Drug Utilization Pattern of Analgesics and Anti-Inflammatory Agents in an Orthopedic Outpatient Department Using World Health Organization Prescribing Indicators: A Prospective Observational Study

Abstract

Background: Musculoskeletal conditions represent a major therapeutic category in outpatient clinics, where analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) constitute primary interventions. Irrational prescribing—marked by polypharmacy, low generic adoption, and inadequate gastroprotection—escalates adverse drug events and financial burden. This study aimed to evaluate the drug utilization pattern of analgesics and anti-inflammatory agents in an orthopedic outpatient department (OPD) using World Health Organization (WHO) prescribing indicators.Methods: A prospective observational study was conducted over six months (October 2025 to March 2026) in the Orthopedic OPD of a tertiary care teaching hospital. Based on WHO recommendations for drug utilization surveys (minimum 600 encounters) and accounting for an anticipated 10% attrition or illegibility rate, a validated sample size of 660 patient encounters receiving at least one analgesic or anti-inflammatory agent was enrolled via systematic consecutive sampling. Demographic parameters, diagnostic categories, and detailed drug profiles were recorded using a pre-tested proforma. Prescriptions were audited against standard WHO core prescribing indicators and the National List of Essential Medicines (NLEM). Data were analyzed using SPSS version 26.0 with descriptive statistics and chi-square tests (p < 0.05).Results: Among 660 analyzed prescriptions (mean patient age: 47.8 ± 14.2 years; female: 54.2%), osteoarthritis (36.8%) and low back pain (24.5%) were the most prevalent diagnoses. A total of 2,145 drug formulations were prescribed. The average number of drugs per encounter was 3.25 ± 0.94. Prescriptions using generic International Nonproprietary Names (INN) accounted for 38.4%. Encounters involving an injection were 9.7%, while an antibiotic was prescribed in 14.2% of encounters. Medications prescribed from the NLEM constituted 61.5%. Non-selective NSAIDs were the most utilized analgesic class (51.2%, led by aceclofenac), followed by simple analgesics/paracetamol (26.4%) and COX-2 selective inhibitors (14.1%). Fixed-dose combinations (FDCs) represented 31.8% of analgesic formulations. Concomitant gastroprotective agents (proton pump inhibitors/H2-receptor antagonists) were co-prescribed in 88.3% of patients aged 60 years or older.Conclusion: While injection use remained within rational bounds, prescribing practices revealed clear areas for improvement—notably the low rate of generic prescribing, frequent utilization of oral multi-drug FDCs, and substantial deviation from the Essential Medicines List. Implementation of institutional prescription audits, clinical pharmacologist reviews, and periodic educational interventions are warranted to align orthopedic pain management with rational prescribing standards.