Documente Academic
Documente Profesional
Documente Cultură
SECARA RASIONAL
(Rational Drug Use)
Nafrialdi
Departemen Farmakologi FKUI
Rational Drug Use
IRRATIONAL
RATIONAL
Types of Irrational Drug
Use
• Incorrect prescribing
• Over-prescribing (dose, duration)
• Under-prescribing
• Extravagant prescribing (unnecessary drugs)
• Multiple prescribing
Impact of Inappropriate
Use of Drugs
Prescribers Drug
DrugRegulation
Regulation
Prescribers Industry
Industry
• Diagnosis Patients
Patients
uncertainty • availability of
• promotion
• lack of education, • drug • misleading unsafe drugs
training and drug misinformation • informal
information claims
prescribers
• heavy patient load • misleading • etc.
• pressure to beliefs Drug
DrugSupply
Supply
prescribe • inability to
• generalization of • inefficient
communicate
limited beliefs management
problems
• misleading beliefs • non-availability
about efficacy of required
drugs
RATIONAL THERAPEUTIC MANEUVER
16
Antibiotic Misuse
• Antimicrobial agents are the most commonly
used and misused of all drugs.
• The inevitable consequence : emergence of
antibiotic-resistant pathogens.
• Overprescribing remains widespread due to
diagnostic uncertainty, patient demand, and
time pressure on clinician
• Reducing inappropriate antibiotic use is thought
to be best way to control resistance..
Some Antibiotic Misuses
• Antibiotic in viral infections (exp. DHF).
• Therapy of fever of unknown origin
masking underlying infection, delay the diagnosis,
rendering culture negative.
• Drug combinations or broadest spectra as a
cover for diagnostic imprecision.
• In the absence of clear indication, antibiotic
often may be used if disease is severe or life-
threatening
• The first consideration in
selecting antimicrobial is
whether it is even indicated.
Selection of Antibiotics
10
1
0 2 4 6 8 10 12 14 16 18 20
number of drugs taken
Polypharmacy in the
Elderly
How Bad Can It Be?
• Elderly = 12% of population but
32% of prescriptions
• Average use for persons 65
– 2 to 6 prescription drugs +
– 1 to 3.4 over-the-counter medicine
Polypharmacy in the
Elderly
• Polypharmacy leads to:
– More adverse drug reactions