An outpatient department based observational study to review the pattern of utilization of proton pump inhibitors for their co-relation with the indications in a tertiary care centre

Background: Proton pump inhibitors (PPIs) are one of the commonest drugs prescribed for a variety of indications. They are considered remarkably safe and prescribed liberally. However, on long term administration, they can cause a number of adverse effects. In a tertiary care hospital, where the patient numbers are large and many attending super speciality centre, a number of patients were observed to receive PPIs for approved and unapproved indications. It was therefore considered prudent to study the prescribed PPIs for a co-relation with their indications or otherwise so as to formulate corrective interventions.Methods: The observational study was conducted in the dispensary of a tertiary care centre. The prescriptions of the patients were the study material. Prescriptions for a full week were taken in for consideration. A total of 4142 prescriptions were studied. All aspects related to PPIs were noted and analysed. Additionally, a note on prescribed calcium supplements, vitamins and antioxidants was made.Results: Of all the prescriptions studied by us, 33% had PPIs in them. Omeprazole was the commonest PPI followed by pantoprazole. Almost half the patients prescribed PPIs, the duration of administration was over 30 days. 78% patients prescribed PPIs also had some or the other non-steroidal anti-inflammatory drug (NSAID) in their prescription. Over one fourth of the total patients also received calcium supplements, vitamins or anti-oxidants.Conclusions: Proton pump inhibitors are very popular drugs and are being prescribed for approved and unapproved indications in the hope of providing relief to the patients. They are being advised quite liberally and more so if any NSAID has been co-prescribed. Even for prescriptions lasting for less than 5 days, PPIs have been included in the presumption to prevent gastritis due to NSAIDs. This practice is contrary to guidelines and also exposes the patients to avoidable adverse drug reactions

An analysis of adherence to the World Health Organisation guidelines pertaining to drug promotional literature by pharmaceutical firms

Background: Pharmaceutical companies used Drug Promotion Literatures (DPLs) as a major tool to advertise their new products. World Health Organization (WHO) has set some guidelines for promotion of drug literature. Thus, this study aimed to evaluate various DPLs for their accuracy and credibility as per WHO ethical criteria.Methods: This was an observational and cross-sectional study. Total 100 drugs advertisements published in various medical journals were collected from the library of the college. Advertisements were selected based on inclusion and exclusion criteria. The selected advertisements were evaluated based on the WHO ethical criteria for drug promotion.Results: From 100 advertisements, 73 were single drug whereas 27 were fixed drug combinations. Antimicrobials (16%) were the most promoted advertisements. Only 28% of the advertisements carried references to support their claim. Out of which majority (91.78%) were from journal articles. The generic name, brand name, names of active ingredients, manufacturer, distributor and dosage regimen were mentioned in majority of advertisements. Drug interactions (12%), contraindications (22%), precautions (24%) and side effects (22%) were least mentioned in the advertisements.Conclusions: It was observed that none of the advertisement followed all the guidelines laid down by WHO. Pharmaceutical companies should follow ethical regulatory measures to promote their product in various journals. The regulatory authority must ensure the pharmaceutical companies to follow ethical guidelines for publishing various drug promotional literatures