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Category: Volume 07 Issue 06 June 2019
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Title: Evaluation of Prescribing Pattern of Corticosteroids in Dermatology OPD in Tertiary Care Hospital

Authors: Dr Laxmi Bhagunde, Dr S.B Tamboli, Dr Rajat Chhabra

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.71

Abstract

Background: Dermatological problems manifest as primary and secondary cutaneous complaints, which are par­ticularly more common in India. The skin problems that are commonly found are acne, burn scars, dermatitis, psoriasis, scabies, vitiligo, pediculosis, herpes simplex infection, varicella, herpes zoster, erythema, urticaria, and so on. Skin diseases amenable to the effects of topical corticosteroids are usually characterized by inflammation, hyperproliferation, and/or immunologic phenomenon. Topical corticosteroids may also be effective in the treatment of skin symptoms, such as burning and pruritus. Successful treatment depends on an accurate diagnosis and consideration of the steroid’s delivery vehicle, potency, frequency of application, duration of treatment, and side effects. Prescribing of drugs is an important skill, which needs to be continuously assessed and refined suitably and it reflects the physician's skill in diagnosis and attitude towards selecting the most appropriate cost-effective treatment. Contemplating the financial affliction of the treatment on the patients and government, prevailing disease prevalence, it is imperative to study the prescribing pattern of corticosteroids in dermatological OPD.

Objectives: To assess the prescribing pattern of corticosteroids and evaluate the monotherapy and utilization of co-administered drugs along with corticosteroids in skin conditions.

Material & Methods: The study design was prospective, single centred, cross sectional observational study. Out of 1410 subjects studied, a sample size of 311.60 was calculated. 312 properly selected subjects with diagnosis made by the treating dermatologist for Skin related ailments requiring Corticosteroids prescription were recruited as study subjects. An initial preparatory phase was followed by data collection phase in Case record forms. The collected data was numerically coded and entered in Microsoft Excel 2007 and analysed and prescribing indicators were calculated by maintaining anonymity and privacy of respondents.

Results: In our findings, in a sample size of 312, it was seen that a total of 365 glucocorticoids were prescribed. The prescriptions showed generic name in 193 (52.9%) cases as compared to 172 (47.1%) prescriptions were done with trade/ brand names. Foremost route used was topical application (76%), whereas 24% of all corticosteroids prescribed were by oral/ parental route. The average number of drugs prescribed per prescriptions were 3.68, whilst the average corticosteroid prescribed was 1.17.

Conclusion: Prescribing by generic name should be encouraged. Prescribers should be encouraged for undertaking correct diagnosis, providing treatment following STGs (Standard Treatment Guidelines) and protocols. This will aid in improving the prescribing of corticosteroid drugs to a large extent.

Keywords: Corticosteroids, prescribing indicators, dermatological diseases.

References

  1. Brazzini B, Pimpinelli N. New and established topical corticosteroids in dermatology. American journal of clinical dermatology. 2002 Feb 1;3(1):47-58.
  2. Burkhart C, Morrell D, Goldsmith L. Dermatological Pharmacology. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman’s the Pharmacological basis of therapeutics. 12th ed. New Delhi: Mc Graw-Hill Publishers; 2011.1803-32.
  3. Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. Journal of the American academy of dermatology. 2005 Jul 31;53(1):S50-8.
  4. Lee M, Marks R. The role of corticosteroids in dermatology. Australian Prescriber. 1998 Jan 1; 21(1): 9-11.
  5. Ramam M, Kumrah L. Systemic Corticosteroid Therapy And The Hypothalamopituitary-Adrenal Axis. Indian Journal of Dermatology. 2001 Jan 1;46(01):1-7.
  6. Shankar PR. Essential medicines and health products information portal. Journal of pharmacology & pharmaco-therapeutics. 2014 Jan;5(1):74-5.
  7. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, Poole C, Schlesselman JJ, Egger M. STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. International journal of surgery. 2014 Dec 31;12(12):1500-24.
  8. Israel GD. Sampling the evidence of extension program impact. University of Florida Cooperative Extension Service, Institute of Food and Agriculture Sciences, EDIS; 1992 Oct. (Last Accessed on 2018 September 12).
  9. Israel GD. Determining sample size: University of Florida Cooperative Extension Service. Institute of Food and Agriculture Sciences, EDIS. 1992. (Last Accessed 2018 September 12).
  10. Bylappa BK, Patil RT, Pillai RT. Drug prescribing pattern of topical corticosteroids in dermatology unit of a tertiary-care hospital. Int J Med Sci Public Health 2015;4:1702-1707.
  11. Kasyap JS, Aiyappa C, Sumathy TK. Topical Corticosteroid Usage in Dermatology OPD in a Medical Teaching Hospital. Journal of Pharmaceutical Research. 2013 Sep 1;12(3):119-21.
  12. Mukherjee S. Assessment of corticosteroid utilization pattern among dermatology outpatients in a tertiary care teaching hospital in Eastern India. International Journal of Green Pharmacy (IJGP). 2017 Jan 9;10(04).178-82.
  13. Mahendra Kumar Jaiswal. Prescription audit of Corticosteroids in Dermatology OPD of a tertiary care teaching hospital of tribal region of central-south India. International Journal of Biomedical Research. 2017; 8(01): 20-25.
  14. Sweileh WM. Audit of prescribing practices of topical corticosteroids in outpatient dermatology clinics in north Palestine. Eastern Mediterranean Health Journal.2006;12(½):161-69.
  15. Tikoo D, Chopra SC, Kaushal S, Dogra A. Evaluation of Drug Use Pattern in Dermatology as a Tool to Promote Rational Prescribing. JK Science. 2011 Sept;13(3):128-31.
  16. Bijoy KP, Vidyadhar RS, Palak P, Chintan SP, Atmaram PP. Drug prescribing and economic analysis for skin diseases in dermatology OPD of an Indian tertiary care teaching hospital: a periodic audit. Indian journal of pharmacy practice. 2012;5(1):28-33.
  17. Kumar AM, Noushad PP, Shailaja K, Jayasutha J, Ramasamy C. A study on drug prescribing pattern and use of corticosteroids in dermatological conditions at a tertiary care teaching hospital. Int J Pharm Sci Rev Res. 2011;9(2):132-5.
  18. Purushotham K, Eesha B R. Prescription Trend of Topical Corticosteroids in Outpatient of Dermatology in a Tertiary Care Hospital in Tumakuru, Karnataka. Int J Pharmacol and Clin Sci. 2016;5(3):77-72.
  19. Rathi SK, D’Souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian journal of dermatology. 2012 Jul;57(4):251-59.

Corresponding Author

Dr Laxmi Bhagunde

Tutor, Department of Pharmacology, HBT and R.N. Cooper Hospital and medical college, Mumbai, Maharashtra