ABSTRACT
Objective: to compare intralesional versus oral chloroquine in cutaneous leishmaniasis and determine the cure rate, duration of treatment, and total dose of drug
Study Design: Randomized controlled study
Place and Duration of Study: department of Dermatology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, from November 2013 to June 2014
Methodology: consecutive 86 patients of cutaneous leishmaniasis, with single to multiple lesions of various sizes were enrolled and divided randomly into group A and B for the purpose of intralesional and oral chloroquine administration, respectively to compare the effect of the two routes on duration of treatment and total dose of the drug. SPSS version 16 was used for data analysis after data entry into it. Quantitative variables like, duration, cost and total dose of treatment were calculated as mean and standard deviation and compared by using T-test. P-value of less than 0.05 was taken as significant
Results: cure rate was 100% in both groups towards the end of treatment. Mean duration of treatment was 9.17 +/- 3 weeks in intralesional [A] group as against 11.37 +/- 3 weeks in oral [B] group [p = 0.0028]. Mean total dose of the drug given to each patient in group A was 5.8 +/- 0.5 gm and in group B, it was 19.2 +/- 1.5 gm, which is significantly higher [p < 0.001]. The total cost of treatment in group A was Rs. 90 +/- 8 and in group B it was Rs. 91 +/- 1 [p=0.446]
Conclusion: duration of treatment is significantly shorter and total dose is lesser with intralesional compared to oral chloroquine in treatment of cutaneous leishmaniasis
ABSTRACT
Background: tinea capitis is an important skin infection in children. Terbinafine has been used as preferred drug but increasing number of resistance and side effect profile suggests search to find another drug with better efficacy and safety
Objective: to compare the efficacy and safety of terbinafine and Itraconazole in tenia capitis
Methodology: it was a randomized control trial on 120 cases of tenia capitis diagnosed on the basis of five clinical signs and symptoms [erythema, desquamation/scaling, papules, pustules and pruritis] which were rated on four point scale [0-absent, 1-mild, 2-moderate, 3-severe] summed as total signs and symptoms score [TSSS] and a positive KOH microscopy and were divided into two equal groups A and B. Group A was treated with terbinafine at a dose of 62.5 mg for children less than 20 kg, 125 mg for 20-40 kg and 250 mg for above 40 kg. Group B was treated with Itraconazole and dosage was as follows; 10-19 kg 50 mg/day, 20-40 kg 100mg/ day, more than 40 kg 200 mg/day. This study was carried out from 1[st] January to 30[th] June 2016, at department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan. These cases were then followed at weeks 02, 04, 06 and 08 and assessed on the basis of KOH microscopy and TSSS score. Negative microscopy and zero TSSS were labeled as cured and parents were also asked about any side effect and tolerability. The data was entered and analyzed by using SPSS version 16
Results: there were 60 cases in each group. Group A has 29 males and 31 females while Group B has 34 males and 26 females. Cure was seen significantly higher in Group B where it was in 86.67% as compared to Group A with 68.33%. [p value 0.01]. There was again significant difference seen when they were compared in terms of cure time where 58.34% of cases in group B were cured by 6 weeks as compared to 40% in Group A. [P value 0.03]. There was no significant difference in terms of side effect profile [p= 0.45] while it was again significantly better in terms of tolerability with Itraconazole [p= 0.02]
Conclusion: intraconazole has better care and safety profile as compared to terbinafine in treatment of Tenia Capitis
ABSTRACT
To determine the bacterial pathogens involved and their antibiotic sensitivity pattern in commonly encountered community acquired superficial skin infections and determine the appropriate empirical antibiotics for such conditions. A descriptive study. A descriptive study was carried out at Department of Dermatology and Pathology Combined Military Hospital Peshawar from 1st Oct 2005 to 31st Jan 2006. Swabs from skin lesions of a total of 117 patients suffering from common primary pyodermas were collected for microbiological analysis. These were stained with gram stain and conventional biochemical and serological tests were performed for identification of different isolates after their culture followed by their antibiotic sensitivity testing with standard antibiotic discs using modified Kirby Bauer disk diffusion method as per National Committee for Clinical Laboratory Standards recommendations. A total of 117 cases were studied with age range from 6months to 60 years [median age 12 years]. Male and female ratio was 1.8:1. There were 12 cases, which did not reveal any growth. Among 69 positive cases of impetigo/ecthyma, in 14 [20.3%] Staphylococcus aureus was isolated; in 26 [37.7%] Streptococcus pyogenes; in 27 [39.1%] both Staphylococcus aureus and Streptococcus pyogenes and in only 2 cases [2.9%] both Staphylococcus aureus and Pseudomonas aerugenosa together were isolated. Among 26 positive folliculitis/furunculosis cases, in 19 [73.1%] Staphylococcus aureus; in 4 [15.4%] Streptococcus pyogenes and in 3 [11.5%] both these organisms were isolated. Among 10 positive cases of cellulitis, in 3 each [30%] Streptococcus pyogenes and Staphylococcus aureus alone and in 4 [40%] both these organisms together were isolated. In 105 positive cases, 72 Staphylococcus aureus and 67 Streptococcus pyogenes were isolated. In 34 cases both these organisms were isolated together. All Staphylococci were found resistant to all b lactamase labile penicillins and there were 6 [8.3%] staphylococci resistant to oxacillin [MRSA]. However, all Staphylococci other than MRSA were susceptible to b lactamase stable penicillins like Amoxicillin-Clavulanic acid. All the MRSA were susceptible to vancomycin and fusidic acid and some of them were susceptible to gentamicin, amikacin, ciprofloxacin, chloramphenicol, doxycycline and clindamycin. All streptococci were susceptible to penicillins, fusidic acid and vancomycin. Almost half of them were resistant to erythromycin and most to doxycycline. First choice for an empirical treatment of community acquired superficial skin infections should be b lactamase resistant penicillins like Amoxicillin-Clavulanic acid. In patients allergic to penicillin, lincosamides [Lincomycin and Clindamycin] or fusidic acid can be a systemic and/or topical alternative