From prescribing indicators to rational drug use: a medication safety perspective

Over the past few decades, the emergence of irrational medicine use has become a significant global health challenge. It has contributed to medication errors, adverse drug reactions, higher treatment costs, increased morbidity, and mortality. Problems with irrational prescribing are a matter of concern in low and middle-income countries, where regulatory control is underdeveloped, healthcare systems are constrained by economic pressures, and there is a shortage of trained personnel. The World Health Organization (WHO) developed core prescribing indicators to assess and promote rational medication use for healthcare settings. These include indicators measuring polypharmacy, antibiotic use, injectable use, generic prescribing, and adherence to essential medicine lists. This narrative commentary explores the potential of WHO prescribing indicators in promoting the rational use of medicines, highlighting their role in patient safety and supporting evidence-based prescribing practices. The five key areas of these indicators provide valuable insights into prescribing practices in healthcare settings of low and middle-income countries. These indicators also support the WHO's initiative of Medication without Harm. Despite their potential strengths, there are some potential limitations, such as failing to capture the data behind the prescribing practices of prescribers and their utility in specialised healthcare settings. The future of rational prescribing lies in adapting these tools through qualitative assessments, comprehensive data collection methods that include qualitative study design approaches, and targeted training interventions to ensure safe, effective, and equitable medication practices across healthcare systems globally.