ABSTRACT
Background: WHO defines Antimicrobial resistance (AMR) as “the ability of a microorganism to stop an antimicrobial from working against it”. The Global burden includes increased morbidity, prolonged illness and a higher mortality rate, along with economic burden. The cause can be tracked down to irrational usage of antibiotics and lack of awareness of rational prescribing practices.Methodology: A cross-sectional questionnaire-based observational study was carried out using a standard pre-validated questionnaire, which was administered to all the medical doctors present in their respective departments during the study period, exploring their knowledge regarding rational antibiotic usage, their attitudes and awareness towards AMR. Informed consent from the participants was obtained verbally, and confidentiality assured. The collected data was analyzed as per descriptive statistics.Results: Majority of doctors (91.3%) have a good knowledge and agree that indiscriminate use of antibiotics leads to antimicrobial resistance. 96.12% of doctors identify it as a global issue but only 85.5% consider it a problem in their hospital. Doctors (78%) have a positive attitude and do not prefer to prescribe an antibiotic for minor illnesses, but only 40% think it might contribute to antimicrobial resistance.Conclusion: Our study has demonstrated that doctors have a good knowledge about the emerging problem of antimicrobial resistance, however a minor percentage of doctors fail to acknowledge this at the level of their own hospital. Regular updates on the local antimicrobial resistance rates & antibiotic stewardship might help to control the global issue of AMR.
ABSTRACT
Background: As medical students start their clinical training, more effort goes in the direction of proper diagnosis and appropriate methods of treatment, leading to improper training in prescription writing causing prescription errors. Physicians should also be encouraged to prescribe unbranded generic medicines which are available at a cheaper price with a comparable bioavailability of drugs and not have a misconception of being less efficacious.Methods: A cross-sectional observational study was carried out over a period of 2 months (September to October 2018). Around 256 prescriptions were randomly collected from general medicine out-patient department. Informed consent was obtained verbally, and confidentiality assured. The collected data was analyzed as per descriptive statistics and compared with the derived standard values for WHO prescribing indicators.Results: The analyzed data showed an average of 2.23±1.03 drugs per prescription. 23% of the prescriptions had at least one drug prescribed by generic name, 25% of prescriptions contained an antibiotic and 31% of prescriptions had an injection. The percentage of drugs prescribed from NLEM (National list of Essential Medicines) was only 57% as compared to the recommended 100%. Additional only 22.4% of the total number of FDCs prescribed were from NLEM.Conclusions: The average number of drugs per prescription was slightly high, indicating polypharmacy. Brand name prescribing dominates as doctors are still reluctant to use generic names being doubtful of the efficacy. Regular prescription audit with reporting might help to bring awareness among doctors to follow the recommended guidelines and minimize prescription errors.
ABSTRACT
Background: New treatment strategies are attempted to treat the fatal complications of the dengue infection, as significant numbers of adult and children are affected resulting in considerable economic impact. Corticosteroids in various regimens have been used in the last 2 decades empirically on the basis of immunomodulation or treat the vascular leakage that occurs in severe dengue.Methods: A descriptive study was conducted among 60 patients who were dengue positive and received treatment from the Department of Medicine at SIMSRC during the period of June-August 2018. The study group (30 patient) was given treatment with intravenous dexamethasone 8 mg initially, followed by 4 mg TID for 3 days. The control group (30 patient) received only IV fluids and antipyretics. The rise in the mean platelet counts over three days was analyzed in both groups were analyzed.Results: The results of this study revealed that after 10-12 hours of initiating steroids in the study group, a higher and early rise of platelet count was achieved. There was gradual improvement and increase in platelets in 3 days’ duration in all 30 of the patients. The mean platelet count (the primary outcome) in the study group was significant compared with the control group.Conclusions: At present, realistic approaches for the early intervention and proper treatment protocol are required to be developed to prevent high mortality and morbidity due to dengue. The drawback of this study was, it was not a double-blind placebo-controlled trial and there were less number of patients.