ABSTRACT
Background: In the branch of ophthalmology, there have been many developments of new ocular therapeutic agents. Indiscriminate use of topical drugs can lead to various unwanted effects. In order to improve drugs therapeutic efficacy, minimize adverse effects, and delay development of resistance, drug utilization trends and patterns need to be evaluated periodically. The objective of the study was to evaluate drug utilization pattern, appropriateness of use and rationality in indoor patients attending ophthalmology department.Methods: A prospective, observational study was conducted over a period of 15 months in the Ophthalmology Department of Tertiary care teaching Hospital after obtaining permission from IEC. Information of patients collected included age, sex, duration of stay, diagnosis, income per capita per month, information about drugs given- their dose, frequency, route and duration were recorded from the day of admission till discharge.Results: A total of 150 patients were enrolled in the study with M:F was 1.43:1. Mean hospitalization was 3.00±1.17 days. Most common disease were cataract (108, 72%) followed by pterygium (15, 10%). Mean of 16.35±4.25 medicines were prescribed. On most occasions (2274, 92.70%) the medicines were prescribed using brand names. Injection gentamicin 147 (98%) and flurbiprofen eye drops 145 (96.67%) were the most common drugs used. Majority (83.20%) of medicines were rational. Out of 125 medicines, 35 (28%) were FDC and 90 (72%) were single ingredient. All 100% medicine uses were appropriate with respect to dosage form, route of administration, dosage, frequency of administration and duration of therapy.Conclusions: Polypharmacy is common practice in eye department which increases inappropriateness and irrational use.
ABSTRACT
Fluoroquinolones are generally regarded as safe antimicrobial agents with relatively few adverse effects or drug interactions. Because of their recognized safety profile and potent in vitro activity, fluoroquinolones have been widely used for the treatment of community- and hospital-acquired infections. Although uncommon, both hypoglycaemia and hyperglycaemia (dysglycaemia) appear to occur with all the fluoroquinolones. It is usually reported in conjunction with impaired creatinine clearance and elderly diabetics receiving concomitant treatment with antidiabetic agents (especially sulfonylureas) or insulin. The exact mechanism of this effect is unknown but is postulated to be a result of blockage of adenosine 5'-triphosphate-sensitive potassium channels in pancreatic cell membranes. Here we report a case of hypoglycaemia in a hospitalized non-diabetic elderly patient in whom this life-threatening adverse effect was related in a temporal fashion to the administration of intravenous levofloxacin meant to cover pulmonary infection in a setting of subacute small bowel obstruction and septicaemia. This case emphasizes the occurrence of profound and prolonged hypoglycaemia consequent upon levofloxacin use, an adverse reaction that has been described with almost all members of the quinolone family of antibiotics. Taking into consideration the frequency of fluoroquinolones use in the hospital and ambulatory setting, clinicians should be cognizant of this potential adverse effect in non-diabetic patients treated with levofloxacin, and they should look out for symptoms of hypoglycaemia and monitor blood glucose levels more frequently, especially early in the course of therapy.
ABSTRACT
Toxic Epidermal necrolysis (TEN) is a rare, life threatening dermatological disorder that is usually induced by medications. Anti-convulsants such as phenytoin, carbamazepine and phenobarbital have been enlisted as high risk drugs for causing TEN. A 25 year old man, a known case of epilepsy, who consumed inadvertently escalated daily dose of 600 mg/day of phenytoin for 10 days, developed TEN which involving more than 30% of body surface area with mucosal involvement. Rigorous treatment of 18 days using systemic and topical antibiotics along with glucocorticoids helped in complete recovery of the patient. Causality analysis of this Adverse Drug Reactions (ADR) showed a probable association on both World Health Organisation (WHO) – Uppsala Monitoring Centre (UMC) scale and Naranjo’s probability scale and Severity scale of 5 on Modified Hartwig and Siegel scale. Medication error is an important cause of such life threatening reactions which requires concern of all health care professionals.
ABSTRACT
Background: Cough and common cold are one of the commonest morbidities in the community. Cough and cold medicines are abound in Indian market despite the fact that majority of them lack scientific evidence of their use in this common condition. Aims & Objective: To analyze the prescribing pattern of ‘cough and cold’ medicines in Central Gujarat. Material and Methods: An observational, cross-sectional, questionnaire- based study was carried out to assess the prescribing pattern of doctors with regard to cough and cold. A total of 100 prescribers with a graduate degree (n=50) or a post-graduate degree (n=50) from Central Gujarat were selected randomly. After interviewing all doctors, data were analyzed to find the percentage of patients prescribed ‘cough & cold medicines’, their types of dosage form, use of FDCs, indications, any adverse events encountered and non-pharmacological measures advocated. Results: Prescribing FDCs for cough and cold was significantly higher (92% vs 72%, P<0.05) in post graduate prescribers attached to private hospitals than in graduate prescribers attached to government/teaching hospitals. Usage of solid dosage forms was significantly higher (p<0.05) in prescribers attached to government or teaching hospitals as compared to prescribers attached to private hospitals (84% vs 60%). About 18% of graduate and 25% of post graduate prescribers gave cough and cold medicines at patients’ behest. Only 15% prescribers prescribed cough and cold medicines for dry cough while antihistamines were advocated by 96% of prescribers. About 50% of the physicians prescribed these medicines for conditions like upper and lower respiratory tract infections. Non pharmacological measures were recommended by 75% prescribers. Conclusion: Efforts are needed to create awareness amongst prescribers about the rational use of cough & cold medicines and also pay attention to ADR caused by them. Reforms in medical education and CME are recommended.