E-drug: Indicators for optimum prescribing (cont'd)
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In addition to the comments of Hilbrand Haak and Richard Laing, I
would like to express my comments on the summary of chapter 9 of
the book "Drug Supply and Use: Towards a Rational Drug Policy in
India" by Dr Anant Phadke, that has been posted by S. Srinivasan.
1. Some of the comments about the indicators have already been
discussed in the WHO manual "How to investigate drug use in health
facilities: Selected drug use indicators (WHO/DAP/93.1)". For
example:
A. Related to indicators of antibiotics use, Srinivasan writes in his
summary "Also, this permissible percentage will vary with the
proportion of infective diseases in the total quantum of diseases in
different areas". The WHO manual states on page 15 "The
indicators of antibiotics use are quite sensitive to whether or not
certain groups of drugs are included as antibiotics, especially in
environments where problems such as parasitic infestation or
tuberculosis are common. Another issue in the definition of
antibiotics for drug use indicators is whether topical antibiotic
preparations, such as skin cream and ophthalmic ointments, should
be counted as antibiotics. In areas where trachoma, bacterial
conjunctivitis or bacterial skin infections are common these products
may be widely used".
B. With regard to injection use, Srinivasan writes "Some injections
used at out-patient clinics are quite rational: tetanus toxoid,
injectable vaccines, inj. penicillin or...". The WHO manual did take
the effect of immunization on this indicator into account (page 14):
"investigators must be instructed about which immunizations are
not to be counted as injections".
2. In the statement in comment Nr.2: "A better indicator would be the
percentage of patients receiving one or more irrational drug
combinations", if "irrational fixed-ratio combinations" is meant by
"irrational drug combinations" it may be a good indicator.
3. In the statement in the comment Nr.5: "Phadke drew up standard
prescriptions (SPs) for 92 common conditions encountered". Isn't it
very difficult for one or two individuals to draw up standard treatment
schedules? Another WHO manual, "Producing national drug and
therapeutic information, The Malawi approach to developing standard
treatment guidelines (WHO/DAP/94.14)" is useful in producing such
standard treatment guidelines.
Thank you,
Dr. Ahmad F. Danish
Former Associate Prof
Pharmacology Faculty of Medicine
Kabul, Afghanistan
e-mail afdanish@hotmail.com
Fax: +92-91-816074
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