ABSTRACT
Background: Typhoid fever is a public health concern in developing countries. Developed countries have also been influenced due to tourism. The drugs used for treating typhoid fever can and have been rendered unusable due to resistance. Monitoring and updating the Salmonella antibiogram is needed to prevent therapeutic failures. This study confirms to the same goal.Methods: This study was conducted retrospectively in a tertiary care hospital in North Kerala with data collected from 2013 to 2017. Years were categorized into four quarters to analyze seasonality. Positive blood culture samples of adults, identified to be Salmonella typhi or paratyphi were subjected to antimicrobial sensitivity.Results: 37 Salmonella isolates were included. July-September quarter was found to have maximum incidence of typhoid fever followed by April-June quarter. All isolates were 100% sensitive to ceftriaxone, chloramphenicol, and amoxicillin-clavulanic acid. Sensitivity lacked for nalidixic acid (48.65%), ciprofloxacin (48.65%) and levofloxacin (70.27%). Sensitivity to ampicillin and cotrimoxazole was 86.49% and 91.89%. Azithromycin efficacy was good overall (94.59%) with resistant isolates emerging in final year of this study.Conclusions: Monsoon is most conducive for typhoid fever occurrence followed by summer. This study confirms utility of ceftriaxone and futility of quinolones and fluoroquinolones in typhoid fever treatment. Azithromycin has started showing emergence of resistance. Ampicillin and cotrimoxazole cannot be relied upon due to variability in sensitivity patterns. Chloramphenicol showed full efficacy throughout the study period which is encouraging. Amoxicillin-clavulinic acid, surprisingly was 100% effective throughout study period. However, no contemporary data is available for comparison.
ABSTRACT
Background: The pattern of drug use in people hospitalized with a primary diagnosis of psoriasis has never been studied previously in India. The aim of the study was to characterize the prescription pattern of people admitted to hospital with psoriasis so that rational prescribing could be promoted among dermatologists. Methods: Case files belonging to 32 patients, admitted in the Department of Dermatology with psoriasis, of a tertiary care teaching hospital in Kerala, over a period of 1-year were retrieved with the assistance of the medical records department. The data thus obtained was analyzed using descriptive statistics. Results: The average age of patients who were admitted with psoriasis was 49.9 years, and their average duration of hospital stay was 7.96 days. A total of 296 formulations were prescribed to 32 patients. Out of 296 formulations, only 10 (3.37%) were generic and rest 286 (96.62%) branded. Fixed dose combinations consisted of 32.43% (96/296) of the prescribed formulations. Psoriasis vulgaris (56.25%) was the most common cause for admission. Of all the prescribed medications, 4 (1.35%) did not contain clear instructions for the route of administration. Strength was clearly mentioned in only 89 (30%) of the preparations. In 98% of the prescriptions, the exact dose was missing. Conclusions: The study reveals various deficiencies which exist in the prescribing pattern of drugs for management of psoriasis. Educational interventions among the doctors as well as students should be carried out to promote rational drug use.