Public Health · Short notes

Rational Drug Use: Short Notes & Cheat Sheet

The WHO definition, common irrational practices, WHO prescribing and patient care indicators, strategies to improve use, and good prescribing steps.

Short notes

Read these before you attempt the topic's MCQs.

The 'P-drug' is a personal first choice the prescriber has already evaluated for a common condition.

WHO (Nairobi, 1985): rational use means patients receive medicines appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period, at the lowest cost to them and their community.
Common irrational practices: polypharmacy, antibiotics for viral infections, unnecessary injections, prescribing by brand name, unneeded tonics and vitamins, and self-medication with prescription-only drugs.
Consequences: antimicrobial resistance, adverse reactions, wasted money and loss of patient trust. High antibiotic and injection use is a recognised problem in Pakistan.

Prescribing indicators: average number of drugs per encounter, % of drugs prescribed by generic name, % of encounters with an antibiotic, % with an injection, and % of drugs from the essential medicines list or formulary.
Suggested ideals: generic prescribing and essential-list use of 100%, antibiotics in fewer than about 30% of encounters, injections in fewer than about 20%, and about 1.6–1.8 drugs per encounter.
Patient care indicators: consultation time, dispensing time, % of drugs actually dispensed, % adequately labelled, and patients' knowledge of correct dosage.
Facility indicators: availability of the essential medicines list and of key drugs.

Educational: training prescribers and dispensers, and public education.
Managerial: standard treatment guidelines, essential medicines lists, drug and therapeutics committees, and audit with feedback.
Regulatory: enforcing prescription-only status and restricting certain antibiotics.
Economic: generic promotion and removing incentives for over-prescribing.
WHO Guide to Good Prescribing: define the problem, specify the objective, choose a personal (P-) treatment, write the prescription, inform the patient, and monitor.

High-yield facts in one place. Cover the right-hand column and test yourself.

Indicator	Suggested target
Drugs per encounter	≈ 1.6–1.8
Prescribed by generic name	100%
Encounters with an antibiotic	< 30%
Encounters with an injection	< 20%
From essential medicines list	100%

Type	Example
Educational	Prescriber training, public campaigns
Managerial	Guidelines, EML, audit and feedback
Regulatory	Prescription-only enforcement
Economic	Generic pricing, removing incentives

Right drug, Right dose, Right duration, Right cost: The four elements of the WHO definition of rational use.

Rational use includes cost to the community, not just clinical appropriateness.
Generic prescribing is a WHO indicator; brand prescribing counts against it.
Education alone rarely changes prescribing for long; combined strategies work better.
The Nairobi conference on rational use took place in 1985.

Attempt the Rational Drug Use MCQs while the notes are fresh. Anything you get wrong is saved to your incorrect list for the next revision round.