Drug use and prescription pattern at the Usmanu Danfodiyo University Veterinary Teaching Hospital ( UDUVTH ) , Sokoto ; A ten-year retrospective study ( 2006-2015 )

A ten year (2006 – 2015) retrospective study was conducted using records from the case files of patients handled at the Usmanu Danfodiyo University Veterinary Teaching Hospital (UDUVTH) in order to ascertain the pattern and problems associated with drug prescriptions in the management of diseases presented to the hospital. The results obtained show that, a total number of 622 patients comprising cattle (4.80%), goats (16.9%), sheep (33%), birds (11.3%), horses (1.1%), dogs (28.6%), cats (2.9%), rabbits (0.8%) and others (0.3%) were presented. Of the total number of 622, 537 (86.2%) received various medicaments ranging from antibacterial drugs (39.1%), anthelmintics (18.1%), acaricides (4.4%), haemoparasiticides (1.3%), antidiarrhoic (2.5%) and analgesic (4.3%). Other drugs dispensed were dietary supplements/vitamins (17.7%), fluids/electrolytes (2,5%), anticoccidialsm (3.7%) and unspecific agents (5.8%) in retrospective study of drug use and prescription pattern at the UDUVTH, Sokoto. 20% of the drugs were given by oral route of administration while parenteral and topical routes constitute 74.2 and 10.3%, respectively. The route of administration of 4% of the medications was not specified. Multiple drug therapy overwhelmed the practice with 80.41% while inappropriate prescription and drug combination was 1.03% of all the drugs used over the study period. The study revealed that antibacterials and anthelmintics are the most widely used drugs and parenteral route of drug administration and polytherapy were the dominant practice in the hospital.


INTRODUCTION
The primary purpose of veterinary drugs, biologics and pesticide chemicals is for the health and welfare of all animals (whether farm, pet, laboratory or zoo animals, safeguard cage birds, reptiles, fish or bees).They are *Corresponding author.E-mail: sani.ismaila@udusok.edu.ng.Tel: +2349038409022.
Author(s) agree that this article remain permanently open access under the terms of the Creative Commons Attribution License 4.0 International License Table 1.Species of animals presented to UDUVTH, Sokoto (2006-2015).also used as therapeutics or for disease prevention, diagnosis, growth promotion in food animals, to increase feed conversion efficiency, and increase milk and egg yield (Aliu, 2001;Kabir et al., 2002).The provision of basic veterinary care is therefore to a large extent based on the rationale use of these products.However, choosing between a wide range of these products and using them judiciously to the best advantage of the patient and the client is not always straight forward (Anjum et al., 2003).In Nigeria, there are only a few registered veterinary medicinal products, with faulty distribution channels and a large number of unqualified persons participating in the animal health industry as medicinal product users.

Year
The Usmanu Danfodiyo University Veterinary Teaching Hospital is one of the tertiary animal health institutions in the country.It was established in 1991 with the primary mandate of serving as a facility for training prospective doctors of veterinary medicine and to provide clinical as well as extension services to its immediate community.Although, studies abound in the literature on diseases encountered in veterinary hospitals and clinics in Nigeria including that of UDUVTH (Akinrinmade, 2014;Ebbo et al., 2003;Mbaya et al., 2008), only a few reports (Ramon-Yusuf, 1990;Agaie and Junaidu, 1997;Kabir et al., 2002) have been documented in Nigeria on veterinary drug use pattern.The dearth of this information has limited the development of true field based data for essential veterinary drug list, veterinary formulary, policies on use of veterinary medicinal products use and code of conducts for personal involved in their use for the optimal cost effectiveness and classification of veterinary medicinal products in the country.
It is in view of the foregoing that this study was designed to assess retrospectively veterinary drug use and prescription pattern at the Usmanu Danfodiyo University Veterinary Teaching Hospital between the years 2006 and 2015.

MATERIALS AND METHODS
Case files of animal patients treated at the large, small as well as ambulatory clinic of the hospital between January 2006 and December 2015 were examined.The species treated, clinical diagnosis made, drugs prescribed and dispensed, number of drugs per visit, routes of administration and pattern of prescription were noted and documented.Pattern of prescription in this write-up means the nature of the drug itself whether the drug is in tablets, suspensions et.c, the frequency and the route of administration, the age, sex and species of the animal and considering the drug combination and the dosage by which the drug is being prescribed.A prescription is termed standard when it considered all the above mentioned subjects on the prescription form and poor when it those not report them.The results obtained for the period were analyzed using descriptive statistics and expressed as percentages.

Species of animals presented to UDUVTH (2006 -2015)
The result indicates that a total number of 622 patients were presented to the hospital during the period under review.Of this number, ovine, canine and caprine were the most presented with 33, 28.6 and 16.9%, respectively, while equine (1.1%) and lapine (0.8%) were the least presented during the study period (Table 1)

Frequency of poly-therapy at UDUVTH, Sokoto (2006 -2015)
It is clear from this study that poly-therapy was common in the treatment of animals presented to the hospital during the period under review.Patients treated with two or more drugs per presentation constituted 71.4% of all cases as compared to 19.6% that received single drug treatment.Two and three drug therapy per visit was the most predominant feature with 40.5 and 27.1% of cases, respectively.The frequency of poly-therapy per visit declined from 10.4 to 2.2 and 0.2%, respectively, for 4, 5 and 6 drugs combinations (Table 3).

Route of administration of drugs dispensed at UDUVTH, Sokoto (2006 -2015)
Fifty eight percent (58%) of the drugs dispensed during this period were administered through the intramuscular injection while oral, topical, subcutaneous and intravenous routes were 24.5, 10.3, 5.7 and 1.5%, respectively.The study suggests that no drug was given by intraperitoneal route during the 10 year study period (Table 4).

Prescription pattern at UDUVTH, Sokoto (2006 -2015)
The results in Table 5 shows that 81.3% of the prescriptions on the case file of patients were not in line with standard practice.

Inappropriate drug use/combinations at UDUVTH (2006 -2015)
Of the total of 1264 drugs used during the period of the study, 13 were inappropriately used based on clinical diagnosis made in each of the patient in which the drugs were dispensed (Table 6).

DISCUSSION
The results of this study show that ovine, canine and caprine were the most common species presented to the UDUVTH, Sokoto.This is not surprising as small ruminants play a very significant role in the socioeconomic life subsistence families and small holder farmers in the study area.The high number of canine species could be due to increase awareness on desirability of attending to the health needs of all species  of animals and increase urbanization of Sokoto city with persons of different faith and social status.There was however no clear yearly trend on the species presented except for year 2007 to 2009 when there was an increasing number of ovine been presented.With regards to drug use, antibacterials and anthelmintics appear to be most widely prescribed/ dispensed drugs.This agrees with earlier reports by Ramon-Yusuf et al. (1990), Agaie and Junaidu (1997) and Kabir et al. (2002).Amongst the antibacterials, oxytetracycline, penicillin and streptomycin were the main agents used.The broad spectrum nature of oxytetracycline and availability and convenience of using long acting formulation might be responsible for its wide range use.This is in addition to its low cost, availability in market and various dosage forms that may likely suite different species and patients in various conditions.Anthelmintics were also one of the leading drugs used under the period under review and albendazole and ivermectin were the lead choices.Earlier report by Agaie and junaidu (1997) indicated that albendazole and morantel tartate were the preferred veterinary anthelmintic by veterinarians and animal health workers in Sokoto.This study confirmed the faith of veterinarians/animal health workers in this area in albendazole while diminished role of morantel may be due to its unavailability in the market.Albendazole is a broad spectrum anthelmintic (ovicidal, larvicidal and effective against adult nematodes), has a wide safety margin (Aremu et al., 2012) as compared to agents like levamisole that are also commonly available and also cost effective in the management of helminthosis.Studies by Agaie et al. (2004) in the study area confirmed the superiority (efficacy) of albendazole over ivermectin and levamisole in the treatment of nematodiasis in sheep.Ivermectin however is an endectocide with very wide safety margin used against both endo and ectoparasites, and larval stages of filarial worms; this may be the reason for its high usage in the hospital.
Polytherapy is common in modern veterinary human and medical practice especially in cases with myriads of clinical signs and symptoms where a number of drugs may be administered to ostensibly to alleviate the discomfort experienced by the patient (Ramon-Yusuf et al., 1990).This approach may be to exploit the benefits of the combination such as broadening the spectrum of activity of the drugs, preventing development of resistance in case of chemotherapeutic agents or reducing the possibility of toxic/side effects of a particular drug or the combination (Aliu, 2007;Aliu et al., 2007).However, in some instances, they could simply be due to inappropriate laboratory support for diagnosis and inexperience of the attending professional.The reason for frequency of polytherapy in UDUVTH may be due to the former than the later.It is however important for practitioners to always note that though polytherapy may benefit some patients, it could also result in some cases with undesirable consequences in patients or even non compliance to medication by the client (Ajuwon and Eghianruwa, 2004).Davies et al. (2007) reported that the frequency of such adverse reactions have been found to increase proportionately with an increasing number of drugs given to a particular patient.
The reason for having most prescriptions on the patient's case files not in tandem with the standard format could be due to the fact that prescription writing and prescription record keeping has not taken firm root in veterinary health care services in Nigeria but for this to occur in a tertiary health facility, cannot be justified.Prescriptions are important source of drug information on drug management history of the patient and drug use in a health facility and could provide needed guide for therapeutic strategies to be adopted by the professionals and policy making in the hospital and the country as a whole.It is really a professional and ethical burden that practitioner must discharge with utmost sense of responsibility where prescriptions should be written with every detail it requires (Broadhead, 2015;Lazarou et al., 1998).
Inappropriate drug use/combination of 1.03% over the ten-year period with the highest figure (4.27%) occurring in 1991 was quite negligible.However, there is need to put in place appropriate measures to review therapeutic measures undertaken in the hospital by senior personnel from time to time and institute continuous education programme on drug use and other aspects of improving services rendered by the hospital.

Conclusion
This study revealed that antibacterials (oxytetracycline, penicillin and streptomycin) and anthelmintics (albendazole and ivermectin) are the most widely used drugs and parenteral route of drug administration, particularly intramuscular and polytherapy were the dominant practice in the hospital.Proper hospital based training programme on management (Adenike, 1998) is therefore recommended to be incorporated into the continuous education programme of the professionals while evidence based therapy should be the norm and encouraged in the hospital.