Drug utilisation in neonatal units in England and Wales: a national cohort study

Purpose To describe drug utilisation patterns in neonatal units. Methods Retrospective observational cohort study using data held in the National Neonatal Research Database (NNRD) for neonatal units in England and Wales including infants born at 23 to 44 weeks’ gestational age (GA) from 01 January 2010 to 31 December 2017. Results The cohort included 17,501 (3%) extremely preterm infants; 40,607 (7%) very preterm infants; 193,536 (31%) moderate-to-late preterm infants; and 371,606 (59%) term infants. The number of unique drugs received by an infant (median (IQR)) increased with decreasing GA: 17 (11–24) in extremely preterm, 7 (5–11) in very preterm, 3 (0–4) in moderate-to-late preterm, and 3 (0–3) in term infants. The two most frequently prescribed drugs were benzylpenicillin and gentamicin in all GA groups, and caffeine in extremely preterm. Other frequently used drugs among preterm infants were electrolytes, diuretics and anti-reflux medications. Among infants <32 weeks’ GA, the largest increase in use was for surfactant (given on the neonatal unit), caffeine and probiotics, while domperidone and ranitidine had the largest decline. Conclusion Antibiotics, for all GAs and caffeine, among preterm infants, are the most frequently used drugs in neonatal medicine. Preterm infants are exposed to a high burden of drugs, particularly antibiotics. Changing patterns in use reflect the emergence of evidence in some areas but several non-evidence-based drugs continue to be used widely. Improvements are needed to ensure rational drug use on neonatal units. Registration ClinicalTrials.gov (NCT03773289). Date of registration 21 Dec 2018.

New trend of drugs abused by secondary school students in Nigeria

Background: It appears that there is a new trend in the types of drugs abused by secondary school students in Nigeria that makes it difficult to identify current drug abusers. Objectives: This study was conducted to reveal the trends with regards to the types of drugs abused by these students in the country. Methods: This is an online and desktop review of published articles about the types of drugs abused by secondary school students during the period that spanned from 2010–2020. Results: In all, 17 research reports were identified as having data on the types of drugs abused by secondary students in the Nigeria. It was found that 18 different drugs were empirically identified as being abused by secondary school students in 9 different states of Nigeria. The observed trend is that alcohol, cannabis, tobacco and cigarettes are the most abused drugs, while drugs that were least abused were cocaine, caffeine, glue, heroine, energy drinks, miraa, rohypnol and tramadol. Conclusion: It was concluded that studies of drug abuse by secondary school students in Nigeria are not yet robust enough to reveal the types of drugs that are currently being abused. Keywords: Adolescent Health; Drug Abuse; Drug Effects; Drug Safety; Drug Utilisation.

Consumption of oral anticancer drugs in Norway compared by different units of measurements – introduction of new DDDs

Background: Antineoplastic agents (ATC group L01) have not been assigned DDDs due to highly interindividualvariation in dosages. Consumption data has therefore been presented in other measurement units such as grams of active ingredient. However, the protein kinase inhibitors (PKIs) are a rapidly growing drug group that was introduced to the market recently and are administered orally in a fixed dose. DDDs were therefore established for the PKIs in 2020. In this study we aim to assess whether the newly assigned DDDs would better express drug utilisation patterns in Norway than the current units of measurement.Methods: Sales data for PKIs (ATC level L01E) by grams, cost, units and packages for 2019 were collectedfrom the Norwegian Drug Wholesales Statistics and data on number of prescriptions and prevalence for 2019were collected from the Norwegian Prescription Database (NorPD). DDDs were calculated by applying thevalues of the new DDDs.Results: The proportions of the different substances varied according to the unit of measurement. DDDs andpackages had the highest similarity and correlated better than grams with the prevalence of use in theNorwegian population. BCR-ABL tyrosine kinase inhibitors was the largest group accounting for 31% ofthe total consumption (DDD/1000 inhabitants/day) and imatinib was the most sold PKI in all units of measurement except cost.Conclusions: Using an international agreed unit of measurement gives reliability to the study result. Assignment of DDDs to PKIs will improve the quality of drug utilisation studies in this area.

The Relevance of Defined Daily Dose concept in Drug Utilisation Research: A Review

According to World Health Organisation (WHO), drug utilisation is defined as the marketing, distribution, prescription and the use of drugs in society with special focus on resulting medical, social and economic consequences and it has turned into a powerful scientific tool for ensuring the rational and cost-effective use of drugs. A standard method is required to identify and aggregate drug data. This manuscript provides an overview of the WHO Anatomical Therapeutic Chemical (ATC) classification and the associated measure, Defined Daily Dose (DDD), as a methodology for evaluating drug utilisation. Keywords: Drug utilisation research, Anatomical Therapeutic Chemical classification system, Defined Daily Dose, Rational drug use.

Drug Utilisation Pattern for Diabetic Foot

Introduction: Diabetic mellitus is a chronic disorder which is rapidly raising, major public health problem. Having DM are more prone to multifarious complication like diabetic foot ulcer, which is highly susceptible to infection. Prevalence of bacterial flora in foot ulcer of this study population indicate current medical scenario of increased multidrug resistant diabetic foot infection, appropriate selection of antibiotic plays important role in DFU management increasing prevalence of antibiotic resistance is a major factor for morbidity or mortality in DFU. The main objective of this study was to asses microbial sensitive resistance to antibiotic and also to know the drug utilisation of antibiotics in DFU. Method: A prospective observational study was carried out in 123 inpatients, after taking written informed consent from those met the study criteria. The study was done from October 2017 to march 2018 in surgery department. Patient case sheet were reviewed and assessed on daily basis. Culture report form and all other relevant data were collected to assess the utilisation of antibiotic, it’s sensitivity and resistant interaction, drug interactions and ADR were assessed by using Micromedex and other resources available in the department Result: In this study population, about 87(70.3%) patients were male and 36(29.27%) female. Mainly patients of age range 41-50 is 47(38.21%)followed by 51-60 is 33(26.83%)then 61-70 is 23(18.70%).Hospital Conclusion: Diabetic foot infections are real public health problem and early diagnosis along with appropriate treatments are essential. Different bacterial profiles and antibiotic sensitivity were found in different DFU. Clinician should try to stay updated in antibiotic sensitivity and resistant pattern of common pathogen in their area for better therapeutic outcome and to minimize medication errors. Keywords: Diabetic foot ulcer, sensitivity, resistant, utilization of antibiotics, therapeutic outcome.

Drug Utilisation Pattern in Ear, Nose and Throat Inpatient Department using WHO Prescribing Indicators

Introduction: Assessment of drug utilisation pattern (DUP) based on World Health Organisation (WHO) drug prescribing indicators would enhance the standards of patient care at all levels of the healthcare. It helps to improve the quality of life in developing countries like Nepal. Objective: To assess DUP in patients admitted in ear, nose and throat inpatient department at a tertiary hospital in Eastern Nepal using the WHO prescribing indicators. Methods: A hospital based cross-sectional descriptive study was carried out in 96 patients in ENT department of a tertiary care teaching hospital from February-April 2019. Pre-designed proforma was used to collect the relevant data from the medical case sheets and drug charts. Descriptive statistics were calculated using Microsoft Excel 2010. Results: Out of 96 patients, 52 (54.17%) were female. Most of the patients (46, 47.18%) were pre­scribed four drugs. Combination of Ibuprofen and Paracetamol (77, 19.74%) was the commonest prescribed drug. Ceftriaxone (62, 63.92%) was the most frequently prescribed systemic antibiotic. The average number of drugs per prescription was 4.06. None of the drugs were prescribed by generic name. Out of 360 drugs, only 118 (30.26%) were prescribed from National List of Essential Medicines (NLEM) and 117 (30.00%) drugs were fixed drug combinations. Ninety two (95.83%) patients had been prescribed at least one antibiotic. Conclusions: The prescribing practices of essential medicines, generic drugs, antibiotics and inject­able drugs showed deviation from the standard recommended by the WHO. The prescribers should be motivated to enhance prescription of drugs by generic names and from NLEM.

“Drugs to avoid” to improve quality use of medicines: how is Australia faring?

Background Each year, the French independent bulletin Prescrire publishes a list of medicines, “Drugs to avoid”, that should not be used in clinical practice as their risk-to-benefit ratio is unfavourable. This study assessed the market approval, reimbursement and use of these medicines in Australia. Methods The approval status of the medicines included in 2019 Prescrire “Drugs to avoid” list was assessed by searching the Australian Register of Therapeutic Goods website. Funding status was assessed on the Pharmaceutical Benefits Scheme (PBS) website, the Australian public insurance system. Use levels were determined by examining governmental reports on prescribing rates including the Australian Statistics on Medicines (ASM) reports, drug use reports released by the Drug Utilisation Sub Committee (DUSC) and PBS statistics. Results Of the 93 medicines included in the Prescrire 2019 “Drug to avoid” list included, 57 (61%) were approved in Australia in 2019 including 9 (16%) that were sold as over-the-counter medicines, 35 (38%) were listed on the PBS, 22 (24%) were registered but not listed on the PBS. Although most of these medicines were used infrequently, 16 (46%) had substantial use despite serious safety concerns. Dipeptidyl peptidase-4 (DPP-4) inhibitors were used by 22% of patients receiving a treatment for diabetes in 2016. More than 50,000 patients received an anti-dementia medicine in 2014, a 19% increase since 2009. Denosumab became the 8th medicine, in terms of total sales, funded by the Australian Government in 2017–2018. Conclusions Prescrire’s assessments provide a reliable external benchmark to assess the current use of medicines in Australia. Sixteen “drugs to avoid”, judged to be more harmful than beneficial based on systematic, independent evidence reviews, are in substantial use in Australia. These results raise serious concerns about the awareness of Australian clinicians of medicine safety and efficacy. Medicines safety has become an Australian National Health Priority. Regulatory and reimbursement agencies should review the marketing and funding status of medicines which have not been shown to provide an efficacy and safety at least similar to alternative therapeutic options.