ABSTRACT
With the significant breakthrough that programmed cell death 1 (PD-1)/programmed cell death 1 ligand 1 (PD-L1) antibody drugs achieved promising clinical outcomes across various tumor types, immunotherapy targeting immune checkpoint has been considered a promising way to treat cancer. However, most recently studies suggest that the hyperprogressive disease occurred frequently during the therapy of using PD-1/PD-L1 antibody drugs and has become an urgent problem to be solved. In this review, we summarize the progress and potential reasons of hyperprogressive disease caused by PD-1/PD-L1 blockade, and further discuss its application based on the rational use of biomarkers for searching the benefit patients.
ABSTRACT
Background: Nowadays irrational use of drugs is a major problem inspite of extensive programs being carried out on rational use of medicines. Therefore, in present study we evaluated OPD prescriptions for rationality and their adherence to prescription format.Methods: A prospective, observational study was carried out in 511 outdoor patients for a period of three months. Quality of prescription writing was assessed for completeness of information and legibility. Rationality was analyzed using WHO core prescribing indicators.Results: Basic information of patient and name of department were written in all the prescriptions. Diagnosis was mentioned in 76.33% cases. Dosage forms, dose, frequency and duration of treatment were mentioned in 97.26%, 73%, 80.04% and 80.23% of prescriptions respectively. About 73.78% prescriptions were legible. Doctor’s name, signature and registration number were present in 80.82%, 82.97% and 15.66%. Total number of drugs in 511 cases was 1074. Average number of drugs/ prescriptions was 2.1±0.8. Drugs were prescribed by generic name in 25.14% cases; drugs from EDL were 57.36%. Antimicrobial agents, injectable drugs and FDCs were prescribed in 25.83%, 12.13% and 39.14% cases. The most commonly prescribed drugs were analgesics, GIT and cardiovascular drugs.Conclusions:This study shows possible areas of improvement in prescription practice that is generic prescribing, use of essential medicines, restraint in use of irrational fixed dose combinations and better quality of prescribing in terms of inclusiveness of information, legibility and doctor’s details.
ABSTRACT
Background: The present study was designed to assess awareness regarding rational drug therapy and fixed dose combinations (FDC) amongst interns and II MBBS students in a tertiary-care teaching hospital in Maharashtra, India.Methods: This cross-sectional, questionnaire-based study containing MCQ and analytical questions on rational drug therapy, fixed dose combinations and role of Pharmacist in dispensing correct drug to the patients was carried out in both interns (n=80) and II MBBS students (n=100). The completed questionnaires were then collected and analysed statistically for responses.Results: Mean average score obtained by II MBBS students (score - 36.66marks) was significantly better than interns (score- 20marks) which probably may be due to pharmacology teaching they were undergoing. II MBBS students were found to be better informed as compared to the interns (p<0.05) on questions related to rational drug therapy. On the questions related to rationality of FDC in Yes/No type, interns and II MBBS students were found to be equally informed (p>0.05). However, on question related to justification of FDC, interns were found to be better informed as compared to the II MBBS students (p<0.05). On single question pertaining to role of pharmacist, interns were found to be better informed than II MBBS students possibly due to their better understanding of patient-pharmacist relationship.Conclusions: Our study highlights the significance regarding knowledge of rational drug therapy and fixed dose combination (both rational and irrational), both rational and irrational, amongst both interns and II MBBS students while identifying the possible areas of interventions to make them rational clinicians.
ABSTRACT
Stevens–Johnson syndrome (SJS) is one of the manifestations of severe form of cutaneous adverse drug reactions (CADRs). Penicillin group of antibiotics is well-known to cause the CADRs. Few cases of amoxicillin and only one case of dicloxacillininduced SJS have been reported. To the best of our literature search, we have not come across a single case of amoxicillin– dicloxacillin-induced SJS. Here, we report a case of amoxicillin–dicloxacillin-induced SJS in a 28-year-old female patient. The rationality of amoxicillin–dicloxacillin fixed drug combination is doubtful. Hence, prescribing rational drug therapy and promptly reporting the adverse drug reactions is essential so that noncompliance to treatment with resultant therapeutic failure and augmented antimicrobial resistance can be avoided.
ABSTRACT
OBJECTIVE: To estimate and optimize the dosing regimens of antibiotics in general surgery with the utilization of Monte Carlo simulation (MCS) based on PK/PD. METHODS: The mean treatment duration(MTD) of different dosing regimens were gathered from clinical cases. MCS model was used to simulate the regimens against Escherichia coli, Klebsiella pneumonius, Acinetobacter baumannii and Pseudomonas aeruginosa, respectively. RESULTS: The CFRs of 500 mg TID, 500 mg QID, 1.0 g BID and 1.0 g TID imipenem against Escherichia coli and Klebsiella pneumonius were greater than that of 500 mg BID (100%; 99%). Correspondingly, MTD of those regimens achieved CFR 100% were shorter than that of 500 mg BID. The CFRs of imipenem against Acinetobacter baumannii and Pseudomonas aeruginosa were all less than 90%, the CFRs of 200 mg BID, 400 mg QD levofloxacin and 200 mg QD, 200 mg BID, 400 mg QD amikacin were all below 90%. CONCLUSION: The 5 dosing regimens of imipenem were all effective against Escherichia coli and Klebsiella pneumonius. In consideration of pharmaceutical economics, 500 mg TID was the most rational choice. It suggested drug resistance and promoted combined medication that the CFRs of imipenem against Acinetobacter baumannii and Pseudomonas aeruginosa failed to achieve 90%. Drug resistance was also demonstrated by low CFR values of levofloxacin and amikacin treatments. Nevertheless, results of MCS showed inversely proportional between MTD and CFRs, and displayed obvious dose-dependent characteristics of levofloxacin and amikacin. On the purpose of achieving effective concentration, sufficient dose once a day of levofloxacin and amikacin medication were recommend.
ABSTRACT
The present study of prescribing pattern for evaluation of rational drug therapy was carried out in Jammu city for a period of six months. Two hundred prescriptions written by qualified medical graduate and postgraduate doctors were collected and studied for their correctness and rationality. The doctor's identity, patient's name, age and address, superscription, route of administration and administration of therapy were mentioned in 27%,100%, 27%, 5%,63%,20% and 66% of prescriptions respectively. Drug use has been found to be inappropriate in 33 % of the drugs and large number of prescriptions do not conform to the ideal pattern .