It has been more than two decades since the Good pharmacy practice guidelines were framed by WHO-FIP jointly and also The IPA had also framed the Good pharmacy practice guidelines 16 years back. The main objective behind the guidelines was to improve the quality of services provided by the community pharmacists and also to promote that the health of the patient is also the responsibility of these pharmacists. Nowadays the focus is on patient-centered Medication therapy and hence in our study we have tried to assess the knowledge and practice of community pharmacy personnel toward Good pharmacy practice guidelines in Hyderabad. We have developed a survey form consisting of 44 questions based on the WHO-FIP guidelines and also on the basis of IPA guidelines. A total of 500 survey forms were distributed at various community pharmacies covering all the areas of Hyderabad. We have received 302 filled in survey forms and these were analyzed question wise and the results obtained were disappointing. 43.3% of dispensing pharmacists were from a different educational background and 15.8% personnel were holders of 10+2 certificate and 3.97% were holders of 10th class certificate. The maximum number of days of training received were 180 days and the minimum number of days of training received were 0 days. Majority of dispensing pharmacists were aware of medication errors and when questioned about the action taken by them if they encountered a prescription with medication errors, surprisingly all of them answered that they will overlook such errors and again when asked why they were overlooking these errors, they have answered that they cannot question the doctors. The authorities must be extra vigilant while licensing a pharmacy and also should be inspecting these pharmacies frequently and also more educational reforms must be inculcated both at the institutional level and also at the practicing level. The practicing pharmacists must be encouraged to attend continuous educational and knowledge upgrading programmes.

Drug use evaluation is an ongoing, systematic, criteria-based program of medicine evaluations that will help ensure appropriate medicine use. If therapy is determined to be inappropriate, interventions with providers or patients will be necessary to optimize pharmaceutical therapy. A DUE can be structured so that it will assess the actual process of administering or dispensing a medicine (i.e., appropriate indications, dose, and medicine interactions) or assess the outcomes. Empirical therapy forms the basis of treatment in India mostly and it is the responsibility of DTC (Drugs and therapeutics committee) to organize a DUE study and adopt suitable protocol for controlling irrational drug use. In our study we have developed a data collection form based upon WHO guidelines for conducting a DUE study on Levofloxacin use evaluation. Ours is a retrospective study conducted from the dates corresponding to 1-8-2015 to 31-7-2016. A total of 62 case records were obtained containing Levofloxacin as one of the drug in the prescription. The gender distribution of case sheets were male-24, female-38. Indication wise the distribution of case sheets were -Lower respiratory tract infections = 26, Pulmonary Kochs = 06, Cystitis = 02, Non indicated = 18, Upper respiratory tract infection = 04, Urinary tract infection = 06. The minimum dose administered was 35 mg/day and the maximum dose administered per day was 2000 mg/day. The minimum number of days of treatment was 1 day and the maximum number of days of treatment was 38 days. All patient folders evaluated with regards to UTI, CAP, KOCHS were found to meet the standard criteria appropriate for Levofloxacin use with respect to dose, and dose frequency. However, in the case of dose duration the evaluation was found to be largely inappropriate for all the justified indications. In addition, twenty nine percentage of Levofloxacin use for unjustified indications was noted. This means that Levofloxacin has been deviated from standard treatment guidelines hence it facilitates the development of resistant strains to Levofloxacin and of no use in the near future, and it also effect the patient economically.

Phenytoin is a hydantoin derivative with a narrow therapeutic index and is indicated in GTCS, nonepileptic seizures, status epilepticus, neuritic pain, as skeletal muscle relaxant, ventricular arrhythmias unresponsive to lidocaine or procainamide, arrhythmias induced by cardiac glycosides, and in prophylactic control of seizures during neurosurgery. The usual practice is that phenytoin is given along with other anticonvulsant drugs like benzodiazepines or valproic acid in case of seizures. But this combination of antiepileptic drugs have got serious drug-drug interactions which usually results in exaggerated effects of either of the drugs. A female patient of 24 years admitted with seizures was put on phenytoin, lorazepam, and valproic acid. After a few days of therapy, she had 2 more episodes of seizures and later on developed nystagmus and truncal ataxia. Even though the effects were attributed to "drug", the physicians failed to take necessary action. Lack of a protocol for monitoring plasma concentrations of the narrow therapeutic index drug was responsible for the toxic effects of Phenytoin and by conducting TDM for phenytoin, such toxic effects could have been avoided.