3. DiagnosisPrescribing Dispensing Adherence Follow-up

12. Patients problem Watery diarrhea with mild dehydration in a child Therapeutic objective Prevention of further dehydration Choose treatment Advice & information – Continue breast feeding, other regular feeding – Careful observation Non-drug treatment – Additional fluids, rice water, curd, fruit juice Drug treatment – Oral rehydration solution Referral – Not required in this case

18. Lack of independent and reliable drug information – Dependency on MRs Drug promotion vs Drug information Brand oriented advertisement – Therapeutic jungle Negative results concealed Overworked physicians Lack of CMEs Availability of OTC drugs

20. Common cold – Use of antibiotics Watery diarrhea in a child – antibiotics Uterine contraction in early pregnancy – Use of progesterone FDCs – Ampi + Clox, Panto + Dome Prescription of allopathic drugs by graduates in other system of medicine Corticosteroids, antibiotics, multivitamins and tonics are by far the most common drugs used irrationally

21. At individual level Acquire adequate knowledge of a limited number of well established drugs of proven efficacy and well documented side-effects (P-drugs) Do not change among equivalent drugs on whim/fancy/material consideration Do not use new drug just because it is novel or is being promoted extensively For >90% drugs, generics are as good and much cheaper than the branded formulations

22. Use treatment regimens that are simple to follow and are cheaper Avoid polypharmacy, as it encourages sloppy diagnosis Check dose and inter-dose interval regularly Avoid repeat prescriptions as a routine Review regularly Inform your patients, ensure their participation

23. At hospital level Hospital drug formulary Hospital antibiotic/infection committee Drug information centre (DIC) Adverse drug reaction (ADR) monitoring At National level Independent drug information National drug formulary Brochures for patients

24. A word for the wise