The rational use of drugs in veterinary medicine has various significances, such as reducing the risk of drug resistance, increasing efficacy, reducing drug residue, and decreasing adverse drug reactions. A retrospective study was conducted to assess veterinary drug prescribing practices at Batu and Arsi-Negelle district veterinary clinics in the rift valley areas of Ethiopia. A total of 2,464 cases were recorded from the case registration books at both the clinics for diseases treated between September 2012 and February 2015. The study results showed that for a total of 2,464 cases diagnosed at both clinics, 3,811 different drugs were prescribed, with an average per encounter of 1.6. Among the total drugs, oxytetracycline, ivermectin, penstrep, sulfa drugs, and albendazole were the most leading prescribed drugs with a frequency of 43.0%, 17.6%, 10.2%, 6.5%, and 1.3%, respectively. All drugs were prescribed by the generic name without any laboratory support of the disease. About 68.3% of the cases were diagnosed by unspecified professionals, whereas 21.7% and 10.1% were done by animal health assistants and veterinarians, respectively. The prescribing practices showed 61.0% of antibiotics and 29.7% of anthelmintics where 45.3% and 54.7% of antibiotics and 17.8% and 82.2% of anthelmintics were given at Batu and Arsi-Negelle veterinary clinics, respectively. Of the prescribed drugs, 4.6% oxytetracycline and 2.6% penstrep were prescribed irrationally to treat diseases that were tentatively diagnosed as parasitic cases. Similarly, 40.5% ivermectin and 17.7% albendazole were prescribed for bacterial infections. In conclusion, this study revealed problems in antibiotics and anthelmintics use, description of routes of administration and length of treatment, and shortage of laboratory diagnostic facilities. Therefore, veterinary drugs, particularly antibiotics and anthelmintics, should be used appropriately to safeguard the public from residual drug impacts and resistance development.
1. Introduction
The rational use of drugs is the use of the right medicines, correct dosage, and correct cost, which is well reflected in the World Health Organization (WHO) definition: “Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their requirements for an adequate period, at the lowest cost” [1]. However, the irrational use of medicines is when one or more of these conditions are not met, for example, too many medicines are prescribed per patient, injections are used where oral formulations would be more appropriate, antimicrobial agents are prescribed in inadequate doses or duration, or antibiotics prescribed for nonbacterial infections, thereby contributing to the growing problem of antimicrobial resistance and prescriptions do not follow clinical guidelines [2].
Problems like lack of information, poor communication between health professionals and animal owners, lack of diagnostic facilities, demand from the owners, and high burden of diseases with overlapping clinical symptoms (e.g., pain, fever, and depression are common symptoms for different conditions which require different drugs) [3] lead to the irrational use of drugs causing ineffective and unsafe treatment, exacerbation or prolongation of illness, distress and harm to the patient, and increase the cost of treatment [4, 5].
Antibiotics are widely used in healthy food-producing animals to promote growth and prevent diseases. This practice favors the emergence and spread of resistant bacteria in both animal and human populations. The routine use of antimicrobials in vast numbers of healthy animals is likely to result in the emergence and spread of antimicrobial-resistant bacteria and cause resistant infections in animals and humans. Likewise, anthelmintic resistance is becoming an increasing global problem resulting from the misuse of these drugs. Resistance to anthelmintic by ruminant nematode parasites is a growing problem throughout the world [6]. Food animals and foods of animal origin are traded worldwide; thus, drug resistance affecting the food supply of one country becomes a potential problem for other countries [2].
There are essential measures to be taken to improve rational drug prescribing. These are critical assessment and evaluation of benefits and risk of drug used; safety and cost of the drug with the existing drug for some indication; identification of the patient’s problem based on symptoms and recognizing the need for action; diagnosis of the disease, identifying underlying cause, and motivating factors that may be specific as in infectious disease or nonspecific; use of possible intervention or treatment which may be nondrug treatment or drug treatment by choosing from different alternatives based on efficacy, convenience, and safety of drugs including drug interactions and high-risk group of patients; start the treatment by writing an accurate and complete prescription, for example, the name of drugs with dosage forms and schedule and total duration of the treatment [7–10].
Currently, in the clinical practice of human and veterinary medicine throughout the world, large amounts of antibiotics are used. Equally, many scientists intensively work on the discovery and synthesizing of new drugs with a broader antimicrobial spectrum, stronger action, and a more satisfactory safety profile. Most failures during antimicrobial therapy may occur when the pathogenic microorganism is unknown and a combination of two or more drugs administered empirically. To avoid these mistakes, clinically confirmed, effective antimicrobial combinations should be used [11]. Globally, more than half of all medicines are prescribed, dispensed, or sold improperly, and 50% of the human patients fail to take them correctly. This is more wasteful, expensive, and dangerous, both to the health of the individual animal patient and to the public as a whole that magnifies the problem of misuse of antimicrobial agents [2].
In humans, assessments of drug use patterns with the WHO drug use indicators are becoming increasingly necessary to promote rational drug use. They are now widely accepted as a global standard for problem identification and used in developing countries [12, 13]. In Ethiopia, a survey conducted on human subjects at hospitals located in different regions of the country revealed irrational drug use [14, 15]. However, in veterinary practice, a few published reports on the rational use of veterinary drugs in the country in general, although different studies were conducted by Beyene et al., revealed irrational use of drugs in veterinary clinics [16].
Hence, the present study was designed to evaluate the rational use of veterinary drugs and to compare magnitudes of different drugs commonly used for the treatment of food animal diseases in the Batu and Arsi-Negelle district veterinary clinics in general and to describe current treatment practices and to evaluate the adherence of the prescriber to the national veterinary treatment guidelines.
2. Materials and Methods
2.1. Study Area and Period
The study was conducted from November 2014 to March 2015 at Batu veterinary clinic, located in the East Shoa zone of the Oromia regional state, and Arsi-Negelle veterinary clinic, located in the Western Arsi zone of the Oromia regional state. Batu has a latitude of 7°56′N and a longitude of 38°43′E with an elevation of 1,643 meters above sea level. The average annual temperature in Batu is 19.3°C and 837 mm of precipitation falls annually. Arsi-Negelle is found in the Western Arsi zone of Oromia having a latitude and a longitude of 7°21′N and 38°42′E, respectively, with an altitude of 2,043 meters above sea level and annual rainfall and temperature of 1,300 mm and 21.5°C, respectively [17].
2.2. Study Design
A retrospective and cross-sectional study was designed to assess rational drug use and to compare commonly used drugs for the treatment of animal diseases at Batu and Arsi-Negelle district veterinary clinics based on WHO drug use indicators as described in [1]. The sample was selected using a systematic random sampling method, and the sampling unit was an animal patient encountered at both veterinary clinics for the treatment of acute and/or chronic illness. Secondary data are the source of information. Accordingly, data were collected from the case book records from the office of both clinics by using systematic random sampling in which every third case and tenth case were recorded at Batu and Arsi-Negelle veterinary clinics, respectively.
2.3. Study Population
The study was conducted between November 2014 and March 2015 on food animal patients (cattle, sheep, goats, and chicken of all ages and sex groups) that were admitted to Batu and Arsi-Negelle district open-air veterinary clinics and treated with drugs. All other nonfood animals (e.g., pets and equines) were excluded from the study. A total of 2,464 case data were collected to evaluate the rational use of veterinary drugs both at Batu and Arsi-Negelle veterinary clinics.
2.4. Data Collection
Data were collected in data collection format retrospectively using case registration books at both the clinics, namely, Batu and Arsi-Negelle veterinary clinics. The specific types of data necessary to measure the prescribing indicators were recorded for each animal patient encounter and entered directly into an ordinary prescribing indicator form. For this particular study, 2464 prescriptions that contain the animal’s characteristics (age, sex, breed, body condition, clinical signs, and symptoms observed); disease diagnosis (name, empiric or physical clinical examination, and confirmatory laboratory tests used); prescribed drugs (type, naming (generic or brand), number of drugs prescribed, route of administration, duration of treatment); and prescriber’s signature, level of education, and years of experiences were collected retrospectively from about 16500 prescriptions written for two and half years period from September 2012 to February 2015. Accordingly, the evaluation of the rational use of veterinary drugs was made based on generic prescription and antimicrobials and anthelmintics prescribed for tentatively diagnosed clinical cases.
2.5. Data Analysis
All data in the ordinary prescribed indicator recording form were entered into a Microsoft Excel spreadsheet (version 2010) and imported and analyzed using SPSS (Version 20). Descriptive statistics such as frequencies, percentages, and cross-tabulation were used to describe the characteristics of the drugs. The Chi-square test was used to compare categorical variables where appropriate. All statistical tests were two-sided, and was considered significant.
2.6. Prescribing Indicators
There was no available guideline for prescribing indicators used in veterinary medicine. As a result, the PRESCRIBING indicators were used in this study [18]. The indicators were pretested and slightly modified to match with clinical practice in veterinary medicine so that they could be used easily to provide accurate data. The final versions of the pretested indicators are as follows:(1)The average number of drugs prescribed per encounter was calculated by dividing the total number of different drug products prescribed with the number of encounters surveyed to measure the degree of polypharmacy.(2)The percentage of drugs prescribed by the generic name was calculated by dividing the number of drugs prescribed by the generic name with the total number of drugs prescribed, multiplied by 100 to measure the tendency of prescribing by generic name.(3)The percentage of encounters in which antimicrobials, anthelmintics, and other drugs prescribed were calculated by dividing the number of patient encounters in which the drug was prescribed with the total number of drugs prescribed and multiplied by 100 to measure the overall use of commonly overused (irrationally prescribed) and costly forms of drug therapy.(4)The percentage of drugs prescribed for each disease encountered was calculated by dividing the number of drugs prescribed for each disease for the total number of encounters and multiplied by 100.
3. Results
A total of 2,464 presented cases to clinics were assessed from Batu (1163) and Arsi-Negelle (1301) district veterinary clinics. A retrospective study has shown that 3,811 drugs were prescribed, and the average number of drugs per encounter was 1.6 with a maximum of 3 and a minimum of 1. Among 3,811 prescribed drugs, 1,637 (43.0%) Oxytetracycline, 671 (17.6%) Ivermectin, and 389 (10.2%) Penstrep were most commonly used. Of these drugs, 45.0% and 55.0% of Oxytetracycline, 16.5% and 83.5% of Ivermectin, and 48.1% and 52.9% of Penstrep were prescribed in Batu and Arsi-Negelle, respectively (Table 1).
Commonly prescribed drugs
Total N (%)
Name of clinics
Batu N (%)
Arsi-Negelle N (%)
Total drugs
3811
1199 (31.5%)
2612 (68.5%)
Oxytetracycline
1637 (43.0%)
736 (45.0%)
901 (55.0%)
Ivermectin
671 (17.6%)
111 (16.5%)
560 (83.5%)
Penstrep
389 (10.2%)
187 (48.1%)
202 (52.9%)
Sulfa drug
247 (6.5%)
100 (40.5%)
147 (59.51%)
Albendazole
51 (1.3%)
6 (11.8%)
45 (88.2%)
Others
816 (21.4%)
59 (7.2%)
757 (92.8%)
N = frequency; others = penicillin, tricalbendazole, multivitamin, tetraconazole, copper sulfate, anesthetic agents, diminazene aceturate, intramammary infusion, digestion powder, vitamin K, and calcium borogluconate.