🌿 Rational Use of Medicines (RUM): A Guide for Safer and Smarter Prescribing

By Dr. Sk Sabir Rahaman, MBBS, MD (Pharmacology), DFM(Family Medicine), FCFM, CCEBDM, CCLSD 

📍 Specialist Family Physician | Consultant Pharmacologist | Lifestyle & Diabetes Expert

Medicines save lives, ease suffering, and improve health outcomes. But when they are used irrationally, they can cause more harm than good. The World Health Organization (WHO) emphasizes the importance of the Rational Use of Medicines (RUM) to ensure patient safety, treatment effectiveness, and cost efficiency.

In this blog, we’ll explore what RUM means, why it matters, and how healthcare professionals can practice it effectively.

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📌 What is Rational Use of Medicines?

According to WHO:

“Rational use of medicines requires that patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and their community.”

In simple words: it’s about prescribing the right medicine, in the right way, to the right patient, at the right cost.

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✅ Core Principles of Rational Prescribing

Think of them as the six rights of medication use:

• Right drug – evidence-based, effective, and needed

• Right dose – neither too high nor too low

• Right duration – adequate length of therapy

• Right route – oral, IV, topical, depending on condition

• Right patient – individualized, considering age, comorbidities, allergies

• Right cost – affordable to patient and society

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🎯 Goals of Rational Prescribing

1. Ensure clinical efficacy and patient safety

2. Prevent adverse drug reactions (ADRs)

3. Minimize antimicrobial resistance

4. Promote cost-effective therapy

5. Build patient trust and adherence

When done correctly, RUM benefits not just the patient, but the entire healthcare system.

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⚠️ Examples of Irrational Drug Use

Type of Irrationality	Clinical Example
Not following guidelines	Prescribing antibiotics for viral upper respiratory tract infection
Underuse of effective drugs	Skipping ORS in acute diarrhea
Incorrect route/dose	Giving IV ranitidine for mild gastritis instead of oral
Use of unproven drugs	Appetite stimulants in children
Prescribing unsafe drugs	Cisapride (cardiotoxic)
Irrational fixed-dose combinations (FDCs)	Ampicillin + cloxacillin
Unnecessary expensive drugs	Third-gen cephalosporins instead of amoxicillin
Polypharmacy	Multivitamins + tonics + enzymes + analgesics together

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🚨 Hazards of Irrational Drug Use

• Therapeutic failure

• More adverse drug reactions

• Antimicrobial resistance

• Higher treatment costs

• Increased hospitalizations

• Loss of patient trust

Clearly, irrational prescribing is not just wasteful—it is dangerous.

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📝 WHO’s Stepwise Approach to Rational Prescribing

Here’s a simple roadmap for healthcare providers:

1. Make a Diagnosis – Identify the illness accurately.

2. Define the Therapeutic Goal – Symptom relief? Infection eradication? Long-term control?

3. Select the Appropriate Drug – Based on efficacy, safety, dose, route, cost, and inclusion in Essential Medicines List (EML).

4. Write a Clear Prescription – Use generic names, specify dose, route, duration, and any special instructions.

5. Educate the Patient – Teach correct use, expected benefits, side effects, and precautions.

6. Monitor and Review Therapy – Track progress, adjust doses, or switch drugs if necessary.

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👩‍⚕️ Rational vs Irrational: A Few Clinical Scenarios

Scenario	Rational Use	Irrational Use
Child with acute diarrhea	ORS + zinc	Antibiotics + antidiarrheals
Mild pain	Oral paracetamol	IV diclofenac + multivitamin injection
Adult with sore throat	Supportive care + antipyretic	Antibiotics without culture

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💡 Tips 

• Always consult Standard Treatment Guidelines (STGs).

• Prefer medicines from the Essential Drug List (EDL/WHO-EML).

• Avoid irrational FDCs unless scientifically justified.

• Be cautious of pharma marketing influence.

• Personalize treatment to each patient’s needs.

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🌍 Final Thoughts

The rational use of medicines is not just a professional duty—it’s a public health necessity. Every irrational prescription contributes to drug resistance, rising costs, and patient mistrust. By following WHO’s principles, prescribers can ensure medicines truly heal rather than harm.