Knowledge, attitude and practice regarding use of fixed dose combination drugs among young prescribers a tertiary care teaching hospital in rural Bengal, India
Keywords:Fixed drug combinations, KAP study, Prescription, Rational drug use
Background: Use of fixed dose combination (FDCs) is a double edged sword with scope for irrational prescribing on one hand and improved pharmacotherapy and patient compliance on the other hand. Irrational FDCs are being marketed aggressively and often young prescribers including Post Graduate Trainees fall prey to the lure of FDCs. This was a Knowledge-Attitude-Practice study regarding of FDC use among the resident doctors working at a tertiary care medical college of rural Bengal.
Methods: This was a cross-sectional, questionnaire based study including 50 resident doctors who were asked to fill a 10-question questionnaire on FDCs anonymously.
Results: Ninety two percent of the study participants were aware of the FDCs. The most commonly perceived advantages were better patient compliance and synergistic effects. Most (96%) cited problems of titrating dosages and problems of more side effects. Only 37.6% knew about the banned FDCs. Preferred FDCs among them were antibiotics (94%), cough syrups (80%) and NSAIDs (68%). Residents of dermatology, orthopaedics, surgery and medicine most commonly prescribed FDCs. Sources of knowledge regarding FDCs were CME (92%), medical representative (76%), colleagues (72%), internet (68%), journals (48%) and textbooks (36%).
Conclusions: The study showed that most participants were aware of the FDCs and also aware of the problems with irrational FDC use. Knowledge regarding banned drugs was poor as was the rationality of such combinations. More CMEs and inter department group discussions could be conducted to improve awareness and FDC prescribing practice among young prescribers.
Guidelines for Registration of fixed dose medicinal combination. WHO technical report series. Available at: https://apps.who.int/medicinedocs/documents/s19979en/s19979en.pdf. Accessed on 28th May 2019.
Balat JD, Gandhi AM, Patel PP, Dikshit RK. A study of use of fixed dose combinations in Ahmedabad, India. Indian J Pharmacol. 2014;46(5):503-9.
Gupta YK, Ramachandran SS. Fixed Dose combination: Issues and challenges in India. Indian J Pharmacol. 2016;48(4):347-9.
McGettigan P, Roderick P, Mahajan R, Kadam A, Pollock AM. Use of fixed dose combination (FDC) drugs in India: central regulatory approval and sales of FDCs containing non-steroidal anti-inflammatory drugs (NSAIDs), metformin, or psychotropic drugs. PLoS Med. 2015 May 12;12(5):e1001826.
Shankar PR, Hassali MA, Shahwani NA, Iqbal Q, Anwar M, Saleem F. Responsible use of fixed-dose combination antibiotics in India. Lancet Glob Health. 2016 Oct 1;4(10):e689.
Solanki MS, Banwari G. Irrational fixed dose combinations of psychotropic drugs in India: Cause of concern. Indian J Pharmacol. 2016;48(4):468-9.
Goswami N, Gandhi A, Patel P, Dikshit R. An evaluation of knowledge, attitude and practices about prescribing fixed dose combinations among resident doctors. Perspect Clin Res 2013;4(2):130-5.
Pundlikrao IP. Fixed combination Product: A review. Indian Journal of Novel Drug Delivery. 2017;9(1):1-11.
Yadav AK, Jeenger J, Panwar D. Evaluation of rationality of fixed-dose combinations prescribed in psychiatric patients. National J Physiol Pharm Pharmacol. 2016;6:150-4.
Gautam CS, Saha L. Fixed dose drug combinations (FDCs): rational or irrational: a viewpoint. Br J Clin Pharmacol. 2008;65(5):795-6.