50% medical prescriptions in India deviated from guidelines: Study

Nearly one in every two medical prescriptions issued in India deviated from standard guidelines, with approximately a tenth showing 'unacceptable deviations', a study, conducted by a team of researchers including those at the All India Institute of Medical Sciences (AIIMS) in New Delhi, has found.

The team analysed 4,838 prescriptions issued by physicians between August 2019 and August 2020 for their compliance with standard treatment guidelines.

These prescriptions were issued at 13 Rational Use of Medicines Centres (RUMC), set up by the Indian Council of Medical Research (ICMR) and located in tertiary care teaching hospitals and medical colleges across the country.

The researchers found that among the 475 prescriptions they deemed to show unacceptable deviations from the standard guidelines, pantoprazole was prescribed the most often -- in 54 of them.

Pantoprazole is known to help bring down the acid created in stomach and is commonly available in pharmacies under many drug names, such as Pan 40.

In the 54 prescriptions, the condition being diagnosed was Herpes Zoster, or shingles -- a viral infection causing painful rashes anywhere on the body.

Tablet pantoprazole 40 milligrams was prescribed along with others, including paracetamol, and ointments, according to the study published in the Indian Journal of Medical Research.

Among these 475 prescriptions, the conditions most commonly diagnosed were found to be upper respiratory tract infections (URTI) and hypertension.

In 35 of the URTI prescriptions, the drug being prescribed was tablet rabeprazole+domperidone (used to treat gastric conditions like acid reflux), which the researchers said was responsible for the prescription to be qualified as one with 'unacceptable deviation'.

The tablet combination was prescribed along with others, including paracetamol and levocetirizine (treats cold and runny nose).

Tablet rabeprazole+domperidone accounted for the second highest among the prescriptions with unacceptable deviations, after pantoprazole, the authors found.

They said the most common potential consequences of irrational drug prescription for patients were high treatment costs and adverse drug reactions.

'Gastroprotective drugs are to be prescribed if the patient has a risk for developing peptic ulcer. Unnecessary prescribing of pantoprazole may lead to potential side-effects such as abdominal bloating, oedema and rash,' the authors wrote.

The researchers said that most of the physicians followed the disease-specific ICMR guidelines, with about 55 per cent adherence.

Where there were no Indian guidelines or recent updates in the guidelines, physicians used the international guidelines, such as those of the American Association of Family Physician or the American Heart Association, they said.