Rational Drug Therapy
IEC Group of Institution, Gr Noida
RATIONAL DRUG THERAPY (RDT)
Rational drug use (RDU) means “prescribing right drug, in
adequate dose for the sufficient duration & appropriate to the
clinical needs of the patient at lowest cost
Objectives of RDT/RDU:
• correct drug
• appropriate indication
• appropriate drug considering efficacy, safety, suitability
for the patient, and cost
• appropriate dosage, administration, duration
• no contraindications
• correct dispensing with appropriate information for
patients
• patient adherence to treatment
Reasons for Irrational Prescribing
1. Lack of training in clinical pharmacology and in basic
principles underlying rational drug use.
2. Lack of continuing education, supervision and critical review
of prescribing practices.
3. Promotional activities by pharmaceutical companies.
4. Desire for prestige.
5. Too many patients.
6. Uncertain diagnosis.
Barriers and Problems for RDT/RDU:
 Problems of availability and affordability
 Far too many products in the market
 Unethical promotion of products
 Irrational prescribing - quackery
 Lack of diagnostic facility
 Use of drugs when no drug therapy is needed
 Use of wrong drugs
 Use of drugs with doubtful efficacy
 Use of drugs with uncertain safety status
 Unnecessary use of injections and antibiotics
 Incorrect administration, dosages, or duration
 Lack of medicine literacy among people
 Poor adherence
 Inadequate or inappropriate dispensing
 No clear strategy by the government
Types of Irrational Prescribing
Irrational drug prescribing can occur when the medication
prescribed is incorrect, inappropriate, excessive, unnecessary or
inadequate (WHO Draft, 1985). Accordingly, the types of
Irrational Prescribing are:
1. Incorrect prescribing
2. Inappropriate prescribing
3. Over prescribing
4. Multiple prescribing
5. Under prescribing
Following information are essential for RDT/RDU
1. Basic pharmacology of a drug.
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By: R C Dhakar, Dept of Pharmacy,
2. Indications for this drug's use.
3. Contra-indications to this drug's use.
4. Side effects of this drug.
5. Drug interactions.
6. Cost to the patient and community.
7. Dosage schedule.
8. What is the quality of the evidence provided about the risk/
benefit ratio of this new drug compared to existing therapy?
9. What conclusions have independent experts reached about
the role of this new drug (e.g., review articles, editorials, etc.
Examples of Rational Combinations
_ Amoxycillin + Clavulinic acid
– Suicide inhibitors) - restore activity
_ Ampicillin + Sulbactum
_ Imipenem + Cilastatin
_ Pyrimethamine + Sulfadoxine
_ Sulfamethoxazole + trimethoprim
_ ferrous salt + Folic acid
Strategies which help in RDT/RDU
• Training for Providers
– Undergraduate education
– Continuing in-service medical education e.g.
seminars, workshops
– Face-to-face persuasive outreach e.g.
academic detailing
– Clinical supervision or consultation
• Printed Materials
– Clinical literature and newsletters
– Formularies or therapeutics manuals
– Persuasive print materials
• Media-Based Approaches
– Posters
– Audio tapes, plays, Radio, television
10 national strategies to promote RDT/RDU:
1. Evidence-based standard treatment guidelines
2. Essential Drug Lists based on treatments of choice
3. Drug & Therapeutic Committees in hospitals
4. Problem-based training in pharmacotherapy
5. Continuing medical education as a licensure requirement
6. Independent drug information e.g bulletins, formularies
7. Supervision, audit and feedback
8. Public education about drugs
9. Avoidance of perverse financial incentives
10. Appropriate and enforced drug regulation
Parameters that are linked to RDT/RDU are
 Treatment guidelines
 Essential Drug list
 Perception of drug quality
 Medical education and culture
 Patient education
 Prescriber monitoring
 Incentives for providers and physicians
Rational Drug Therapy By: R C Dhakar, Dept of Pharmacy,
IEC Group of Institution, Gr Noida
 Dispensing rights for physicians