A recent study showed that in Pakistan, doctors prescribe significantly more medications to patients than established standards, issuing more than twice the number of drugs in a single prescription. Furthermore, only one out of the four prescribed medications was issued under its generic name, which substantially exceeds World Health Organization (WHO) norms.
According to WHO data, an average prescription should contain between 1.6 and 1.8 medications. However, a large hospital in Peshawar, Pakistan, recorded an average of 10.56 medications. This study was conducted by researchers from the Health Services Academy of Islamabad (HSA) and published in the journal 'Discover Public Health'.
The situation in Pakistan has its specific characteristics, but it is also important to consider the practice in India. According to a report by the National Institute of Health, various studies on drug prescribing patterns in India show that doctors prescribe an average of 2.2 to 3.9 medications per outpatient prescription, which is also above WHO parameters.
WHO Parameters
The WHO establishes the following guidelines: an average prescription should contain between 1.6 and 1.8 medications; drugs should be prescribed predominantly by their generic name; antibiotics should only be used when necessary; and injections should be used exclusively when needed.
Why do doctors prescribe many medications?
Professor Dr. Ajit Jain from Rajiv Gandhi Hospital explains that sometimes patients present with multiple symptoms simultaneously, such as a combination of fever, body aches, vomiting, heartburn, and weakness. In such cases, a doctor may prescribe separate drugs for each problem. Additionally, some patients themselves demand quick relief from their condition. Some doctors also prescribe additional agents to prevent possible side effects of the illness. Nevertheless, not all doctors exceed the established parameters; in some cases, more than two medications are prescribed for timely monitoring of the patient's condition, based on their individual characteristics.
When can doctors prescribe more medications?
The WHO allows prescribing more than two medications if the patient's medical condition requires it. This usually happens when a patient has serious conditions simultaneously, such as diabetes, high blood pressure, and heart disease. Also, for treating certain diseases, including tuberculosis, cancer, or HIV, the simultaneous use of several medications is necessary to eliminate dangerous bacteria.
What are the risks of taking a large number of medications?
Dr. Jain warns that some patients start taking more medications on their own. For example, while taking an antispasmodic, they might add heartburn medication or vitamins. This increases the risk of drug side effects and the probability of interactions between different drugs. This issue is particularly relevant for the elderly and those who already suffer from chronic diseases. Excessive use of painkillers and antibiotics poses a serious threat, as these drugs negatively affect the liver and kidneys.
What should the patient do?
If a doctor prescribes several medications, the patient must not stop taking any drug independently. However, they have the right to ask the doctor why each drug was prescribed, how long to take it, and whether all prescribed medications are necessary. It is important to remember that antibiotics or painkillers should never be taken without consulting a doctor.