Rationality verses irrationality in fixed dose combinations: at a tertiary teaching hospital of rural Chhattisgarh, India

Ahmed Tabish, Tanveer A. Khan, Chandel N. B., Rao Anand, Mishra Chandresh


Background: Rational drug prescribing can be defined as appropriate drugs prescribed in the right dose, at correct time intervals and for a sufficient duration. Irrational drug use is a common problem in many countries of the world.

Methods: A prospective observational study was conducted, total 300 patients attending various outpatient departments of tertiary health care rural hospital in Rajnandgaon district were interviewed and their prescriptions were analysed.

Results: Total 350 drugs were prescribed 60 (17.14%) were prescribed by generic name and the rest 290 (82.86%) were prescribed by brand name. Only 18 (5.14%) drugs were not prescribed from hospital formulary. 264 (75.43%) drugs were dispensed from hospital pharmacy. On the basis of rationality score 53% prescriptions were rational, 30% semi rational and 17% irrational.

Conclusions: In a rural hospital, where hospital formulary is based on WHO Essential medicine list, hundred percent utilization of hospital pharmacy service doctors and patients would ensure rational prescribing benefits of the patients coming from rural and uneducated background.


Chhattisgarh, FDCs, Prescribing, Rationality

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Patil PJ, Patil MJ, Patil VR, Deshmukh TA, Band SS: A survey on awareness of Fixed Dose Combinations (FDCs) among patients, physicians and pharmacists at Pune and Beed (India). Ind J of Phar Practic. 2013;6(3):49-52

Pradhan SC, Shewade DG, Shashindran CH, Bapna JS. Drug utilization studies. Natl Med J India. 1988;1:185-9.

Uppal R, Nayak P, Sharma PL. Prescribing trends in internal medicine. Int J Clin Pharm Ther Toxicol. 1984;22:373-6.

Srishyla MV, Krishnamurthy M, Naga Rani MA, Clare M, Andrade C, Venkataraman BV. Prescription audit in an Indian hospital setting using the DDD (defined daily dose) concept. Indian J Pharmacol. 1994;26:23-8.

WHO Technical Report Series, WHO expert committee on specifications for pharmaceutical preparations, 39th report, Geneva, WHO. 2005.

McKinsey and Company. India Pharma 2020 Propelling access and acceptance, realising true potential. 2013. Available at: ExecutiveSummary.pdf (accessed Jan 9, 2015).

Biswas NR, Biswas RS, Pal PS, Jain SK, Malhotra SP, Gupta AS, Pal SN. Patterns of prescriptions and drug use in two tertiary hospitals in Delhi. Indian J Physiol Pharmacol. 2000 Jan 5;44(1):109-12.

Shankar RP, Partha P, Nagesh S. Prescribing patterns in medical outpatients. Int J Clin Pract. 2002;56:549-51.

Pollock EVA. The proliferation of irrational metformin fixed-dose combinations in India. The Lancet Diabetes and Endocrinology. 2015;3(2):98-100.

Jain N, Akarte A, Deshmukh P, Kannojia P, Garud N, Yadav A. Rationality of Fixed Dose Combinations: An Indian Scenario. The Pharma Research. 2009;01:158-68.

Parliament of India: Rajya Sabha. Department-related Parliamentary Standing Committee on Health and Family Welfare. Fifty-ninth report on the functioning of the Central Drugs Standard Control Organisation (CDSCO). May 8, 2012. Available at: welfare/59.pdf (accessed Oct 9, 2014).

Belongia EA, Schwartz B. Strategies for promoting judicious use of antibiotics by doctors and patients. BMJ. 1998;317:668-71.

Schaffner W, Ray W, Federspiel C, Miller W. Improving antibiotic prescribing in office practice. JAMA. 1983;250:1728-32.

Ekedahl A, Anderson S, Hovelius B, Molstad S, Liodholm H, Melandor A. Drug prescription attitudes and behavior of general practitioners. Effects of problem oriented educational programme. Eur J Clin Pharmacol. 1995;47:381-7.

Nehru M, Kohli K, Kapoor B, Sadhotra P, Chopra V, Sharma R. Drug utilization study in outpatient ophthalmology department of government medical college Jammu. JK Science. 2005;7(3):149-51.

Maini R, Verma KK, Biswas NR, Agrawal SS. Drug utilization study in dermatology in a tertiary hospital in Delhi. Ind J Physiol Pharmacol. 2002 Jan 25;46(1):107-10.