Five Levels of Rational Use. Essential Drugs Monitor No. 007 (1988)
(1988; 1 page)


Dr. Andrew Herxheimer from the Charing Cross and Westminster Medical School at the University of London summarizes the five levels of rational and optimal drug use in an article in the seventh issue of the Essential Drugs Monitor. First, one must determine if a drug is necessary for the treatment of the condition at hand or if there is a better alternative. Second, the type of drug action that would best treat the condition must be identified. Third, the most appropriate drug that can perform that action must be selected. For example, the choice of the appropriate antibiotic will depend on community drug resistance patterns and patient allergies. Fourth, the dose of the drug must be considered. This includes how often a drug should be taken, at what intervals, and how long treatment should be continued. There is often a recommended starting dose for adults that must be altered depending on the weight, height, age, and gender of the patient. The frequency of dose administration is determined by how long the effect of one dose lasts and whether the effect is intended to be continuous. Lastly, patients must be given the necessary information to properly use the drug. Herxheimer states that the greatest improvements have been made on choosing the right drug while more work needs to be done on determining if drug treatment is necessary. Herxheimer concludes his article by stating that individuals should be taught about rational drug use from an early age. (Abstract by Flannery Bowman, 2013)

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