ABSTRACT
Background: Kolkata, one of the major metropolitan cities of India, is also the capital of the state West Bengal, contributes largest number of malaria cases reported from West Bengal. The present study was undertaken to assess the anti-malarial prescribing pattern in a tertiary care teaching hospital in Kolkata.Methods: This was an observational, prospective, cross-sectional study for a period of one year (from March 2017 to February 2018) in which prescriptions of diagnosed pediatric and adult malaria patients were scanned and reviewed for anti-malarial use pattern. Core drug use indicators were also analyzed to assess the rational prescribing pattern.Results: During one-year study period, 122 adult and 24 child malaria patient encounters were screened. Among adult patients, 48(39.3%) patients had P. falciparum and 74(60.7%) patients had P. vivax malaria; in children, 9(37.5%) patients had P. falciparum and 15(62.5%) patients had P. vivax malaria. All adult and pediatric P. vivax malaria patients were treated with chloroquine. Artemisinin derivatives were prescribed to 91.67% of adult and 88.88% of pediatric falciparum malaria patients, 77.09% of adults and 66.67% of children received ACT. Artemether- lumefantrine was the most commonly prescribed ACT (33.34% in adults and 55.56% in children). Prescriptions were usually in generic name and from National EDL. Percentage of encounters with antibiotics was high in both age group but percentage of encounters with injections was low in adults and children. Conclusion: Chloroquine was used rationally for treatment of P. vivax malaria patients. Artemether-lumefantrine was the most common ACT used for treatment of P.falciparum malaria cases though the National guideline for treatment of malaria does not recommend Artemether-lumefantrine for this state and region for treatment of falciprum cases.
ABSTRACT
Rheumatoid arthritis (RA) is an autoimmune disease affecting about 1% of people, with the highest incidence between 40 and 70 years. Methotrexate is a folic acid antagonist that has good efficacy and safety in the treatment of RA. Methotrexate (MTX) and non-steroidal anti-inflammatory drugs are often concomitantly administered in clinical practice for the treatment of RA. In this case report 46 year old male patient, a known case of rheumatoid arthritis was admitted with history of knee joint pain and swelling. Methotrexate was initially started in a dose of 7.5 mg per week, dose was then increased to 15 mg per week. Six weeks later, the patient complained of oral ulcerations, erythematous, itchy and edematous rash on all four limbs and trunk. The patient was re-evaluated and was diagnosed with Stevens-Johnson syndrome. All the previous medications were stopped. The patient was treated with steroids, prophylactic antibiotics and antifungal drugs. The lesions started to heal after 5 days of hospitalization. Thus the treatment of Rheumatoid arthritis with methotrexate should be carefully considered due to its increased toxicity and risk of severe skin reactions.