Anaphylactic Reaction Following Injection Cefotaxime Sodium

This is a case study of anaphylactic reaction to cefotaxime sodium in a 23-year-old female who underwent a lower segment cesarean section under spinal anesthesia. Cefotaxime sodium, an antibiotic belonging to the class of cephalosporins, was administered intravenously postoperatively for prevention of infection. The patient complained of breathlessness, swelling around both eyes, and pruritus and urticarial rash over her abdomen, legs, and forehead. The case was successfully managed by withholding the medication and treatment of symptoms. According to the WHO-Uppsala Monitoring Centre causality assessment scale, a probable causal relationship between the suspected drug (cefotaxime sodium) and anaphylactic reaction was made. The severity was found to be moderate (Level 3). Although cefotaxime has well established place in surgical prophylaxis, this case study emphasizes on constant observation and meticulous follow-up of patients receiving it in clinical practice as there is possibility of an adverse drug reaction (ADR) which can be life-threatening. Such happenings can add to challenges faced by the treating physician in the present COVID-19 era. Recognizing ADR helps reduce morbidity and mortality. Reporting ADR helps in documentation and education of healthcare professionals.

Angioedema caused by over the counter use of dicyclomine hydrochloride and paracetamol fixed dose combination in a child: a case report

Authors describe a case of angioedema in a male child due to over-the-counter (OTC) use of fixed dose combination (FDC) of Tab. dicyclomine hydrochloride (20mg) and paracetamol (500mg) for abdominal pain. Use of OTC drugs in children without a doctor抯 suggestion can lead to unnecessary medication use and is not free of risks. Here, there is a probable causal relationship between the suspected drug and angioedema according to WHO-UMC criteria for Causality Assessment. This case was also reported to the Pharmacovigilance Programme of India (PvPI) through PvPI ADR android application.

Comparison of efficacy, safety and cost-effectiveness of clotrimazole 1% cream and sertaconazole 2% cream in patients suffering from of mild to moderate tinea corporis, attending tertiary care hospital out-patient department: a randomized, open-labeled, comparative, parallel group trial.

Background: Tinea corporis is a common dermatophytic infection of the body involving keratin layer of skin. This lesion presents as an annular plaque with an advancing border along with central clearing. Clotrimazole is topical, conventional imidazole antifungal drug and has given good efficacy in tinea corporis. Sertaconazole is new topical imidazole antifungal claimed to be superior to old topical imidazoles in tinea corporis. The aim of this study was to compare efficacy, safety and cost effectiveness of topical antifungals, clotrimazole 1% cream and sertaconazole 2% cream in patients suffering from mild to moderate tinea corporis attending out-patient department of tertiary care hospital in Vidarbha region of Maharashtra. Methods: This was a prospective, comparative, randomized trial with 2 parallel treatment arms of 4 weeks duration. Patients were diagnosed on the basis of clinical evaluation and microscopic findings of KOH mount. Hundred patients were randomly assigned into two groups of clotrimazole 1% cream, and sertaconazole 2% cream with 50 patients in each group. Evaluation was carried out at baseline, 1st week, 2nd week and 4th week for efficacy parameters viz. itching, erythema and scaling, physician’s global assessment (PGA), safety and cost effectiveness. Results: Topical sertaconazole 2% cream was highly efficacious and superior to clotrimazole 1% cream in improvement of clinical parameters, PGA and mycological cure at the end of the treatment phase. At end of the follow-up phase both the trial drugs were effective with no recurrence or relapse of tinea corporis. However, clotrimazole 1% cream was safe and cheaper. Conclusions: Topical clotrimazole 1% cream and sertaconazole 2% were effective and well tolerated in patients of tinea corporis. Effectiveness of sertaconazole was early and superior with tolerable side-effects. However, clotrimazole was costeffective.

Impact of media: self-medication and the rising problem of antimicrobial resistance.

Antimicrobial agents (AMAs) are one of the most commonly used as well as misused drugs. Antimicrobial resistance is an important growing global health issue which needs urgent addressal. Self-medication involves the use of medicinal products by the patient to treat self-recognized disorders, symptoms, recurrent diseases, or minor health problems. Medicines for self-medication are often called over the counter (OTC) drugs, which are available without a doctor’s prescription through pharmacies, mostly in the developing countries. Self-medication particularly with antibiotics has been widely reported, leading the World Health Organization to call attention to its dangers as a cause of antimicrobial resistance.

Evaluation of anti-depressant effect of lemon grass (Cymbopogon citratus) in albino mice.

Background: Depression is a common serious psychiatric disorder and the available anti-depressant treatments are associated with many unwanted side-effects. Thus, various herbal products have been tried. The advantages of herbal treatments would include its complementary nature to the conventional treatment, thus making the latter a safer and cheaper option for depressive disorders. The objective of the present study was to evaluate the anti-depressant activity of lemon grass (Cymbopogon citratus) in albino mice and compare it with Imipramine. Methods: A total of 60 Swiss albino mice weighing around 20-40 g of either sex were divided into 10 groups (n=6). They were orally administered with tween 80, as a control, 20 mg/kg imipramine (standard), 5 mg/kg and 10 mg/kg C. citratus (test drugs), and combination of imipramine (10 mg/kg) and C. citratus (10 mg/kg). Duration of immobility was observed for last 4 mins of total 6 mins period in groups 1-5 for forced swimming test (porsolt test) and groups 6-10 for tail suspension test each on 1st, 8th and 15th day and recorded as mean±standard error of the mean. Results were analyzed by one-way analysis of variance, followed by Tukey’s post-hoc test. Results: Lemon grass at the above doses significantly reduced the immobility time in both the tests compared with the control (<0.05). The reduction in the duration of immobility at the dose of 10 mg/kg was comparable to imipramine. Conclusions: The essential oil of lemon grass (C. citratus) has significant anti-depressant activity comparable to imipramine.

The irrational fixed dose combinations in the Indian drug market: an evaluation of prescribing pattern using WHO guidelines.

Background: Evaluation of the pattern of fixed dose combinations (FDCs) prescribing amongst the practitioners in a tertiary care hospital in Central India. Methods: Nine hundred and ninety four prescriptions, containing 639 FDCs were scrutinized in the tertiary care hospital. After excluding the total and the interdepartmental repetitions, the numbers of FDCs were 278, which were considered for final analysis. Inclusion criteria were FDCs from the major out-patient department (OPD) of the tertiary care hospital from January 2011 to December 2011. FDCs from the wards, casualty, infectious disease unit, intensive cardiac care unit (ICCU), tuberculosis and chest and HIV unit were excluded from the study. FDCs were analysed for the different pattern of prescribing and rationalism. Results were expressed as percentages. Results: Out of 639 FDCs, the most commonly prescribed FDCs were B complex (12.20%), pantoprazole plus domperidone (9.55%) and amoxicillin plus clavulanic acid (7.35%). Seventy percent of the FDCs were prescribed to the age group of 21-60 years. The FDCs were maximum from the department of medicine (25.59%), followed by surgery (15.47%) and ENT 13.69%. Out of 278 FDCs, only 5.4% were rational, and rest of the FDCs were irrational. Ninety five percent of all FDCs were brand names. The physicians were unaware of the active pharmacological ingredients (APIs) of 20.86% FDCs. Ninety two percent FDCs were available as over the counter (OTCs). Forty eight percent FDCs were costing from Rs. 0-50. There were 2.87% FDCs whose price was above Rs. 500. Conclusions: Irrational FDCs are prescribed by all the departments. Physicians were ignorant about the essential drugs and FDCs. Patients didn’t have access to rational medicines. Therefore, physicians and regulators should be alerted in time. Regulatory actions or government laws should be made mandatory. Availability and access to 348 essential medicines for basic health care should be the priority of the government. Implementation of central drug standard control organisations (CDSCO) guidelines on industries for manufacture of FDCs must be made compulsory.

Promoting the proper use of medicines in rural school children of India.

Background: The problem of irrational use of medicines is prevalent in rural India. For safe and proper use of medicines there is a need to understand the proper way of taking medicines. Teaching proper use of medicines is the most neglected domain of the school health curriculum. So this study targeted school going children in rural area of India as the earlier the intervention, the more firmly longer lasting health related behavior can be successfully inculcated. The objectives of the study were (1) To study base level knowledge about use of medicines and (2) To implement and see the effect of an intervention to increase medicine knowledge in the form of information, education and communication (IEC) in rural school children. Methods: This was an interventional, questionnaire based (quantitative) study in which an intervention in the form of lectures which was given to school children. Rural school going children in age group of13-15 years were selected from 3 different schools of rural areas of Nagpur district, India. 500 school children were included after obtaining permission from school authorities and informed consent from their parents. Pretesting done by administering a questionnaire containing 20 questions to assess children's base level knowledge about medicine use. The same questionnaire was repeated on 16th and 45th day of intervention i.e. daily lectures of 25-30 minutes for 15 days on proper use of medicines, to judge the improvement. Results: It was observed that the interventions brought about a positive change in the knowledge of the students as well as increased awareness about proper use of medicines. Conclusions: This study showed that properly timed and meticulously implemented intervention can bring about a positive change in the attitude and knowledge of school children.

Anti-hyperalgesic effect of paracetamol in rat model of thermal hyperalgesia: implications for the treatment of neuropathic pain.

Background: Neuropathic pain conditions are prevalent in general population and difficult to treat. Most currently available therapies do not provide adequate benefit in all treated patients. Though Paracetamol is available for more than 100 years and have huge safety data, it is still not included in any treatment guidelines for neuropathic pain, as very few studies have evaluated its effects in neuropathic pain conditions. The aim of this study was to evaluate antihyperalgesic activity of paracetamol and to compare it with antihyperalgesic effect of amitriptyline and gabapentin in rat model of thermal hyperalgesia. Methods: Male albino wistar rats weighing 200-250 g of body weight and 4-6 months old were used. After anaesthetizing rats with 2% halothane, mild thermal injury was induced using hot plate analgesiometer. Drugs were administered intraperitoneally 30 minutes after thermal injury. Paw withdrawal latencies were measured at 30, 60, 90 and 120 minutes after drug administration. Statistical analysis done using GraphPad Prism version 5.01 and one way ANOVA followed by post hoc Dunnett's test or Tukey's test were used. Results: Paracetamol showed both dose as well as time dependent antihyperalgesic activity. Gabapentin demonstrated significantly more antihyperalgesic activity compared to amitriptyline (p< 0.05) and paracetamol (p< 0.01). Conclusions: Paracetamol showed antihyperalgesic activity however, it was less as compared to drugs like gabapentin and amitriptyline. Considering the excellent safety profile of paracetamol, it might be useful adjuvant drug for treatment of neuropathic pain conditions.