An in-depth study of drugs prescribing pattern in the Surgery Department of a Tertiary Care Teaching Institute in Northern India.

Background: In surgical patients, a number of drugs are prescribed to prevent post-operative infections and to relieve pain. Therefore, prescription audit should be periodically performed in Department of Surgery to analyze the present scenario of drugs prescribed for the surgical/post-operative patients. This will help us to use the medicines rationally and decrease the adverse effects in surgical patients. The main aim of the study was to evaluate the drugs prescribing pattern in the Surgery Department in Tertiary Care Teaching Institute. Methods: Patients’ prescriptions or case record forms were randomly collected over a period of 1 year from the Department of Surgery at GGS Medical College and Hospital, Faridkot, Punjab (India) for analysis and rationalization. Results: A total of 900 prescriptions was collected and analyzed for drugs used in surgical patients. Average number of drugs prescribed is 4.26. The most commonly prescribed drugs were anti-microbial agents (AMAs), gastrointestinal tract (GIT) related, non-steroidal anti-inflammatory drugs (NSAIDs) and multivitamins and trace elements, and their percentages were 37.90%, 23.36%, 14.14 %, and 9.11% respectively. About 95% drugs were prescribed by non-generic (Trade) names. Drugs prescribed from National Essential Medicines List (EML) and World Health Organization EML were 69.25% and 45.31% respectively. Average cost per prescription per day was Rs. 610/- (INR) or $10.34 USD in a surgical patient. Conclusions: There is a high tendency and frequency to prescribe four and more than four drugs to post-operative patients. Most drugs prescribed were AMAs, GIT related, NSAIDs and Multivitamins and trace elements. There is an urgent need to develop proper prescription writing skills in budding doctors regarding the use of EML/drugs list and generic medicines to reduce the cost of treatment.

Knowledge and attitude towards antimicrobial self medication usage: a cross sectional study among medical and nursing students.

Background: Antimicrobial drug resistance is a fast mounting universal crisis. Many factors like self medication, inappropriate use and unregulated sale of medicines and self medication have been attributed to this problem. The objective was to determine extend and causes of antimicrobial self medication and to compare the knowledge attitude of senior and junior medical/nursing students. Methods: We conducted a cross-sectional study on randomly selected 410 students from Baba Farid University of Health Sciences Faridkot, Punjab. A total sample of 220 medical students were enrolled from GGS Medical College, Faridkot (1st year students 50 and 170 above 1st year senior medical students ) and 190 nursing students were enrolled from University College of Nursing, Faridkot. Results: prevalence of antimicrobial self medication came out to be around 74%. The most common cause for seeking antimicrobial (self therapy) was upper respiratory tract infection. A statistical significant knowledge/attitude gap was found between senior and fresher medical/nursing students. Conclusions: High prevalence of antimicrobial self medication among medical/nursing students is a matter of concern and it should be discouraged at appropriate level to safeguard students from preventable adversary exposure.

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.

Modulation of serum concentrations of melatonin by carbamazepine and valproate.

Evidence has accumulated about the involvement of reactive oxygen species (ROS) in epilepsy. The neuromodulator melatonin has been shown to reduce oxidative stress in various animal models due to its free radical scavenging properties. The present study investigated whether carbamazepine and valproate alter serum concentrations of melatonin. Epileptic children were randomly assigned to receive carbamazepine/ valproate monotherapy till 22 patients were recruited in the study. At the tenth day, in the evening, samples were drawn for baseline endogenous melatonin estimation. The patients were then administered exogenous melatonin, and repeat samples were drawn after 30 minutes. Serum levels of melatonin were estimated using Melatonin ELISA kits. The median levels of melatonin were 165.0 pg/ml (Range 50.0-350.0) in CBZ+MEL group and 78.0 pg/ml (Range 13.0-260.0) in the VPA+MEL group. The observed difference in melatonin levels could be attributed to the difference in antiepileptic drugs, additive increase in reactive oxygen species due to disease combined with carbamazepine, or possibly to a difference in melatonin kinetics in conditions of oxidative stress.

Comparative Effect of Timolol, Levobunolol and Betaxolol on IOP in Patients of Chronic Simple Glaucoma

In this prospective randomized parallel study we compared the effects of topical timolol maleate, levobunolol hydrochloride and betaxolol hydrochloride on intraocular pressure (IOP) in the patients of primary open angle glaucoma after 16 weeks of instillation as 1 drop 12 hourly in 0.5% concentration. 23 eyes of 16, 19 eyes of 12 and 20 eyes of 12 patients were included in timolol, levobunolol and betaxolol groups respectively. Timolol, levobunolol and betaxolol lowered IOP by 13.05 ± 1.53, 14.05 ±1.47 and 7.58 ± 0.90mmof Hg respectively after 6weeks and by16.12±1.67,16.28 ±1.85 and 8.535 ± 0.983 mm of Hg respectively after 16 weeks (P<0.001). Both levobunolol and timolol produced greater reduction in IOP than betaxolol (P<0.001). The results of our study indicated that betaxolol is less efficacious in lowering IOP in Indian patients and could only be preferred over timolol in glaucoma patients with associated chronic obstructed pulmonary disease (COPD) or bronchial asthma. However, Levobunolol could be a better alternative to timolol , as being a longer acting agent with IOP control for 24 hrs after single instillation and can be used as once a day instillation with better safety profile.

Pharmacoeconomics.

Pharmacoeconomics focuses on the costs and benefits of drug therapy and pharmacoeconomic evaluations provide a basis for resource allocation and utilization. It is increasingly becoming important for health policy decision-making. A pharmacoeconomic evaluation may be conducted as an economic assessment incorporated into clinical trials. Such trials should compare the new drug/procedure with an older drug or existing intervention. Four techniques are used for economic evaluation, namely, cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The choice of the evaluation method depends on the nature of outcomes and the context in which the choices need to be made. Pharmacoeconomics is a young science that will improve with application. Its need is undeniable, especially in developing countries.