ABSTRACT
Background: Antimicrobials are the greatest discovery of the twentieth century. To limit the emergence and spread of resistance, antibiotic therapy should be adjusted according to the results of microbiological culture. Klebsiella isolates causes various types of infections and the incidence of antibiotic resistance is also high in Klebsiella infections. So, Authors plan this study to analyze how the results of microbiological cultures influence the antibiotic use in the treatment of Klebsiella infections.Methods: It is a record based observational prospective study which assessed the impact of Klebsiella positive culture results on antibiotic prescribing pattern and its impact on clinical outcome. Patients with empirical antibiotic therapy and Klebsiella positive were included and patients with inadequate data were excluded in this study and the data were recorded. Recorded data were entered and analyzed in Microsoft Office Excel-2013. Unpaired student t-test was used to compare the mean duration of hospital stay using Past software (version 3.20).Results: There were total 400 patients in our study. Amikacin was the most common drug (n=202) used as empirical therapy. Empirical antibiotic therapy was changed in 161(40.25%) patients. Meropenem was the most commonly used definitive drug. Mean duration of hospital stay is less in empirical sensitive antibiotic therapy as compared to empirical resistance antibiotic therapy having p value <0.0001 which shows significant difference between two groups showing better clinical outcome.Conclusion: Initial empirical therapy with broad-spectrum antimicrobials is a treatment strategy for severe Klebsiella infections.
ABSTRACT
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, potentially life-threatening acute adverse drug reaction (ADR), typically characterized by a long latency period (2-6 weeks to 3 months) from drug exposure. DRESS syndrome is defined by the presence of fever, cutaneous eruption, lymphadenopathy, systemic or asymptomatic internal organ involvement (e.g. Hepatitis, carditis, interstitial nephritis, interstitial pneumonitis, etc.) and haematological abnormalities, mainly leucocytosis, eosinophilia and sometimes atypical lymphocytosis. There are around 50 culprit drugs which cause DRESS syndrome e.g. carbamazepine, phenytoin, allopurinol, sulfa derivatives, antidepressants, antiepileptics, non-steroidal anti-inflammatory drugs and antimicrobials. The incidence of DRESS syndrome has been estimated to be between 1 in 1,000 and 1 in 10,000 drug exposures. There are many reported cases of DRESS syndrome due to carbamazepine, phenytoin, vancomycin, levitiracitam, ceftriaxone etc. Author presented a case of DRESS syndrome by carbamazepin. RegiSCAR and Japanese consensus group have developed specific criteria for making the diagnosis of DRESS syndrome. The patient described here met the majority of criteria according to RegiSCAR scoring guidelines for a diagnosis of DRESS syndrome induced by carbamazepine. As per RegiSCAR diagnostic criteria author had concluded that this was a “Definite” case of DRESS (Drug Reaction with Eosinophilia and Systemic Symptom) syndrome induced by carbamazepine. Carbamazepine is most common broad-spectrum antiepileptic drugs so, this case report will raises awareness among physician to suspect DRESS syndrome in patients who present unusual complaints and skin findings after starting antiepileptic drugs.
ABSTRACT
OBJECTIVE: Objective of this study was to determine the level of knowledge about tuberculosis among patients registered in district tuberculosis center, Bhavnagar. METHODS: A community based cross-sectional study was carried out among New Pulmonary Tuberculosis patients registered in District Tuberculosis Centre, Bhavnagar during 1st January, 2009 to 30th April, 2009. Data collection was carried out between 1/05/2009 to 30/06/09 at 144 patients’ house with help of pre-tested structured questionnaire which comprised of socio-demographic variables and variables to assess the knowledge about tuberculosis. RESULTS: In our study, majority of the patients were male (70.1%) with the most commonly involved age group of 21 to 30 years (30.6%). Nearly one-third (31.9%) of the respondents were illiterate and 44% had received primary education. Only 6.9% of study subjects had correct knowledge about the cause of the disease. Knowledge regarding major symptoms was found in only 47% & knowledge about mode of transmission was found in only 30.6% of respondents. Majority of the respondents (97.2%) have a correct knowledge about the duration of treatment of Tuberculosis. CONCLUSION: In this study, majority of study subjects had poor knowledge about cause of tuberculosis, its mode of transmission & major symptoms while knowledge regarding the duration of treatment was found better among most of the respondents. Proper knowledge and education about tuberculosis is vital to cope the challenge of this devastating disease. DTC, being the main center providing treatment, can play a critical role to raise knowledge among the patients about tuberculosis & its prevention.