Prescribing of bisphosphonates and antibiotics in Pakistan: Challenges and opportunities for the future

Objective: The management of patients with osteoporosis and the rational use of antibiotics are growing concerns in Pakistan. The first step is to assess utilisation patterns, prescribing behaviour and the potential rationale among a range of medicines including bisphosphonates and antibiotics, and subsequently use the findings to suggest potential future policies for all key stakeholders to improve patient care in the future. Methods: A questionnaire-based, cross-sectional study in both private and public healthcare facilities in Pakistan, conducted between January 2011 and December 2012, involving 438 physicians and 15824 prescriptions. The second study involved 9984 outpatient prescriptions, 127 inpatient cases and over 100 prescribers and dispensers. Key findings: There was adequate history taking and examinations in approximately half of the physicians surveyed, with prescribing typically taking into account issues such as disease severity (84% of respondents) and the socioeconomic status of patients (53%). Prescribing of bisphosphonates was common certainly compared with medicines to treat cardiovascular diseases and diabetes. However, there are concerns with the low use of generics, high rate of antibiotic prescribing, variable availability of medicines, medical representatives being a key source of information on medicines and typically a limited number of formularies. Conclusion: There are considerable opportunities to improve the rational use of medicines in Pakistan including physician education, prescribing guidance and formularies. In addition, educating patients and physicians concerning antibiotics. These should be coordinated among key stakeholder groups. There is also a need to ensure low prices for generics and enhance their utilisation.