ABSTRACT
Background: The emergence of antimicrobial resistance is a worldwide challenge threatening to negate the gains made by discovery of antimicrobial agents (AMAs). Antimicrobial Stewardship Program (ASP) is an important strategy for ensuring appropriate use of AMAs and controlling emergence of antibiotic resistance. Implementation of ASP must start with assessment of the current state of antimicrobial use. This study was therefore conducted to assess the prevalent prescribing patterns in a tertiary care hospital and identify gaps which warrant corrective intervention.Methods: This prospective pilot study presents analysis of the first 30 Patients from the medicine ward prescribed at least one antimicrobial agent during the two months of study period. Relevant data was collected in AMA record form. Appropriateness of AMAs was analyzed regarding selection as well as administration protocol as per the hospital antibiotic policy.Results: Out of the 60 AMAs prescribed to these patients, most commonly prescribed were cephalosporins (63.3%), anti-amoebics (26.6%) and macrolides (23.3%). Common diseases involved were urinary tract infection, acute gastroenteritis, sepsis and lower respiratory tract infections. Use of AMAs was found to be appropriate for the indication in 42 %, dose in 97%, duration 60 %, route 93% and frequency 90 %.Conclusions: This gap between the appropriate and the actual practice use of AMAs indicates an urgent need of rigorous implementation of ASP in order to avoid emergence of resistance and to conserve the sensitivity to the available AMAs.
ABSTRACT
Background: Directly observed treatment short course (DOTS) is a cornerstone of Revised National Tuberculosis Control Program of India. Adverse drug reactions (ADRs) induced by this therapy is common and it causes signifi cant morbidity and mortality. Hence, the present study was undertaken to determine the incidence and pattern of ADRs and to assess causality and severity. Methods: We conducted prospective, observational study at DOTS center of tertiary care hospital, Pune. 150 pulmonary tuberculosis patients undergoing DOTS therapy were enrolled. They were monitored weekly in an intensive phase and monthly in the continuation phase. The suspected ADRs were recorded and assessed for causality and severity by standard algorithms. Results: Incidence of ADRs due to DOTS was 19.33% & total 35 ADRs had occurred in our study. Gastrointestinal intolerance, arthralgia & itching with or without rashes were most common ADRs (incidence rates: 12.67%, 2.67% and 2.67%, respectively). On evaluation of causality by Naranjo algorithm, majority of ADRs 91.43% were “possible.” As per WHO- Uppsala Monitoring Center scale, majority of ADRs 91.43% were “possible.” As per Modifi ed Hartwig and Siegel scale, majority of ADRs were “moderate” (48.57%) but 8.57% were “severe.” Female gender was found to be a signifi cant risk factor for developing ADRs (odds ratio: 3.08, 95% confi dence interval: 1.33-7.12. 3.33%). ADRs & hepatotoxicity was major reason for defaulting from DOTS (60%). Conclusion: ADRs induced by DOTS are common and there is need of incorporating pharmacovigilance system for this vital public health program. Counseling of patients for timely prevention, detection, and management of ADRs will help in minimizing the further occurrence of ADRs.
ABSTRACT
Background: Hepatotoxicity by chemicals and drugs is a common clinical problem. Presently very few drugs are showing effectiveness in prevention and treatment of hepatic damage. So in this study, we evaluated the role of trimetazidine in carbon tetrachloride (CCl4) induced liver damage in rats. Objective of current study is to evaluate effects of prophylactic trimetazidine against carbon tetrachloride induced liver damage in rats. Methods: Liver damage was induced in 30 albino rats by CCl4 (0.5 ml/kg, i.p.) once daily for 7 days. Extent of damage was studied by assessing biochemical parameters (SGOT, SGPT, ALP, proteins and bilirubin). These biochemical observations were supplemented by pentobarbitone Sleeping Time and Histological Examination of liver. The effect of co-administration of trimetazidine (doses 5 and 10 mg/kg p. o.) on the above parameters was investigated. Liv.52® was used as Positive Control. Data was analyzed by one way ANOVA, followed by Dunnett's test. Results: Trimetazidine significantly prevented CCl4 induced elevation of serum SGOT, SGPT, ALP and bilirubin (total and direct), and reduction in protein level. Pentobarbitone sleeping time and histological examination of the liver showed consistent results. The results were comparable to that of Liv.52®. Conclusions: Trimetazidine, when administered prophylactically, shows hepatoprotective effect against CCl4 induced liver damage.
ABSTRACT
Background: Most of the common ailments are managed by general practitioners (GPs). GPs prescribe major bulk of the drugs sold in the market. Naturally, irrational use of drugs at this level could lead to disastrous consequences. So this study was undertaken to determine prescribing pattern of Antimicrobials (AMA) and the rationality of drug usage by GPs in Pune city. Methods: It was a cross-sectional study. Pune city was divided into 5 zones. MBBS, BAMS and BHMS GPs doing Allopathic practice were selected randomly. 2 GPs of each specialty per zone were selected; this gave us 10 GPs of each degree – so total 30 GPs.30 Prescriptions at each GP were collected – total 900 prescriptions. The following parameters were studied- Diagnosis of patient, Average no. of drugs/prescription Percentage of AMAs prescribed, Rationality of AMA, Selection of AMAs diagnosis wise, Rationality of Prescription. Results: More than 75% patients coming to GPs were suffering from communicable diseases. Average no. of drugs / prescription and percentage of prescription with AMAs was high in all GPs. Macrolides was the most common group of AMA used by MBBS whereas Cephalosporins was used by BAMS and BHMS. Irrational use of AMAs was high in BHMS GPs. Use of irrational FDCs, banned drugs, steroids was high in BAMS GPs. Conclusions: There are deficiencies in prescription practices among all GPs. Not only are GPs prescribing the highest number of AMAs per prescription anywhere, their prescription practices for common health problems are highly inappropriate. High level of irrational use of drugs by BAMS and BHMS GPs are cause of concern.
ABSTRACT
Background: To study extent of cognitive impairment by epilepsy & antiepileptic treatment and evaluate the role of piracetam on it. Methods: 48 animals were divided into 6 groups: I-Control, II- Topiramate, III-Topiramate+Piracetam, IV-Valproate, V-Valproate+Piracetam, VI-Piracetam. Baseline cognitive functions were measured using Cook’s pole climbing apparatus (CPCA) and Elevated plus maze (EPM). In CPCA, on completion of training, number of avoidances (NOA) out of 10 trials were noted while in EPM, transfer latency (TL) was measured. Kindling was induced by 30mg/kg Pentylenetetrazol (PTZ), i.p. to all groups (except Group I) on alternate days till seizures developed. Groups were treated with respective drugs orally for 21 days and cognitive functions measured again. Results: Significant decrease in NOA & increase in TL was observed after PTZ kindling. Topiramate further significantly impaired NOA and TL whereas Valproate significantly reduced NOA in CPCA but increase in TL was not significant. Treatment with Piracetam significantly increased Topiramate, Valproate and PTZ kindling induced decrease in NOA as also significantly reduced Topiramate and PTZ kindling induced increase in TL. Conclusion: Seizures are associated with cognitive impairment. Cognitive impairment caused by Sodium valproate differs from Topiramate. Piracetam, a known nootropic can be used in alleviating cognitive impairment associated with epilepsy & chronic antiepileptic therapy.