ABSTRACT
Background: Inappropriate antimicrobial use contributes to antimicrobial resistance. Assessing knowledge, perception and attitude regarding antimicrobial use serves as a prelude to design and implement educational modules to promote rational antimicrobial use.Methods: An online questionnaire based cross-sectional study involving 338 medical students; under-graduates, interns and post-graduates was conducted in a medical college in south India. Chi-square test or Fisher exact test were used to determine association between variables.Results: Fifty percent of the participants (170/338) responded to the questionnaire. The responses were similar across undergraduates, interns and post-graduates. Majority of the responders had good knowledge regarding use of antimicrobials. Most of the participants (92.35%) expressed that a broad-spectrum antimicrobial should be started to treat a serious infection while awaiting culture and sensitivity reports and 88.82% did not prefer to use antimicrobial agents for common cold. Similarly, most of the respondents (93.56%) were aware of the fact that antimicrobial resistance is a global problem. However, many of them (74.71%) were not aware of antimicrobial stewardship programme in their college.Conclusions: This study revealed that most of the students had good knowledge, fair perception and positive attitude regarding the use of, and resistance to antimicrobial agents but not about stewardship programmes. Proactive measures are required to sensitise medical students on antimicrobial stewardship programmes.
ABSTRACT
Background: Pregnancy is a physiological condition during which immune system is weakened. Therefore, most women are prone to develop infections during this period for which antimicrobials are prescribed. Drugs used during pregnancy may lead to teratogenicity. Therefore, this study was done with the following objectives: 1.to determine the type of infections encountered, 2.to assess the prescription profile of antimicrobials and 3.to assess FDA categories of antimicrobials used in pregnant women in a tertiary care center in Telangana, India.Methods: This was a prospective observational study conducted on pregnant women attending antenatal clinic (ANC) at Mediciti Institute of Medical Sciences (MIMS) from 1st January 2018 to 30th June 2018.Results: Out of a total of 165 cases enrolled, 57 (34.5%) cases were prescribed antimicrobials and 108 (65.5%) were treated symptomatically. The mean (SD) age of women who were prescribed antimicrobials was 22.9 (2.97) years. Of the conditions encountered, respiratory tract infections (RTIs) accounted for 31%, followed by urinary tract infections (UTIs) 26% and gastroenteritis 25%. Most prevalent infections which required antimicrobials prescription were UTIs (36.84%), followed by Gastroenteritis (17.54%). Majority of the antimicrobials prescribed were from Betalactams (40.34%), followed by Nitrofuranes (29.82%), Nitroimidazoles (17.54%) and Antifungals (8.77%). Antimicrobials prescription was more in the 3rd trimester (63.1%), followed by 2nd trimester (31.6%) and 1st trimester (5.3%). Majority of the antimicrobials were administered orally (75.44%), followed by injections (15.79%) and per vaginal route (8.77%). Antimicrobials were mostly prescribed from FDA Category B (96%).Conclusions: RTIs were the most common among the conditions encountered. However, UTIs were the leading cause for antimicrobial prescriptions. Antimicrobials prescription was more during 3rd trimester. Most antimicrobials prescribed were safe as they were from FDA Category B.
ABSTRACT
Background: To estimate the prevalence of vitamin B12 deficiency in a rural south Indian community and to evaluate the association between metformin use and prevalent vitamin B12 deficiency in people with T2DM stratified by oral vitamin B12 supplementation.Methods: Using a cross sectional study design, a random sample of people with T2DM (N=438) was recruited from a rural community. Vitamin B12 deficiency was defined as serum B12 ?200pg/ml. Data on metformin dose, duration of use, oral vitamin B12 supplementation, and diet were collected. Laboratory measurements included complete blood count, tests for hepatic, renal, and thyroid function, as well as serum vitamin B12 levels and HbA1c.Results: The prevalence of vitamin B12 deficiency in people with T2DM was 11.2% (95% Confidence Interval (CI) 8.2%-14.1%). The odds of vitamin B12 deficiency in patients receiving a metformin dose of 2 grams/day were 4 times higher compared to those receiving ?1 gram/day, after adjusting for oral B12 supplementation (odds ratio 4.2;95% CI 1.5-11.8). The odds of vitamin B12 deficiency in those taking metformin and receiving oral vitamin B12 supplementation were lower compared to those on metformin and not receiving vitamin B12 supplementation (adjusted odds ratio 0.20; 95% CI 0.06-0.70).Conclusions: Vitamin B12 deficiency affects 1 in 10 people with T2DM, is associated with higher dose metformin use, and oral vitamin B12 supplementation mitigates B12 deficiency in this group.