Geriatric prescribing in the medical wards of a teaching hospital in Nepal.

A retrospective study on prescribing patterns for 100 randomly selected geriatric patients admitted over a period of 1 year to the medical wards of the Tribhuvan University Teaching Hospital (TUTH) in Nepal showed that polypharmacy was prevalent. During a hospital stay, 73% patients received more than five, 54% received more than eight, and 24% received more than nine drugs concurrently. Although the average drug exposure per patient during a hospital stay was found to be 11.2, this figure would actually go up to 14.5 if all the active ingredients of the fixed-dose combination products prescribed (15.4% of all drugs) were taken into account. Intravenous fluids were the most commonly prescribed drugs and were given to 91% of the patients. Antibiotics (excluding metronidazole and antituberculous drugs) were given to over three-quarters (77%) of the patients. Ciprofloxacin was the most commonly prescribed antibiotic. Of the 42 patients treated with this drug, 31 (73.8%) received it intravenously, either for a part of or throughout the course. This antibiotic was prescribed concurrently with theophylline in 14 patients without the facility for monitoring plasma-theophylline levels. It was also administered at the same time as antacid in nine patients. Nearly half (46.4%) of the drugs were prescribed by brand or proprietary names. The prescribing error of leaving the prescription card undated or unsigned when prescribing or stopping drugs was found to be high. The results of this survey indicate that there is considerable scope for improving geriatric prescribing practices in the medical wards of TUTH. Copyright 1997 John Wiley & Sons, Ltd.