Copyright (c) 2020 Mohd Wasiullah
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
An Approach of Clinical Pharmacist in Minimising Length of Hospital Stay of Patients and Rational Use of Antimicrobials
Corresponding Author(s) : Mohd Wasiullah
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 2 No. 4 (2014): 2014 Volume 2- Issue -4
Abstract
Irrational drug therapy remains a global phenomenon. The mean number of drugs per prescription should be as low as possible since higher figure always leads to increased risk of drug interaction, development o f bacterial resistance, affect patient compliance and increases costs. The aim of present study is to reduce patient stay in inpatient setting. This may be studied by involving the factor like Drug interaction, Percentage of amount spent on anti-microbial (cost of therapy). This study will help for promoting the rational use of antimicrobials along with the reduction in hospital stay of the patient. The study was done in three wards of pediatric of MMIMSR.200 cases of anemia and 100 cases of UTI were collected during the pre intervention and post intervention studies.P1 was placed as a control while wards. P2 and P3 were placed as tests during the adherence study. The percentage of anemic patient at the time of admission in both the categories was severe 30% and mild to moderate was 70% during pre intervention but in post intervention it was found 22% and 82% respectively. 72% patient having mild to moderate anemia in pre intervention study. While it was 82.88% in post intervention studies. It is clear that the maximum percentages of the patient are those suffering from mild to moderate anemia. Patients when they were classified on the basis of associated infection it was found that 3.33% and 31.88% had infection during pre-Intervention and Post-Intervention studies. While for mild to moderate it was found 85.70% and 85.36% in pre-Intervention and Post-Intervention studies respectively.
Keywords
Preintervention
Postintervention
Drug-interaction
Rational use
Hospital stay
, Cost of therapy
Associated infection
Anaemic
References
-
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[3]. B. Benoist, E. McLean, I. Egli, and M. Cogswell, Worldwide Prevalence of Anaemia 1993–2005. WHO Global Database of Anaemia, World Health Organization, Geneva, Switzerland,
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[5]. B.S. Balakrishna. Rational use of drugs. Proceedings of National Seminar on Hospital and Clinical Pharmacy, J.S.S College Mysore. 1999, 24.
[6]. Calvin.M. Kunin, T.Tupasi, W.A Craig. Use of antibiotics. Annals of Internal Medicine J 973:79: 555-560. [7]. Camargo AL, Cardoso Ferreira MB, Heineck I. Adverse drug reactions: a cohort study in internal medicine
units at a university hospital. Eur J Clin Pharmacol 62, 2006, 143 –9.
[8]. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW,Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA.
[9]. Corsonello A, Pedone C, Corica F, Antonelli Incalzi R, on behalf of the Gruppo Italiano di Farmacovigilanza (GIFA) investigators. Polypharmacy in the elderly patients at discharge from the acute care hospital. Ther Clin Risk Manage 3, 2007, 197–203.
[10]. D.Sharma, K.H Reeta, D.K Badyal, S.K Garg and V.K Bhargava. Antimicrobial. Prescribing pattern in an Indian Tertiary Hospital. Indian J PhysiolpharmacoI A2(4), 1998, 533-537.
[11]. Death and adverse clinical events in elderly patients according to disease clustering: the REPOSI study.
Rejuvenation Res 13, 2010, 469–77.
[12]. Delhi Society for promotion of rational use of Drugs, Standard Treatment Guidelines 2002.
[13]. Delhi Society for promotion. Of Rational use of Drugs, The Medicines Scenario India: Perceptions and Perspectives 1996.
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patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 89, 2011, 845– 54.
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[23]. Guru Prasad Mohanta and S.M Baranidharan. National essential drugs list an overview. Indian Journal of Hospital Pharmacy November-December, 1997, 223-224.
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[31]. Jonathan D, Quick et al "Managing Drug Supply", Management Sciences for Health in Collaboration with WHO, 2nd Edition, Kumarian Press 2001, 124-135.
[32]. Jonathan H. Ross and Robert Kay "Pediatric urinary tract infection and reflun" American family physician March 59(6), 1999, 1485
[33]. K.K.Kafle, S.M. • Rajbhandarai, I(Srivastava and S.Regmi. Drug prescribing in out-patient departments in teaching hospital in Nepal. IndianJournal of Pharmacology. 3, 1991, 219 -221.
[34]. Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy:the influence of age and gender. Ther Clin Risk Manag 1, 2005, 39–48.
[35]. Kuruvilla, K.George and K.R John. Prescription patterns and cost analysis of drugs in a base hospital in South India. The National Medical Journal of India. 7(4), 1994, 167 -168.
[36]. L. Jaber, S. Rigler, A. Taya et al., ?Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy,? Journal of Pediatric Hematology/Oncology, 32(8), 585 –588, 2010
[37]. National Institute for Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and long-term management. Available at: www.nice.org.uk/cg054. Accessed 2008
[38]. P. Geisser and S. Burckhardt, ?The pharmacokinetics and pharmacodynamics of iron preparations,? Pharmaceutics, 3(1), 2011, 12–33.
[39]. P. L. Geltman, L. K. Hironaka, S. D. Mehta et al., ?Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops,? Journal of Pediatrics, 154(5), 2009, 738
[40]. Paediatric pharmacopoeia, Royal Children's Hospital Melbourne, 13.
[41]. Passarelli MCG, Jacob-Filno W, Figueiras A. Adverse drug reactions in an elderly hospitalized population.
Inappropriate prescription is a leading cause. Drug Aging 22(9), 2005, 767 –77.
[42]. Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 121(6), 2008. Available at: www.pediatrics.org/cgi/content/full/121/6/e1489
[43]. Pharmacist's Drug Handbook, American Society of health system pharmacists, spring House Corporation 2001.
[44]. Pope G, Wall N, Peters CM, et al. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients. Age Ageing 40, 2011, 307–12.
[45]. Richard Grol, Jah.annes Dalhuijsen, Seip Thomas, Cees 'in" t veld. Guy Rutten, Henk Mokkink. "Attributes of Clinical Guidelines that inflience use of 'guidelines in general practice: Observational Study: BMJ 817, 1998, 858 - 6l.
[46]. S.C Pradhan, D.G Shewade, Uma Tekur, D.Pachiappan, A.K Dey, C.Adithan, C.H Shashindran and J.S Bapna. Changing pattern of antimicrobial utilization in an Indian teaching hospital. International Journal of clinical pharmacology, Therapy and Toxicology. 28(8), 1990, 339 -343.
[47]. S.L. NASA and Poonam Gulati. Prescription errors prevention by pharmacists. TheIndian Journal of Hospital Pharmacy. 1990, 129-130.
[48]. Srijayam M. and jhansi Rani P. Energy balance in selected anemia adoleseant girl. The Indian journal of nutrition and dieteties 2001, S4-S9.
[49]. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli JP. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 54, 2006, 1516 –23.
[50]. To reduce polypharmacy and falls in an ambulatory rural elderly population. J Gen Int ern Med 23, 2008, 399–404.
[51]. Tooth L, Hockey R, Byles J, Dobson A. Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women.J Clin Epidemiol 61, 2008, 151 –9.
[52]. Trade names and generic names in drug prescriptions. Bulletin. Hospital and Clinical Pharmacy Services, MCH, Trivandrum.
[53]. Tulner LR, Frankfort SV, Gijsen GJPT, van Campen JP, Koks CH, Beijnen JH. Dug–drug interactions in a geriatric outpatient cohort. Prevalence and relevance. Drugs Aging 25(4), 2008, 343–55.
[54]. Using a large health insurance database. Pharmacoepidemiol Drug Saf 2009,doi:10.1002/pds.1841.
[55]. Van der Hooft CS, Sturkenboom CJM, van Groothest K, Kingma HJ, Stricker HC. Adverse drug reactions - related hospitalizations. A nationwide study in The Netherlands. Drug Saf 29(2), 2006, 161–8.
[56]. WHO and ECHO International Health Services, Essential drugs and Medicines. Practical Pharmacy The
U.K. Department for International Development, 5, 1997.
[57]. Wilson N, Gnjidic D, March L, et al. Use of PPIs are not associated with mortality in institutionalized older people. Arch Intern Med 171, 2011, 866.
[58]. Wilson NM, Hilmer SN, March LM, et al. Associations between Drug Burden Index and falls in older people in residential aged care. J Am Geriatr Soc 59, 2011 , 875–80.
[59]. World Health Organization, Guidelines for WHO Guidelines, EIP / G PT / EQC /2003.1.
[60]. World Health Organization, the rational use of Drugs in the management of acute Diarrhoea in Children, 1990.
[61]. World Health Organization, World Health Report 2002: Reducing Risks, Promoting Healthy Life, World Health Organization, Geneva, Switzerland, 2002.
References
[1]. Alexpoulou A, Dourakis SY, Mantzoukis D, Pitsariotis T, Kandyli A, Deutsch M, et al.Adverse drug reactions as a cause of hospital admissions: a 6-month experience in a single center in Greece. Eur J Int Med 19, 2008, 505–10.
[2]. American Academy of Pediatrics, Clinical practice 'Guideline: Treatment of the School Aged child with Attention - Deficit / Hyperactivity Disorder", 108(4), 2002, 1033.
[3]. B. Benoist, E. McLean, I. Egli, and M. Cogswell, Worldwide Prevalence of Anaemia 1993–2005. WHO Global Database of Anaemia, World Health Organization, Geneva, Switzerland,
[4]. B. Glader, ?Diseases of the blood; section 2—anemias of inadequate protection: iron deficiency anemia,? in Nelson Textbook of Pediatrics, R. M. Kliegman, R. E. Behrman, H. B.
[5]. B.S. Balakrishna. Rational use of drugs. Proceedings of National Seminar on Hospital and Clinical Pharmacy, J.S.S College Mysore. 1999, 24.
[6]. Calvin.M. Kunin, T.Tupasi, W.A Craig. Use of antibiotics. Annals of Internal Medicine J 973:79: 555-560. [7]. Camargo AL, Cardoso Ferreira MB, Heineck I. Adverse drug reactions: a cohort study in internal medicine
units at a university hospital. Eur J Clin Pharmacol 62, 2006, 143 –9.
[8]. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW,Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA.
[9]. Corsonello A, Pedone C, Corica F, Antonelli Incalzi R, on behalf of the Gruppo Italiano di Farmacovigilanza (GIFA) investigators. Polypharmacy in the elderly patients at discharge from the acute care hospital. Ther Clin Risk Manage 3, 2007, 197–203.
[10]. D.Sharma, K.H Reeta, D.K Badyal, S.K Garg and V.K Bhargava. Antimicrobial. Prescribing pattern in an Indian Tertiary Hospital. Indian J PhysiolpharmacoI A2(4), 1998, 533-537.
[11]. Death and adverse clinical events in elderly patients according to disease clustering: the REPOSI study.
Rejuvenation Res 13, 2010, 469–77.
[12]. Delhi Society for promotion of rational use of Drugs, Standard Treatment Guidelines 2002.
[13]. Delhi Society for promotion. Of Rational use of Drugs, The Medicines Scenario India: Perceptions and Perspectives 1996.
[14]. Dept of Health &Family Welfare, Govt. of Himachal Pradesh, Standard Treatment Guidelines, 2000.
[15]. DJ Quinin and R.O Day. Clinically important drug interactions. (Chapter 7 and Appendix B).Avery’s Drug treatment, 4, 1997. Aids international limited.
[16]. Drugs and Therapeutic Committee-A practical guide, WHO in ColIabration with Management Science for Health, 2003, 100.
[17]. G.Tomson and I.Angunawela. Patients, doctors and their drugs. EurJ ClinPharmacol 39, 1990, 463 -467. [18]. Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly
patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 89, 2011, 845– 54.
[19]. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation [20]. Ghai OP, Essential Pediatrics, 4, 1998, 193-203.
[21]. Gnjidic D, Le Couteur DG, Abernethy DR, et al. A pilot randomized clinical trial utilizing the drug burden index to reduce exposure to anticholinergic and sedative medications in older people. Ann Pharmacother; 44, 2010, 1725–32.
[22]. Gnjidic D, Le Couteur DG, Abernethy DR, et al. Reducing drugs in older adults is more.Arch Intern Med 171, 2011, 868–9.
[23]. Guru Prasad Mohanta and S.M Baranidharan. National essential drugs list an overview. Indian Journal of Hospital Pharmacy November-December, 1997, 223-224.
[24]. H.S.REHANA, M.A.Nagarani and Moushumi Rehan. A study on the drug prescribing pattern and use of antimicrobial agents at a tertiary care teaching hospital in Eastern Nepal. Indian Journal of Pharmacology. 30, 1998, 175-180
[25]. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 5, 2007, 345–51.
[26]. Hayes O. W. "Clinical' Practice Guidelines: A review Journal of the American Osteopathic Association, 64(9), 1994, 732.
[27]. Indian drug review (IDR) March /April 2, 1999.
[28]. J.S. Bapna. D.G. Shewade and S.C Pradhan. Training medical professional on the concepts of• essential Drugs and rational drug Use 13r.JC/inFharmac. 37, 1994, 399-400.
[29]. J.S. Bapna. U.Tekur, B.Gitanjali, C.H Shashindran S.C Pradhan, M.ThuJasimani and G.Tomson. Drug utilization at primary health care level in Southern India. EurJ ClinPharmacal 43, 1992, 413 -415.
[30]. John O. Forfar and Gavin C. Arneil "Acute dysuria can be treated potassium citrate mixture in older children. Text book of pediatric Churchill living store, 4th edition 1992, 1026 -1041.
[31]. Jonathan D, Quick et al "Managing Drug Supply", Management Sciences for Health in Collaboration with WHO, 2nd Edition, Kumarian Press 2001, 124-135.
[32]. Jonathan H. Ross and Robert Kay "Pediatric urinary tract infection and reflun" American family physician March 59(6), 1999, 1485
[33]. K.K.Kafle, S.M. • Rajbhandarai, I(Srivastava and S.Regmi. Drug prescribing in out-patient departments in teaching hospital in Nepal. IndianJournal of Pharmacology. 3, 1991, 219 -221.
[34]. Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy:the influence of age and gender. Ther Clin Risk Manag 1, 2005, 39–48.
[35]. Kuruvilla, K.George and K.R John. Prescription patterns and cost analysis of drugs in a base hospital in South India. The National Medical Journal of India. 7(4), 1994, 167 -168.
[36]. L. Jaber, S. Rigler, A. Taya et al., ?Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy,? Journal of Pediatric Hematology/Oncology, 32(8), 585 –588, 2010
[37]. National Institute for Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and long-term management. Available at: www.nice.org.uk/cg054. Accessed 2008
[38]. P. Geisser and S. Burckhardt, ?The pharmacokinetics and pharmacodynamics of iron preparations,? Pharmaceutics, 3(1), 2011, 12–33.
[39]. P. L. Geltman, L. K. Hironaka, S. D. Mehta et al., ?Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops,? Journal of Pediatrics, 154(5), 2009, 738
[40]. Paediatric pharmacopoeia, Royal Children's Hospital Melbourne, 13.
[41]. Passarelli MCG, Jacob-Filno W, Figueiras A. Adverse drug reactions in an elderly hospitalized population.
Inappropriate prescription is a leading cause. Drug Aging 22(9), 2005, 767 –77.
[42]. Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 121(6), 2008. Available at: www.pediatrics.org/cgi/content/full/121/6/e1489
[43]. Pharmacist's Drug Handbook, American Society of health system pharmacists, spring House Corporation 2001.
[44]. Pope G, Wall N, Peters CM, et al. Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients. Age Ageing 40, 2011, 307–12.
[45]. Richard Grol, Jah.annes Dalhuijsen, Seip Thomas, Cees 'in" t veld. Guy Rutten, Henk Mokkink. "Attributes of Clinical Guidelines that inflience use of 'guidelines in general practice: Observational Study: BMJ 817, 1998, 858 - 6l.
[46]. S.C Pradhan, D.G Shewade, Uma Tekur, D.Pachiappan, A.K Dey, C.Adithan, C.H Shashindran and J.S Bapna. Changing pattern of antimicrobial utilization in an Indian teaching hospital. International Journal of clinical pharmacology, Therapy and Toxicology. 28(8), 1990, 339 -343.
[47]. S.L. NASA and Poonam Gulati. Prescription errors prevention by pharmacists. TheIndian Journal of Hospital Pharmacy. 1990, 129-130.
[48]. Srijayam M. and jhansi Rani P. Energy balance in selected anemia adoleseant girl. The Indian journal of nutrition and dieteties 2001, S4-S9.
[49]. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli JP. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 54, 2006, 1516 –23.
[50]. To reduce polypharmacy and falls in an ambulatory rural elderly population. J Gen Int ern Med 23, 2008, 399–404.
[51]. Tooth L, Hockey R, Byles J, Dobson A. Weighted multimorbidity indexes predicted mortality, health service use, and health-related quality of life in older women.J Clin Epidemiol 61, 2008, 151 –9.
[52]. Trade names and generic names in drug prescriptions. Bulletin. Hospital and Clinical Pharmacy Services, MCH, Trivandrum.
[53]. Tulner LR, Frankfort SV, Gijsen GJPT, van Campen JP, Koks CH, Beijnen JH. Dug–drug interactions in a geriatric outpatient cohort. Prevalence and relevance. Drugs Aging 25(4), 2008, 343–55.
[54]. Using a large health insurance database. Pharmacoepidemiol Drug Saf 2009,doi:10.1002/pds.1841.
[55]. Van der Hooft CS, Sturkenboom CJM, van Groothest K, Kingma HJ, Stricker HC. Adverse drug reactions - related hospitalizations. A nationwide study in The Netherlands. Drug Saf 29(2), 2006, 161–8.
[56]. WHO and ECHO International Health Services, Essential drugs and Medicines. Practical Pharmacy The
U.K. Department for International Development, 5, 1997.
[57]. Wilson N, Gnjidic D, March L, et al. Use of PPIs are not associated with mortality in institutionalized older people. Arch Intern Med 171, 2011, 866.
[58]. Wilson NM, Hilmer SN, March LM, et al. Associations between Drug Burden Index and falls in older people in residential aged care. J Am Geriatr Soc 59, 2011 , 875–80.
[59]. World Health Organization, Guidelines for WHO Guidelines, EIP / G PT / EQC /2003.1.
[60]. World Health Organization, the rational use of Drugs in the management of acute Diarrhoea in Children, 1990.
[61]. World Health Organization, World Health Report 2002: Reducing Risks, Promoting Healthy Life, World Health Organization, Geneva, Switzerland, 2002.
[2]. American Academy of Pediatrics, Clinical practice 'Guideline: Treatment of the School Aged child with Attention - Deficit / Hyperactivity Disorder", 108(4), 2002, 1033.
[3]. B. Benoist, E. McLean, I. Egli, and M. Cogswell, Worldwide Prevalence of Anaemia 1993–2005. WHO Global Database of Anaemia, World Health Organization, Geneva, Switzerland,
[4]. B. Glader, ?Diseases of the blood; section 2—anemias of inadequate protection: iron deficiency anemia,? in Nelson Textbook of Pediatrics, R. M. Kliegman, R. E. Behrman, H. B.
[5]. B.S. Balakrishna. Rational use of drugs. Proceedings of National Seminar on Hospital and Clinical Pharmacy, J.S.S College Mysore. 1999, 24.
[6]. Calvin.M. Kunin, T.Tupasi, W.A Craig. Use of antibiotics. Annals of Internal Medicine J 973:79: 555-560. [7]. Camargo AL, Cardoso Ferreira MB, Heineck I. Adverse drug reactions: a cohort study in internal medicine
units at a university hospital. Eur J Clin Pharmacol 62, 2006, 143 –9.
[8]. Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW,Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA.
[9]. Corsonello A, Pedone C, Corica F, Antonelli Incalzi R, on behalf of the Gruppo Italiano di Farmacovigilanza (GIFA) investigators. Polypharmacy in the elderly patients at discharge from the acute care hospital. Ther Clin Risk Manage 3, 2007, 197–203.
[10]. D.Sharma, K.H Reeta, D.K Badyal, S.K Garg and V.K Bhargava. Antimicrobial. Prescribing pattern in an Indian Tertiary Hospital. Indian J PhysiolpharmacoI A2(4), 1998, 533-537.
[11]. Death and adverse clinical events in elderly patients according to disease clustering: the REPOSI study.
Rejuvenation Res 13, 2010, 469–77.
[12]. Delhi Society for promotion of rational use of Drugs, Standard Treatment Guidelines 2002.
[13]. Delhi Society for promotion. Of Rational use of Drugs, The Medicines Scenario India: Perceptions and Perspectives 1996.
[14]. Dept of Health &Family Welfare, Govt. of Himachal Pradesh, Standard Treatment Guidelines, 2000.
[15]. DJ Quinin and R.O Day. Clinically important drug interactions. (Chapter 7 and Appendix B).Avery’s Drug treatment, 4, 1997. Aids international limited.
[16]. Drugs and Therapeutic Committee-A practical guide, WHO in ColIabration with Management Science for Health, 2003, 100.
[17]. G.Tomson and I.Angunawela. Patients, doctors and their drugs. EurJ ClinPharmacol 39, 1990, 463 -467. [18]. Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly
patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther 89, 2011, 845– 54.
[19]. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation [20]. Ghai OP, Essential Pediatrics, 4, 1998, 193-203.
[21]. Gnjidic D, Le Couteur DG, Abernethy DR, et al. A pilot randomized clinical trial utilizing the drug burden index to reduce exposure to anticholinergic and sedative medications in older people. Ann Pharmacother; 44, 2010, 1725–32.
[22]. Gnjidic D, Le Couteur DG, Abernethy DR, et al. Reducing drugs in older adults is more.Arch Intern Med 171, 2011, 868–9.
[23]. Guru Prasad Mohanta and S.M Baranidharan. National essential drugs list an overview. Indian Journal of Hospital Pharmacy November-December, 1997, 223-224.
[24]. H.S.REHANA, M.A.Nagarani and Moushumi Rehan. A study on the drug prescribing pattern and use of antimicrobial agents at a tertiary care teaching hospital in Eastern Nepal. Indian Journal of Pharmacology. 30, 1998, 175-180
[25]. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother 5, 2007, 345–51.
[26]. Hayes O. W. "Clinical' Practice Guidelines: A review Journal of the American Osteopathic Association, 64(9), 1994, 732.
[27]. Indian drug review (IDR) March /April 2, 1999.
[28]. J.S. Bapna. D.G. Shewade and S.C Pradhan. Training medical professional on the concepts of• essential Drugs and rational drug Use 13r.JC/inFharmac. 37, 1994, 399-400.
[29]. J.S. Bapna. U.Tekur, B.Gitanjali, C.H Shashindran S.C Pradhan, M.ThuJasimani and G.Tomson. Drug utilization at primary health care level in Southern India. EurJ ClinPharmacal 43, 1992, 413 -415.
[30]. John O. Forfar and Gavin C. Arneil "Acute dysuria can be treated potassium citrate mixture in older children. Text book of pediatric Churchill living store, 4th edition 1992, 1026 -1041.
[31]. Jonathan D, Quick et al "Managing Drug Supply", Management Sciences for Health in Collaboration with WHO, 2nd Edition, Kumarian Press 2001, 124-135.
[32]. Jonathan H. Ross and Robert Kay "Pediatric urinary tract infection and reflun" American family physician March 59(6), 1999, 1485
[33]. K.K.Kafle, S.M. • Rajbhandarai, I(Srivastava and S.Regmi. Drug prescribing in out-patient departments in teaching hospital in Nepal. IndianJournal of Pharmacology. 3, 1991, 219 -221.
[34]. Koh Y, Kutty FBM, Li SC. Drug-related problems in hospitalized patients on polypharmacy:the influence of age and gender. Ther Clin Risk Manag 1, 2005, 39–48.
[35]. Kuruvilla, K.George and K.R John. Prescription patterns and cost analysis of drugs in a base hospital in South India. The National Medical Journal of India. 7(4), 1994, 167 -168.
[36]. L. Jaber, S. Rigler, A. Taya et al., ?Iron polymaltose versus ferrous gluconate in the prevention of iron deficiency anemia of infancy,? Journal of Pediatric Hematology/Oncology, 32(8), 585 –588, 2010
[37]. National Institute for Health and Clinical Excellence. Urinary tract infection in children: diagnosis, treatment and long-term management. Available at: www.nice.org.uk/cg054. Accessed 2008
[38]. P. Geisser and S. Burckhardt, ?The pharmacokinetics and pharmacodynamics of iron preparations,? Pharmaceutics, 3(1), 2011, 12–33.
[39]. P. L. Geltman, L. K. Hironaka, S. D. Mehta et al., ?Iron supplementation of low-income infants: a randomized clinical trial of adherence with ferrous fumarate sprinkles versus ferrous sulfate drops,? Journal of Pediatrics, 154(5), 2009, 738
[40]. Paediatric pharmacopoeia, Royal Children's Hospital Melbourne, 13.
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