Professional Documents
Culture Documents
Appropriate indication
Appropriate drug
Appropriate administration, dosage, and duration
Appropriate patient
Appropriate patient information
Appropriate evaluation
Problems of Irrational Drug Use
Examples of Common
Inappropriate Prescribing
Practices
The overuse of antibiotics and
antidiarrheals for nonspecific childhood
diarrhea
Indiscriminate use of injections for
malaria
Multiple or over-prescription
Use of antibiotics for mild, non-bacterial
infection, e.g., URI
Tonics and multivitamins for malnutrition
Unnecessary use of expensive
antihypertensives
Problems of Irrational Drug Use
Drug Imports
Provider and
Consumer Behavior
Hospital or
Health Center
Center
Private Physician or
Other Practitioner
Illness Patterns
Pharmacist or
Drug Trader
Public
Problems of Irrational Drug Use
Factors Underlying
Irrational Use of Drugs
Patients
Patients
drug
misinformati
on
misleading
beliefs
inability to
communicate
problems
Industry
Industry
Prescribers
Prescribers
lack of education
and training
lack of drug
information
heavy patient load
pressure to
prescribe
generalization of
limited beliefs
misleading beliefs
about efficacy
promotion
misleading
claims
Drug
DrugSupply
Supply
Drug
DrugRegulation
Regulation
availability of
unsafe drugs
informal
prescribers
etc.
inefficient
management
nonavailability of
required
drugs
Impact of Inappropriate
Use of Drugs
Reduced
quality of
therapy
morbidity
mortality
Waste of
resources
Risk of
unwanted
effects
Reduced availability
increased cost
adverse reactions
bacterial resistance
Psycho-social
impacts
patients rely on
unnecessary drugs
Three
27%
Three
29%
Two
14%
Two
9%
One
1%
One
3%
Six +
6%
Six+
13%
Four
26%
Four
35%
Five
19%
Five
17%
Under 5
5
4
3
Under Five
Five & Over
2
1
0
All Cases
Diarrhea
DiarrheaResp.Dis.Skin G.I. Musculoskel.
Musculoskel
Problems of Irrational Drug Use
10
% Of Patients Receiving
Antibiotics
E. Java & W. Kalimantan, Indonesia, 2007
None
35%
One
56%
None
12%
Three/More
3%
Three/More
2%
One
36%
Two
27%
Two
29%
Under
5
5&
Over
11
% Of Patients Receiving
Injections
E. Java & W. Kalimantan, Indonesia, 2007
None
56%
None
26%
One
54%
Two or More
10%
Two or More
20%
One
34%
Under 5
5 & Over
Problems of Irrational Drug Use
12
1.4
1.2
1
Under Five
Five & Over
0.8
0.6
0.4
0.2
0
Antibiotics
AnalgesicProblems
Cough/Cold
Antihist. Others
of Irrational Drug Use
13
14
Yemen
Uganda
Sudan
Malawi
Indonesia
Bangladesh
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Jamaica
Ghana
Cameroon
El Salvador
0
15
% Prescribed as Generics
Public Sector Drug Use Indicator Studies
2000-2003
Sudan
Indonesia
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Ghana
Cameroon
El Salvador
Jamaica
0
20
40
60
80
100
% Generic
Problems of Irrational Drug Use
16
% Receiving Antibiotics
Public Sector Drug Use Indicator Studies
2000-2003
Yemen
Uganda
Sudan
Malawi
Indonesia
Bangladesh
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Jamaica
Ghana
Cameroon
El Salvador
0
20
40
60
80
100
17
% Receiving Injections
Public Sector Drug Use Indicator Studies
2000-2003
Yemen
Uganda
Sudan
Malawi
Indonesia
Bangladesh
Zimbabwe
Tanzania
Nigeria
Nepal
Ecuador
Guatemala
Eastern Caribbean
Jamaica
Ghana
Cameroon
El Salvador
0
20
40
60
80
100
18
Average Consultation
Time
Public Sector Drug Use Indicator Studies
2000-2003
Malawi
Indonesia
Tanzania
Nigeria
Nepal
0
19
Tanzania
Nigeria
Nepal
Eastern Carribean
Ghana
0
50
100
150
200
20
20
40
60
80
100
21
Malawi
Tanzania
Nigeria
Nepal
Ecuador
Cameroon
Ghana
El Salvador
Guatemala
Jamaica
0
20
40
60
80
100
22
Conclusion
Drug use is the end of the therapeutic
consultation.
Health professionals have a
responsibility to ensure that the right
drug is prescribed, dispensed and taken.
Methods exist to measure drug use and
to change practices.
Improving drug use improves the quality
of care and frequently lowers cost.
Problems of Irrational Drug Use
23