Prescribing Trends and Rationality Analysis of Fixed-Dose Combinations: A Cross-Sectional Study in Bangladesh

Background: Fixed-dose combinations (FDCs) are increasingly used in clinical practice to enhance therapeutic efficacy, reduce pill burden, and improve patient adherence. However, irrational prescribing of FDCs remains a significant concern, particularly in low- and middle-income countries such as Bangladesh, where regulatory oversight may be limited. Irrational FDCs can increase adverse drug reactions, financial burden, and contribute to antimicrobial resistance.
Objective: This study aimed to evaluate the prescribing trends and assess the rationality of FDCs in a tertiary care hospital in Bangladesh.
Methods: A cross-sectional observational study was conducted at the Department of Pharmacology, Community Based Medical College Hospital, Bangladesh, over a period of January to December 2025,including 89 randomly collected prescriptions from outpatient departments. Data on patient demographics, diagnosis, and prescribed FDCs were recorded using a structured form. Each FDC was classified as rational or irrational based on standard treatment guidelines, pharmacological compatibility, and recommendations from the WHO and the Bangladesh National Essential Medicines List. Data were analyzed using SPSS version 25, with descriptive statistics (frequency and percentage) and Chi-square tests to assess associations between diagnosis, demographics, and rationality. A p-value <0.05 was considered statistically significant.
Results: Among the 89 prescriptions, 61 (68.5%) contained at least one FDC. Of these, 34 (55.7%) were rational, while 27 (44.3%) were irrational. Amoxicillin + Clavulanic acid was the most frequently prescribed rational combination, and Ciprofloxacin + Tinidazole was the most common irrational combination. Chi-square analysis revealed a significant association between diagnosis and rationality (χ² = 9.82, df = 3, p = 0.02), indicating higher rational FDC prescribing for infectious conditions compared to gastrointestinal or pain-related conditions.
Conclusion: While rational FDC prescribing is observed, a substantial proportion of prescriptions remain irrational, underscoring the need for stronger guideline enforcement, prescriber education, and awareness programs to promote safe and effective pharmacotherapy.