A survey of paediatric prescribing and dispensing in Karachi.

In an effort to understand the paediatric prescribing practices of family physicians and dispensing of medicines from pharmacies, a survey was conducted in Karachi. Another objective was to understand the factors influencing such practices. Hundred family physicians and 55 pharmacists were surveyed. Four groups of drugs namely antidiarrhoeals, appetite stimulants, multivitamins and brain tonics were identified for assessment, these being drugs widely promoted by the pharmaceutical industry. Some of these drugs are known to have deleterious effects and therapeutic benefit of most of them is dubious. It was observed that roughly 55% of all drugs prescribed by the physicians fell into the aforementioned drug categories. These drugs also constituted nearly 60% of all sales of the pharmacies surveyed. The survey indicates that the antidiarrhoeal drugs Imodium (Ioperamide) and Lomotil (diphenoxylate) are being commonly prescribed though they have hazardous side effects and are unsuitable for use in children. Thirteen percent of physicians are still prescribing the anabolic steroid Durabolin (nandrolone phenylpropionate) as an appetite stimulant long after promotion for this purpose has been dropped. The survey indicates that 95% of the physicians relied upon industry promotional material as their main source of information about drugs. The survey highlights the need to introduce the concept of rational drug use in the undergraduate and postgraduate education.