ABSTRACT
Aim: To study drug utilization pattern of antimicrobial agents in various outpatient departments of a tertiary care teaching rural dental hospital. Methods: A prospective-observational study was carried out in 200 patients from January 2014 to March 2014. Relevant information was obtained from the interview as well the hospital case record. Structured and pre-tested format was used for compiling the data. Results: The majority of the patients (51.5%) were in age group 41 to 60 years. Common conditions for antibiotic use included periodontal diseases (46.5%), endodontic diseases (38.5%) and dental caries (21.5%).Five antimicrobial drug formulations were used leading to a total of their 253 drug uses. Amoxicillin alone (64%) was the most commonly prescribed antimicrobial formulation followed by amoxicillin plus clavulanic acid (31.5%), metronidazole (26.5%), ofloxacin plus ornidazole (3%) and doxycycline (1.5%). The average number of antimicrobials prescribed per patient was 1.61. The average duration of antimicrobial was found to be minimum 3 days to maximum 5 days. Except ofloxacin plus ornidazole, all of the prescribed antimicrobials have been included in the WHO Model List of Essential medicines. 50.59% and 49.40% of total antimicrobial drug formulations were prescribed by generic and brand names respectively. Conclusions: Drug utilization data can help to formulate appropriate clinical guidelines for drug use and facilitate rational use of medicines in population.
ABSTRACT
Background: Most common ADRs associated with radiocontrast media are rash, fever, nausea, vomiting and shivering. Rarely life threatening anaphylaxis and acute hypersensitivity reaction may also occur. Very few studies are carried out in India focusing on this aspect. Aims & Objective: To study and report the Adverse Drug Reactions (ADR) caused by radio contrast media in a tertiary care teaching rural hospital. Material and Methods: Two hundred and fifty seven patients from Radiology department were observed for occurrence of adverse drug events (ADEs) from 01 Jul 2012 to 31 Jul 2012. ADEs were either spontaneously reported or elucidated from personal interviews were analysed. Results: Total 8 (3.11%) out of 257 patients who had undergone for ionic radio contrast dye investigation had a single event of ADR. Total occurrence rate of ADR is 3.11%. Most common ADR was rash followed by shivering, nausea, vomiting and fever with use of ionic contrast media. All Adverse Drug Reactions, according to WHO-UMC and Naranjo’s scale were of “probable” category. All the ADRs were at level-3 according to Modified Hartwig and Siegel severity scale. All the ADRs according to Modified Schumock and Thornton criteria for Preventability of an ADR are of “not preventable” category. All the ADRs were of “Bizarre” type. All the patients were treated with antihistaminic and steroids. Conclusion: It is recommended to use non-ionic contrast media instead of ionic media by all the health care professionals. Treatment with steroids and antihistaminic in patients who develop ADRs due to radiocontrast media can be effective.
ABSTRACT
Fluoroquinolones are generally regarded as safe antimicrobial agents with relatively few adverse effects or drug interactions. Because of their recognized safety profile and potent in vitro activity, fluoroquinolones have been widely used for the treatment of community- and hospital-acquired infections. Although uncommon, both hypoglycaemia and hyperglycaemia (dysglycaemia) appear to occur with all the fluoroquinolones. It is usually reported in conjunction with impaired creatinine clearance and elderly diabetics receiving concomitant treatment with antidiabetic agents (especially sulfonylureas) or insulin. The exact mechanism of this effect is unknown but is postulated to be a result of blockage of adenosine 5'-triphosphate-sensitive potassium channels in pancreatic cell membranes. Here we report a case of hypoglycaemia in a hospitalized non-diabetic elderly patient in whom this life-threatening adverse effect was related in a temporal fashion to the administration of intravenous levofloxacin meant to cover pulmonary infection in a setting of subacute small bowel obstruction and septicaemia. This case emphasizes the occurrence of profound and prolonged hypoglycaemia consequent upon levofloxacin use, an adverse reaction that has been described with almost all members of the quinolone family of antibiotics. Taking into consideration the frequency of fluoroquinolones use in the hospital and ambulatory setting, clinicians should be cognizant of this potential adverse effect in non-diabetic patients treated with levofloxacin, and they should look out for symptoms of hypoglycaemia and monitor blood glucose levels more frequently, especially early in the course of therapy.
ABSTRACT
Toxic Epidermal necrolysis (TEN) is a rare, life threatening dermatological disorder that is usually induced by medications. Anti-convulsants such as phenytoin, carbamazepine and phenobarbital have been enlisted as high risk drugs for causing TEN. A 25 year old man, a known case of epilepsy, who consumed inadvertently escalated daily dose of 600 mg/day of phenytoin for 10 days, developed TEN which involving more than 30% of body surface area with mucosal involvement. Rigorous treatment of 18 days using systemic and topical antibiotics along with glucocorticoids helped in complete recovery of the patient. Causality analysis of this Adverse Drug Reactions (ADR) showed a probable association on both World Health Organisation (WHO) – Uppsala Monitoring Centre (UMC) scale and Naranjo’s probability scale and Severity scale of 5 on Modified Hartwig and Siegel scale. Medication error is an important cause of such life threatening reactions which requires concern of all health care professionals.