Prescription pattern and rationality of fixed-dose combinations in a tertiary care hospital: Insights from a cross-sectional study

Abstract

Background: The fixed dose combinations (FDCs) are widely used in India with an aim to decrease the pill burden, simplify the treatment and improve adherence, but irrational use of FDCs may lead to increased adverse effects and antimicrobial resistance. Recent regulatory audits in India banned several FDCs and focused on rational use of approved FDCs. Objectives: To determine the prescription pattern and rational use of FDC in this tertiary care center.  Method:  This was a cross sectional study, carried out in a Tertiary care hospital over three months. Three hundred prescriptions were randomly collected from different medicine and surgical specialties and the drug dispensing outlet. The prescribed FDCs were classified based on WHO criteria and present regulatory status, as therapeutic class, indication and rationality. Results: 48.6% of the prescriptions had at least one FDC. There were 262 identified FDCs. The most common were antimicrobials (54.2%), gastrointestinal combinations (38.9%), analgesic/antipyretic combinations (35.5%) and vitamin/mineral preparations (18.3%). Overall, 88.5% of FDCs were rational, 9.2% were irrational and 2.3% were indeterminate. The more that an antimicrobial combination had guidance support was more rational. Conclusions: The FDC use in our set up was not highly prevalent, and most of the uses were rational.  However, there is still a need for periodic review of prescriptions, for the implementation of formularies and education of prescribers to enhance rational use.

Keywords: fixed-dose combinations; prescription pattern; rationality; tertiary care hospital.