M. MALIK & col
508
Laboratory diagnosis can improve the treatment of malaria, but the results
of the present study showed that only few facilities were offering any laboratory
diagnostic services for the confirmation of malaria before prescribing anti-‐malarial
drugs to the patients. However, it was observed that prescribing of anti-‐malarial
drugs after laboratory confirmation only decreased significantly the total number
of prescriptions in Malawi (11).
Antibiotics are usually not preferred in the treatment of malaria and do not
conform to the treatment guidelines. But prescribing of anti-‐malarial drugs along
with an antibiotic and an antipyretic was seen as a common practice at both public
and private healthcare facilities.
The results of the present study are in line with another study indicating
overuse of antibiotics and injections promoting irrational drug use and higher rate
of emergence of resistance of anti-‐malarial drugs (12). Dose of the anti-‐malarial
drugs was not calculated as per patient body weight and drugs were mostly being
prescribed by their brand names. The overall low generic prescribing observed
was comparable to the results of the other studies conducted in Nigeria and Nepal
(13, 14). Chloroquine is usually the most commonly prescribed oral antimalarial
drug in most of the countries as compared to quinine and other anti-‐malarial drugs
due to its continuous availability, affordable price or an established pattern by
which most doctors treat uncomplicated malaria initially by giving chloroquine,
followed by oral quinine for non-‐responding cases. Similar pattern was followed in
healthcare facilities in Nigeria (15). Although, Chloroquine is recommended as first
line drug in the treatment of all types of malaria while Sulfadoxine/pyrimethamine
and artemether/lumefentraine are only recommended as first line drugs for
confirmed cases of
Plasmodium falciparum
in national standard treatment
guidelines of Pakistan.
The prevalence of
P. vivax
is more common in Punjab while
P. falciparum
is
more frequently seen in Baluchistan and Sindh (4). But the results of the present
study showed significant use of artemisinin based combination therapy for the
treatment of malaria in Punjab although most of them were aware of the fact that
P. vivax
is more common in Punjab.
Rational prescribing requires that prescribers follow a standard process of
prescribing and in accordance with standard treatment guidelines. High rate of
inappropriate prescriptions for treating malaria are mostly due to lack or incorrect
doses, frequency, dosages and duration of treatment (15).
The result of the present study showed poor adherence of prescribers with
the standard treatment guidelines for malaria. Prescribers having different
designations and levels of experience working in public or private sector were not
