ABSTRACT
Background: Rational antimicrobial therapy means that the patients receive medications appropriate to their clinical needs, in needs, in doses that meet their own individual requirements for an adequate period of time and at the lowest cost they and the community can afford. Aim and Objective: The present study was aimed at assessing antibiotic prescribing pattern in eight clinical departments of Government Doon Hospital and to assess their rational use according to the indication, dose, duration, frequency, route of administration, any drug interactions, and contraindications (suitability). Materials and Methods: It was a cross-sectional observational study carried out in the Government Doon Hospital for a period of 3 months. Total 280 prescriptions, at least 20–30 each from eight clinical departments from OPD and IPD (Medicine, surgery, gynecs, orthopedics, ENT, ophthalmology, dermatology, and dentistry), were included in the study. Results: In our study, out of total 1202 drugs prescribed to 280 patients, 493 antibiotics were prescribed. The most commonly prescribed antibiotics were b lactams (39.75) followed by nitro imidazoles (22.9%), azoles (8.11%), and aminoglycosides (7%). The type of the treatment used is empirical in 28.5% cases, prophylactic in 5% cases, and definitive therapy in 66.42 % cases. In fixed dose combinations, total FDCs prescribed were 26. The most commonly used FDCs were amoxiclav and Piptaz. The most frequently prescribed antibiotics were ceftriaxone, amikacin, and metronidazole. The majority of the diseases in which antibiotics were prescribed were alcoholic liver disease, liver abscess, burns, tinea corporis, vaginitis and pain in lower abdomen, and tuberculosis. The number of rational prescriptions in our study is 68.28% according to the indication, dose, duration, frequency, and route of administration in accordance with standard treatment guidelines. The number of irrational prescriptions is 31.72% in terms of inappropriate antibiotic (13.48%), treatment without indication (25.84%), long duration of dosing (40.44%), and inappropriate frequency (17.97%). The prescribing from hospital formulary was 71% while the prescribing from national essential drug list was 65.5% which is still less compared to the WHO guidelines. Conclusion: The irrational prescribing by use of duplicate antibiotics of the same class, using inappropriate antibiotics, using the antibiotic for prolonged periods and incorrect frequency, should be discouraged. The irrational use causes harm to the patient, dissatisfaction, and prolongs hospital stay. The injectables should be given only in case of emergency or systemic infections, reducing the cost, and inconvenience. Rational fixed dose combinations improve compliance, produce synergism and reduce the severity of adverse effects, and prevent emergence of resistance. De-escalation practice, dose optimization, and drug modification/change should be practiced to shorten hospital stay and improve the outcome.
ABSTRACT
Alkaline phosphatase have been demonstrated histochemically in the cytoplasm of neutrophils. Altered LAP activity has been observed in a number of conditions. Increased values are found in various inflammatory lesions where as in different malignancies LAP falls. Our study was aimed to see the alteration in LAP activity in case of squamous cell carcinoma. The study was carried out in peripheral blood smears of 185 cases (110 cases of squamous cell carcinoma and 75 of normal persons). After histochemical staining, LAP scoring was done. LAP score in Squamous cell carcinoma (mean +/- SD = 57.41 +/- 16.9). No significant difference in LAP score was found according to the site and grade of carcinoma, and in relation to metastasis. 43 cases were followed up after variable periods of treatment. LAP score was found to be significantly raised following treatment, (mean +/- SD = 21.14 +/- 5.94, p < 0.001). It is concluded that LAP scoring might be used as a cheap and simple technique to diagnose occult malignancies and to assess the response to therapy.