Nwolisa C E, Erinaugha E U, Ofoleta S I
Department Of Paediatrics, Federal Medical Centre, Owerri. Imo State, Nigeria.
J Trop Pediatr. 2006 Jun;52(3):197-200. doi: 10.1093/tropej/fmi095. Epub 2005 Dec 9.
Prescribing practices of doctors in different clinical settings have been documented but there is a dearth of information on prescribing practices with regards to children especially the under fives. This study set to describe the prescribing practices of doctors attending to under fives in a children's outpatient clinic. The information obtained is expected to aid in designing appropriate interventions. Between January and April 2004 the age, sex and drugs prescribed for under fives seen at the children's outpatient clinic of Federal medical centre, Owerri in South eastern Nigeria were extracted at the end of each day's consultations from their cards and entered into a spread sheet. Patients who had no prescriptions were excluded. A total of 2471 medications were prescribed for 790 patients who met the criteria for inclusion in the study. Antimalarials, Analgesics, Antibiotics, Vitamin C, Antihistamines and Multivitamin preparations were the commonest drugs prescribed. The prescription rate per patient was 3.13. While three different antimalarials were prescribed a total of twelve different antibiotics were. Prescription rate for injections was 1.9 per cent. Only 13.3 per cent of the patients had all their drugs prescribed in generic names. The others had at least two drugs prescribed in brand names. The difference in cost between same drugs prescribed in brand names as against in generic names were between 41.7 per cent and 60 per cent. All the antimalarials and analgesics prescribed were in the Nigerian National essential drug list while only 16.7 per cent of antibiotics prescribed were not. This study has documented significant flaws in the prescribing practices of these doctors, particularly the low rate of prescription in generic names, high rate of antibiotics prescription, inappropriate prescription of multivitamin preparations and Vitamin C and a relatively high rate of poly pharmacy. Suggested interventions include developing and circulating easy to use treatment guidelines for diseases commonly seen in our centre and a regular audit of the application of these guidelines. Continuing medical education of doctors on rational drug use and evidence based medicine should also be instituted.
不同临床环境下医生的处方行为已有记录，但关于儿童尤其是五岁以下儿童的处方行为的信息却很匮乏。本研究旨在描述儿童门诊中为五岁以下儿童看病的医生的处方行为。所获得的信息有望有助于设计适当的干预措施。2004年1月至4月期间，每天门诊结束时，从尼日利亚东南部奥韦里联邦医疗中心儿童门诊的病历卡中提取五岁以下儿童的年龄、性别及所开药物，并录入电子表格。无处方的患者被排除。共有790名符合纳入标准的患者被开具了2471种药物。抗疟药、镇痛药、抗生素、维生素C、抗组胺药和多种维生素制剂是最常开具的药物。每位患者的处方率为3.13。共开具了三种不同的抗疟药，而抗生素共有十二种。注射剂的处方率为1.9%。只有13.3%的患者所有药物都开的是通用名。其他患者至少有两种药物开的是商品名。同一药物商品名处方与通用名处方的成本差异在41.7%至60%之间。所有开具的抗疟药和镇痛药都在尼日利亚国家基本药物清单中，而开具的抗生素中只有16.7%不在该清单中。本研究记录了这些医生处方行为中的重大缺陷，尤其是通用名处方率低、抗生素处方率高、多种维生素制剂和维生素C的不适当处方以及相对较高的多药联用率。建议的干预措施包括制定并分发针对本中心常见疾病的易于使用的治疗指南，以及定期审核这些指南的应用情况。还应开展针对医生的合理用药和循证医学的继续医学教育。
