RATIONAL USE OF DRUGS

Prajogo Wibowo
 What is drug?
• Drug is any substance or product which is
used to prevent, relieve or cure a pathological
state or to explore or influence physiological
or pathological mechanisms for the benefit of
the patient.
The aim of any drugs management systems are

• To deliver the correct drugs to the patient

who needs that medicine
• In order to achieve this goal :
Drug therapy should be undertaken in
accordance with principles of rational
prescribing
• The principles of rational prescribing :
Essential element for effective, safe and
economical use of medicines
 What does the rational use of drugs
require (WHO, 1987)?
• The rational use of drugs requires that
patients receive medicines appropriate to
their clinical needs, in doses that meet their
own individual requirements, for an
adequate period of time, and at the lowest
cost to them and the community.
 criteria rational use of drugs:
• Correct diagnosis
• Appropriate indication
• Appropriate drug(s)
• Appropriate dosage, administration &
duration of treatment
• Appropriate patient
• Appropriate information
• Appropriate evaluation & follow-up
 criteria Irrational Use of Drugs:
1. Medically inappropriate
• Inappropriate indications
• Inappropriate dosage, administration, and duration of
treatment
• Inappropriate information

2. Risk-benefit ratio > 1

There are 5 types of irrational drug use, such as

1. Under prescribing-occurs if a drug is

prescribed when:
– needed medications are not prescribed
– dosage is inadequate
– length of treatment is too brief
2. Incorrect prescribing-occurs if a drug is
prescribed when:
– drug given for incorrect diagnosis
– wrong drug selected for diagnosis
– prescription prepared improperly
– adjustments not made for co-existing medical,
genetic, environmemtal, or
3. Extravagant prescribing-occurs if a drug is
prescribed when:
– A less expensive drug provides comparable
efficacy and safety
– symptomatic treatment of mild conditions diverts
funds from treating serious illness
– brand-name drug used when less expensive
equivalents are available
4. Overprescribing-occurs if a drug is prescribed
when:
– Drug is not needed
– Dose is too large
– Treatment period is too long
– Quantity dispensed is too great for current course
of treatment
5. Multiple prescribing-occurs if a drug is
prescribed when:
– Two or more medications are used when fewer
would achieve same effect
– Several related conditions are treated when
treatment of primary condition would improve or
cure the other conditions
 Factors underlying irrational use of drugs

1. Patient:
– Drug misinformation
– Misleading beliefs
– Inability to communicate problems
2. Prescribers:
– Lack of education and training
– Lack of drug information
– Heavy patient load
– Pressure to prescribe
– Generalization of limited beliefs
– Misleading beliefs about efficacy
3. Industry
– Promotion
– Misleading claims

4. Drug supply
– Inefficient management
– Non-availability of required drugs
5. Drug regulation
– Availability of unsafe drugs
– Informal prescribers
 Impact of inappropriate use of drugs

1. Reduced quality of therapy

– morbidity
– mortality

2. Waste of resources
– reduced availability
– increased cost
3. Risk of unwanted effects
– adverse reactions
– bacterial resistance

4. Psycho-social impacts
– patients rely on unnecessary
Strategies to improve use of drugs
• Educational:
– Inform or persuade
– Health providers
– Consumers

• Managerial:
– Guide clinical practice
– Information systems
– Drug supply
• Economic:
– Offer incentives
– Institutions
– Providers and patients

• Regulatory:
– Restrict choices
– Market or practice controls
– Enforcement
 4 critical factors
that determine the selection of an antibiotics
1. Identity of the organism-usually identifies
through Gram stain or culture.
2. Safety of the drug.
3. Site of infection-for examples, some drugs
cross the blood-brain barrier whereas others
do not.
4.Patient’s medical history-allergies immune
status, renal and hepatic condition, pregnancy,
and lactation status.
 empiric therapy
• Early intervention through the use of an
antibiotic before a pathogen is identified.
• Because early intervention usually helps to
improve the outcome of an infection,
antibiotics are sometimes used before a
Gram’s stain or culture of the pathogen is
obtained. Physicians use information from the
history, physical examination, and any other
completed diagnostic tests to determine
which antibiotic to use.
 The common causes of failure of
antimicrobial therapy are

1. Drug factors
– Pharmacokinetics
– Pharmacodynamics
– Toxicity
– Cost
2. Host factors
– Allergy or history adverse drug reaction
– Patient age
– Pregnancy
– Genetic or metabolic abnormalities
– Renal and hepatic function
– Site of infection
– Concomitant drug therapy
– Underlying disease state(s)
3. Pathogen factors
4. Laboratory factors
• Antimicrobial prophylaxis is the use of
antibiotics to prevent disease. Examples
include prevention of tuberculosis among
individuals who are in close contact with
infected patients, and pretreatment of
patients with artificial heart valves who are
undergoing dental procedurs.
Antimicrobial prophylaxis is recommended for
the following procedures:
– High anticipated infection rates
– Procedures for the consequence of infection are
especially serious (e.g. prosthesis insertion, grafts)
• Antimicrobial prophylaxis recommendations
for prevention of wound infection and sepsis
in surgical patients, such as cardiothoraxic
surgery, head and neck surgery, neurosurgery,
cataract surgery, orthopaedic surgery, general
surgery, obstetery and gynaecology, urology,
and vascular surgery.