V. S. Mathur

Prescribing Patterns and Therapeutic Implications for Diabetic Hypertension in Bahrain

OBJECTIVE: To determine drug prescription patterns and the extent of conformity with World Health Organization/International Society of Hypertension (WHO/ISH) guidelines in diabetic hypertension. DESIGN: Retrospective prescription-based survey. SETTING: Seven primary-care health centers, comprising approximately one-third of primary-care health centers in Bahrain. PATIENTS: Patients with type 2 diabetes and hypertension. MAIN OUTCOME MEASURE: The prescribing pattern of antihypertensive and antidiabetic drugs. RESULTS: Among a study sample of 1463 patients with type 2 diabetes and hypertension, antidiabetic agents were prescribed as monotherapy in the following descending order: glyburide, gliclazide, insulin, and metformin. As combinations, sulfonylureas plus metformin was most popular, followed by metformin plus insulin, and sulfonylureas plus insulin. Sulfonylurea and metformin with insulin was rarely used. There was no significant difference in prescribing of glyburide and metformin between the elderly and young middle-aged diabetic patients; many patients older than 65 years were treated with a β-blocker along with a long-acting sulfonylurea. Both as monotherapy and in overall use, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium-channel blockers were most often prescribed. Among 35.5% patients treated with antihypertensive combinations, various two- and three-drug combinations of β-blockers, ACE inhibitors, calcium-channel blockers, and diuretics were often used. The proportion of patients taking atenolol 100 mg/d was higher with combination regimens. Hydrochlorothiazide 25 mg or equivalent thiazide diuretics were extensively used. CONCLUSIONS: The prescribing pattern of antihypertensives in diabetic hypertension differs in many instances from WHO/ISH guidelines, especially regarding the choice of antihypertensive drugs and their combinations. The appropriateness of antidiabetic drug choice is questionable in relation to the antihypertensive used.

Rational pharmacotherapy of hypertension in the elderly: analysis of the choice and dosage of drugs

Objectives: To determine in older people with uncomplicated hypertension: (a) the pattern of prescribing of antihypertensives; (b) the extent of physicians’ adherence to recommendations on dosage for antihypertensive combinations; (c) whether prescribing practice conforms with recommended therapeutic guidelines; and (d) the frequency of prescribing of other drugs which have the potential to alter the efficacy of antihypertensive agents.

Trends in ophthalmic antimicrobial utilization pattern in Bahrain between 1993 and 2000: a resurgence of chloramphenicol?

OBJECTIVES The occurrence of aplastic anemia following topical administration of ophthalmic chloramphenicol is controversial and debated internationally. We have determined the influence of such debate on the utilization of ophthalmic chloramphenicol in Bahrain, through studying the utilization patterns of ophthalmic antimicrobial preparations by the Ministry of Health, with an emphasis on chloramphenicol, between 1993 and 2000. Cost-implications of these patterns are examined. MATERIAL AND METHODS Information on the annual purchase of ophthalmic antimicrobial drug preparations and their unit price was obtained from the Directorate of Materials Management, Ministry of Health, and analyzed. RESULTS In 1993, the 3 most commonly purchased ophthalmic antibacterial preparations were oxytetracycline 1% eye ointment (40.1%); sulfacetamide 10% and 20% eye drops (25.3%); and chloramphenicol 0.5% eye drops and 1% eye ointment (10.8%). In 2000, oxytetracycline remained the most frequently purchased preparation (33%), followed by chloramphenicol (21.2%). Between 1993 and 1999, chloramphenicol purchases fluctuated between 10% to 16.4% with a remarkable increase to 21.2%, in 2000. Chloramphenicol accounted for 8.6% and 15.1% of cost of total ophthalmic preparations purchased in 1993 and 2000, respectively. CONCLUSION Despite continued concerns of potential risks of ophthalmic chloramphenicol, this preparation is extensively utilized in Bahrain. We are of the opinion that for minor infections, chloramphenicol ophthalmic preparations should be replaced by safer alternatives. Further, we recommend that their use be reserved for ocular infections that are resistant to other antimicrobials, and that ophthalmologists, at the secondary care level, should supervise such treatment.

Adverse Effects of Two Long-Acting Depot Antipsychotic Drugs

SummaryA comparison of the adverse effects of the depot preparations of flupenthixol decanoate (Depixol®) and fluphenazine decanoate (Modecate®) was conducted in 100 chronic schizophrenic patients attending the outpatient department at the Psychiatric Hospital, Bahrain.Although akathisia, parkinsonism, weight gain and endocrine effects were seen in a large number of cases, there was no statistically significant difference in their incidence between the 2 groups. Furthermore, there was no difference in the efficacy of the 2 preparations studied.We observed abnormal hair loss in 42 cases — 22 on Depixol® and 20 on Modecate®. This previously unreported side effect is probably due to these long-acting antipsychotic drugs.

Promoting Rational Prescribing in Problem-Based Curriculum

In this paper an ongoing programme on rational selection of drugs and prescription writing at the College of Medicine and Medical Sciences (CMMS), Bahrain is described. The CMMS follows the integrated curriculum of problem-based, learner directed learning where all the basic and clinical sciences are presented through simulated patient problems. The six year curriculum is divided into three phases — the Premedicai, Unit and the Clerkship phase. In this programme the student acquires not only knowledge but skills, values and attitudes which go a long way in moulding him to be a good physician. Exercises on rational selection of drugs and prescribing skills are introduced in the unit system at an early stage in unit I. In this unit the student learns about the prescription order and its components, common abbreviations used, household measures and the skill to use the Formularies and the Pharmacopoeia. This is followed by exercises on prescription writing contained in a work book. During the subsequent units the student makes a regular visit to the skill laboratory where they get a new set of exercises centered around the problems in a work book containing objectives, instructions, relevant text and pages from the British National Formulary and clinico-therapeutic exercises. The exercises are aimed on rational selection of a drug, preparing personal formulary, critical appraisal of current literature and writing of chart orders and prescriptions. So far five such exercises out of the planned eight have been completed. The preliminary evaluation based on the results of the responses in work book 4 and the formative assessment have shown very encouraging results.

Utilisation of Psychotropic Drugs in Patients of the Long Stay Ward

SummaryA survey of the prescribing of psychotropic drugs was carried out at the Psychiatric Hospital of Bahrain. This retrospective study on 60 inpatients of the Long Stay Ward revealed a man: woman ratio of 2.7. 91% of the men and 88% of the women were over 40 years old. 44 of the 60 patients had a diagnosis of schizophrenia, the rest had dementia, depression, schizoaffective disorders, drug-induced psychosis, general paralysis or Huntington’s chorea. 95% of patients received anti-psychotic drugs. Thioridazine was the most common drug followed by chlorpromazine. The mean number of drugs/patient was 1.7, with 41.7% of patients receiving only 1 drug. Tardive dyskinesia was observed in 11 patients and 9 experienced varying degrees of tremor. The findings confirm that psychiatric illness treated by psychiatrists need not lead to polypharmacy. As a consequence, its treatment may be less likely to result in adverse reactions than when patients are treated by general practitioners.