Analysis of the Use of Chinese Proprietary Medicines in the

Prescriptions of Acute Upper Respiratory Tract Infection in a

Hospital from January to June 2021

Qin Tao

1,2

, Jingyue Yu

, Xueqin Chen

, Huiling Liao

, Ling Huang

, Liu Yang

, Yongquan Lai

and Haihong Fang

1,*

School of Pharmacy, Jiangxi Science and Technology Normal University, Nanchang 330013, China

Gaoxin Hospital of the First Affiliated Hospital of Nanchang University, Nanchang 330000, China

Keywords:

Upper Respiratory Tract Infection, Rational Medication Use, Prescription Review, Chinese Proprietary

Medicine.

Abstract:

Objective To provide a basic reference for the rational use of medicines for patients in the clinic and improve

the safety and reliability of Chinese proprietary medicines in treating acute upper respiratory tract infections

(URTI) in our hospital and trace the causes of the improper use of medicines. Methods We extracted the

outpatient prescriptions for URTI from January to June 2021, and analyzed the basic information of these

prescriptions, such as the percentage and amounts of Chinese proprietary medicines and the type of drug

combination; the improper prescriptions of Chinese proprietary medicines were confirmed by a pharmacist

manual review. Results A total of 2279 prescriptions for patients with acute URTI were reviewed, among

which 1939 prescriptions contained Chinese proprietary medicines. Minor patients aged from 1 to 17 years

accounted for a large portion of the 1939 prescriptions, and the male-female ratio was 1074:865. Among the

1939 prescriptions, 30 Chinese proprietary medicines were used, and the top three were Kanggan Oral Liquid

(20%), Chimonanthus nitens Oliv. Leaf Granules (14.78%), and Lan Qin Oral Liquid (14.09%). The

combinations of two and three Chinese proprietary medicines were 381 and 69 cases, respectively. And there

were four cases that used four kinds of Chinese proprietary medicines simultaneously. The rate of improper

prescriptions was 2.27%. Conclusion From January to June 2021, the use of Chinese proprietary medicines

in the outpatient prescriptions for treating acute URTI in our hospital was basically reasonable. However,

attention should be paid to the problems existing in improper prescriptions, and the training in TCM theories

should be strengthened.

1 INTRODUCTION

Acute upper respiratory tract infection (URTI) is an

acute inflammation of patients caused by various

viruses or bacteria attacking the upper respiratory

tract, such as the nasopharynx and throat. It mainly

includes rhinitis, acute tonsillitis, tracheitis, acute

pharyngitis, sinusitis, acute herpes pharyngitis,

influenza, etc. More than 70% of acute URTI is due

to virus infection, and a small portion is due to

bacterial infection. Antibiotic treatment is commonly

used in Western medicine, and it should be effective

(Chinese Medical Association, 2020). However, the

hazards of antibiotic abuse are self-evident in the

context of increasing bacterial resistance. In contrast,

according to Chinese medicine theories, URTI

belongs to external fever and wind-warm lung-heat

syndromes. The main principle of treatment is to

relieve the exterior syndrome and clear the pathogen.

The disease course is generally short and easy to cure.

Chinese medicine has a large proportion in the

treatment of acute URTI because of its strict formula,

precise efficacy, convenience to carry, and ease to

take. However, there is often unclear differentiation

of symptoms and signs and confusion in clinical use,

so the rational application of Chinese proprietary

medicines in the prescription of acute URTI needs to

be monitored (Fang, 2019).

Tao, Q., Yu, J., Chen, X., Liao, H., Huang, L., Yang, L., Lai, Y. and Fang, H.

Analysis of the Use of Chinese Proprietary Medicines in the Prescriptions of Acute Upper Respiratory Tract Infection in a Hospital from January to June 2021.

DOI: 10.5220/0012013700003633

In Proceedings of the 4th International Conference on Biotechnology and Biomedicine (ICBB 2022), pages 86-91

ISBN: 978-989-758-637-8

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

2 MATERIALS AND METHODS

2.1 General Methods

A total of 2279 prescriptions for patients with acute

URTI issued in our hospital from January to June

2021 were reviewed, among which 1939

prescriptions contained Chinese proprietary

medicines. Among these, improper prescriptions of

Chinese proprietary medicines were confirmed by a

manual review by our pharmacist experts.

2.2 Results and Analysis

2.2.1 General Information of Patients

Among the 1939 prescriptions, 1074 cases were male,

and 865 cases were female. As for the age

distribution, adults aged 18-60 years (41.83%)

accounted for the most, followed by children aged 1-

6 years (37.34%) and adolescents aged 7-17 years

(14.13%).

2.3 Data Statistics

2.3.1 Major Medication Use

A total of 30 Chinese proprietary medicines were

used in the reviewed prescriptions. The main

medications used were heat-clearing, symptom-

relieving, and lung-heat-removing medications and

expectorants. The Xiyanping Injection was used in 47

cases (18 cases by intramuscular injection and 29

cases by intravenous drip) and Tanreqing Injection in

nine cases (by intravenous drip). The top five

medications are shown in Table 1.

Table 1: Top Five Chinese Proprietary Medicines.

Generic name of the medication Amount use

ercentage

Kanggan Oral Liqui

502 20.32%

Chimonanthus nitens Oliv. Leaf Granules 365 14.78%

Lan Qin Oral Liqui

348 14.09%

Xiao'er Baotaikang Granules 254 10.28%

Lung-Clearing and Cough-Stopping Mixture 231 9.35%

2.3.2 Combined Use of Two or More

Chinese Proprietary Medicines

Among the 1939 prescriptions, 381 cases used two

Chinese proprietary medicines simultaneously. The

most frequently used combination was Kanggan Oral

Liquid with Xiao'er Baotaikang Granules (41 cases),

followed by Compound Codeine Platycodon Tablets

with Chimonanthus nitens Oliv. Leaf Granules (39

cases), Compound Codeine Platycodon Tablets with

Lan Qin Oral Liquid (27 cases), Chimonanthus nitens

Oliv. Leaf Granules with Suhuang Cough-relieving

Capsules (20 cases), and Lan Qin Oral Liquid with

Suhuang Cough-relieving Capsules (17 cases). In 69

cases, three kinds of Chinese proprietary medicines

were used at the same time. In four cases, four kinds

of Chinese proprietary medicines were used at the

same time.

Table 2: Top 10 Combinations of Two Chinese Proprietary Medicines in Prescriptions and the Frequency of Use.

Two Chinese proprietary medicines used in combination Frequency of use

Kanggan Oral Liquid + Xiao'er Baotaikang Granules 41

Compound Codeine Platycodon Tablets + Chimonanthus nitens Oliv.

Leaf Granules 39

Compound Codeine Platycodon Tablets + Lan Qin Oral Liqui

Chimonanthus nitens Oliv. Leaf Granules + Suhuang Cough-relieving

Capsules 20

Lan Qin Oral Liquid + Suhuang Cough-relieving Capsules 17

Feilike Mixture + Kanggan Oral Liqui

Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules 14

Feilike Mixture + Xiao'er Baotaikang Granules 12

Kanggan Oral Liquid + Lung-Clearing and Cough-Stopping Mixture 11

Analysis of the Use of Chinese Proprietary Medicines in the Prescriptions of Acute Upper Respiratory Tract Infection in a Hospital from

January to June 2021

Table 3: Top 10 Combinations of Three Chinese Proprietary Medicines in Prescriptions and the Frequency of Use.

Combinations of Three Chinese Proprietary Medicines

Frequency of use

Kanggan Oral Liquid + Xiao'er Baotaikang Granules + Xiao'er Chaigui Tuire Granules 17

Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules + Suhuang Cough-relieving

Capsules 7

Kanggan Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules + Xiao'er Baotaikang

Granules 5

Feilike Mixture + Kanggan Oral Liquid + Xiao'er Baotaikang Granules 4

Feilike Mixture + Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules 4

Feilike Mixture + Lianhua Qingwen Capsules + Chimonanthus nitens Oliv. Leaf Granules 4

Chuanwang Xiaoyan Capsules + Lan Qin Oral Liquid + Suhuang Cough-relieving Capsules 3

Chuanwang Xiaoyan Capsules + Chimonanthus nitens Oliv. Leaf Granules + Suhuang Cough-

relieving Capsules 3

Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules + Xiyanping Injection 3

Feilike Mixture + Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules + Lianhua

Qingwen Capsules 2

Table 4: Examples of the Combinations of Four Chinese Proprietary Medicines.

Combinations of Four Chinese Proprietary Medicines

Feilike Mixture + Chimonanthus nitens Oliv. Leaf Granules + Xiyanping Injection + Xiao'er Chaigui Tuire

Granules

Chuanwang Xiaoyan Capsules + Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules +

Suhuang Cough-relieving Capsules

Jinhua Qinggan Granules + Lan Qin Oral Liquid + Chimonanthus nitens Oliv. Leaf Granules + Suhuang

Cough-relieving Capsules

Kanggan Oral Liquid + Pudilan Anti-inflammatory Oral Liquid + Xiyanping Injection + Xiao'er Chaigui

Tuire Granules

2.3.3 Analysis of Improper Prescriptions

Among the 1939 prescriptions analyzed, there were

44 improper prescriptions, and the prescription failure

rate was 2.27%. The main problems of the improper

prescriptions were inadequate syndrome

differentiation (71.11%) and contraindications of

medications (22.22%), followed by repeated

medication and medication exceeding a normal

course. These reviewed prescriptions had a relatively

high pass rate, and there were no improper

prescriptions with problems such as inappropriate

indications and inappropriate dosages, which may be

related to the automatic interception of improper

prescriptions by our prescription review system in the

early stage.

Table 5: Distribution of the number of improper prescriptions.

Distribution of the number of improper prescriptions

Type

Number of

prescriptions

Percentage of the number of

improper prescriptions /%

Percentage of the number of all

prescriptions /%

Inadequate syndrome

differentiation

32 71.11% 1.65%

Contraindications of

medications

10 22.22% 0.52%

Medication exceeding

a normal course

1 2.22% 0.05%

Repeated use of

medications

1 2.22% 0.05%

Total 44 97.78% 2.27%

ICBB 2022 - International Conference on Biotechnology and Biomedicine

3 DISCUSSION

3.1 Medication Use in Special

Populations

Since the physiological systems of children are not

fully developed and their pharmacodynamics and

pharmacokinetic characteristics are significantly

different from those of adults, they cannot be simply

considered a reduced version of adults (Jing, 2016).

In our hospital, 5.52% of the populations with acute

URTI are infants and children under one year of age,

and 37.34% are children aged 1-6 years. In contrast,

the single doses of Kanggan Oral Liquid (20.32%),

Chimonanthus nitens Oliv. Leaf Granules (14.78%),

and Lan Qin Oral Liquid (14.09%), which account for

the top three medications used, are not suitable for

children, who often require a half or 1/3 of a single

dose. Inaccurate dosing can easily lead to overdose or

underdose. Only very few of the 30 Chinese

proprietary medicines in use contained

recommendations for dosing for children. In terms of

the completeness of the instructions, all Chinese

proprietary medicines either lack the recommended

dosage for children or contraindications, and it is

difficult to see a complete and clear record of adverse

reactions.

3.2 Inadequate Syndrome

Differentiation

According to the TCM theory, there are three main

types of URTI: colds with the wind-cold syndrome,

wind-heat syndrome, and summer-dampness

syndrome. The treatment of cold with the wind-cold

syndrome is removing the wind-cold and application

of pungency and warmth to relieve the symptoms.

The treatment of cold with the wind-heat syndrome is

removing wind-heat and application of pungency and

cool to relieve the symptoms. The treatment of

summer-dampness evidence relieves the symptoms,

resolves dampness, regulates qi-flow, and harmonizes

the middle Jiao (Fang, 2019). For example, Kanggan

Oral Liquid is suitable for clearing heat and

detoxifying toxins for wind-heat colds. It is used for

fever, headache, nasal congestion, sneezing, sore

throat, general weakness, and aches and pains caused

by external wind heat. But it is not suitable for people

with wind-cold colds, which are characterized by

heavy chill, light fever, no sweating, headache, nasal

congestion, runny nose, itchy throat, and cough.

Xiao'er Chaigui Tuire Granules are suitable for wind-

cold colds by relieving the symptoms, improving

sweating, and clearing the heat. It is used for children

with external fever, with the following symptoms:

fever, head and body pain, runny nose, thirst, red

throat, yellow urine, dry stool, etc. It cannot be used

in patients running a high fever with wind-heat colds

(Rong, 2017). In this prescription analysis, seven

cases of patients who were prescribed a combination

of two Chinese proprietary medicines took Kanggan

Oral Liquid and Xiao'er Chaigui Tuire Granules

simultaneously, and some patients who were

prescribed a combination of four Chinese proprietary

medicines took Kanggan Oral Liquid, Pudilan Anti-

inflammatory Oral Liquid, Xiyanping Injection, and

Xiao'er Chaigui Tuire Granules simultaneously.

3.3 Contraindications of the

Medications

Xiyanping Injection is contraindicated in infants and

children under the age of one year and should be used

with caution in children aged 1-2 years (Wang, 2019).

During the review, we found that there were still five

cases of 1-year-old patients and five cases of 2-year-

old patients using Xiyanping Injection in our hospital.

3.4 Medication Exceeding a Normal

Course

The recommended medication for pediatric URTI

characterized mainly by fever, aching in limbs,

headache, and sore throat, is Lianhua Qingwen

Capsules. The dosage is one capsule at a time for 3-5

years old children, two capsules at a time for 6-10

years old children, and four capsules at a time for

children older than 11 years old, three times a day.

Administration for three days can relieve the above

symptoms and shorten the time before the abatement

of fever (Chinese Journal of Integrative Medicine,

2021). In this review, we found a case in which four

boxes of Lianhua Qingwen capsules were prescribed,

and the duration of medication was up to eight days

at the maximum dose, which obviously exceeded the

normal course of medication.

3.5 Route of Administration

One study showed that the incidence of adverse

reactions differed between different routes of

administration of Xiyanping Injection (1.49% for

intramuscular injection and 3.73% for intravenous

drip, P<0.05, which means the difference is

statistically significant) (Liu, 2016). Statistics

showed that more patients in our hospital were

administered Xiyanping by intravenous drip (29

Analysis of the Use of Chinese Proprietary Medicines in the Prescriptions of Acute Upper Respiratory Tract Infection in a Hospital from

January to June 2021

cases) than by intramuscular injection (18 cases), and

the rationality of this needs to be discussed.

3.6 Repeated Medication

Among the Chinese proprietary medicines for the

treatment of wind-heat colds, there was a high rate of

duplication in Scutellaria baicalensis Georgi,

Forsythia suspensa, Platycodon grandiflorus, and

Lonicera japonica Thunb. flowers, and the combined

medication may pose a risk of overdose for patients.

Some medications contain a toxic component, poppy

husk. Modern pharmacological and chemical studies

have shown that the main pharmacological

components of poppy husk herbs are alkaloids, such

as morphine, narcotine, codeine, papaverine, and

protopine, which have significant analgesic and anti-

cough effects (Nanjing University of Chinese

Medicine, 2006; Chinese Pharmacopoeia

Commission, 2010). Codeine has pharmacological

effects similar to morphine and is an addictive and

respiratory depressant. It is one of the ten low

addictive narcotic medications considered by the

United Nations. Thus, it needs to be considered in the

actual administration whether the patient is taking an

excessive amount of codeine when using Lung-

Clearing and Cough-Stopping Mixture, which

contains a certain amount of poppy husk, in

combination with Compound Codeine Platycodon

Tablets.

4 CONCLUSION

Chinese proprietary medicine has been widely used in

clinical due to its remarkable curative effect, small

toxic side effects and convenient administration. In

the outpatient prescriptions of acute URTI in our

hospital from January to June 2021, 85% of the

prescriptions used Chinese proprietary medicine, and

the qualified rate of prescriptions reached 97.73%.

The results showed that the use of Chinese

proprietary medicines in the prescriptions for treating

acute URTI was basically reasonable. Whereas the

problems of unreasonable prescriptions should be

paid attention to, and the training of TCM theory for

physicians should be strengthened. The prescription

analysis also found that the proportion of Chinese

proprietary medicines in children's use was large.

Therefore, attention should be paid to the use of

children's drugs. It is suggested that drug R&D

enterprises should develop doses suitable for children

and improve clinical trials.

ACKNOWLEDGMENTS

This work was supported by the College Students'

Innovative Entrepreneurial Training Plan Program of

Jiangxi Science and Technology Normal University

(No. 202115041113, No. 20201404119) and the

Innovation Special Fund Project of Graduate (No.

YC2021-X21).

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Analysis of the Use of Chinese Proprietary Medicines in the Prescriptions of Acute Upper Respiratory Tract Infection in a Hospital from

January to June 2021