Pattern of anti-diabetic drugs prescribed for type 2 diabetes mellitus patients in a tertiary care hospital of India: an observational study

Background: Type 2 diabetes mellitus (T2DM) is a leading cause of significant morbidity and mortality in developing countries. Evaluation of anti-diabetic drug use pattern guides the healthcare professionals to identify early signals of irrational prescribing and to plan interventions to optimize the benefits of pharmacotherapy.Methods: Observational descriptive study was conducted on 500 prescriptions of T2DM patients collected from Outpatient department of a tertiary care hospital. Prescriptions were analysed for type, number, generic/brand names, fixed dose combinations (FDCs) of anti-diabetic drugs and anti-diabetic drugs prescribed from within National List of Essential Medicines (NLEM) 2015.Results: Average number of anti-diabetic drugs per prescription was 2.5. Of these 49% were from within NLEM and only 39% were prescribed by their generic names. Among all the anti-diabetic groups of drugs used, biguanide (32.85%) was the most frequently prescribed followed by insulins (25.4%) and DPP-4 inhibitors (13.75%). Combined drug therapy was more prevalent than monotherapy (70% versus 30%). Metformin+sitagliptin and metformin+linagliptin were most commonly prescribed fixed dose combinations.Conclusions: Recent trend of anti-diabetic drug use included newer anti-diabetic drugs in combination with metformin to achieve better euglycemia and to minimize complications of T2DM

Knowledge, attitude and practice of pharmacovigilance among community pharmacists in Delhi, India

Background: Lack of knowledge of Pharmacovigilance (PhV) and Adverse Drug Reactions (ADRs) reporting culture among the prescribers have been identified as major factors for under reporting of ADRs. In an attempt to increase the reporting many countries have allowed pharmacists to report ADRs. This study was planned to assess the knowledge, attitude and practices of PhV among community pharmacist in Delhi, India.Methods: Cross sectional, questionnaire based study was conducted to evaluate the knowledge, attitude and practice of PhV among 200 community pharmacists of Delhi (west Delhi) India.Results: Majority (74%) of the respondents felt that ADR reporting is necessary but only 9% were aware of existing PhV Program of India. Only 5% of pharmacists knew about elements of PhV. Forty percent (40%) of pharmacists did not know where to report ADRs and 26% felt that there is no need to report ADRs. Significant number (77%) of pharmacists felt that ADRs reporting will damage their image. 96% never try to find ADRs and in case if they get ADRs from patients, majority (95%) of them never report to anybody. Almost all (96%) of respondents cited busy schedule as the main reason for non-reporting and 86% said that it will be very convenient if ADRs are collected by someone from them.Conclusions: Community pharmacists had positive attitude towards ADRs reporting but their knowledge and practice regarding PhV need to be improved. There is a need of regular training to increase their role in PhV

Treatment and disposal practices of pharmaceutical effluent containing potential antibiotic residues in two states in India and perceptions of various stakeholders on contribution of pharmaceutical effluent to antimicrobial resistance: a qualitative study

Abstract Background Antimicrobial resistance (AMR) is a looming pandemic, demanding prompt actions to avert catastrophic consequences. Effluents from pharmaceutical industries containing antimicrobial residues could serve as one of the entry points of these drugs to the environment. This qualitative study explores the treatment and disposal practices of pharmaceutical effluent (PE) containing potential antibiotic residues (ARs) by interviewing major stakeholders. In addition, we assessed their knowledge and perception on contribution of PE to AMR. Methods The study was conducted in the two Indian states, Haryana and Telangana and at the federal level. Data was collected by semi-structured in-depth interviews of 29 participants from 17 stakeholders/organizations viz. Central Pollution Control Board (CPCB), State Pollution Control Boards (SPCBs) of Telangana and Haryana, civic body, pharmaceutical manufacturers, pharmaceutical associations and civil society. Data was analyzed using thematic analysis. Results The effluent treatment and disposal practices varied with the multinational companies (MNCs) having advanced technologies whereas the small and medium-scale pharmaceutical companies (SMPCs) having effluent treatment plants as per the regulations but often under-utilized. The presence of ARs in the PE was considered inconsequential by SPCBs and SMPCs and majority of stakeholders imputed other causes as major contributors to AMR. However, the MNCs were well aware of the contribution of PE to AMR and CPCB also considered ARs as direct source of AMR. The central regulators as well as MNCs expressed concerns regarding the current regulations lacking maximum ARs in the PE. Conclusion Setting up regulatory standards for maximum ARs in PE, their implementation and monitoring is an urgent need to curb environmental contribution of ARs to AMR. The findings of our study will help in systematic approach in policy making, awareness programs and capacity-building in dealing with the ARs in PE to combat AMR