Medicines are nothing in themselves, but are the very hands of God if employed with reason & prudence.
– Herophilus, a Greek physician, 300 B.C
The concept that Herophilus stated in 300 B.C is evident today when World Health Organisation (WHO) defines rational medicine use as “…patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, and the lowest cost to them and their community.”1World Health Organisation – Rational use of Medicines.
In simple words, what WHO is advocating today is: “Ordering the right medicine for the right patient at the right time and in the right amount with due consideration of costs“.
The Cambridge/Oxford English Dictionary defines “Rational” as that which is based on reason, which is sensible, sane or moderate.
However, today medicines are being used irrationally and this is not a local or country specific problem, but has emerged as a global problem. WHO observes that, “… more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly. The overuse, underuse or misuse of medicines results in wastage of scarce resources and widespread health hazards.”2World Health Organisation – Rational use of Medicines.
So what constitutes irrational use of medicine and why it occurs?
- Use of Wrong Medicine – WHO estimates that less than 40% of patients in developing countries, are treated according to standard treatment guidelines 5Managing for rational medicine use – WHO document. For eg. Many children with acute diarrhea are indiscriminately prescribed and dispensed unnecessary and ineffective antibiotics/antidiarrheals instead of the recommended Oral Re-hydration Therapy (ORT).
- Use of Ineffective Medicine – Excessive and unnecessary use of multivitamin tonic is an example. A review of prescription quality at a Pharmacy in Goa, India showed than in one week, 40% of prescriptions included multivitamin preparations.6Irrational drug use in India: a prescription survey from Goa. It occurs primarily because of common practice or because of common beliefs held by patients, that more the medicines are prescribed, the better.
- Use of Unsafe Medicines – For eg use of anabolic steroids for growth or appetite stimulation in children/adults 7Managing for rational medicine use – WHO document. The likelihood of adverse reactions or side-effects outweigh the perceived therapeutic benefits.
- Use of More Medicines than required (Polypharmacy): For eg. a patient with upper respirator infection receiving prescriptions for antibiotics, cough remedies, analgesics and multivitamins 8Irrational drug use in India: a prescription survey from Goa. .
- Underuse/incorrect use of effective medicines: Several studies show that ORT was prescribed to only a small proportion of children with acute diarrhea in children. Antibiotics are one of the most frequently used incorrectly. Many studies indicate the frequent use of antibiotics for viral infections where they are ineffective. Patients often self medicate using antibiotics or other prescription only medicines, they take only as much medicines as needed to feel better and then save the remainder for a future illness.
- Use of Medicines when none is needed: In many countries, both developed and developing, the majority of children suffering from minor upper respirator tract infections are treated with antibiotics, which are not needed.
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