Int J Curr Pharm Res, Vol 16, Issue 6, 89-92Original Article

A PROSPECTIVE, OBSERVATIONAL DRUG UTILIZATION STUDY IN THE DERMATOLOGY OUT-PATIENT DEPARTMENT OF A GOVERNMENT HOSPITAL, NANDYAL, ANDHRA PRADESH

PUJARI SREENIVASULU NAIK1, NAGA VISHNU KANDRA2*, K. SANTHA BAI3

1Department of DVL, Government General Hospital, Pulivendula, Andhra Pradesh. 2Department of Pharmacology, Santhiram Medical College, Nandyal, Andhra Pradesh. 3Department of Pharmacology, Government Medical College, Nandyal, Andhra Pradesh
*Corresponding author: Naga Vishnu Kandra; *Email: doctorvishnu2023@gmail.com

Received: 06 Sep 2024, Revised and Accepted: 18 Oct 2024

ABSTRACT

Objective: The data regarding drug utilization in dermatology departments of southern parts of India is limited. Recent studies on drug utilization in dermatology across India, reported high prescription of branded drugs, low adoption of essential drugs and polypharmacy. Hence, this study was conducted to analyze the drug utilization pattern for common skin diseases as per WHO prescribing indicators.

Methods: This study was done in the Out-patient department (OPD) of dermatology at Government General Hospital (GGH), Nandyal, in collaboration with department of Pharmacology for a period of 4 mo and Institutional ethical committee (IEC) permission was taken before conducting the study.

Results: A total number of 344 prescriptions were analyzed. Average number of drugs per prescription was 2.5 (including Fixed drug combination (FDC) drugs). Total number of drugs accounted to 860. Majority of prescriptions have 3 drugs per prescription (57.1%) and only 8.7% of prescriptions have more than 3 drugs per prescription. Analyzed data as per World Health Organization (WHO) prescribing indicators indicate 74% of prescribed drugs were from National List of Essential Medicines (NLEM), 2.5% were FDC drugs and 13.14% of the drugs prescribed were antibiotics. Polypharmacy was noted to be only 0.7% in the study.

Conclusion: A periodic audit of prescriptions will reduce errors and motivate the health care professionals for rational drug use. Special consideration is to be given to extended public health initiatives to prevent skin infections because they account for about 70% of diseases in daily life.

Keywords: Dermatology, Drug utilization, Polypharmacy

© 2024 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2024v16i6.5087 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

Skin constitutes the largest organ of the human body. Thus, it is exposed to injury by various extrinsic factors such as environmental, chemical, infectious agents and intrinsic factors such as metabolic, genetic, and immunological. Collectively, skin disease was the fourth leading cause of non-fatal health burden in 2017 globally. Skin disorders are seldom fatal but constitute 2% of Out-Patient Department (OPD) consultations worldwide. In India prevalent skin conditions includes but is not limited to dermatitis, urticaria, fungal skin infection, acne, alopecia and conditions such as Psoriasis, skin cancer and adverse drug reaction on the skin are less prevalent [1-3]. Drugs play crucial role in improving human health and promoting the well-being of individuals. However, to produce desired effect, they must be safe efficacious and must be prescribed in a rational manner [4]. Drug utilization studies was defined in 1977 by WHO as the marketing, distribution, prescription and use of drugs in a society, with a special concern on medical, social and economic consequences. Clinical trials provide evidence of efficacy and safety, while drug utilization study is necessary to know extent of drug use, to identify variability in drug use among different regions or within a region, identify problems concerning rational use of drugs, plan targeted interventions to improve drug use and to measure impact of interventions [5, 6].

The data regarding pattern of drug utilization, particularly in dermatology departments of southern parts of India is very much limited. Recent studies on drug utilization in dermatology across India have reported issues regarding high prescription of branded drugs, low adoption of essential drug and polypharmacy, thus creating concern regarding the rational prescription of drugs in dermatology. Keeping these facts in consideration, the current study is planned to analyze pattern of drug use for common skin diseases in Dermatology OPD at GGH, Nandyal, which helps in improving the overall efficacy and safety of drug therapy for skin diseases.

MATERIALS AND METHODS

This study was done in OPD of dermatology at GGH, Nandyal, in collaboration with department of Pharmacology. This is a single-centric, prospective, observational, cross-sectional and descriptive study. Duration of study was February 2024 to May 2024, for a period of 4 mo and IEC permission (No. 48625) was taken before conducting the study.

Inclusion criteria

  1. Patients of any age and gender visiting department of dermatology

  2. Patients prescribed with atleast one drug

  3. Patients who gave informed consent

Exclusion criteria

  1. Patients with burns, leprosy, tuberculosis, terminal illness

  2. Pregnant/lactating females

  3. Patients enrolled in other clinical trials

  4. Patients who were not prescribed drugs related to dermatology

  5. Patients who did not consent to the study

Written Informed consent was taken from all the patients who were involved in this study. Data collected in this study includes name, dose, dosage form of the respective prescribed generic/brand drugs, Fixed drug dose combination (FDC) drugs and drugs included in National list of essential Medicines (NLEM). Descriptive analysis of data was done using Statistical package for Social Sciences (SPSS) software and Microsoft Office. A total number of 344 prescriptions were analyzed for characteristics in demography, drug utilization pattern, disease incidence and WHO core drug prescribing Indicators.

RESULTS

Prescriptions in the collected data was distributed in the ratio of 1.91 as per gender (table 1, fig. 1).

Table 1: Gender distribution

Sex Frequency Percentage
Female 118 34.30%
Male 226 65.69%
Ratio 1.91
Total 344 100%

Among the collected data, it was found that majority of the population with dermatological diseases belong to age group (21-30) y (table 2).

Table 2: Age group distribution

Age group (in years) Males Females Total Percentage
≤ 12 40 31 71 21%
13-20 43 18 61 18%
21-30 54 33 87 25%
31-40 39 17 56 16%
41-50 20 12 32 9%
51-60 20 5 25 7%
>61 10 2 12 3%
Total 226 118 344 100%

Average number of drugs per prescription was 2.5 (including FDC drugs). Out of 344 prescriptions, total number of drugs accounted to 860 (after decoding FDC drugs). Majority of prescriptions have 3 drugs per prescription (57.1%) and only 8.7% of prescriptions have more than 3 drugs per prescription (table 3, fig. 2).

Table 3: Number of drugs per prescription

Number of drugs per prescription Number of prescriptions Number of drugs Percentage
1 51 54 6.27%
2 111 232 26.93%
3 163 491 57.10%
4 16 67 7.80%
5 2 10 1.20%
6 1 6 0.70%
Total 344 860 100%

Majority of the drugs were prescribed via Oral route (57.5%) (fig. 3).

Fig. 3: Various classes of drugs prescribed via different routes

Antifungals were the most prescribed drugs (31.6%) followed by antihistaminics (27.1%), Antibiotics (13.4%), Steroids (11.5%), NSAIDs (4.77%) and Moisturisers (4%). Flucanazole was commonly prescribed antifungal via topical route. Among antihistaminics Levocetrizine, Cetrizine, Chlorpheniramine were most commonly pescribed via oral route. Some of the topical antibiotics prescribed were Fusidic acis amd Clindamycin. 93.2% of prescribed steroids were via topical route. A total of 35 moistirisers 22 keratolytics were prescribed via topical route only. A total of 5 antiviral agents and 39 NSAIDs were prescribed via oral route (table 4, 5).

Table 4: Various classes of drugs prescribed via different routes

Class of drug Oral Topical Injectable Total number of drugs
Antibiotics 81 31 1 113
Antifungals 135 124 - 259
Anti-histaminics 220 - - 220
Steroids 6 82 3 91
Antiparasitic and Antihelminthic drugs 6 17 - 23
Antivirals 5 - - 5
NSAIDs 33 - - 33
H2 blockers 2 - - 2
Minerals and Vitamins 4 - - 4
Moisturizers - 42 - 42
Keratolytics - 27 - 27
Others 41 - - 41

Table 5: Various drugs prescribed among different classes via different routes

Class of drug Drug name Total number of drugs prescribed % Total number of drugs prescribed in the class % of total drugs prescribed
Antihistaminics Chlorpheneramine 28 12.93% 220 26.83%
Cetrizine 22 10.08%
Levocetrizine 170 76.97%
Steroids Dexamethasone 1 1.03% 91 11.10%
Mometasone 84 92.26%
Prednisolone 3 3.09%
Triamcinolone 3 3.60%
Antifungals Clotrimazole 134 51.60% 259 31.59%
Flucanazole 124 48.02%
Ketoconazole 1 0.38%
Antibacterials Amoxicillin 46 40.70% 113 13.14%
Azithromycin 1 1.76%
Cefadroxil 3 2.21%
Cefixime 3 3.09%
Ceftriaxone 1 0.44%
Ciprofloxacin 1 0.44%
Clindamycin 1 0.88%
Dapsone 1 0.44%
Doxycycline 12 10.61%
Fusidic acid 44 39.38%
Antiparasitic and antihelminthics Albendazole 4 18.51% 23 2.80%
Hydroxychloroquine 1 1.85%
Permethrin 17 77.77%
Diethylcabamazine 1 1.85%
Antivirals Acyclovir 5 100% 5 0.61%

Table 6 indicates summary of the analyzed data and according to it, as per WHO prescribing indicators which include (74%) from NLEM, 2.5% were FDC drugs and 13.14% of the drugs prescribed were antibiotics. Polypharmacy was noted to be only 0.7% among collected prescriptions.

Table 6: Summary of the current study

Observations Results
Total number of prescriptions 344
Total number of prescribed drugs 860
Average number of drugs per prescription 2.5
Total number of drugs from NLEM 606 (74%)
Percentage of FDCs 2.50%
Total number of drugs prescribed by generic name 808 (98.6%)
Drugs prescribed by brand name 12 (1.4%)
Encounters with Antibiotic 113 (13.14%)
Encounters with Injection 4 (0.47%)
Percentage of Polypharmacy in prescription 0.57%

The current study suggested that Tinea (33.2%) is the common dermatological disease, especially Tinea cruris followed by corporis and is commonly seen in males of age group 20-40 y. Second most common dermatological disease in the collected data is Pyoderma (11.9%) in male children of age less than 12 y. Urticaria (6.6%) is common dermatological disease seen in females of age group 10-20 y in the collected data. Acne vulgaris (3.6%) was seen in patients of the age group 18-23 y.

DISCUSSION

To improve drug utilization, especially in developing countries, international agencies like International Network for Rational Use of drugs (INRUD) and World Health Organization (WHO) have given standard indicators for drug use that can describe the drug use situation in a country, region or individual health facility [7]. Skin conditions are usually misdiagnosed all over the world and hence, continuous monitoring of drug use is required to detect any change from contemporary practices or available guidelines [8]. Demographic data in the current study involving gender correlates with studies done by Vineeta D et al. [9], Surabhi Gupta et al. [10], whereas data involving age group correlated with studies done by Jaiswal MK et al. [11] and Manjusha Sajith et al. [12]. The average number of drugs per prescription is close to recommended limit of 2.0 as per WHO. Polypharmacy (=/>5 drugs per prescription) in the current study was only 0.57%. 2.5% of total prescribed drugs were FDCs. Although there are benefits of prescribing FDCs, it is preferable to keep the FDCs and polypharmacy use as low as possible because it may lead to an increased risk of undesirable drug interactions, poor compliance and eventually, high expense for the patient. In the present study, 70.5% drugs are prescribed from NLEM, which is in contradiction to WHO standards (100%). 98.6% of drugs were prescribed with generic names in current study, which is near to the WHO standards (100%) [13]. The main advantage of using generic names is easier drug identification, which help for better exchange of information between healthcare providers [14]. In the current study, the usage of antifungal drugs correlates with a study by Khorbragade et al. [15], Yuwante et al. [16]. Drugs prescribed in the current study are mostly via oral route and least were prescribed via parenteral route, which is in line with a study by Jaiswal MK et al. [12]. Tinea followed by Pyoderma, were the common dermatological diseases among the collected data which is in correlation with studies by Khobragade et al. [15] and S. P. Narwane et al. [17]. Eczema was found to be 4.5% among the dermatological conditions of the collected data but in a study by S. P. Narwane et al., Eczema is the third common dermatological condition. Scabies is found in 5.9% of the collected data in current study, whereas it was commonly reported in a study by Chakrawarty et al. [18]. This is probably due to differences in the geographical distribution of dermatological diseases. Amoxicillin followed by Fusidic acid, were the most prescribed antibiotics in the current study, which contrasts with a study by Manjusha singh et al. [11] where clindamycin, azithromycin and minocycline were the most prescribed antibiotics. Most prescribed oral steroid was Mometasone and oral steroid was prednisolone in the current study, whereas in a study by Kumar et al. [19], Clobetasol propionate was most commonly prescribed topical steroid. This might be due to variations in drug availability, dermatological conditions and preferences by physician in prescription.

CONCLUSION

With an objective to record drug uitilization pattern among common skin diseases, the present study was conducted, which revealed that WHO prescribing indicators were followed in the prescriptions of this study. A periodic audit of prescriptions will reduce errors and motivate policymakers and healthcare professionals for rational use of drugs to improve quality of healthcare. Special consideration is to be given to extended public health initiatives to prevent skin infections because they account for about 70% of diseases in daily life.

FUNDING

Nil

AUTHORS CONTRIBUTIONS

All the authors have contributed equally

CONFLICT OF INTERESTS

Declared none

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