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This research aims to summarize and discuss issues related to psychiatric drugs by using the classification system of the Pharmaceutical Care Network Europe (PCNE) and to provide a reference for the development and direction of clinical pharmacists' work in the future. Psychiatric patients who were hospitalized in our hospital from Janurary 2023 to December 2023 were enrolled. Drug-related problems (DRPs) were evaluated using the PCNE classification system (version 9.0). The types, causes, intervention plans, acceptance of intervention plans, and statuses of DRPs were analyzed. A total of 362 patients were included, covering 405 DRP cases, with an average DRP of 1.12 for each patient. All 405 DRP cases underwent interventions, with a success rate of 83.46%. The main categories of related drugs were psychotropic drugs (70.37%), anti-infective drugs (8.89%), and cardiovascular system drugs (5.19%). The main DRPs were possible adverse drug events (21.24%), poor treatment effects (69.14%), and unnecessary medication treatment (9.63%). The main causes of DRPs were inappropriate drug selection (18.52%), inappropriate combinations of drugs (16.05%), and excessive drug dosage (13.58%). The PCNE classification system helps clinical pharmacists improve their ability to identify and solve DRPs faced by psychiatric departments, improve pharmaceutical care efficiency, and ensure rational drug use., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Rational drug prescribing skills of interns remain bleak despite clinical pharmacology training during their second year, warranting the need for further training. This study was designed to evaluate the effectiveness of a short-structured learner-centric training program using the World Health Organization (WHO) guide to good prescribing in improving interns' knowledge of rational drug use and their rational drug prescribing skills., Methods: This quasi-experimental study was implemented at a tertiary care teaching hospital in South India. We conducted a short-structured learner-centric training program on rational drug prescribing for interns in September 2022, using the WHO guide to good prescribing. The medical interns who consented to participate were included in the study. A pre-test was administered at the start of the training, followed by a post-test and feedback questions at the end of the program. Statistical tests used for quantitative data were the Wilcoxon signed-ranks test and McNemar's Chi-square test. Qualitative data were analyzed using manual content analysis., Results: Of the 77 interns who attended the training program, 73 provided consent and completed both the pre-test and the post-test. Their mean age was 22 years, with a slight preponderance of female participants (53.4%). Overall, there was a statistically significant increase in the median (interquartile range) total scores from 52 (44.6 - 60) to 84 (70 - 88) after the training ( P = 0.001), out of a maximum score of 93. Also, a significantly greater number of them wrote legible prescriptions (grade 4/excellent - 44 in pre-test vs 52 in post-test; P = 0.001) after the training., Conclusion: The short-structured learner-centric training program based on the WHO guide to good prescribing significantly improved the knowledge of rational drug use and rational drug prescribing skills among medical interns., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Background: This study aims to compare antimicrobial drug usage in our hospital to Jiangsu Province and China from 2020 to 2022., Research Design and Methods: A detailed analysis was performed using data from the National Antimicrobial Drug Clinical Application Monitoring Network. Several parameters were studied: the rate of antimicrobial drug use, number and types of drugs used, the rate of combined use, rate of microbiological examinations, drug use intensity, and cumulative Defined Daily Doses (DDDs)., Results: From 2020 to 2022, our hospital's antimicrobial drug usage rate was consistently lower than Jiangsu Province and China. The average number of drug types and the combined drug use rate were higher in 2020 but fell below those in Jiangsu Province and China in 2021 and 2022. Our microbiological examination rate consistently surpassed that of Jiangsu Province and China. Furthermore, our Antimicrobial Usage Density and cumulative DDDs were notably lower. While AUD remained stable, DDDs showed a decreasing trend. The most dominant drug in DDDs was cefditoren, a third-generation cephalosporin., Conclusions: During the pandemic years, our hospital not only met the requirements for antimicrobial drug usage, microbiological examination, AUD, and cumulative DDDs but also demonstrated a consistent year-by-year decrease in drug usage and DDDs.

Introduction: Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital., Methods: This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics., Results:  Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters., Conclusion: The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings., Recommendation:  Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Modh et al.)

Background & objectives Medication-related harm is known to be the cause for about 1/10th of hospitalizations. Some estimates from India show that about 90 per cent of medicines consumed are inessential or irrational and contribute towards high out-of-pocket expenditure on health. In this context, the Indian Council of Medical Research in 2022 constituted a National Task Force (NTF) to explore possible solutions that could improve safe and rational use of medicines (SRUMs). The objective of this study was to identify research ideas in the field of SRUM through a survey of relevant stakeholders, and further to prioritize the research ideas using a pre-identified set of criteria. Methods The responses from the identified stakeholders were assessed using the Child Health and Nutrition Research Initiative method, which is an established research priority-setting methodology. First, the NTF asked for two to six research ideas from relevant Indian and global stakeholders on solutions to improve SRUM. The ideas were checked for duplicates, re-phrased where necessary and classified into various sub-themes. Subsequently, the research ideas were scored by Indian experts with relevant technical expertise using a pre-defined set of five criteria: innovativeness, effectiveness, translational value, answerability and applicability. Each research idea received from a stakeholder was assigned a score under each of the five criteria. The overall research priority score was calculated as a mean of all five criteria-specific scores and converted into a percentage. Results The final output of the prioritization process was a list of research ideas or questions, ranked by their scores. Total 209 unique ideas were received from 190 respondents, which were scored by 27 experts. The top three research topics on medication safety focused on cost-effective strategies for improving antimicrobial stewardship, safe use of poly-pharmacy in geriatric patients and drug take-back policy interventions. Regarding the rational use of medicine, the top three topics included testing mobile application-based antimicrobial stewardship interventions, development of diagnostics for antimicrobial resistance, and behavioural interventions. Interpretation & conclusions Several priority ideas found in this study also align with those of global priority, e.g., safe disposal practices and enhanced pharmacovigilance, rational use of medicines. Patient engagement, which underlines many of the top scoring ideas found in this study, is also inclined with the top research priorities reported by the WHO priority exercise on research into the safe use of medicines. However, to the best of our knowledge, this is the first such work from a low- and middle- income country on medication safety and rational use of medicines. The findings of this research priority-setting exercise can help to guide research for the development of policy-relevant and novel interventions to improve SRUM in India.

Background: Poor drug prescription patterns (PP) result in irrational medicine use, avoidable stock outs and drug expiries., Objective: This study primarily assessed the effects of PP on the performance of the pharmacy department (PD) of Mbarara Regional Referral Hospital (MRRH) Uganda., Methods: This was a mixed method cross-sectional study conducted in the outpatient department (OPD) of MRRH, questionnaires were administered to 86 prescribers and 300 patient prescriptions were reviewed. Ethical clearance was granted and informed consent of patients. Data were analysed, presented in the form of graphs, tables., Results: The overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officersThe overall prescription fill rate was 60.5%, being higher among dental officers and lower among those who did not adhere to generic prescribing and EML. Medical officers made most prescriptions at 69.3%. Prescriptions with four (47.1%) and six (17.5%) medicines respectively were made by clinical officers. Of the 300 prescriptions, 76% adhered to the Essential Medicines List (EML), 62% used generic name including 87.3% from dental officers and 52.9% by clinical officers., Conclusion: Prescription pattern affected the performance of the PD of MRRH, calling for its continued monitoring to ensure that guidelines are upheld, EML and UCG are availed and utilized., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Background: This study aimed to understand the knowledge, attitude, and practice (KAP) of drug use among residents in western China and its influencing factors for accurately designing the knowledge, contents, and methods of popular science activities for safe drug use among residents to provide a reference for conducting rational drug use educational activities and improving residents' level of safe drug use., Methods: A cross-sectional questionnaire survey was conducted to investigate the KAP of medication among western China residents and its influencing factors from March to April 2023. Each question option was assigned a score according to logic, and the risk factors for resident medication safety KAP were explored through univariate and logistic regression analyses., Results: A total of 7,557 valid questionnaires were collected, with an effective recovery rate of 96.7%. The average scores of KAP were 72.77 ± 22.91, 32.89 ± 10.64, and 71.27 ± 19.09, respectively. In the evaluation criteria of the questionnaire, the score of medication knowledge reached "good," and the score of attitude and practice was "average." Multiple linear regression analysis indicated that male sex and low education level were significant factors affecting the lack of drug knowledge among residents. Old age and low education level were the factors of poor attitude toward medication. The low condition of medical security was a factor in residents' irregular drug use behavior., Conclusion: The overall level of rational drug use among residents in western China is good, but there are still some inconsistencies. Rational drug use education should be conducted according to the risk points of residents in drug safety KAP to further improve the level of rational drug use of residents., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shi, Tan, Shu, Zhou, Dan, Yang and Chen.)

Background: We aimed to examine the cost-related prescribing performance of primary care physicians who had a higher versus lower tendency of arbitrary prescribing., Methods: In this cross-sectional study, we evaluated the prescriptions of primary care physicians in Istanbul, collected with 3:1 systematic sampling. We determined higher versus lower arbitrary prescribing by the physician's degree of writing the solo diagnosis of "Z00- General examination without diagnosis/complaint": those for whom such prescriptions constituted >5% were classified as Group A and those with them at <0.5% as Group B. We compared these two groups by the total and disease-specific drug costs per prescription they produced for 10 frequently encountered indications., Results: The median cost of disease-specific medication for all diagnoses in Group A and Group B, except anemia, was equal. In upper respiratory tract infections (URTIs), hypertension, anemia, diabetes, and conjunctivitis, the mean prescription costs of Group A were significantly higher than those of Group B (P < .001, P < .001, P = .009, P = .007, and P < .001, respectively), whereas disease-specific drug costs per prescription were similar (P > .05 in all diagnoses). In myalgia, Group A had lower cost per prescription (P < .001) and higher analgesic costs per prescription (P < .001) compared to those in Group B. We found significantly higher disease-specific drug cost share in Group B for URTIs (antibiotic), gastroesophageal reflux disease (gastric acid-suppressant), hypertension (antihypertensive), anemia (iron preparations), diabetes (antidiabetic), depression (antidepressant), and conjunctivitis (corticosteroid) than those in Group A (P < .001 for each)., Conclusions: Our study showed that physicians who had a higher tendency of prescribing for no clear indication are also more likely to produce costly prescriptions., (© The Author(s) 2022. Published by Oxford University Press on behalf of Fellowship of Postgraduate Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The global issue of irrational drug use, particularly concerning pediatric patients, is a significant concern. Notably, there has been a lack of studies assessing rational drug prescribing for pediatric patients within Afghanistan's healthcare system. This investigation aimed to address this gap by examining drug prescribing patterns at the Indira Gandhi Pediatric Health Institute (IPHI) in Kabul, Afghanistan., Methods: A prospective cross-sectional analysis was conducted to evaluate the prevailing drug prescribing practices at the outpatient department of IPHI in Kabul, Afghanistan. A systematic random sampling method was employed to select 600 outpatient prescriptions from the institute, following the World Health Organization (WHO) guidelines for investigating drug utilization in healthcare facilities., Results: The average age of patients was 4 years, and the average number of drugs per prescription was 2.9. Notably, 84% of prescriptions included one or more antibiotics, surpassing the WHO standard of <30%. Furthermore, 67% of the prescribed drugs were listed on Afghanistan's national essential drugs list (EDL), falling below the standard value of 100%. Only 35.1% of the prescribed drugs were in generic form, also lower than the recommended 100%. Moreover, 5.7% of all prescriptions included injections, the ideal value is <20%. The most frequently prescribed drug groups were anti-microbials (25.7%), followed by non-steroidal anti-inflammatory drugs (NSAIDs), (21.4%), gastrointestinal drugs (17.3%), and vitamins (7.8%)., Conclusion: The study's findings indicate that, on average, a higher number of drugs were prescribed per patient visit at IPHI compared to recommended standards. Additionally, there was a lower utilization of generic drugs and drugs from Afghanistan's national essential drugs list (EDL), with an over-prescription of antibiotics., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Ltd.)

Background: Carbapenem antibiotics are a pivotal solution for severe infections, particularly in hospital settings. The emergence of carbapenem-resistant bacteria owing to the irrational and extensive use of carbapenems underscores the need for meticulous management and rational use. Clinical pharmacists, with their specialized training and extensive knowledge, play a substantial role in ensuring the judicious use of carbapenem. This study aimed to elucidate the patterns of carbapenem use and shed light on the integral role played by clinical pharmacists in managing and promoting the rational use of carbapenem antibiotics at Wenzhou Integrated Traditional Chinese and Western Medicine Hospital., Aim: To analyze carbapenem use patterns in our hospital and role of clinical pharmacists in managing and promoting their rational use., Methods: We performed a retrospective analysis of carbapenem use at our hospital between January 2019 and December 2021. Several key indicators, including the drug utilization index, defined daily doses (DDDs), proportion of antimicrobial drug costs to total hospitalization expenses, antibiotic utilization density, and utilization rates in different clinical departments were comprehensively analyzed., Results: Between 2019 and 2021, there was a consistent decline in the consumption and sales of imipenem-cilastatin sodium, meropenem (0.3 g), and meropenem (0.5 g). Conversely, the DDDs of imipenem-cilastatin sodium for injection increased in 2020 and 2021 vs 2019, with a B/A value of 0.67, indicating a relatively higher drug cost. The DDDs of meropenem for injection (0.3 g) exhibited an overall upward trend, indicating an increasing clinical preference. However, the B/A values for 2020 and 2021 were both > 1, suggesting a relatively lower drug cost. The DDDs of meropenem for injection (0.5 g) demonstrated a progressive increase annually and consistently ranked first, indicating a high clinical preference with a B/A value of 1, signifying good alignment between economic and social benefits., Conclusion: Carbapenem use in our hospital was generally reasonable with a downward trend in consumption and sales over time. Clinical pharmacists play a pivotal role in promoting appropriate use of carbapenems., Competing Interests: Conflict-of-interest statement: We have no financial relationships to disclose., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: Healthcare systems in both developing and developed countries were not free from prescription errors. One of the effects of prescription errors is irrational prescribing. According to the estimation of the World Health Organization (WHO), greater than 50% of medicines are prescribed and dispensed irrationally. On the other hand, research on drug use patterns in the private healthcare sector is scarce. This study aimed to assess prescription Completeness and Drug use Pattern using WHO prescribing indicators in Private Community Pharmacies in Lemi-Kura sub-city., Methods: Based on the WHO prescribing indicators, a retrospective cross-sectional technique was employed to examine the completeness and drug-prescription patterns. The study was conducted from April to May 2021. Prescriptions, kept for 1 year that was prescribed from March 2020 to March 2021, by private healthcare sectors, were analyzed. A systematic random sampling technique was employed to select prescriptions obtained from private health facilities. Data were analyzed using SPSS ® version 26.0 software., Results: Of a total of 1000 prescriptions, 1770 drugs were prescribed and the average number of drugs per prescription was 1.77. Prescriptions for two drugs account for 38% of these, while prescriptions for three drugs account for 15%. Age, sex, and card number were written on 99.0%, 99.2%, and 41.8% of prescriptions, respectively. The patient's name was written on every prescription. Even though the availability of other therapeutic information on the prescription made it appear greater, only 44.2% of prescriptions included the dosage form of medications. The generic name was used for the majority of the medications (67.8%). Furthermore, assuming that each prescription was for a single patient, 71% of patients received antibiotics, and 2% received injectable medicines. The National List of Essential Medicines-Ethiopia was used in 99.6% of the prescriptions., Conclusions: On the basis of the finding of this study, the prescribing and prescription completeness indicator showed deviation from the standard recommended by WHO. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing prescription errors in Ethiopia. Hence, in-service training for prescribers should be provided to improve adherence to basic prescription writing., (© 2023. Dr. Zaheer-Ud-Din Babar and Auckland UniServices Ltd.)

Polypharmacy can result in drug-drug interactions, severe side-effects, drug-disease interactions, inappropriate medication use in the elderly, and escalating costs. This study aims to evaluate nursing home residents' medication regimens using a rational drug use web assistant developed by researchers to mitigate unnecessary medication usage. This analytical, cross-sectional study included data from nursing home residents recently recorded in a training family health center. Sociodemographic information, medical conditions, and prescribed medications of all patients in the nursing home ( n = 99) were documented. Medications were assessed using an artificial intelligence-aided rational drug use web assistant. Instances of inappropriate drug use and calculations of contraindicated drug costs were also recorded. The study revealed that 88.9% ( n = 88) of patients experienced polypharmacy, with a mean value of 6.96 ± 2.94 drugs per patient. Potential risky drug-drug interactions were present in 89.9% ( n = 89) of patients, contraindicated drug-drug interactions in 20.2% ( n = 20), and potentially inappropriate drug use in 86.9% ( n = 86). Plans to discontinue 83 medications were estimated to reduce total direct medication costs by 9.1% per month. After the assessment with the rational drug use web assistant, the number of drugs that patients needed to use and polypharmacy decreased significantly. This study concludes that the rational drug use web assistant application, which is more cost-effective than the traditional manual method, assisted by artificial intelligence, and integrated into healthcare services, may offer substantial benefits to family physicians and their geriatric patients.

Different sexes and genders experience differentiated risks of acquiring infections, including drug-resistant infections, and of becoming ill. Different genders also have different health-seeking behaviours that shape their likelihood of having access to and appropriately using and administering antimicrobials. Consequently, they are distinctly affected by antimicrobial resistance (AMR). As such, it is crucial to incorporate perspectives on sex and gender in the study of both AMR and antimicrobial use in order to present a full picture of AMR's drivers and impact. An intersectional approach to understanding gender and AMR can display how gender and other components 'intersect' to shape the experiences of individuals and groups affected by AMR. However, there are insufficient data on the burden of AMR disaggregated by gender and other socio-economic characteristics, and where available, it is fragmented. For example, to date, the best estimate of the global burden of bacterial AMR published in The Lancet does not consider gender or other social stratifiers in its analysis. To address this evidence gap, we undertook a scoping review to examine how sex and gender compounded by other axes of marginalization influence one's vulnerability and exposure to AMR as well as one's access to and use of antimicrobials. We undertook a gendered analysis of AMR, using intersectionality as a concept to help us understand the multiple and overlapping ways in which different people experience exposure vulnerability to AMR. This approach is crucial in informing a more nuanced view of the burden and drivers of AMR. The intersectional gender lens should be taken into account in AMR surveillance, antimicrobial stewardship, infection prevention and control and public and professional awareness efforts, both donor and government funded, as well as national and international policies and programmes tackling AMR such as through national action plans., (© The Author(s) 2023. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.)

Rational drug use is a pivotal concept linked with morbidity and mortality. Immigration plays a significant role as a determinant affecting individuals' health-related attitudes, behaviors, and the pursuit of health services. Within this context, the study was initiated to assess the factors influencing health literacy and rational drug use among Syrian immigrants in Istanbul. A cross-sectional study was undertaken on 542 Syrian adults utilizing a three-part questionnaire encompassing sociodemographics, rational drug use, and the e-health literacy scale (eHEALS). With an average age of 39.19 ± 13.10 years, a majority of participants believed medications should solely be doctor-prescribed (97%) and opposed keeping antibiotics at home (93.7%). Yet, 62.5% thought excessive herbal medicine use was harmless. The mean eHEALS score stood at 20.57 ± 7.26, and factors like age, marital status, income, and duration of stay in Turkey influenced e-health literacy. Associations were seen between low e-health literacy and being female, being older, having a lower education level, and regular medication use. Syrian immigrants displayed proper knowledge concerning antibiotics yet exhibited gaps in their understanding of general drug usage, treatment adherence, and herbal medicines. Approximately 80.3% had limited health literacy, pointing to the need for targeted interventions for enhanced health and societal assimilation.

Background: Irrational drug use remains a major issue in developing countries; hence this study used the World Health Organization and the International Network for the Rational Use of Drugs (WHO/INRUD) core drug indicators to assess the quality of prescribing and dispensing practices in Primary Health Centres (PHCs) in Obio-Akpor Local Government Area (LGA) in Nigeria., Methods: This descriptive cross-sectional study which covered 10 PHCs in Obio-Akpor LGA comprised a review of prescription records and a survey of patients and prescribers. A systematic random sample approach was used to retrieve 1300 prescriptions from August to October 2021 to evaluate prescribing indicators while direct observation of 325 consecutive patient encounters in the PHCs was used to evaluate the patient-care indicators. Twenty-three prescribers in the 10 PHCs who were available and willing to participate in the study, completed the self-administered questionnaire for assessment of the factors affecting prescribing practices. Descriptive and inferential analyses were done using the Statistical Package for the Social Sciences and p-values d" 0.05 were considered statistically significant., Results: From the 1300 retrieved prescriptions, a total of 3805 medications were prescribed for the 1300 encounters giving 2.9 (± 0.5) as the mean medications prescribed per encounter. Prescriptions in generic forms were 69.9% and 75.6% of drugs prescribed were from the Nigeria essential medicine list for PHCs. Encounters with antibiotics and injectables included in the prescriptions were 62.6% and 22.3% respectively. Antimalarial, antihypertensive, and antidiabetic medications were prescribed in 43.8 %, 9.6 %, and 1.7 % of the cases, respectively. Most (91.6 %) of the recommended drugs were dispensed, 98.2% of the drugs dispensed were appropriately labelled, and 95.5 % of the patients had an adequate understanding of their drug doses. The pharmacy stocked 88.7% of the key medications, and all PHCs had a copy of the EDL., Conclusion: There was evidence of irrational drug use practices in PHCs in Obio-Akpor LGA. This calls for the implementation of periodic training for PHC workers, the promotion of effective monitoring and adherence to the policy of rational drug use in PHCs., Competing Interests: The Authors declare that no competing interest exists, (Copyright © 2023 by West African Journal of Medicine.)

Introduction: Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs., Methods: A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs., Results: A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05)., Conclusion: The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: This study examined the effects of education given to patients diagnosed with the COPD on self-care agency and rational drug use., Methods: This study has a pretest-posttest quasi-experimental design. Participants were divided into two groups, those who received training with the COPD Guide booklet (n = 40) and routine clinical care (n = 43)., Results: As a result of the study found a statistically significant difference between the self-care agency and rational drug use scale post-test mean scores of the patients in the intervention and control group in favor of the intervention group (p < 0.01)., Conclusion: Education on COPD management increased patients' self-care agency and their information, attitudes, and behaviors regarding rational drug use., Practice Implications: Clinicians can integrate a COPD Guide into routine care for patients with COPD., Competing Interests: Declaration of Competing Interest The authors have no direct or indirect competing interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Aim: the aim of this research is to investigate the relationship between rational drug use and healthy lifestyle behaviours of university students., Method: this descriptive and cross-sectional study consisted of 1115 students from a university in the Southeast-East Anatolia Region in the autumn semester of the 2019-2020 academic year. In the collection of data, 'Student Introduction Form', 'The Rational Drug Use Scale' and 'The Health-Promoting Lifestyle Profile II' were used. Ethical approval was obtained from the Batman University Ethics Committee. In addition, necessary legal permissions were obtained from the institution where the study was conducted and from the students. Descriptive statistics, number, percentage, independent t -test, ANOVA test and Spearman's rank correlation were used in the Statistical Package for Social Science (SPSS) 22.0 package software to analyse the data., Results: the average age of the students was 21.31 ± 2.37 years, and their monthly drug expenditure was 142.63 ± 157.200 Turkish Lira. Some 28.1% of them were third-year students, 59% had graduated from Anatolian high school, 59.6% were living with their nuclear family, 49.1% had an equal level of income and expenditure, 7.7% had no chronic disease, and 9% had regular medication. Some 57.8% of them had health insurance. The Health-Promoting Lifestyle Profile II scale mean score of the students was 124.12 ± 21.37 and the Rational Drug Use Scale mean score was 33.65 ± 6.75. A statistically significant difference was found between the students' class, income, and the total mean scores of the health-promoting lifestyle profile II scale ( p  < 0.05). A statistically significant difference was found between the school type, family type and income status of the students and the total mean scores of the rational drug use scale ( p  < 0.05)., Conclusion: a strong positive correlation was found between rational drug use scale and the health-promoting lifestyle profile II scales., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To establish a concise and easy-to-understand reference manual for outpatient primary care providers, promoting correct diagnosis of digestive system diseases and rational antimicrobial use., Methods: The establishment of the manual encompassed two processes: the development of a draft manual and the validation of the manual. The development process was based on a literature review and expert discussion. The manual comprises portions for disease diagnosis and rationality of antimicrobial use. The validation process employed a two-round Delphi technique, collecting consensus through paper-based or mail-based communications. The response of the Delphi group was assessed by the level of authority and commitment of the panelists and the degree of agreement among them. Furthermore, the manual was preliminarily applied among primary care physicians., Results: A total of 29 panelists completed the Delphi working process. They were authoritative in their professional fields with authority coefficients of 0.813 and 0.818 for the two portions of the manual, respectively. The level of commitment of the panelists was measured by response rates, which were 100.00% and 96.67% for Round 1 and 2. After two rounds, a consensus was achieved with the consensus rates for the two portions of the manual being greater than 65% and 70%, respectively. Kendall W -tests had P -values < 0.001 in both rounds. This reference manual provides 200 diagnostic indicators for 29 common digestive diseases and recommendations for the rational use of antimicrobial agents for 13 categories of digestive diseases. The primary care physicians who used the reference manual reported high satisfaction and frequent usage., Conclusion: Based on a collective consensus of professionals, a reference manual has been established, to provide a concise and easy-to-understand guide specifically for physicians and pharmacists in outpatient primary care. It could facilitate rapid learning to improve the accuracy of diagnosis and treatment for digestive disorders., Competing Interests: The authors declare that they have no competing interests in this work., (© 2023 Wei et al.)

Increased bacterial drug resistance has become a serious global public health problem. The application of antibiotics involves various clinical departments, and the rational application of antibiotics is the key to improving their efficacy. To provide a basis for further improving the etiological submission rate and standardizing the rational use of antibiotics, this article discusses the intervention effect of multi-department cooperation in improving the etiological submission rate before antibiotic treatment. A total of 87 607 patients were divided into a control group (n = 45 890) and an intervention group (n = 41 717) according to whether multi-department cooperation management was implemented. The intervention group involved the patients hospitalized from August to December 2021, while the control group involved the patients hospitalized from August to December 2020. The submission rates of the two groups; the rates before antibiotic treatment at the unrestricted use level, the restricted use level, and the special use level in departments; and the timing of submission were compared and analysed. The overall differences in the etiological submission rates before antibiotic treatment at the unrestricted use level (20.70% vs 55.98%), the restricted use level (38.23% vs 66.58%), and the special use level (84.92% vs 93.14%) were statistically significant before and after intervention (P < .05). At a more specific level, the etiological submission rates of different departments before antibiotic treatment at the unrestricted use level, the restricted use level, and the special use level were improved, but the special activities of multi-department cooperation management did not improve the submission timing significantly. Multi-department cooperation can effectively improve the etiological submission rates before antimicrobial treatment, but it is necessary to improve measures for specific departments to improve long-term management and incentive and restraint mechanisms., (© The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Metformin is the basic drug for treating diabetes, and the plateau hypoxic environment is an important factor affecting the pharmacokinetics of metformin, but there have been no reports of metformin pharmacokinetic parameters in patients with diabetes mellitus type 2 (T2DM) in the high-altitude hypoxic environment. This study aims to investigate the effect of the hypoxic environment on the pharmacokinetics and assess the efficacy and safety of metformin administration in patients with Type 2 diabetes mellitus (T2DM)., Methods: A total of 85 patients with T2DM taking metformin tablets in the plateau group ( n =32, altitude: 1 500 m) and control group ( n =53, altitude: 3 800 m) were enrolled according to the inclusion and exclusion criteria, and 172 blood samples were collected in the plateau group and the control Group. A ultra-performance liquid chromatography/tandem mass spectrometry (UFLC-MS/MS) method was established to determine the blood concentration of metformin, and Phoenix NLME software was used to establish a model of pharmacokinetics of metformin in the Chinese T2DM population. The efficacy and serious adverse effects of metformin were compared between the 2 groups., Results: The population pharmacokinetic modeling results showed that plateau hypoxia and age were the main covariates for model building, and the pharmacokinetic parameters were significantly different between the plateau and control groups (all P <0.05), including distribution volume ( V ), clearance ( CL ), elimination rate constant ( K e), half-life( T 1/2 ), area under the curve (AUC), time to reach maximum concentration ( T max ). Compared with the control group, AUC was increased by 23.5%, T max and T 1/2 were prolonged by 35.8% and 11.7%, respectively, and CL was decreased by 31.9% in the plateau group. The pharmacodynamic results showed that the hypoglycaemic effect of T2DM patients in the plateau group was similar to that in the control group, the concentration of lactic acid was higher in the plateau group than that in the control group, and the risk of lactic acidosis was increased after taking metformin in the plateau population., Conclusions: Metformin metabolism is slowed down in T2DM patients in the hypoxic environment of the plateau; the glucose-lowering effect of the plateau is similar, and the attainment rate is low, the possibility of having serious adverse effects of lactic acidosis is higher in T2DM patients on the plateau than on the control one. It is probably suggested that patients with T2DM on the plateau can achieve glucose lowering effect by extending the interval between medication doses and enhancing medication education to improve patient compliance.

Background: Traditional medicine (TM) is commonly used as a treatment in Indonesia. This raises the need for an analysis of its potential development and irrational use. Therefore, we analyze the proportion of TM users among chronic disease patients and its associated characteristics to optimize the use of TM in Indonesia., Methods: A cross-sectional study of treated adult chronic disease patients was conducted using the fifth Indonesian Family Life Survey (IFLS-5) database. Descriptive analysis was used to identify the proportion of TM users, while a multivariate logistic regression was used to analyze their characteristics., Results: This study included 4901 subjects and identified 27.1% as TM users. The highest TM use was in subjects with cancer (43.9%), liver issues (38.3%), cholesterol issues (34.3%), diabetes (33.6%), and stroke (31.7%). Characteristics associated with TM users were a perception of one's current health as unhealthy (OR 2.59, 95% CI 1.76-3.81), low medication adherence (OR 2.49, 95% CI 2.17-2.85), age above 65 years (OR 2.17, 95% CI 1.63-2.90), having higher education (OR 1.64, 95% CI 1.17-2.29), and residence outside of Java (OR 1.27, 95% CI 1.11-1.45)., Conclusions: Low medication adherence among TM users highlights the potentially irrational use of treatment in chronic diseases. Nevertheless, the longstanding use of TM users indicates the potential for its development. Further studies and interventions are needed to optimize TM use in Indonesia., (© 2023. The Author(s).)

Background: The World Health Organization has promoted "test and treat" guidelines for malaria since 2010, recommending all suspected malaria cases be confirmed with a parasitological test, typically a rapid diagnostic test (RDT), prior to treatment with antimalarial medications. However, many fevers at private drug shops in Uganda continue to be treated presumptively as malaria without diagnostic testing., Methods: The purpose of this study was to document private sector malaria case management in rural Uganda through a cross-sectional survey of drug shop clients in Bugoye sub-county. Drug shop vendors ( n = 46) recorded information about sales interactions with clients reporting fever or requesting antimalarials and collected capillary blood samples from clients who purchased medications without an RDT. We estimated the proportion of clients who purchased an RDT, adhered to the RDT result, and received antimalarials without having laboratory-confirmed malaria., Results: Most drug shops were unlicensed (96%) and sold RDTs (98%). Of 934 clients with suspected malaria who visited study drug shops during the data collection period, only 25% bought an RDT. Since some clients reported previous RDTs from the public sector, 40% of clients were aware of their malaria status at the drug shop. Among those with negative tests, 36% still purchased antimalarials. Sixty-five percent of clients who purchased an antimalarial without an RDT subsequently tested negative., Conclusions: Despite national guidelines, drug shop clients who purchase antimalarials from drug shops in Bugoye are often not tested to confirm a malaria diagnosis prior to treatment. Most clients treated presumptively with antimalarials did not have malaria. Interventions are needed to improve malaria case management and rational drug use in the private sector., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Shelus, Mumbere, Mulogo, Barrington, Baguma, Muhindo, Herrington, Emch, Maman and Boyce.)

Aims and Objectives: The aim is to determine the frequency of potential drug-drug interactions (pDDIs) and to analyze the clinically relevant drug interactions among hypertensive pregnant women., Materials and Methods: This was an observational, cross-sectional study conducted at a tertiary care hospital. The prescriptions of the hypertensive pregnant women admitted to the hospital from June 2021 to December 2021 were analyzed for potential drug-drug interactions using the database from Lexicomp ® Solutions android mobile application version 7.5.4 (Wolters Kluwer, The Netherlands)., Results: A total of 127 patients were evaluated during the study period of 6 months, of which 70 (55.12%) had pDDIs. The total number of pDDIs was 85, of which 70 (82.35 %) were clinically relevant interactions with the majority of them having moderate severity (81.17%) followed by minor severity (17.65%) and major severity (1.18%). The most frequently interacting pDDIs were between Labetalol and Lornoxicam (42.35%), followed by Labetalol and Diclofenac (22.35%)., Conclusion: This study highlights the high prevalence of potential drug interactions among hypertensive pregnant women and the need for rational drug use and strict vigilance in their monitoring., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ragam et al.)

Aim: This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education., Methods: This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching., Results: Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes., Conclusion: The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Rampant chloroquine/hydroxychloroquine poisoning in Nigerian hospitals following suggestions of its possible efficacy in the treatment and prevention of the newly emerged COVID-19 disease informed this survey., Objectives: The aim of this study was to assess the knowledge, attitude and perception of the Nigerian populace on the use of chloroquine in the COVID-19 pandemic., Methods: This cross-sectional study was done by administering an electronic questionnaire created using Google Docs, through social media cascade methods including the WhatsApp application software to capture data on chloroquine use between April 20 and June 20, 2020., Results: Six hundred and twenty-eight people responded to the questionnaire (response rate 99.2%, mean age 41.05 ± 12.3) from the six geopolitical zones in Nigeria with 556 (88.5%) having tertiary level education. Only 21 (3.3%) of the respondents took chloroquine for treatment or prevention. Respondents from the North-west geopolitical zones used chloroquine 5.8 (95% CI: 1.55, 21.52, p=0.02) more times than other zones while the age group 20-29 were 8.8 times more likely to use chloroquine than any other age group (95% CI: 3.53, 21.70, p = 0.00). Female respondents were 2.3 times more likely to use chloroquine than the males (OR 2.26 95% CI: 0.90-5.68; p=0.08) and those in the income bracket of N75,000-99,000, 2.5 times more than other income groups., Conclusion: Young adults, North-western geopolitical zone, and female gender should be target groups for education on rational chloroquine use. The danger of chloroquine overdose should be communicated to the general population in Nigeria., (© 2023 Olukosi AY et al.)

Objective: Since 50% of drug use all over the world is used other than rational drug use, rational drug use, which is associated with the perception of the disease, is important for the course of the disease. This study aimed to determine the effect of disease perception levels on rational drug use in liver transplant patients receiving immunosuppressive therapy., Methods: This descriptive and cross-sectional study was conducted with patients who came to the outpatient clinic for control between May-September 2022 with the participation of patients who underwent liver transplantation and followed up in a liver transplant institute in eastern Turkey. In the collection of the study data, "sociodemographic information form" prepared by the researchers, "Brief Illness Perception Questionnaire", and "Rational Drug Use Scale" were employed., Results: In this study conducted with 206 patients, the mean age of patients with liver transplantation was 48.66 ± 9.4 years, 59.7% were male, 80.1% were married, and 33.5% were high school graduates. It was determined that the disease perception levels and rational drug use levels of the patients who underwent liver transplantation were moderate. It was also determined that as the education levels of the liver transplant patients increased, their levels of illness perception and rational drug use also statistically significantly increased (p < 0.05). It was found that there was a significant and moderate relationship between illness perception and rational drug use, and that as their level of illness perception increased, their level of rational drug use also increased (r:0.622, p < 0.05). It was observed that the disease perception level explained 38.7% of the change in rational drug use (R 2 :387, p < 0.05)., Conclusions: In the study, it was observed that high illness perception levels of liver transplant patients increased their levels of rational drug use. It is important to raise the awareness of patients in order for them to cope with illnesses and to have a high level of illness perception., Competing Interests: The authors did not experience any conflict of interest in the writing of this article. Informed consent statement Verbal consent was obtained from all participants and then included in the study., (© 2023 The Authors.)

Introduction: This study evaluated quantitatively the impact of the first batch of the catalog of Key Monitoring and Rational Use Drugs (KMRUD) in Hubei Province on policy-related drug use and expenditures. Methods: This study is aimed to provide a basis for the successful implementation of subsequent catalogs of KMRUD, which may promote the standardization of clinical application of related drugs and effectively reduce drug expenses of the patients. Data on the procurement records of policy-related drugs from January 2018 to June 2021 were obtained from the Drug Centralized Procurement Platform of the Public Resources Trading Center in Hubei Province. Interrupted time-series (ITS) analysis was used in this study. Results: After the implementation of the first batch of the catalog of KMRUD, the consumption of policy-related drugs decreased by 83.29% in 2020. The spending on policy-related drugs decreased by 83.93% in 2020. The introduction of the first batch of the catalog of KMRUD was associated with a significant decrease in the spending on policy-related drugs in the level ( p = 0.001). Before the implementation of the KMRUD catalog policy, the Defined Daily Doses (DDDs) (β 1 = -32.26 p < 0.001) and spending (β 1 = -3662.19 p < 0.001) on policy-related drugs showed a downward trend. In the aggregated ITS analysis, the Defined Daily Dose cost (DDDc) of policy-related drugs decreased significantly in the trend ( p < 0.001). After the implementation of the KMRUD catalog policy, the monthly procurement volume of 10 policy-related drugs have a significant downward trend ( p < 0.05), and 4 policy-related drugs have a significant upward trend ( p < 0.05). Conclusion: After the policy intervention, the total DDDc on policy-related drugs indicated sustained reductions. The KMRUD policy overall achieved the goal of limiting policy-related drug use and controlling cost increases. And it is recommended that the health department quantify the usage indicator of adjuvant drugs, uniform standards, and apply prescription reviews and dynamic supervision, and other measures to strengthen supervision., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Wen, Wang, Chen, Liu and Mao.)

Objective: Using perioperative VTE prophylactic anticoagulant pathway delicacy management, we aimed to explore the role of clinical pharmacists in perioperative VTE prophylactic anticoagulant treatment and the effect of the clinical medicine pathway implementation., Methods: In compliance with evidence-based medicine, combined with clinical practice, clinical pharmacists participated in the formulation of the perioperative anticoagulant clinical medicine pathway. The PDCA cycle was strictly implemented. Urologic Department, Affiliated Hospital of Qingdao University, Qingdao Shandong, China, served as a pilot department for the evaluation of the effect of drug clinical pathway implementation., Results: The anticoagulant clinical medicine pathway for the urologic department was formulated and implemented from October 2020 to August 2021. The entry rate gradually increased, and the accuracy of thrombosis risk assessment improved. The proportion of drugs in the department and the per capita drug cost decreased significantly., Conclusion: The perioperative VTE prophylactic anticoagulant pathway showed significant achievements in the rational use of urologic anticoagulant drugs, lowering the cost of medical care. Therefore, it could be considered a novel long-term mechanism for rational analgesia drug use., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

In a cross-sectional study, rational drug use status of pregnant women and relevant factors were evaluated. The smallest sample size to determine the awareness of rational drug use in pregnant women was calculated as 377 with 95 percent confidence and ±5 margin of error. The stratified sampling method was used for selecting participants. Data were collected using the Pregnant Information Form and the Rational Drug Use Self-Awareness Scale between August 6, 2021 and October 28, 2021. In data analysis, the Mann-Whitney U test was used to compare two non-normally distributed groups, while Kruskal Wallis was used to compare the mean in groups of 3 or more. The mean age of the examined pregnant women was 29.43 ± 5.32, and more than half of them had an education level of higher education. It was determined that 92.8 percent of the pregnant women had social security, 81.4 percent lived in a nuclear family. The total mean score of Rational Drug Use Self-Awareness Scale was 54.25 ± 9.79, indicating a high rational drug use awareness in pregnant women. This study showed that the awareness of rational drug use was low in those with low education level, those without social security, and those living with extended families.

Background: To address the problems related to drug resistance and medication safety, the rational drug use (RDU) policy has been implemented in Thailand since 2014. Theoretically, the policy was supposed to bring drastic changes to the way clinicians prescribe medications and its impacts on clinical practice, however, it has not yet been investigated. The study aimed to describe the experience of community health nurses with regard to the impact of RDU policy implementation on their practices., Methods: Focus group interviews and in-depth interviews with community nurses were conducted. Thematic analysis was performed., Results: Five themes emerged from the analysis, namely, (1) a welcome opportunity, (2) RDU as the quality of healthcare, (3) multidisciplinary collaboration, (4) reinventing productive interactions between nurses and patients, and (5) challenges over control of medications prescribed or purchased elsewhere., Conclusions: Implementing RDU in primary care provides opportunities for protecting individual patients and public health as well as safeguarding against professional prescription error. This can be made possible by adopting a systemic approach to changes. Additional educational and organizational support will optimize health professionals' contribution to the implementation and hence optimal outcomes of this important policy.

Background: Drug-induced acute kidney injury (DIKI) is a common adverse drug reaction event but is less known in pediatric patients. The study explored the DIKI in Chinese pediatric patients using the Pediatric Intensive Care database (PIC). Method: We screened pediatric patients with acute kidney injury (AKI) using the KDIGO criteria from the PIC and then assessed the relationship between their drugs and DIKI using the Naranjo scale. For the fifteen frequently used DIKI-suspected drugs, we divided patients into drug-exposed and non-exposed groups, using the outcome of whether DIKI was presented or not. Propensity score matching (PSM) was used to control for the effects of four confounders, age, gender, length of hospital stay, and major diagnosis. Unconditional logistic regression was used to identify statistically significant differences between the two groups. Results: A total of 238 drugs were used 1,863 times by the 81 patients with DIKI during their hospital stay. After screening the Naranjo scale to identify the top 15 suspected DIKI drugs with a high frequency of use, we found that furosemide injection ( p = 0.001), midazolam injection ( p = 0.001), 20% albumin prepared from human plasma injection ( p = 0.004), fentanyl citrate injection ( p = 0.001), compound glycyrrhizin injection ( p = 0.026), vancomycin hydrochloride for intravenous ( p = 0.010), and milrinone lactate injection ( p = 0.009) were associated with DIKI. Conclusion: In critically ill pediatric patients, DIKI is more likely to occur after using furosemide injection, midazolam injection, 20% albumin prepared from human plasma injection, fentanyl citrate injection, compound glycyrrhizin injection, vancomycin hydrochloride for intravenous, milrinone lactate injection., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Hu, Ye, Li, Feng, Huang, Guo, He, Tan, Yang, Li and Guo.)

Antibiotic consumption accounted for approximately 15-20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26-4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups ( p -value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13-52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24-4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sirilak, Kanjanarat, Nochaiwong and Katip.)

Pregnant women should know rational drug use and have enough health literacy both for maternal and fetal health. This study was carried out to examine the rational drug use knowledge and health literacy levels of pregnant women and the relationship between these two variables. A cross-sectional design was used in the study, and it was conducted between July 31 and September 30, 2019 with the participation of 417 pregnant women in Turkey. The cluster sampling method was used for selecting participants. The data collection tools included a Descriptive Information Form, the Rational Drug Use Scale, and the European Health Literacy Survey. The study data were collected by using the face-to-face interview method. In the study, 77.7 percent of the pregnant women knew rational drug use, but 41.2 percent of them had inadequate and 39.8 percent had a problematic-limited level of health literacy. According to the linear regression analysis, it was found that rational drug use was positively affected by the health literacy level and that a one-unit increase in health literacy level of pregnant women increased the level of rational drug use knowledge by 0.190 (β) units ( p  < .05). It was found that although more than three quarters of the pregnant women in the study knew rational drug use, their health literacy was inadequate and at a problematic-limited level. This study showed that the health literacy of pregnant women affected their knowledge of rational drug use, and as the level of health literacy increased, the level of rational drug use knowledge increased, as well.

Aim: This study aimed to investigate the key points in the transformation of the functions of the Drug and Therapeutics Committee (DTC) of the Shandong Provincial Third Hospital and how to provide full authority to its role in the control of rational drug use, especially in the management of antibiotic use. Method: A prescription review management group, antimicrobial stewardship group, and rational drug use service group were established under the DTC. From January 2016 to December 2021, each group played a role in promoting rational drug use and antimicrobial stewardship. In addition, we performed statistics on typical management cases, irrational drug use, bacterial resistance rate, and drug costs from 2015 to 2021 to evaluate the effect of management by the DTC. Results: Intervention by the DTC led to a significant reduction in prescribing errors (71.43%, p < 0.05), the intervention acceptance rate increased by 16.03%, and the problem solved rate increased by 32.41% ( p < 0.05). Resistance rates of general spectrum antibiotics were reduced remarkably after the intervention. The quality of drug treatment was improved and patient drug expenses was continuously reduced. Conclusion: Giving full play to the functions of the DTC can significantly improve the level of drug treatment and reduce unreasonable drug use to save unnecessary drug expenses and slow the development of drug resistance., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yang, Zheng, Guan and Lv.)

Background: The safety assessment of ulinastatin can guide clinical practice. The present study aimed to investigate the real-world safety of ulinastatin in China., Methods: This multicenter study retrospectively analyzed the post-marketing surveillance data of consecutive patients treated with ulinastatin between August 2014 and June 2017 in the general wards and the intensive care units (ICU) of nine hospitals in China. Adverse drug reactions/adverse drug events (ADRs/ADEs) were collected and evaluated in a post-marketing database., Results: A total of 11,252 consecutive patients were included in the study: 7009 ICU patients and 4243 general ward patients. Eleven patients with ADRs/ADEs were observed, including nine ICU patients and two general ward patients. The clinical manifestations were liver dysfunction (n = 5 ICU cases, n = 1 general case), thrombocytopenia (n = 2 ICU cases, n = 1 general case), leukopenia (n = 1 ICU case), and rash (n = 1 ICU case). During the study period, the drug ADR/ADE rate of ulinastatin injection was 0.98‰ (11/11,252 × 1000‰). Among the 11,252 valid patients, only 327 received ulinastatin in accordance with the drug specifications. After excluding unreasonable drug use, the calculated ADR rate was 3.06‰ (1/327 × 1000‰) (95% confidence interval: 0.0‰-17.1‰). In ICU and general ward patients, the use of other drugs combined with ulinastatin was associated with the occurrence of ADRs/ADEs (100% with ADRs/ADEs vs. 0% in controls, P < 0.001)., Conclusions: The incidence of ADRs/ADEs of ulinastatin is < 5‰. The ADRs/ADEs involved limited organs, mainly the skin, gastrointestinal tract, and blood. In most cases, the ADRs/ADEs gradually alleviated or recovered after drug withdrawal. The inappropriate/off-label use of ulinastatin should be the focus of surveillance., (© 2022. The Author(s).)

Context: The rational prescription leads to a healthy and good-quality life of a patient. Irrational, inappropriate, and unnecessary prescriptions are major therapeutic issues in Bangladesh, which can cause severe consequences., Aim: This cross-sectional study was conducted to evaluate the prescription patterns and errors as well as to review the most frequently prescribed drug classes among outpatients at a secondary hospital in Pabna, a district of Bangladesh., Methods: A total of 400 prescriptions were reviewed from March 2019 to May 2019. In this study, statistical data analysis was implemented by IBM SPSS Statistics V22 and data revealed in frequencies, mean, and percentage. Spearman's rank correlation coefficient was calculated to show the correlation between bivariate coded variables., Results: The results revealed that majority of the prescription were prescribed for females (73.5%) where proton-pump inhibitors (PPIs), analgesics, vitamins, and single antibiotics were most frequently prescribed medicine for the female patients compared to male patients. Almost half of the collected prescription contained four medicines (47%). Maximum number of prescriptions contained two (30.5%) essential drugs and among 1402 medicines of 400 prescriptions, antiulcerants were most frequently prescribed medicine (23.32%) where esomeprazole was highly prescribed generic drug (44.75%). Moreover, Spearman's rank correlation coefficient suggested that PPIs and analgesics were frequently prescribed medicines at a time for the patients (0.182). According to the age group, the study also got some significant variations in prescribing pattern. However, most common prescription errors were prescriber's name not mentioned (100%), diagnosis not mentioned (96.75%), dose not indicated (15.41%), and wrong drug name (0.36%)., Conclusion: Findings of the current study represent the existing prescribing trends of different therapeutic classes of drugs and common prescription errors in a secondary health facility of Bangladesh. From this study, it is observed that physicians prescribed rationally in some cases but need to ensure rationality in all prescriptions. Continuous monitoring of drug use, development of prescribing guidelines, and training are recommended to ensure and implement good-quality prescribing practices for promoting the rational and cost-effective use of drugs., Competing Interests: All authors contributed equally to this work., (Copyright: © 2021 Perspectives in Clinical Research.)

What Is Known and Objective: This study aimed to explore methods to optimize the function of Drug and Therapeutics Committees (DTCs) in controlling irrational drug use. Clinical pharmacologists contribute their specific knowledge and skills to DTCs and help guide rational therapeutics. The DTC is the highest organization of hospital pharmacy management., Methods: From January 2016 to August 2021, the DTC promoted the optimization of clinical drug treatment schemes and reduced unreasonable drug use by improving the organizational framework, clarifying the division of functions, regularly monitoring drug use, organizing expert comments, scientific decision-making and functional intervention. During this time, we statistically analysed typical management cases, irrational drug use and drug cost to evaluate the effectiveness of the DTC's management., Results and Discussion: The DTC's intervention led to a significant reduction in prescribing errors (65.98%, p < 0.05); the intervention acceptance rate increased by 16.37%; and the rate of problem resolution increased by 45.84% (p < 0.05). The level of drug treatment was improved, and the proportion of patients' drug expenses was reduced., What Is New and Conclusion: The DTC carried out a series of continuous improvement work that played a significant normative role in clinical drug use. Giving more power to the DTCs can significantly improve the level of drug treatment and reduce unreasonable drug use, which reduces unnecessary drug expenses., (© 2022 John Wiley & Sons Ltd.)

Purpose: Over-the-counter (OTC) sale of antibiotics have contributed to the growing threat of antibiotic resistance. The Government of India has instituted regulatory measures, such as Schedule H1 and public campaigns such as Red Line Campaign, to limit such sales. This study was conducted to assess the perceptions of stakeholders regarding their effectiveness., Methods: To assess Schedule H1, pharmacists who own retail pharmacies in the state of Kerala, India, were interviewed using a pre-prepared question guide. In the next phase, healthcare professionals and patients in a hospital were shown the Red Line on an antibiotic blister pack and asked about its significance. Finally, 100 patients were shown a blister pack of Amoxicillin, and asked to identify the medicine or its use., Results: It was observed that there is poor awareness about antibiotic regulations and a perception of laxity in enforcement. Regarding the Red Line, only 7% of healthcare professionals could describe its significance and none among patients. Among the 100 patients who were shown Amoxicillin, only 42 could identify it as an antibiotic or describe its use., Conclusions: There is a general perception that regulations are poorly enforced and all are not aware of the Red Line campaign including healthcare professionals. Greater awareness at all levels about appropriate antibiotic use through prescriptions followed by greater efforts towards regulatory implementation and compliance should form parts of a multi-modal strategy to contain OTC sales of antibiotics. This will greatly help to aid physicians in improving overall healthcare through safe and effective prescribing., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Off-label drugs use is widespread in ophthalmology due to the delay in drug approvals and package inserts update. It has been found to vary among different medical institutions in China, leading to safety problems since inappropriate use. Guidance is urgently needed regarding how best to use the drugs for unapproved indications and routes of administration. We aimed to develop an evidence-based guideline to guide off-label drugs used in ophthalmology in China. The practice guideline was developed by the Hospital Pharmacy Professional Committee, Chinese Pharmaceutical Association, following the WHO handbook for guideline development . The guideline was initially registered in the International Practice Guidelines Registry Platform (IPGRP-2021CN096). The clinical questions included in the guideline were identified through a three-round Delphi vote. Databases search was performed in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, and WanFang Database from their inception to 31 March 2021. Systematic reviews and meta-analyses for each clinical question were conducted individually to synthesize available scientific evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and grade the recommendations' strengths. The multidisciplinary guideline groups were set up, including ophthalmologists, pharmacists, methodology experts, pharmacologists, pharmacoeconomists, and lawyers. The guideline identified 25 clinical questions included. A total of 32 systematic reviews, including 24 conducted by the systematic review group and eight high-relevance published within 2 years, were referred to address these questions. Finally, the guideline presented 32 recommendations addressing 25 clinical questions, involving five strong recommendations and 27 weak recommendations for the treatment of ocular fundus, corneal disease, glaucoma, and endophthalmitis. Current evidence from clinical studies supports the off-label drugs used in ophthalmology. We developed an evidence-based guideline using a rigorous multidisciplinary approach to guide these usages in route clinical practice., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Li, Wang, Zhang, Wei, Lu, Zhai and Zhang.)

Aim of the Study: STOPP/START criteria appear to be a useful tool to curb inappropriate prescribing (IP), which encompasses errors of both, over and under-treatment. This study aimed to find out whether application of STOPP/START reduces the IP effectively in primary care., Methods: This prospective cross-sectional study was conducted in two family health centers (FHCs) in Istanbul. All older adults who applied to FHCs between 01-07-2018 and 01-07-2020 were enrolled. The potential inappropriate medications (PIMs) and potential prescription omissions (PPOs) were identified according to STOPP/START version 2 criteria. Mean drug consumptions before and after STOPP/START were compared using Student's t-test., Results: Among 1023 participants there were 626 females and 397 males. The mean age was 73.33±7.30 years. The number of the patients seen at FHCs was 657 (64.2%) while 366 (35.8%) of them were visited at home. Of the patients, 383 (37.8) were 75 years old or older and 631 (62.2%) of them were under 75. Overall number of drugs consumed per patient was 5.49±3.93 while it was 6.01±3.71 and 4.55±4.138 for outpatients and home patients respectively (p<0.001). By application of STOPP criteria, among the 5616 medications consumed by the overall patients, 881(%15.6) of them were found to be potentially inappropriate. 424 (41.4%) patients were using at least one PIM. This ratio was 354 (53.8%) in outpatients and 70 (19%) in home patients. START criteria identified 380 (%7.4) PPOs. There were 246 (24.0%) patients at least with one PPO; 155 (42.3%) of whom were home patients and 91 (13.8%) were outpatients. Regarding the age groups; PIM ratio was 35.5% in patients under 75 and 52.1% over 75 whereas PPO ratio was 22.5% under 75 and 26.8% over 75., Conclusion: This study supports the data reporting the effectiveness of STOPP/START criteria in primary care units in implementing appropriate prescription criteria., (Copyright © 2021 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To assess medicine use based on World Health Organization (WHO) core drug-use indicators in selected public health facilities of the South Indian Union Territory., Methods: A prospective cross-sectional study was conducted for period of one year (from March 2019 to February 2020) in 10 selected public health facilities based on the WHO document How to investigate drug use in health facilities. Total 900 prescriptions were analysed to study prescribing, patient care and health facility indicators. The results were compared with the WHO standard measures., Results: The overall average number of drugs per prescription was 3.2. Percentage of prescriptions with antibiotics and injections were found to be 36.6 and 11.4%, respectively. Percentage of drugs prescribed by generic name was 74.6%. Percentage of drugs prescribed from the National List of Essential Medicine was 93.3%. Average consultation and dispensing time were found to be 3.9 minutes and 49.3 seconds, respectively. The percentage of drugs dispensed in this study was 98.5 and 61.6% of medicines were properly labelled; 76.7% of patients had correct knowledge of each medicine dispensed to them. Mean availability of key essential medicine was 73.4%., Conclusion: Indicators such as percentage of drugs prescribed from the National List of Essential Medicine, availability of copy of essential medicine list and percentage of drugs dispensed were found to be as per WHO optimal value. Indicators such as average number of drugs per prescription, average consultation and dispensing time and percentage of medicines labelled were found below optimal value and need to be improved., (© 2021 British Pharmacological Society.)

Introduction: Obstacles encountered when maintaining excellent dispensing practices for children include a lack of age-appropriate dosage forms, a shortage of medications in appropriate strengths for children, a lack of appetizing drugs, and a lack of competence in pediatric pharmacy. These difficulties contribute to ineffective dispensing procedures and an urgent need to study whether oral dose forms of medications are dispensed to children in a rational way., Objective: The purpose of this study is to evaluate the rational dispensing of oral dosage forms of medicines to children, as well as the factors that influence this practice., Methods: Using validated indicators, a cross-sectional study design was utilized to analyze the rational dispensing practice of oral dosage forms of medicines administered to children under the age of 12 years in seven pharmacies and two drug stores over a one-month period., Results and Discussions: Out of 810 medicines, 11.7% and 4% were irrationally manipulated, 5.8% and 1.8% needed manipulation, 3.7% and 0.2% were alternatively dispensed, 8.8% and 7.5% of the medicines had correct advice on their label and also 745 medicines were adequately labeled in the hospital and the selected drug stores. In this study, 92% of medicines were adequately labeled and had sufficient advice on their labels, 15.3% of medicines were irrationally manipulated and around 7.7% of the dosage forms needed manipulation during dispensing. The type of medicine retail outlet had a significant effect on the percentage of instances where alternative solid oral dosage forms were dispensed (p = 0.003), the percentage of dosage forms were adequately labeled (p = 0.008), and the percentage of dosage forms were irrationally manipulated before dispensing (p = 0.001)., Conclusion: The rational dispensing practice of oral dosage forms of medicines was relatively poor and there is room for improvement., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Ejeta et al.)

Background: The "4 + 7" volume-based procurement is a "large group purchase" led by the Chinese government, with the aim of reducing the price of medicines by trading volume for price. Although the "4 + 7" drugs had passed the national consistency evaluation, the adverse drug reactions need to be further evaluated to ensure the safety of the "4 + 7" drugs with low prices. We aimed to analyze the occurrence characteristics and related influencing factors of adverse reactions of psychiatric drugs under the chinese drug volume-based procurement policy(4 + 7 policy), and provide references for clinical medication., Methods: 137 cases of adverse drug reactions of four psychotropic drugs reported under the "4 + 7" policy in Wuxi Mental Health Center in 2020 were collected. The gender and age of patients, related "4 + 7" drugs, involving organs / systems, clinical manifestations, distribution of new / serious adverse reactions, clinic outcomes were analyzed., Results: Among the 137 cases of adverse drug reactions, the incidence of adverse drug reactions was the highest in patients aged 61-70 (25.38%). Mainly involved 4 "4 + 7" psychiatric drugs, of which olanzapine tablets caused the most adverse reactions (54, 39.24%). The adverse reactions mainly involved the digestive system, nervous system, cardiovascular system, blood and lymphatic system, among which the digestive system was the most common (61, 44.53%). A total of 8 cases (6.16%) of new and 26 cases of serious adverse reactions were reported, all of which led to the prolongation of disease course. Except for the transient side effects, most of that were improved or cured with no death, disability or teratogenicity after stopping or reducing the dose with symptomatic treatment., Conclusion: Since more and more drugs will be included in "4 + 7" for clinic, clinical pharmacists should strengthen the publicity and training of the knowledge of "4 + 7" drugs, strengthen the monitoring of adverse drug reactions, and provide timely feedback to the clinic, in order to achieve early prevention, early identification, timely diagnosis and reasonable intervention of the adverse drug reactions under the context of "4 + 7" policy., (© 2022. The Author(s).)

Background: The overuse of antibiotics is a serious public health problem and a major challenge in China, and China lacks up-to-date evidence on the nationwide antibiotic use in different healthcare settings. The changes of China's antibiotic use under the COVID-19 pandemic are still unknown. Objective: This study aimed to investigate the use of antibiotics in China's public medical institutions based on a three-year nationwide surveillance and to examine the impact of the COVID-19 pandemic on China's antibiotic consumption. Methods: This study used nationwide drug procurement data from the China Drug Supply Information Platform (CDSIP). We retrospectively analyzed antibiotic procurement data of 9,176 hospitals and 39,029 primary healthcare centers (PHCs) from 31 provinces in mainland China from January 2018 to December 2020. Antibiotic utilization was measured by defined daily doses (DDDs) and DDD per 1,000 inhabitants per day (DID). Generalized linear regression models were established to quantify the impact of the COVID-19 pandemic on antibiotic use. Results: The total antibiotic consumption among all healthcare settings increased from 12.94 DID in 2018 to 14.45 DID in 2019, and then dropped to 10.51 DID in 2020. More than half of antibiotics were consumed in PHCs, especially in central regions (59%-68%). The use of penicillins (J01C) and cephalosporins (J01D) accounted for 32.02% and 28.86% of total antibiotic consumption in 2020. During 2018-2020, parenteral antibiotics accounted for 31%-36% of total antibiotic consumption; the proportion is more prominent in central and western regions and the setting of hospitals. Access category antibiotics comprised 40%-42% of the total utilization. Affected by COVID-19, the antibiotic consumption was significantly dropped both in hospitals ( β = -.11, p < .001) and PHCs ( β = -.17, p < .001), as well as in total ( β = -.14, p < .001). Significant increments were observed in the proportion of total antibiotics ( β = .02, p = .024) consumed in hospitals (against the consumption in all healthcare settings), as well as parenteral antibiotics ( β = 1.73, p = .001). Conclusion: The consistent preferred use of penicillin and cephalosporin, as well as injections, among China's public healthcare institutions should draw concern. China's antibiotic consumption significantly declined during the COVID-19 pandemic, which brings opportunities for antibiotic use management in China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yang, Geng, Liu, Wen, Wu, Cui and Mao.)

Objective: To investigate the current status of knowledge and behavior about rational drug use in college students in different colleges and universities in a city in southwest China, providing reference for students' education of rational drug use in colleges and universities., Methods: A questionnaire survey on knowledge and behavior in rational drug use was carried out on the students recruited by occasional sampling method in 6 colleges and universities in Zunyi, China. Statistical analyses on demographic information and answers to questionnaire questions were carried out with SPSS 18.0., Results: A total of 865 valid questionnaires were recovered from 923 questionnaires sent out. Some knowledge and behaviors of the students on drug use were irrational. There was statistically significant difference in some specific questions of the knowledge in rational drug use between medical and non-medical students ( P <0.05); the average score of rational drug use behavior of medical students was lower than that of non-medical students ( P <0.05); the average score of the rational drug use behavior of female students was lower than that of male ( P <0.05); the students' major types had significantly different influence on their behavior in rational drug use ( P <0.05). The school-carried pharmacy education can effectively improve students' rational medication; the majority of college students believed that it is necessary to popularize the knowledge of rational drug use on campus; and students' favorite way to acquire knowledge about rational drug use was to attend related lectures or elective courses., Conclusion: The knowledge and behavior of rational drug use among college students need to be improved. Professional medical education may exert a positive impact on rational drug use among college students. Thus, it is necessary to popularize the knowledge of rational drug use among college students, especially in non-medical colleges and universities., Competing Interests: The authors report no conflicts of interest in this work., (© 2022 Yin et al.)

In recent years, the incidence of breast cancer has been increasing on an annual basis. Human epidermal growth factor receptor-2 (HER-2) is overexpressed in 15-20% human breast cancers, which is associated with poor prognosis and a high recurrence rate. Trastuzumab is the first humanized monoclonal antibody against HER-2. The most significant adverse effect of trastuzumab is cardiotoxicity, which has become an important factor in limiting the safe use of the drug. Unfortunately, the mechanism causing this cardiotoxicity is still not completely understood, and the use of preventive interventions remains controversial. This article focuses on trastuzumab-induced cardiotoxicity, reviewing the clinical application, potential cardiotoxicity, mechanism and discussing the potential interventions through summarizing related researches over the past tens of years., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lin, Xiong, Wang, Li, Hou, Li and Li.)

Background: L-carnitine is an endogenous vitamin-like amino acid derivate which plays an essential role in energy metabolism and can be easily lost via dialysis. Deficiency of L-carnitine has great effects on many aspects of bodily functions. To determine the deficiency degree and adjust the supplementation dose, a rapid, sensitive, and specific method for the detection of endogenous L-carnitine in the plasma of dialysis patients using ultra-high performance liquid chromatography-Orbitrap high resolution mass spectrometry (UHPLC-Orbitrap-HRMS) was developed and validated., Methods: The plasma samples were processed by protein precipitation and centrifugation before analysis using UHPLC-Orbitrap-HRMS. Sample separation was achieved with a hydrophilic interaction liquid chromatography (HILIC) column, using an isocratic elution with a runtime of 5 min. The separated analytes were detected by positive ionization mode in full scan mode and targeted-single ion monitoring (t-SIM) mode. Mildronate was used as the internal standard (IS)., Results: All the plasma could be detected in the range of 6.169 to 197.394 µM, with adequate accuracy, precision, and recovery. The method was validated in fortified validation with relative standard deviations (RSD) 5.15-8.74%. This method was applied to the analysis of 105 dialysis patients and 39 healthy participants, the results revealed that peritoneal dialysis patients without L-carnitine supplementation should pay more attention to L-carnitine monitoring, meanwhile, all the hemodialysis patients were advised to be routinely given a full dose of L-carnitine, no matter whether they had taken L-carnitine or not., Conclusions: This study developed a simple and rapid UHPLC-Orbitrap-HRMS method for detection of endogenous L-carnitine in dialysis patients, which could be useful to promote rational drug use., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-21-6784/coif). All authors report funding from the Soochow Science and Technology Project (SYSD2019182 and SYSD2020184), the Youth Project of Soochow Scientific Research Project (KJXW2019017), the pre-research project of the Second Affiliated Hospital of Soochow University (SDFEYQN1917), Tianqing Pharmaceutical Foundation of Jiangsu Pharmaceutical Association (TQ2021058), Hengrui Pharmaceutical Foundation of Jiangsu Pharmaceutical Association (H202145), National Natural Science Foundation of China (82070838), and Lift Project for Discipline Construction of The Second Affiliated Hospital of Soochow University (XKTJ-XK202010). The authors have no other conflicts of interest to declare., (2022 Annals of Translational Medicine. All rights reserved.)