ABSTRACT
Introduction: Acute coronary syndrome (ACS) is an emerging epidemic in our country and is adding economic burden to theexisting health-care system. Long duration prescriptions and cost of drugs are making treatment a luxury. This study aims toanalyze the cost-effectiveness of the prescription pattern in post-angioplasty ACS patients treated in the intensive care unit(ICU) at a tertiary care hospital.Purpose: The purpose of the study was to carry out the cost analysis to study the economic burden of prescriptions for thetreatment of ACS after angioplasty.Materials and Methods: A cross-sectional observational study was performed on prescriptions of 600 patients of ACS treatedwith angioplasty at cardiac ICUs at J. J. Hospital Mumbai from September to October 2018 and analysis was carried out tofind out cost-effectiveness.Results: Maximum incidence was found in the 7th decade (31%) followed by the 6th decade (30.5%). 74.5% were males. A totalof 5972 drugs were analyzed which also included drugs incorporated in drug-eluting stents. An average number of drugsprescribed per prescription was 9.95 (minimum 9 and maximum 17). Nearly 56.29% of total drugs were exclusively prescribedfor ACS and 41.27% drugs were used as supportive treatment. Only 15.75% of total drugs were prescribed by generic name.Only 1/3rd of the prescribed drugs were available in hospital pharmacy. Cost analysis revealed the cost per prescription being4,422.58 Indian National Rupee (INR) of which 2,148.62 INR was borne by the patient.Conclusion: Most drugs are not prescribed by generic names and thus are unavailable in hospital pharmacy which increasesthe treatment cost. Studying the prescription pattern and making appropriate amendments in treatment policies will reduce thefinancial burden and lead to better health care.
ABSTRACT
Background: Urinary tract infection (UTI) is one of the most common bacterial infections encountered and treated worldwide. The objective was to determine the incidence, culture-sensitivity status, prescription pattern of antibiotics and response to various antibiotics and other therapeutic considerations in patients of complicated UTI (cUTI). Methods: The observational prospective analytical study conducted in Department of Nephrology, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai. Results: A total percentage of patients having UTI was 13.08%. Of these 200 patients, 119 patients were female (60%) and 81 patients were male (41 %). Among male, the prevalence was seen more in geriatric age group and among female in adult group. Symptomatologically, fever was the most common symptom. Among male, diabetes mellitus was most commonly associated with cUTI whereas recurrent UTI were more common among female. Of the 200 patients, culture sensitivity was done in 133 patients. Escherichia coli was found to be the most common organism. Quinolones were the most commonly prescribed first line drug followed by beta-lactamase inhibitors. Combinations such as cefoperazone + linezolid were the most commonly prescribed second-line drug, followed by combination of ceftriaxone or cefoperazone with metronidazole. Paracetamol was the most common non antibiotic support given. Conclusions: The results of this study may not be representative of the general population; but UTIs are often treated empirically, and susceptibility tests are often carried out only when the patient has failed one or more courses of antibiotics.
ABSTRACT
Drug-induced nephrotoxicity is an extremely common condition and is responsible for a variety of pathological effects on the kidneys. Drug-induced acute renal failure (ARF) accounted for 20% of all ARF cases. Drugs showed to cause nephrotoxicity exert their toxic effects by one or more common pathogenic mechanisms. Although it is impossible to present all the drugs causing the nephrotoxicity, this article will summarize the mechanism of injury associated with particular common medications, discuss clinical presentations, renal markers, and evaluate strategies that prevent or minimize renal injury. Drug-induced nephrotoxicity tends to be more common among certain patients and in specific clinical situations. Therefore, successful prevention requires knowledge of pathogenic mechanisms of renal injury, patient-related risk factors, drug-related risk factors, and preemptive measures, coupled with vigilance and early intervention. General preventive measures include using alternative nonnephrotoxic drugs whenever possible; correcting risk factors, if possible; assessing baseline renal function before initiation of therapy, followed by adjusting the dosage; monitoring renal function and vital signs during therapy, and avoiding nephrotoxic drug combinations. Surprisingly, little information is available to guide us with respect to avoiding complications in critical illness; therefore, it is necessary to follow the guidelines.