibiotic, in that case, the therapeutic advantages are undervalued.

Numerous outcomes result from the incorrect usage of antibiotics; one of them is the

occurrence of 'antibiotic resistance'. Microbes are no longer exterminated by antibiotics that

managed to exterminate them. Higher doses need to be employed to achieve minimum

inhibitory concentrations. Another significant outcome is the alarming expenses incurred by

the government, insurance schemes and on patients when antibiotics are misused.

Governments invest a lot of capital to deal with resistant strains because they lead to

extended hospital stays and prolonged antibiotic use of costly antibiotics. It is important to

utilize the most relevant antibiotics for infectious circumstances.

This emphasizes the serious need for vigilant surveillance, formulation of standard antibiotic

regulation policies and enforcement of policies for antibiotic usage, stringent infection

control strategies as well as logical antibiotic prescribing patterns to facilitate the careful

usage of these drugs that will have a significant positive financial privilege and boost the


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excellence of care being delivered to patients. So, we recommend studying the antibiotic

prescribing, dispensing, and packaging patterns of antibiotics to relatively withstand the

unfair usage of antibiotics and decrease antibiotic resistance growth.

METHODOLOGY

Study design: This study was a prospective, observational and descriptive study.

Study site: This study was carried out in various Departments such as General Medicine,

Pediatrics, OBG, Surgery, ICU of CSI Holdsworth Memorial (Mission) hospital, Mysore,

Karnataka, India.

Study period: The study was performed for 6 months from September 2018to February

2019.

Research approval: The Institutional Ethics Committee of Farooqia College of Pharmacy,

Mysore, Karnataka, India, approved the study before commencement of the research.

Search strategy: Searched from Medline, Pubmed, Plusone, Winley Online Data Base,

Journal of Applied Pharmaceutical Science and many other articles were collected and

referred. The keywords used in Google search engines were prescribing patterns, dispensing

patterns and packaging patterns.

Sources of data: Patient data for the study were collected from the following sources:

Prescriptions from patient’s medication charts were collected.

Pharmacists from different community pharmacies were interviewed.

Nurses gave information about the route of administration and frequency of

administration.

Case records: Patient care notes, medication charts, past medical history.

Culture sensitivity tests were referred

Patient data collection forms which includes demographic details (Name, Age, Gender)

Current diagnosis from doctor’s notes was referred.

Medication prescribed (dose, route of administration, strength, frequency, indication,

therapy interval).

Study protocol

A Protocol for the project titled “Assessment of Prescribing, Dispensing and Packaging

patterns of Antibiotics in tertiary care hospital” was prepared.

Submitted protocol for ethical committee clearance.


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A well-designed data collection form was prepared. Data collection form included the

following details: Demographics of patients like patient name, age, gender, weight, IP

number, ward, unit, date of admission, date of discharge, extent of hospital stay.

Computerization of data collection forms using Microsoft ® access 2007 was created for

the documentation of collected data and also for easy accessibility, retrieval and analysis

of collected data.

Analyzed patient medication charts for prescribing, dispensing and packaging patterns of

antibiotics.

Percent occurrence on hospital parameters on the packaging of antibiotics was collected

by review of different antibiotic products obtained from pharmacies located in Mysore.

Observational study was done to view and record the data. Prospective analysis was

performed to examine the result.

All the collected information was subjected for statistical analysis.

Data was analyzed, and percentages were calculated.

Based on the results of the present study and discussions from previous researchers

conclusion was reported.

RESULTS

In a total of 550 patients medication charts analyzed, details of medication charts without

antibiotics were found in 93 (17%) medication charts, one antibiotic in 230 (42%)

medication charts, two antibiotics in 150 (27%) medication charts, three antibiotics in 59

(11%) medication charts and four antibiotics in 18(3%) of medication charts (Figure 01).


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Gender distribution of patients

Out of 550 patients, 215(39%) females and 335(61%) males were found (Figure no-2).


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Distribution of patients according to age groups

Out of 550 patients, 15 patients were below 1 year, followed by 60 patients between 1 year to

18 years, 105 patients between 19-30 years, 145 patients between 31- 60 years and 225

patients were above 60 years (Figure: 3)(Table : 3).

Table 3: Distribution of patients according to age group.

Age groups Number of patients (Percentage)

Below 1year 15(3%)

1 To 18 60(11%)

19 To 30 105(19%)

31 To 60 145(26%)

Above 60 Years 225(41%)

Details of antibiotic treatment in different departments

The details of antibiotic treatment in different departments are given below and it was found

to be used as therapeutic, unknown and prophylactic. Prophylactic antibiotic medicines were

most commonly prescribed in surgical and obstetrics and gynecology units. In 41 medication

charts, the intention of antibiotic prescription was unidentified (Figure 4).


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Drugs prescribed per treatment chart

From the above graph, it was figured out that 391 patients were prescribed with more than 6

drugs. This indicates that out of 550 patients, 391 patients had polypharmacy. (Figure 5).


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Table 4: different antibiotics prescribed.

Ceftriaxone 115 Metronidazole 67

Cefixime 52 Azithromycin 38

Ciprofloxacin 22 Albendazole 7

Cefuroxime 80 Moxifloxacin 1

Clindamycin 8 Ofloxacin 4

Ampicillin 6 Levofloxacin 16

Doxycycline 23 Cefperazone 5

Cefpodoxime 2 Amikacin 28

Gentamycin 20 Rifaximin 3

Vancomycin 10 Meropenem 10

Cefotaxim 22 Cefadroxyl 8

Cefaclox-xl 15 Cefpodroxyl 5

Netlimycin 1 Amoxycillin 30

Linezolid 4 Tinidazole 1

Cefalexin 1 Rifampicin 1

Table 5: details of combination of antibiotics prescribed.

Ofloxacin +tinidazole 1

Amoxycillin+ clavulanic acid 30

Cefaperazone+ sulbactum 38

Ciprofloxacin + tinidazole 25

Cefpodoxime + clavulanic acid 1

Cefepime + tazobactum 2

Ceftriaxone + sulbactum 15

Ofloxacin +tinidazole 1

Details of pharmacological classification of antibiotics prescribed

Out of 724 antibiotics prescribed in the study, 369 (60%) cephalosporin’s, 49 (8%)

aminoglycosides, 14 (2%) quinolones, 38 (6%) macrolides, 6 (1%) penicillins, 10 (2%) beta

lactamase inhibitors, 23 (4%) tetracyclins, 4 (1%) linezolid, 10 (2%) vancomycin, 10 (2%)

meropenem,, 8 (1%) anthelmentics, 8 (1%) lincomycin, 3 (0%) rifaximin, 67 (11%)

metronidazole. (Figure 6).


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Frequency of anttibiotics administration

All the medications were administered based on various regimens such as twice daily (1-0-1),

once daily (1-0-0), thrice daily (1-1-1), STAT, SOS and also by giving half dose or divided

dose as required (Figure: 7).


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Drug interactions

Out of 550 prescriptions analyzed during the study, we figured 118 serious drug interactions,

379 moderate drug interactions, 165 minor drug interactions, and 5 Drugs that are

contraindicated. The given pie chart represents different drug interactions (Figure 8).

Route of administration

Among 724 prescribed antibiotics, 496(68.5%) administered by intravenous (IV) route and

235 (32.4%) by oral route (PO). (figure 9).


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Dispensing patterns of antibiotics

Out of 50 pharmacists interviewed from 10 clinics and 20 community pharmacies, we figured

out the dispensing patterns of antibiotics. The results are shown below:

Pharmacists qualification

Out of 50 pharmacists and pharmacist assistants interviewed 7 (12%) had passed 10th

,

followed by 5 (8%) had done PUC, 23 (38%) pharmacist had done D.Pharm, 15 (25%) had

studied B. Pharm and 10 (17%) have studied other degrees ( Figure 10 ).

Pharmacists knowledge about antibiotics, antibiotic resistance and its side effects

0ut of 50 pharmacists interviewed about knowledge of antibiotics, 10 had poor knowledge, 5

had good knowledge, 10 had very good knowledge and 25 pharmacists had excellent

knowledge about antibiotics. When we checked the knowledge about 'antibiotic resistance',

15 had poor knowledge, 10 had good knowledge, 15 had very good knowledge, and 10 had

excellent knowledge. The knowledge about side effects was found to be poor in 8

pharmacists, good in 13 pharmacists, very good in 16 pharmacists and excellent in 13

pharmacists (Figure 11).


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Dispensing of antibiotics according to brand name or generic name

Out of 724 antibiotics dispensed, 435 antibiotics were dispensed according to brand name,

250 antibiotics were dispensed according to generic name and 14 antibiotics were not

available. (figure 12).


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Antibiotics dispensing pattern

Dispensing of antibiotics was analyzed and it was figured out that the dispensing of

antibiotics is done according to the number of units prescribed or based on patients needs.

Table 7: details of antibiotics dispensing patterns.

Antibiotics in generics No of units prescribed and dispensed

Cefuroxime Same

Ceftriaxone Same

Metronidazole Same

Ampicillin Same

Gentamycin Same

Vancomycin Same

Ciprofloxacin Different

Cefpodoxime Different

Cefotaxim Same

Azithromycin Same

Cefpodroxyl Same

Cefaperazone Same

Cefixime Same

Cefadroxyl Different

Amikacin Same

Rifaximin Different

Cefpodem Different

Levofloxacin Different

Netlimycin Same

Meropenem Same

Ofloxacin Different

Linezolid Same

Cefalexin Different

Tinidazole Same

Albendazole Same

Ramizole Same

Cefpodoxime Same

Amoxycyllin+ clavulanic acid Same

Cefaperazone+ sulbactum Same

Ciprofloxacin + tinidazole Same

Cefepime + tazobactum Same

Ceftriaxone + sulbactum Same

Cefpodoxime + clavulanic acid Same

Ofloxacin + ornidazole Different

Dispensing of antibiotics based on patient counseling

Dispensing patterns of antibiotics figured that only 190 out-patients out of 200 patients were

counseled about antibiotic usage, whereas 500 inpatients out of 550 patients were not

counseled about antibiotic usage.


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The dispensing patterns of antibiotics in community pharmacies were analyzed, out of 400

patients. it was figured out that pharmacists dispensed antibiotics along with counseling to

275 patients and did not counsel 125 patients while dispensing antibiotics. (Figure13).

Brand prescribed and brand dispensed

0ut of 724 antibiotics dispensed, we figured out that there was a mismatch between the brand

prescribed and brand dispensed. We also figured out that the brand prescribed was most of

the time not available hence the same drug with different brand names was dispensed (Figure

14).


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Packaging patterns

The major and minor packaging commodities of 550 antibiotics were assembled. A whole of

32 major and minor packaging substances of all commodities have been accessed,

Common Regulatory parameters

Medical parameters.

The common regulatory parameters are

1) Generic Name

2) Brand Name

3) Date of manufacturing

4) Manufacturer name

5) Mailing Address of the Manufacturer

6) Legibility of the inserts

7) Product volume,

8) Quantity of the package (net weight, amount)

9) Supply of label


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10) Sterility profile

11) Maximum Retail Price

12) License of the product (DAR No.)

13) Manufacturing License

14) Batch No/Lot No

15) Date of Expiry

16) Type of Dosage form

17) Bilinguality.

The hospital parameters are

1. Indication

2. Contraindication

3. Composition or Ingredients

4. Adverse/Side Effect


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5. Preservative used

6. Mechanism of action (Pharmacology)

7. Instruction for pediatric and geriatric use

8. Time of the rejection after opening

9. Storage condition / Pharmaceutical precaution

10. Instruction for usage

11. Drug interaction

12. Dose to be administered

13. Overdose

14. Warning

15. Usage in pregnancy & Lactation

DISCUSSIONS

This research completely accentuates the method of Poly Pharmacy and injudicious usage of

antibiotics in clinical practice. This research indicated a great allegiance to the essential


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medicine list, more prescription by generic name. Despite this there is misusage of antibiotics

in tertiary care hospital, mainly in the management of indications.

The obligation of bacterial sickness in India is almost the largest in the whole world. It is a

common assumption that antibiotics exploit a critical function in restricting morbidity and

mortality in specific country. However, Antibiotic usage has improved slowly in current

time. Antibiotics are almost often universally packed by manufacturers in packs heavily run

by the cost of economies and convenience rather than any scientific basis or interval of

therapy.

Details of treatment with antibiotics

A total of 550 patients medication charts reviewed, details of medication without antibiotics

in 93(17%) medication charts, one antibiotic in 230 (42%) medication charts, two antibiotics

in 150 (27%) medication charts, three antibiotics in 59 (11%) medication charts and four

antibiotics in 18(3%) of medication charts were figured. In a research conducted by Isaac AJ

et al. on “Assessment of Prescription patterns And Monitoring Adverse Drug Reaction of

Antibiotics In Pediatric In-patients", similar to our study, among the total 160 patients, one

antibiotic was prescribed in 132 (83%) patients, two antibiotics in 26 (16%) patients and

three antibiotics in 2(1%) patients.

Gender distribution of patients

Out of 550 patients, 215(39%) females and 335(61%) male were figured in our research

when compared to the research of Issac AJ On “Assessment of Prescription patterns and

Monitoring Adverse Drug Reaction of Antibiotics in Pediatric Inpatients” which showed that

86 patients were males and 74 were females. There was a preponderance of male patients in

our study, which could be the reflection of the general patterns of sex distribution in the

population of the vicinity of the study site. This could also be due to the common tendency of

parents' over cautious apprehension towards the health of a male child.

Most prescribed antibiotics

In our study, we figured out that ceftriaxone was the highest prescribed followed by

cefuroxime and metronidazole, compared to Kanish R study on the “Prescribing patterns of

antibiotics in the department of pediatrics in a tertiary care medical college hospital”.

Cephalosporins were the highest prescribed, followed by aminoglycosides.


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Distribution of antibiotics according to pharmacological classification of drugs

Out of 724 antibiotics prescribed in the study, 369 (60%) cephalosporins, 49

(8%)aminoglycosides, 14 (2%) quinolones, 38 (6%) macrolides, 6 (1%) penicillins, 10 (2

beta lactamase inhibitors, 23 (4%) tetracyclins, 4(1%) linezolid, 10 (2%) vancomycin, 10

(2%) meropenem, 8 (1%) antihelmentics, 8 (1%) lincomycin, 3 (0%) rifaximin, 67 (11%)

metronidazole. When compared to the study conducted by Issac A J the total antibiotics

prescribed contains cephalosporin 152 (80%), aminoglycoside 18 (9%), quinolones 13 (7%),

antibiotic combination 4 (2%), B-lactamase inhibitors 2 (1%), macrolide antibiotics 1 (1%)

each. cephalosporin comprised 80% of the prescribed antibiotics, which includes cefixime

1% and ceftriaxone 99%. The mostly used aminoglycoside antibiotic was amikacin, and the

widely used quinolone antibiotics were ofloxacin.

Details of antibiotic treatments in different departments

The detail of antibiotic medication in different departments in our study was figured to be

used as therapeutic, unknown and prophylactic. Prophylactic antibiotic medications were

most commonly experienced in surgical and obstetrics and gynecology units. In 41

medications, the intention was unspecified. Surgery department showed a high prophylactic

prescription of antibiotics. The study conducted by V.K.G Lim on the “Patterns of Antibiotic

Use in Hospitals in Malaysia” indicated that roughly two-thirds of all treatments were for the

purpose of treatment and the others for prophylaxis. The main intention to prescribing

antibiotics was therapeutic in 1,263 (66%) prescriptions and in 32% (614), the purpose was

prophylactic. Prophylactic medications were also more popular assortments of antibiotics.

In 25% of cases antibiotics were prescribed based on culture reports and in most of case

sheets, culture results were not mentioned. It is important to perform prior culture sensitivity

test before prescribing any antibiotics. This can impede the growth of 'antibiotic resistance',

reduce the side effects of drugs, and decrease medication expenses. Moreover this will help

with the selection of appropriate antibiotics. In the current research, 98% of medicines were

prescribed from the WHO list of necessary medicine 2013, which is also related to Kanish et

al research. Strict antibiotic prescribing policy significantly overcome the overuse of

antibiotics and reduces the development of resistance to antibiotics. Prescription pattern

analysis or auditing types of studies are to be conducted on a large scale in different health

sectors. The study will then be more effective and help make local policy for antibiotics

prescription in pediatric and other specialties.


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Dispensing patterns

Distributing antibiotics without valid prescription and by non-pharmacists are usual in this

particular area. This research also figured various cases of irrational dispensing of antibiotics.

Thus, there has an essential need to deal with these matters and stimulate correct methods of

dispensing of antibiotics.

We also found out that in some pharmacies a different brand of antibiotic was dispensed than

the actual prescribed one without the consultation of physicians. This reveals the commercial

attitude of community pharmacies. In general, a community pharmacy must be like a

professional service provider rather than a business or a trade. We also found that rarely

pharmacists undergo any training or continuous pharmacy education to update themselves for

their professional development. Hence there is need to educate pharmacist on rational use of

antibiotics

Packaging patterns

We invariably found a mismatch between the amount of doses prescribed by the physicians

and the standard packaging sizes available for most common prescribed antibiotics. This type

of packaging pattern may lead to strip cutting, which results in cutting off the medicines

name, date of manufacturing, date of expiry, and sometimes it is difficult to identify which

medicine it is used for. Some patients terminate prescription whenever their signs develop as

well, rather than completing the whole process. This formulates the chance of reutilizing the

symmetry medication for forthcoming usage, boosting the probability of the medication’s

misusage to deal with the non-susceptible organisms.

Medicines dispensed in the original fixed packaging may result in under- or oversupplies of

antibiotics are leading to either suboptimal interval of medication or 'leftover' antibiotics.

Even if general practitioners try to fulfill the approaches, complications in conforming

diagnoses and striving to adjust package size with directions is a significant barrier to

perform very effectively.

Such mismanagement in an interval between guidelines and dictated by packaging may

symbolize that as a substantial amount of antibiotics are allocated and not expended for the

prescribed acute sickness, contributing to redundant antibiotic doses in society. Prescribers

should ensure their attention about the mismatch between antibiotic pack sizes and guideline

suggestions for their interval is contributing to 'antibiotic resistance' in the society.


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Besides, antibiotics are almost universally packaged by manufacturers in packs that are

heavily run by expense of economies and convenience rather than by any scientific basis or

interval of therapy, individualized packaging adds to the healthcare charge, specifically when

medicines are out-of-pocket charges for clients.

Comprehensive civil insight and sensitization of physicians and modification of hospital

medication system is the necessity of the time to make the modifications at all apparent levels

for the long term and better healthcare result in hospital exercise.

Resistance of Antibiotic is not only a danger issue for a particular sufferer; it decreases the

persuasiveness of traditional medication and serves a prominent danger to civil health by

improving the complexness and outlay of medication and lowering the percentage of a

successful result.

CONCLUSION

In this study, antibiotic prescription and dispensing pattern was not rational as there is poly

pharmacy, overuse and inappropriate use of antibiotics, prescription of antibiotics without

prior culture sensitivity tests, and dispensing of antibiotics without counseling by non

pharmacists. Cephalosporins classes of antibiotics were commonly prescribed and parenteral

route of drug administration was highly used in this research. Average drug encountered per

patient were high (6) which increases the risk of drug interactions and leads to polypharmacy.

Strict antibiotic prescribing policy significantly overcome the overuse of antibiotics and

reduces the development of resistance to antibiotics. Prescribing drugs by generic name and

only after culture sensitivity test and writing prescriptions by the physicians in capital letters

can significantly reduce medication errors and antibiotic resistance. There is a need to switch

over from parenteral to oral route of antibiotics as soon as possible when the clinical

condition permits; this would reduce the cost associated with drug therapy.

General public awareness, sensitization of health care professionals and revision of clinical

drug policy is the need of the hour to bring the changes at all possible level for the long term

and better clinical outcome in medical practice.

Quality of life can be improved by enhancing standards of medical treatment at all levels of

the health care delivery system. Setting standards and assessing the quality of care through

performance review should become part of everyday clinical practice.


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Proper information on the products packaging material is essential as it may lead to

mislabeling, mismarking or change in the original package and deletion of expiry dates from

the bottles or vials of pharmaceutical products. So, the manufacturers of pharmaceutical

products should be careful in designing the primary and secondary packaging items of

antibiotic drug products.

This emphasizes the urgent need for vigilant surveillance, formulation of strict antibiotic drug

policies, implementation of standard protocols for antibiotics usage, stringent infection

control practices as well as rational antibiotic prescription in order to streamline the judicious

use of antibiotics which will have a significant positive economic benefit and improved

quality of care being delivered to patients.

Public attention, sensitization of physicians, pharmacists and manufacturers for modification

of prescribing, dispensing and packaging patterns of antibiotics is necessary for rational use

of antibiotics. Excellence in healthcare can be boosted by improving the prescribing,

dispensing and packaging pattern of antibiotics by physicians, pharmacists and by

manufacturers in healthcare system. Establishing ideas and evaluating the excellence of care

through performance analysis is the need of the hour in everyday hospital practice.

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ASSESSMENT OF PRESCRIBING, DISPENSING AND PACKAGING