Author: Stoisavljevic-Satara, S.
Follow up on the use of drugs is a subject of many investigations since it creates the ground for the comprehensive overview on the medical, economic, and social aspects of drug prescription, drug administration, sale and drug abuse. All these aspects are of the importance for both every individual and for the society as such. The main problem with prescription of drugs to children is: choice of drug and definition of dose.
Purpose / Objective
In the first part of this investigation, the aim was to analyze the use of drugs in the Pediatric Clinic of the Clinical Center Banjaluka during three years (1996, 1999, and 2000), and to compare obtained data with the principles of modern pharmaco therapies. Further on, for the obtained results of this investigation to establish potential influence of no medical factors in the prescription and utilization of drugs, as well as to define the role of humanitarian assistance in the prescription practice among medical doctors.
In the second part of the work, the aim was to analyze hospital therapeutic lists for some of the more common diseases in 2000, such as urinary infections in children, infection of respiratory tract and obstructive lung diseases. On the basis of this analysis, we shall gain insight into the prescription habits of our doctors and have a possibility to compare these with the attitudes of rational pharmacotherapy.
Using data from the information center of the Clinical Center Banjaluka, we carried out the analysis on the use of drugs within the Pediatric Clinic during years 1996, 1999 and 2000. For the investigation, we utilized data from the hospital pharmacy, actually the summary lists that the pharmacy sent to respective clinics. These drugs were separated from those drugs that arrived for humanitarian assistance and those that were provided through the regular supply channels. In our work, we used the ATC/DDD methodology. ATC - Anatomical Therapeutic Chemical classification of drug, and systems of DDD - Defined Daily Dose as the measurement units are officially accepted and recommended by WHO as a toll for the follow-up on the use of drugs among a certain population or health care institution.
The second part of the retrospective study was carried out in the Clinic for children's diseases of Clinical Centre Banjaluka. Through insight from medical documents for year 2000 (protocols and patients' list), we extracted data on the total number of hospitalised patients, the number of patients with the most common diagnoses, age and body weight, the results of the microbiological analysis, prophylaxis and therapy of certain conditions (tonsilopharyngitis, otitis media, bronchitis, pneumonia, asthma, urinary tract infections and pyelonephritis). Results are shown as relative values.
Key Findings and Conclusions
The share of humanitarian assistance in the supply of drugs in the Clinic for children's diseases during the observed years was significant and thus, it had a major impact on the therapeutic choice made by medical doctors. The share of drugs obtained from humanitarian assistance programs was biggest in year 1996, when it reached 64% of all used drugs, while the lowest share was in year 2000 - 36.6%.
During the observed period, vitamins and multi-vitamin preparations were used in large quantities and unjustifiably. During the year 1996, in the Pediatric clinic, from the groups of drugs that have an effect on the digestive tract and metabolism, the most commonly used were multivitamins, of which 100% came from humanitarian assistance; then insulin, which was also provided 100% from the assistance; vitamin C from the regular supply; B-complex, 90% from the assistance, and other drugs.
The most frequently used antibiotics during the observed period were aminopenicillin and natural penicillin. Since we analyzed hospital conditions, the advantage should be given to parenteral forms of penicillin.
During the year 1996, in first place among the respiratory drugs, nasal decongestives (provided through the regular supply) could not be justified from the point of pharmacotherapy. There was an overuse of expectorants and anti-cough drugs, despite very little evidence of their relative efficiency and a lot of criticism for their extensive use, on account of the Health Insurance Fund.
During the year 2000, in the Clinic for Children's Diseases of the Clinical Center Banjaluka, 67% of children were hospitalized due to respiratory diseases (obstructive bronchitis, infections of the upper respiratory tract, pneumonia, and asthma).
Infections of the urinary tract and pyelonephritis were causes for the hospitalization of 8% of children.
For a small proportion of patients (12%), a microbiological analysis of the pharynx was done.
The choice of antibiotics (aminopenicillin) and even more the duration of the anti-microbial therapy for treatment of sore throat / tonsillopharyngitis were irrational.
For all patients with infection of the urinary tract and pyelonephritis, urinal culture was performed and therapy was administered according to the results of antibiogram.
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