Methodology for surveillance of antimicrobials use among out-patients in Delhi.

Background & objectives: Determining antibiotic use in the population is problematic in India, as there are no population level databases on prescriptions and over-the-counter sales. This study attempts to establish a methodology for surveillance of antibiotic use in the community. Methods: Antibiotic use was monitored in fi ve municipal wards of Delhi, from January-December 2004. Thirty co-operative retail pharmacies were enrolled in Inderpuri (7), Karol Bagh (3), Patel Nagar (5), Rajinder Nagar (6) and Rajouri Garden (9); data on antibiotic use were collected in two ways. Firstly, bulk purchase data were collected by recording the quantities of all antibiotics purchased by these pharmacies every month over one year. Secondly, 15-25 ‘exit interviews’ were conducted with patients leaving the enrolled pharmacies every month. Antibiotic use from bulk purchase data was measured as defi ned daily dose (DDD)/1000 population and from exit interview data as DDD/1000 patients visiting the pharmacy during data collection and also as per cent patients receiving an antibiotic. Results: Bulk purchase and exit interview data showed some similar patterns of antibiotic use with a growing peak in the consumption of most antibiotics classes in the months of February and March. Use of the fl uoroquinolone group (J01MA) was much higher than other antibiotic classes by both methods. Exit interviews revealed that 21 per cent of persons who visited the pharmacies bought antibiotics. Both measures of use from exiting patient interviews showed the same trend over time. Interpretation & conclusions: Both drug use methods can be used to measure antibiotic use in the private retail pharmacies and outpatient department of public facilities. Surveillance of antimicrobial drug use from private retail pharmacies in a municipal zone in Delhi indicated overuse of antimicrobial drugs, particularly fluoroquinolines.

Gastric acid study in patients operated on for perforated duodenal ulcer.

OBJECTIVES: To determine the acid secretory status of patients operated on for perforated duodenal ulcer, with or without prior history suggestive of acid-peptic disease. METHOD: Basal and peak acid output were measured in 48 patients with perforated duodenal ulcer who were treated by simple closure alone, 10 patients with uncomplicated chronic duodenal ulcer and 30 normal controls. Patients operated on for perforated duodenal ulcer were analyzed according to presence (or absence) and duration of prior history of acid-peptic disease. RESULTS: Peak acid output was similar in controls and patients with perforated duodenal ulcer with no prior symptoms. However, patients with prior symptoms had significantly higher peak acid output, similar to those with uncomplicated duodenal ulcer. CONCLUSION: Patients with perforated duodenal ulcer with no antecedent history of acid-peptic disease have normal gastric acid output. These patients may therefore have other etiological factors for their ulcers.