Prescribing pattern of antibiotics among postoperative patients admitted in gynaecology and obstetrics department of tertiary care hospital in Northern India

Background: The objective of the study was to study the prescribing pattern of the antibiotics in postoperative patients admitted in gynaecology and obstetrics.Methods: Current prospective observational study was conducted in the department of pharmacology, Government Medical College, Kathua in collaboration with department of gynaecology and obstetrics for a period of six months duration from 1st May 2019 to 31st October 2019. The case sheets of all post operated patients above eighteen years of age admitted were studied and analyzed.Results: Total of 1807 case sheets were analyzed and showed that 4245 antibiotics were prescribed with an average of 2.3 antibiotics prescribed. Oral cefuroxime (17.3%) was maximally prescribed in patients who delivered normal presentation with episiotomy and injection ceftriaxone along with tinidazole and gentamycin were prescribed (58.4%) where caesarean section was done. While injection ceftriaxone and sulbactum along with tinidazole and gentamycin (17.09%) was prescribed in patients who were operated for gynaecological diseases. Maximum (80%) of the antibiotics were prescribed under brand name.Conclusions: Cephalosporin’s are commonly prescribed antibiotic and in eighty percent brand names were prescribed. Results underscore that antibiotic in generic name should be encouraged.

Assessment of the knowledge, attitude and practice of self medication among second year undergraduate medical students in a tertiary care teaching hospital

Background: Inappropriate self-medication is a cause of concern as it can result in wasteful expenditure, prolonged suffering, drug dependence, resistance and increase in morbidity. Self medication assumes significance among medical students as they have knowledge about ailments and medicines. The aim of the study was to assess the knowledge, attitude and practice of self-medication among undergraduate medical students.Methods: The present study was conducted in December 2017 among second professional undergraduate medical students in the Department of Pharmacology and Therapeutics, GMC Jammu after obtaining approval from the Institutional Ethics Committee of GMC, Jammu. A total of 123 students who took self-medication during last six months were included and given a questionnaire that included open and close ended questions about self-medication. Data was analysed using Microsoft Excel and presented as number and percentages.Results: Total of 123 second professional undergraduate MBBS students were analysed. 72 (58.53%) were males and 51 (41.46%) were females. 96 (78%) students practised self-medication. Allopathic drugs were most commonly used for self medication (93.5%), followed by Ayurvedic drugs. Fever and headache were common ailments treated with self medication. Common class of drugs used for self medication were antipyretics (66.6%), antibiotics (42.2%). Adverse drug reactions were perceived as the most common disadvantage of self medication. Analysis of source of information revealed that old prescriptions (33%), internet (18%) were the main sources of information. Regarding prevention of self medication, many students perceived that enhancing awareness was the most effective solution (72.3%) followed by stoppage of supply of medicines without prescription(39.8%).Conclusions: Self medication is practised by a majority of students. As responsible self medication is now increasingly being considered as a component of self-care, there is need for review of educational programs especially teaching of rational and judicious use of medicines to the undergraduate medical students.

KAP on antibiotic usage and resistance among second professional medical students

Background: Antibiotics are wonder drugs as they prevent and treat bacterial infections. However, their irrational use even by wrong prescribing behaviour of physician leads to antibiotic resistance medical students are future doctors and are provided knowledge and practice of antibiotics in treatment, and prevention of diseases in their study curriculum of second professional course mainly in chapters of pharmacology and microbiology. Therefore, the present study was to determine the second-year medical students’ knowledge, attitude and perception regarding antimicrobial use and resistance.Methods: Study was conducted on second professional undergraduate medical students from Government Medical College, Jammu. 140 students participated, and informed consent was taken prior to study. A validated questionnaire comprised of 20 questions was provided to them and responses were recorded. Questionnaire was comprised of 20 questions (13 questions attributed to knowledge of antibiotics usage and resistance, six to attitude and one question regarding perception).Results: The students showed fair knowledge about antibiotics and resistance. Percentages of fully correct answers was between 63-100% regarding knowledge of antibiotics. The attitude results revealed that self-medication by the student was observed in 67%, while 70% agreed that they had left over antibiotics at home, but only 42% committed that they take these left over antibiotics. As far as practice was concerned the maximum students consult text books as source of knowledge regarding resistance followed by Wikipedia.Conclusions: The current study observed high score of knowledge than attitude in medical students regarding antibiotic usage and resistance and increasing influence of internet like Wikipedia. This underscores the need for more effort in updating the students regarding antibiotic usage and resistance and laying more emphasis in the core curriculum of their academics.

A questionnaire based study to evaluate the knowledge, attitude and perception towards pharmacovigilance among doctors in rural hospital, Jammu, India

Background: Monitoring and reporting of adverse drug reactions (ADRs) is very important to minimize or prevent drug caused harm. Thus, pharmacovigilance deals with it and ensures the patient safety. However, most of pharmacovigilance centers are concentrated in the urban tertiary care hospitals and contributes the maximum reports of ADRs. Participation of the rural health workers is equally important towards the success of pharmacovigilance.Methods: The study was conducted using a pre-validated questionnaire among forty doctors in rural Sub district hospital Akhnoor, Jammu after approval of the institutional ethical committee of Government Medical Jammu. The questionnaire consisted of 16 questions (7 related to knowledge, 4 related to attitude, and 4 related to practice and one question pertained to under reporting). The responses were recorded, and data obtained was analysed and presented as number and percentage.Results: Total 66.6% doctors gave correct response regarding the definition of pharmacovigilance and purpose of pharmacovigilance was given by 76.6% of doctors. 70% agreed that ADR reporting is a professional obligation for them. 80% responded that health care professionals are responsible for reporting ADRs. 63.3% of them were aware of a pharmacovigilance programme of India. A total of 96.6% doctors agreed that reporting of ADR is necessary and 93.3% were of the view that pharmacovigilance should be taught in detail. Majority of doctors have experienced ADRs in patients and 36.6% have seen the ADR reporting form. However, only 10% have ever reported ADR to a pharmacovigilance center. No remuneration (50%), lack of time to report ADR (30%), belief that a single unreported case may not affect ADR database (10%), and difficulty to decide whether ADR has occurred or not (10%) were important causes for under reporting of ADRs.Conclusions: Current study has shown that majority of the doctors have good knowledge and attitude about pharmacovigilance. However, under reporting is still a major concern among rural doctors and efforts are needed to address this problem of under reporting by conducting CMEs on regular basis.

Primary dysmenorrhea: evaluation and treatment pattern among female medical students

Background: Dysmenorrhea is a very common condition in females in fertile age group and its affective and somatic features often limit female mobility which results in loss of work hours. The aim of the study was to evaluate prevalence, severity, drug usage and loss of work days among young female medical students.Methods: The current questionnaire based study was done in Department of pharmacology, GMC Jammu over a period of 3 months. Female students aged between 17-24 years who consented for participation were included. The demographic profile and detailed history of dysmenorrhea was recorded.Results: Out of 342 participants, 218 females (63.7%) had history of dysmenorrhea. Most of the dysmenorrhic females had menarche between 13-14 yrs of age (73.3%) and menstrual cycle of 21-34 days (82.5%), duration of bleeding less than 6 days (91.6%) and had a positive family history of dysmenorrhea (58.7%). Majority of females had mild to moderate features of dysmenorrhea (93.4%). Most common medication was Mefenemic acid alone and in combination (90.5%). Most of the females took self-medication (69.8%) and only 30.2% took medicines on advice of doctor. 71.5% students missed their classes due to symptoms of dysmennorhea.Conclusions: Dysmenorrhea is quite prevalent among college going medical students. Most of them had positive family history. Mefenemic acid and its combination was frequently used to treat symptoms. On an average 1-2days were lost due to dysmenorrhea.

Evaluation of capsule labelling for its wall contents as gelatin or non gelatin

Background: Capsules are the most commonly used solid drug dosage form and are made up of gelatin or non gelatin. Currently the gelatin based capsules drug formulations are more used. However, current issue of vegetarian and non vegetarian capsules has come up due to recent Indian government initiative to promote vegetarian capsules.Methods: There were 100 capsule dosage forms were examined for the gelatin or HPMC wall contents and nature of medicine contained in capsules, whether ayurvedic or allopathic.Results: Out of 100 capsules studied 55 had gelatin wall base while 25 had HPMC and 20 capsule labels did not mention the nature of capsule wall constituent. Out of 55 gelatin capsules 30 were of allopathic while 25 capsules were of ayurvedic medicines. Among HPMC, 15 were ayurvedic while 10 allopathic. 20 capsules had no mention of its constituent and among these non labelled capsule formulations had 11 from ayurvedic and 9 from allopathic medicines.Conclusions: The current study revealed that gelatin capsules forms bulk in Indian market. Even the gelatin capsules contained ayurvedic medicines while 10% of HPMC capsules contained allopathic medicines. Non labelled capsules formed 20% of total capsules. These findings suggest wider scope for promotion of HPMC based capsules.

Comparative study of impact of marketing strategies of pharmaceutical houses on prescription practices of doctors rural vs urban

Background: Indian pharmaceutical market is fast going and there is a stiff competition amongst them as single product is marketed by different brand names. The pharmaceutical houses adopt different strategies to influence the physician to promote their products. These strategies are known to influence the prescription behaviour of physician, which may have variable impact among rural and urban doctors. Aim of the study was to compare the impact of marketing strategies of pharmaceutical houses on prescription practices of rural and urban doctors.Methods: The current crossover study was conducted among urban and rural doctors. A questionnaire consisting of 17 questions was presented to the doctors and their responses regarding different aspects of marketing strategies was recorded. Comparison between two groups was done using unpaired t-test.Results: Different strategies had impact on prescription pattern of doctors working in rural and urban institutions. All 17 parameters were affected similarly except e-mailing where urban doctors were more influenced (p=0.005).Conclusions: Present study indicates marketing strategies by different pharmaceutical houses do influence prescription pattern of physicians. Both urban and rural doctors were similarly affected except e- mailing which had more impact on urban doctors.

Drug-induced diseases (DIDs): An experience of a tertiary care teaching hospital from India.

Background & objectives: Drug-induced diseases (DIDs) are well known but least studied. data on DIDs from India are not available. Hence, this retrospective cross-sectional study was undertaken using suspected adverse drug reaction (ADR) data collected form Pharmacovigilance Programme of India (PvPI) to evaluate profile of DIDs over two years, in a tertiary care teaching hospital from north India. Methods: the suspected ADRs in the form of DID were evaluated for drug and disease related variables and were classified in terms of causality. Results: DID rate was 38.80 per cent. Mean duration of developing DIDs was 26.05 ± 9.6 days; 25.16 per cent had more than one co-morbid condition. Geriatric population (53.99%) accounted for maximum DIDs followed by adult (37.79%) and paediatric (8.21%). Maximum events were probable (93.98%) followed by possible (6.04%). All DIDs required intervention. Gastritis (7.43%), diarrhoea (5.92%), anaemia (4.79%), hypotension (2.77%), hepatic dysfunction (2.69%), hypertension (1.51%), myalgia (1.05%), and renal dysfunction (1.01%) were some of the DIDs. Anti tubercular treatment (ATT ), anti retroviral treatment (ART), ceftriaxone injection, steroids, non-steroidal anti-inflammatory drugs, antimicrobials and anticancer drugs were found as commonly offending drugs. Interpretation & conclusions: Our findings show that DIDs are a significant health problem in our country, which need more attention.

Gender Based Knowledge, Attitude and Practices About Swine Flu in a Rural Indian Population.

During recent Influenza A H1N1(swine flu) outbreak the current study was undertaken to assess knowledge, attitude and practices (KAP) of rural population of Jammu region regarding swine flu. 270 participants were administered a pre-designed and pre-tested questionnaire consisting of 26 questions evaluating KAP. Overall knowledge score was 62.9%. More than 90% had heard of swine flu, knew prevalent season and had knowledge of disease symptoms. However, knowledge about preventing vaccine was low (27.7%). Overall attitude score was 79.5%. Higher number of the participants expressed willingness to seek more knowledge about disease prevention , though half of them were not satisfied with health authorities efforts. The total practice rate was 60%.Preference for nutritious diet and willingness to use tissue/handkerchief was over 80% ,but only 40% expressed willingness to use mask. On most of the parameters of KAP, there was no difference on gender basis except for swine flu treatment ,panic reaction and preference for herbal medication in females. The current study found good KAP regarding swine flu in the rural area of Jammu. However, unwillingness to use mask, dissatisfaction with health agencies and lack of knowledge about population at risk is a matter of concern.

Comparative Profile of Adverse Drug Reactions with Antimicrobials:Women Vs Men.

The current retrospective cross sectional study was undertaken using suspected ADR data collection form used under Pharmacovigiliance Programme of India (PvPI). A total of 2586 ADR events were recorded in 3years out of which 392(15.15%) were because of antimicrobials. males constituted 253 patients (64.54%) and females constituted 139 patients (35.45%) with male: female ratio as 1.8:1. Adults were more commonly affected followed by geriatric and pediatric population in both the groups. I.V route followed by oral route of drug administration accounted maximum ADR in similar way in both the genders. Monotherapy was responsible for 81.81% for males and 82.01% for females. Among combinations 78.26% in males and 64% in females were irrational as per latest WHO13th essential drug list. Majority of ADR, 88.14% and 92.80% were of moderate severity among males and females respectively. Maximum ADR were latent, type-A, probable in nature as per Naranjo and WHO-UMC scale. Inj.ceftriaxone followed by tab. azithromycin, tab.ofloxacin-ornidazole were the commonest antimicrobials responsible for ADRs in both the genders. The most common system involved was dermatological followed by GI in both males and females. On statistical comparison, no significant differences were observed among both the genders in any of the parameters except causality assessment scale (P<0.5). The current study suggests the ADRs due to antimicrobials are a significant health problem. No major gender related differences were observed in ADR profile of our study cohort.

Isoniazid Induced Psychosis (Self Harm Behaviour) with Neuropathy & Vitamin B6 Deficiency.

Isoniazid induced psychosis (IIP) is well reported with varied clinical presentations. Many hypotheses are available to explain the mechanism of (IIP) but lack conclusive evidence in its favour. The current case establishes neuropathy with vitamin B6 deficiency as a possible cause for IIP warranting early clinician's attention as the condition may be potentially serious & life threatening.

Comparative Adverse Drug Profile of Deflazacort Vs Conventional Corticosteroids in Spontaneous Reporting System of Pharmacovigilance.

The current observational cross-sectional study was undertaken using suspected adverse drug data collection form available under (PvPI) to evaluate comparative ADR profile of DFZ Vs CCS for 3 years in spontaneous reporting system of ADRs in current PvPI. Total number of ADR reports during the study period was 3024, out of which ADRs reports due to CS were 112 accounting for a rate of 3.70%. The rate of total ADR events with CS was 4.11%. Geriatric, urban and female population predominated in contributing ADRs with both CCS and DFZ in the study. Self medication of CCS and DFZ contributed 10.95% and 7.69% of total ADRs. Oral route contributed maximal ADRs. Irrational drug prescription contributed substantially. Maximum ADRs due to CCS and DFZ were moderate, latent, non-serious, type A and were probable followed by possible in nature as per WHO UMC scale. Gastritis, new onset hypertension/ loss of hypertensive control, loss of diabetic control, obesity/overweight, dyslipedemia were common ADRs. Thus, ADRs due to CS is a substantial health problem. ADR profile did not vary although DFZ recorded less ADRs.

Efficacy and Cardiovascular Safety of Topical Timolol, Brimonidine & Latanoprost in Newly Diagnosed Patients of Open Angle Glaucoma.

The present study was conducted in chronic open angle glaucoma patients to evaluate their efficacy in reducing IOP and their cardiovascular safety. 48 newly diagnosed patients of glaucoma completed the trial. Patients were divided into three groups and received medications in form of topical instillations. Group I (Timolol 0.5% twice a day), Group II (Brimonidine Tatrate 0.2% twice a day) & Group III (Latanoprost 0.005% once a day) for 12 weeks. All the three medications, significantly decreased IOP (P<0.05), however, Latanoprost caused maximum decrease in IOP, followed by Brimonidine and Timolol. Visual Acquity was not affected by any of the medication. Pulse Rate and PR Interval were decreased in Timolol group significantly (P < 0.001) while Brimonidine and Latanoprost did not alter Pulse Rate. Blood Pressure was not affected by either of medication except Brimonidine which caused reduction in systolic Blood Pressure at 12 weeks. The results of present study demonstrates superiority of Latanoprost over Timolol and Brimonidine as it lacked effect on Pulse Rate, Blood Pressure and HR, besides being more efficacious.

Efficacy and Tolerability of Tamsulosin Alone and in Combination with Dutasteride in Patients of Benign Prostatic Hyperplasia.

The present prospective randomized study was conducted to find out efficacy and tolerability of tamsulosin alone (0.4mg) and tamsulosin (0.4mg) in combination with dutasteride (0.5mg) in patients of BHP. Two groups of 20 patients each received either of the regimes for 24 weeks. Both groups were evaluated for uroflowmetric, ultrasonography and AUASS parameters. Both regimes caused significant increase in Qmax, Qave, voided volume and concomitant decrease in voiding time, flow time and time to peak flow(P<0.0001). Ultrasonographically assessed prostate volume and residual urine volume decreased significantly with combination group, whereas only residual urine volume was decreased in tamsulosin group. Both groups caused improved AUASS (P<0.0001).Combination group produced more improvement than tamsulosin alone on Qmax, Qave and flow time (P<0.05) and decrease in prostate volume (P<0.001). Both regimes were well tolerated.The combination appears to have an additive effect.