Half of Indian medical prescriptions deviate from standard guidelines

A recent study conducted by researchers, including those from the All India Institute of Medical Sciences (AIIMS) Delhi, has found that one out of every two medical prescriptions in India deviates from standard treatment guidelines, with approximately 10% showing "unacceptable deviations."

The study analyzed 4,838 prescriptions issued by physicians between August 2019 and August 2020 to evaluate their adherence to standard guidelines.

These prescriptions were gathered from 13 Rational Use of Medicines Centres (RUMC) established by the Indian Council of Medical Research (ICMR) in various tertiary care teaching hospitals and medical colleges across India. The findings were published in the Indian Journal of Medical Research.

Among the 475 prescriptions categorized as having unacceptable deviations, pantoprazole was the most frequently prescribed medication, appearing in 54 of these prescriptions. Pantoprazole, often sold under names like Pan 40, is used to reduce stomach acid. In these cases, it was prescribed for patients diagnosed with Herpes Zoster, a viral infection causing painful rashes, along with other medications like paracetamol and ointments.

Upper respiratory tract infections (URTI) and hypertension were the most commonly diagnosed conditions in these prescriptions. In 35 cases of URTI, tablet rabeprazole domperidone, used to treat gastric conditions such as acid reflux, was prescribed, leading to the classification of these prescriptions as having unacceptable deviations. This medication was often prescribed alongside paracetamol and levocetirizine, which is used to treat cold symptoms and runny nose.

The study highlighted that tablet rabeprazole domperidone was the second most common medication with unacceptable deviations, following pantoprazole. The researchers pointed out that irrational drug prescriptions could result in high treatment costs and adverse drug reactions. They emphasized that gastroprotective drugs like pantoprazole should only be prescribed if the patient is at risk of developing peptic ulcers, as unnecessary use can cause side effects such as abdominal bloating, edema, and rash.

Despite these deviations, the study noted that around 55% of physicians adhered to the disease-specific guidelines set by the ICMR. In instances where no Indian guidelines existed or were outdated, physicians relied on international guidelines from organizations like the American Association of Family Physicians and the American Heart Association.