Drug utilization pattern of NSAIDs assessed with the anatomical therapeutic chemical classification/defined daily dose system in an orthopedic department
To study the drug utilization pattern of NSAIDs using the Anatomical Therapeutic Chemical classification/Defined Daily Dose (ATC/DDD) system in patients admitted to the orthopedic department of a tertiary-care teaching hospital.
A cross-sectional prospective observational study was carried out in 200 patients from March to August 2014. Demographic information, disease related details, drug history and adverse drug reactions (ADRs) were recorded by personal interview and from case files daily for drug utilization analysis.
The majority of patients were aged 18–30 years (30 %), most were male (80 %) and the most common orthopaedic condition causing hospitalization was fracture/dislocation (77 %). The most commonly prescribed drug group was analgesics, with NSAIDs being the most commonly prescribed type of analgesic (97 %). The majority of prescribed drugs were from the World Health Organization (WHO) Essential Medicine List (92 %) and Indian national essential drug list (100 %). Polypharmacy and high polypharmacy was reported in 71 and 14.5 % of patients respectively. No fixed-dose combinations of analgesics were used. Oral tablet diclofenac (M01AB05) 50 mg was the most frequently prescribed analgesic (97 % of patients; 840.5 DDD), followed by intravenous injection tramadol (N02AX02) in 56 % (189.3 DDD), intramuscular injection diclofenac (M01AB05) 75 mg in 55 % (87 DDD) and oral tablet paracetamol (N02BE01) 500 mg in 38.5 % (58.3 DDD) of patients. ADRs (mainly gastritis despite concomitant use of histamine H2 blockers) were reported in 4 % of patients; all ADRs were of ‘possible’ category according to the WHO–Uppsala Monitoring Centre causality assessment method.
Fracture-dislocation and arthritis were the most common causes for hospitalization in the orthopedic department. Selection of analgesics and their dosage regimen complied with the WHO guidelines of pain management.
KeywordsParacetamol Tramadol Define Daily Dose Orthopedic Department Orthopedic Ward
Sincere thanks to Dr. Pandit, Professor and Head of Orthopedic department of the civil hospital, for allowing conduction the study in the orthopedic department. Also thanks to Dr. Gaurav Modi, Assistant professor, Community Medicine for his help in statistical analysis of the data.
Compliance with ethical standards
Nidhi Patel received a scholarship for this short-term student Indian Council of Medical Research project.
Conflicts of interest
Nidhi Patel, Rima Shah and Jatin Buch declare that they have no conflicts of interest relevant to the content of this manuscript.
The study protocol was approved by the human research ethics committee of the institute prior to commencement of the study. All the patients participating in the study were given clear explanations about the purpose and nature of the study in a language they understood and written informed consent was obtained before inclusion in the study. The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and/or comparable ethical standards.
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