A Case Control Study on Risk Factors and Drug Prescription Patterns in Glaucoma at a Tertiary Eye Care Center in a City of Western India

Introduction: Glaucoma is an idiopathic, progressive optic disc neuropathy complicating into irreversible blindness if untreated. Early diagnosis by screening cases from high-risk populations has a pivotal role in managing this major public health problem with high treatment expenditures. Objectives: To identify the various ocular and non ocular risk factors of glaucoma and to identify the drug prescription pattern among glaucoma patients. Method: This was an observational, case-control study including 165 adult Glaucoma patients on treatment as cases and 165 age and sex-matched healthy individuals as controls, all of which were randomly selected from the patients visiting a tertiary eye care center. Various risk factors, drug prescription pattern and symptoms of the patients were recorded and analyzed. Results: A total of 165 adult Glaucoma patients and age and gender matched 165 controls were enrolled. Majority of the patients (41.21%) complained of blurring of vision at the time of study. The Odds ratios for Family history, Hypertension, Diabetes Mellitus, Migraine, Sleep apnea and Smoking showed strong association as risk factors for Glaucoma and the differences between the two groups were statistically significant (p value < 0.05). The mean number of drugs per prescription ± SD was 1.88 ± 0.79. Fixed drug formulations were prescribed in 42.4% patients. All the drugs were prescribed by their brand names and majority of them were in the form of eye drops. Conclusion: Primary Open Angle Glaucoma (POAG) was the most common subtype in the study. Age, Family history, Myopia, Hypertension, Diabetes Mellitus, Sleep Apnea, Migraine, Corticosteroid usage and Smoking emerged as putative risk factors. In consistence with present guidelines, Prostaglandin analogs were the most prescribed antiglaucoma drugs. The considerable proportion of asymptomatic cases (23%) suggests the need for periodic eye examinations to detect glaucomatous changes at an early stage.

Estudio de utilización de fármacos antipsicóticos en el hospital psiquiátrico Manuel Piti Fajardo de Manzanillo

Se realizó un estudio observacional, descriptivo, longitudinal y retrospectivo del tipo prescripción- indicación y estudio cuantitativo de consumo, con el objetivo de identificar los patrones de prescripción de antipsicóticos en pacientes con diagnóstico de esquizofrenia y trastornos relacionados hospitalizados en el Hospital Psiquiátrico Manuel Piti Fajardo de Manzanillo en el periodo comprendido de enero de 2013 a enero de 2015. Los datos se obtuvieron de las historias clínicas. La mayoría de los pacientes se encontraban en el rango de edad comprendido entre los 18 y 40 años de edad, del sexo femenino y soltero. Un mayor porcentaje tenía un tiempo de enfermedad mayor a cinco años, un tiempo de hospitalización mayor a un mes, y no tenía hospitalizaciones previas. El diagnóstico más frecuente fue el de esquizofrenia. Un pequeño grupo de pacientes presentó alguna comorbilidad psiquiátrica, como el trastorno depresivo. El antipsicótico más empleado, sea como monoterapia o en combinación con otro antipsicótico, fue clorpromazina. En general estos medicamentos fueron empleados dentro del rango terapéutico, con buena respuesta al tratamiento; las reacciones adversas medicamentosas que se presentaron fueron principalmente trastornos extrapiramidales y sedación; la asociación de antipsicóticos con depresores del sistema nervioso central fue la interacción medicamentosa potencial más frecuente.

An observational, descriptive, longitudinal and retrospective study of the prescription-indication type and quantitative study of consumption was carried out, with the aim of identifying the patterns of prescription of antipsychotics in patients with a diagnosis of schizophrenia and related disorders hospitalized at the Manuel Piti Fajardo Psychiatric Hospital of Manzanillo in the period from January 2013 to January 2015. The data were obtained from medical records. Most of the patients were in the 18 to 40 year age range, female, and single. A higher percentage had a time of illness greater than five years, a hospital stay greater than one month, and had no previous hospitalizations. The most frequent diagnosis was schizophrenia. A small group of patients presented some psychiatric comorbidity, such as depressive disorder. The most widely used antipsychotic, either as monotherapy or in combination with another antipsychotic, was chlorpromazine. In general, these drugs were used within the therapeutic range, with a good response to treatment; the adverse drug reactions that occurred were mainly extrapyramidal disorders and sedation; the association of antipsychotics with central nervous system depressants was the most frequent potential drug interaction.

Foi realizado um estudo observacional, descritivo, longitudinal e retrospectivo da prescrição-indicação e estudo quantitativo do consumo, como objetivo de identificar os padrões de prescrição de antipsicóticos em pacientes diagnosticados com esquizofrenia e transtornos relacionados internados no Hospital Psiquiátrico Manuel Piti Fajardo, em Manzanillo, no período de janeiro de 2013 a janeiro de 2015. Os dados foram obtidos a partir de prontuários. A maioria dos pacientes estavan afaixa etária entre 18 e 40 anos, do sexo feminino e solteiro. O percentual maior apresentou tempo de doença superior a cinco anos, tempo de internação superior a um mês, não com internações anteriores. O diagnóstico mais frequente foi a esquizofrenia. Um pequeno grupo de pacientes tinha alguma comorbidade psiquiátrica, como transtorno depressivo. O antipsicótico mais usado, seja como monoterapia ou em combinação com outro antipsicótico, foi a clororomazina. Em geral, esses fármacos foram utilizados dentro da faixa terapêutica, com boa resposta ao tratamento; as reações adversas de drogas que ocorreram foram principalmente distúrbios extrapiridais e sedação; a associação de antipsicóticos com depressores do sistema nervoso central foi a interação potencial mais frequente de drogas.

Patterns and outcomes of empirical antimicrobial use in elderly outpatients: A pilot observational study from North India

Introduction: Despite the rampant use of antimicrobials in health?care settings, the safety and clinical outcome data of antimicrobials are scarce in the elderly population. The main aim of this study is to assess the prescription pattern, therapeutic gains, and adverse reactions resulting out of antimicrobial use in elderly outpatients. Subjects and Methods: This was a prospective observational study conducted for 7 months from June 2019 to December 2019 in elderly patients visiting the geriatric outpatient department of a tertiary hospital of North India. Primary outcomes included clinical improvement as well as the incidence and type of adverse drug reactions (ADRs) observed with antimicrobial use. Results: Of 110 participants recruited, 107 were assessed for clinical outcomes. The common indications of antimicrobial use were lower respiratory tract infection (48.6%), urinary tract infection (18.7%), and worm infestations (14%). Macrolides (57%) and beta?lactams (43%) were the commonly prescribed individual antimicrobials. Outcome?wise, clinical improvement was seen in 91.3%, 88.5%, and 14.3% of patients receiving beta?lactams, macrolides, and antiprotozoals, respectively. ADRs occurred in 17.7% of participants and gastrointestinal disturbance was the commonly reported ADR. Beta?lactams and macrolides were responsible for the majority of ADRs, in 19.6% and 13.1% of participants, respectively. No association of antimicrobial?associated clinical responses or ADRs was observed with demographics and underlying comorbidities. Conclusions: Elderly patients with respiratory tract infections showed improvement with empirical extended-spectrum beta-lactams and azithromycin therapy. The response was suboptimal to empirically selected antiprotozoal therapy. Elderly patients are at increased risk of ADRs. Close to one out of every five elderly prescribed beta?lactams may develop ADR to the antimicrobial agent. Larger clinical studies are required to predict the risk factors of ADRs and poor responsiveness to antimicrobials.

Los médicos y la industria farmacéutica: impacto sobre actitudes y hábitos de prescripción / Physicians and the pharmaceutical industry: impact on prescription attitudes and habits

Resumen Introducción: La relación médico-industria farmacéutica (IF) se ha identificado como un problema ético por favorecer conflictos de interés derivados de los beneficios que reciben los médicos y que pueden afectar su juicio clínico. Objetivo: Identificar la frecuencia de participación de médicos en actividades financiadas por la IF, las actitudes de estos profesionales hacia los representantes de la IF, su conducta prescriptiva y la asociación de sus características y del trabajo con la participación en actividades financiadas por la IF. Método: Encuesta transversal a médicos internistas y cardiólogos. El cuestionario incluyó características de los médicos y centro de trabajo, participación en actividades financiadas por la IF, actitudes hacia los representantes y conducta de prescripción. Resultados: Se analizaron 455 cuestionarios, 78.5 % de los encuestados tuvo conocimiento de la relación médico-IF, la mayoría respondió reunirse con representantes de la IF, 30 % indicó haber recibido subsidios financieros y 10 % consideró que los obsequios afectan su prescripción. Tener conocimiento previo de la relación médico-IF se asoció con menor participación en actividades educativas financiadas por por la IF. Conclusión: Las prácticas y preferencias hacia la IF muestran la necesidad de diseñar estrategias para evitar la prescripción inapropiada.

Abstract Introduction: The physician-pharmaceutical industry relationship has been identified as an ethical problem, due to conflicts of interest motivated by the benefits that doctors receive and that can affect their clinical judgment. Objective: To identify the frequency of physicians participation in activities financed by the pharmaceutical industry (PI), their attitudes towards PI representatives (PIRs), their prescriptive behavior and the association between their characteristics and their workplace with their participation in activities financed by the PI. Method: Cross-sectional survey to internists and cardiologists. The questionnaire included characteristics of the doctors and their workplace, participation in activities financed by the PI, attitudes towards PIRs, and prescription behavior. Results: 455 questionnaires were analyzed; 78.5 % of surveyed subjects were aware of the physician-PI relationship, the majority acknowledged meeting with PIRs, 30 % indicated having received financial subsidies and 10 % considered that gifts affect their prescription. Having prior knowledge of the physician-PI relationship was associated with less participation in PI-financed educational activities. Conclusion: Practices and preferences towards the PI show the need to design strategies to avoid inappropriate prescription.

A pharmacoepidemiological study of prescription patterns of ?2 sympathomimetic bronchodilators in exacerbation of non-severe asthma in tertiary care hospitals, not needing hospitalization

Background: Arformoterol, the (R, R) enantiomer of the racemic (R, R / S, S) diastereomer, formoterol, is a short and long acting ?2 agonist bronchodilator. Levosalbutamol, the (R, R) enantiomer of racemic diastereomer (R, R / S, S) salbutamol, has a greater affinity for the ?2 receptor. Occupation of ?2 receptors by agonists result in the activation of the Gs-adenylyl cyclase-cAMP-PKA pathway, followed by phosphorylative events leading to bronchial smooth muscle relaxation. The aim of this pharmacoepidemiological study was to analyse the prescription patterns, and prescription content analysis, of arformoterol, levosalbutamol, formoterol or salbutamol, in non-severe asthma exacerbation in tertiary care hospitals, not needing hospitalization.Methods: It was a multi-centre, retrospective, observational and analytical study of 100 asthmatic patients’ hospital medical records, treated with 3 doses of arformoterol, levosalbutamol, formoterol or salbutamol nebulization, followed by peak expiratory flow rates (PEFR) measurement at the baseline and 6 minutes, after each dose; along with adverse effects recording. The number of prescriptions of 100 patients was recorded, the percentage of prescriptions was calculated, and the prescription content analysis was done.Results: PEFR of the patients showed significant increase after the first, second and third doses of bronchodilator nebulisation, with negligible adverse effects. Salbutamol was most commonly prescribed (45 prescriptions, 45%), followed by levosalbutamol (35 prescriptions, 35%), formoterol (15 prescriptions, 15%) and arformoterol (5 prescriptions, 5%). All aspects of prescription content analysis showed 100% completeness.Conclusions: Arformoterol was more effective, but equally safe, as compared to levosalbutamol, formoterol and salbutamol. Prescription frequency of salbutamol was followed by levosalbutamol, formoterol and arformoterol. Prescription content analyses showed 100% completeness.

Evaluation of Antihypertensive Drug Prescription Patterns, Rationality, and Adherence to Joint National Committee-8 Hypertension Treatment Guidelines among Patients Attending Medicine OPD in a Tertiary Care Hospital.

Introduction: The increasing prevalence of hypertension isattributed to population growth, ageing and behavioural riskfactors, such as unhealthy diet, harmful use of alcohol, lackof physical activity, excess weight and exposure to persistentstress. The present study was conducted to study on variousfacets of antihypertensive drugs prescribing at present scenarioat Dr B.C. Roy Hospital, Haldia, and with objectives of studyingprescribing patterns and rationality of antihypertensive drugsin essential hypertension with or without specific co-morbidconditions and to check compliance of treatment as per JNC-8hypertension treatment guidelines in the outpatients attendingthe Department of Medicine.Material and Methods: Data regarding anti-HTN monotherapy and combination therapy was recorded. Evaluation forrational drug therapy by evaluating average number of drugsper prescription, fixed dose combination (FDC) prescriptionrate, prescription laying down importance of lifestylemanagement, prescription with defined anti-HTN goals,prescriptions with correct dose strength and dosage schedulewas evaluated.Results: Out of 100 hypertensive patients under evaluation 67was males (67%) with a M:F ratio of 2.03:1. Mean SBP wasslightly higher in male patients. Hypertension was classifiedaccording to JNC-8 guidelines and found 22 (22%) (Prehypertension/pre-HTN), 57 (57%) (Stage 1 hypertension),and 13% (stage 2 hypertension) cases. Dyslipidemia wasnoted much more common associated disorders among newlydiagnosed hypertensive of either sex.Conclusion: Diuretics (8%) were most widely prescribeddrugs followed by ARBs (6%), ACE Inhibitors (5%) andcalcium channel blockers (4%) as monotherapy. Adherence ofJNC 8 guidelines among all study hypertensive participantswhile prescribing medications varied between 62% to 92%,with an average of 75%. None of the prescriptions mentionedban drug formulation(s). Still 15% of the prescriptionshad suggested combined drugs with debated rationalityformulations.

Antidepressant Prescription Patterns in Bipolar Disorder: a Nationwide, Register-based Study in Korea

BACKGROUND: The role of antidepressants (ADs) in bipolar disorder is long-standing controversial issue in psychiatry. Many clinicians have used ADs as a treatment for bipolar depression, and the selection of therapeutic agents is very diverse and inconsistent. This study aimed to examine recent AD prescription patterns for patients with bipolar disorder in Korea, using the nationwide, population-based data. METHODS: This study utilized the Korean nationwide, whole population-based registry data of the year 2010, 2011, and 2013. All prescription data of the ADs, antipsychotics, and mood stabilizers of the sampled patients diagnosed with bipolar disorder (n = 2,022 [in 2010]; 2,038 [in 2011]; 2,626 [in 2013]) were analyzed for each year. RESULTS: Annual prescription rate of ADs was 27.3%–33.6% in bipolar disorder, which was gradually increasing over the 3-year period. The combination pattern of ADs and antipsychotic drugs tended to increase over 3 years. The proportion of females and the prevalence of comorbid anxiety disorder were significantly higher in AD user group in all three years. Among individual ADs, escitalopram was prescribed most frequently, and fluoxetine and bupropion were prescribed to the next many patients. The mean duration of bipolar depressive episodes was 135.90–152.53 days, of which ADs were prescribed for 115.60–121.98 days. CONCLUSION: Our results show prescription rate of ADs in bipolar disorder was maintained at substantial level and increased in recent 3 years. More empirical data and evidence are needed to establish practical treatment consensuses.

Estudio de utilización de antibióticos en el servicio de consulta externa de un hospital público en Bogotá, D.C. / Study of the use of antibiotics in the outpatient service of a public hospital in Bogotá, D. C.

Se realizó un estudio de utilización de medicamentos sobre hábitos y calidad de la prescripción, con el fin de describir las características y potencial uso no adecuado de los antibióticos en el servicio de consulta externa de un hospital de segundo nivel de la ciudad de Bogotá, D.C. En las 8077 prescripciones analizadas se encontraron 613 (8%) con al menos un antibiótico de uso sistémico. Los antibióticos más dispensados fueron: Amoxicilina, Cefalexina, Ciprofloxacina, Dicloxacilina, Doxiciclina. Se prescribieron combinaciones de dos antibióticos en el 3% de las fórmulas, siendo la más frecuente macrólido-penicilina. Todas las prescripcion esanalizadas cumplieron con los requisitos de calidad y el 0,4% de los tratamientos no tenían el tiempo de duración del tratamiento. La frecuencia de uso de los antibióticos en el servicio de consulta externa fue más baja que en otros estudios. Se identificaron potenciales usos no adecuados como la falta de diagnóstico infeccioso, combinación de antibióticos no documentada, interacciones de medicamentos y falta de información adecuada en la administración de tetraciclinas.

A study on drug use habits and quality of prescribing was conducted to describe the characteristics and potential inadequate use of antibiotics in the outpatient service of one of the Bogota's second-level hospitals. In 8077 prescriptions analyzed it was found 613 (8%) with at least one antibiotic for systemic use. Amoxicillin, Cephalexin, Ciprofloxacin, Dicloxacillin, and Doxycycline were the most dispensed antibiotics. Combinations of two antibiotics were prescribed for 3% of the formulas; the most common of these was macrolide-penicillin. All prescriptions analyzed met the quality requirements and only 0.4% of the treatments did not have the time duration of treatment. The found frequency of use of antibiotics in outpatient services was lower than in other studies. Potential not suitable uses as the lack of infectious diagnosis, antibiotic combination unreported, drug interactions and lack of adequate information on the administration of tetracyclines were identified.

Prescription Patterns and Appropriateness of Topical Mupirocin in Ambulatory Care using the Korean National Health Insurance Claims Database

BACKGROUND: Mupirocin, a topical antimicrobial agent has been used for patients with methicillin-resistant Staphylococcus aureus and recently mupirocin resistance was issued in some studies. The objective of this study was to analyze prescription patterns of topical mupirocin, to evaluate appropriateness of prescriptions in the ambulatory setting, and to compare frequency of mupirocin usage in South Korea with that in United States. METHODS: Topical mupirocin prescription patterns (the number of prescription and a prescription period), and appropriateness of prescription (including a prescription rate over 10 days, a repeat prescription rate within 30 days and a prescription rate within labeled indications) were analyzed using the 2012 Health Insurance and Review and Assessment service-National Patient Sample dataset of South Korea. The National Ambulatory Medical Care Survey dataset was used to quantify topical mupirocin prescription in United States for comparison. RESULTS: In South Korea, the prescriptions rate for use over 10 days was 3%, the repeat prescription rate within 30 days was 8.87% and the prescription proportion within labeled indications was 33.84%. The most frequent diagnostic code was nonbacterial infection. The prescription rate per 1000 population of topical mupirocin in South Korea was calculated to be 46.07, whereas in United States was calculated to be 13.10. CONCLUSION: Topical mupirocin has been used frequently and inappropriately, so further studies are required to investigate the rationale behind such prescribing mupirocin patterns.

Prescription patterns of antihypertensive drugs in a tertiary care hospital in India.

Background: The present study was conducted to analyze the prescribing patterns and utilization of antihypertensive drugs at a tertiary care center in India. Methods: A cross-sectional analysis of prescriptions of patients of essential hypertension attending outpatient department of a tertiary care hospital during the period of December 2011 to March 2012 was done. Hypertensive patients with comorbidities were excluded from study. The data were analyzed to fi nd out demographic characteristics of patients, number of drugs prescribed per prescription, drugs, which are commonly prescribed, antihypertensive drugs used concurrently, percentage of drugs prescribed by generic name and over all drug utilization frequency. Results: During the study period, 465 prescriptions for hypertension were analyzed. This study revealed that most of the patients were on combination of antihypertensive drugs (67.97%) while 31.18% patients received mono therapy. Among mono therapy drugs, calcium channel blockers (CCB) (31.03%) were prescribed most. Utilization of other major drug classes as mono therapy in decreasing order is angiotensinconverting enzyme inhibitors (28.28%), diuretics (17.93%), beta-blockers (11.72%) and angiotensin receptor blockers (10.34%). Among those who were treated with drug combinations, 64.24% received 2-drug, 25.95% received 3-drug regimen and 8.54% received 4-drug regimen. In combination therapy, 2-drug combination consisting of a CCB and a diuretic was most commonly (24.14%) prescribed. Conclusions: This study represents the current prescribing patterns for antihypertensive drugs and provides the baseline data for similar studies in future, as patterns in prescribing antihypertensive drugs keep changing.