Evaluation of Rational Drug Use in Outpatients with Urinary Tract Infection at a Rural Indian Hospital: A Cross-sectional Study

Introduction: Urinary Tract Infections (UTIs) in outpatients are frequently treated empirically with antibiotics. It is essential to assess prescribing patterns to address irrational drug use and prevent the development of antimicrobial resistance. Aim: To evaluate rational drug use in outpatients with UTIs. Materials and Methods: The present cross-sectional study was conducted in the Medicine Outpatient Department (OPD) at Swami Ramanand Tirth Rural Government Medical College, Ambajogai, Maharashtra, India. A total of 1,000 prescriptions from patients diagnosed with UTIs between December 2018 and June 2020 were evaluated for demographic characteristics, co-morbidities, and medication profiles. The World Health Organisation (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology was used to assess prescriptions using metrics such as Prescribed Daily Dose (PDD), DDD, PDD:DDD ratio, and DDD per 1,000 Inhabitants per Day (DID). Rationality was evaluated using WHO prescribing indicators and the Index of Rational Drug Prescribing (IRDP). Categorical data were analysed using the Chi-square test and Pearson’s correlation. Results: The UTIs were more common in females, 682 (68.2%), than in males, 318 (31.8%). The most frequent co-morbidities were diabetes mellitus 360 (36%), urolithiasis 190 (19%), and Benign Prostatic Hypertrophy (BPH) 104 (10.4%). A total of 2,550 drugs were prescribed, most commonly nitrofurantoin 256 (25.6%), paracetamol 280 (28.0%), norfloxacin 113 (11.3%), pantoprazole 149 (14.9%), levofloxacin 118 (11.8%), amoxicillin 55 (5.5%), cefpodoxime 29 (2.9%), and disodium hydrogen citrate 1,000 (100%). The mean PDD was 675.71±607.29 mg, mean DDD was 0.92±1.03 mg, the PDD:DDD ratio was 1.0±0.5, and DID was 0.0492±0.0452. The average number of drugs per encounter was 2.55. Of all drugs prescribed, 42.03% were written by generic name and 53.05% were from the Essential Medicines List (EML). Antibiotics were prescribed in all encounters; no injections or Fixed-Dose Combinations (FDCs) were used. The overall IRDP index was 2.03. Conclusion: Low DID values indicate limited antibiotic utilisation. Minimal polypharmacy and the absence of injections or FixedDose Combinations (FDCs) demonstrate rational prescribing practices. However, universal antibiotic prescribing and a low IRDP index suggest considerable scope for improvement.