In-Vitro Study of Antimicrobial Activities of Five Different Commercial Fixed Dose Combination Drugs in Indian Market.

Objective: In-vitro determination of antimicrobial activities of five different fixed dose combination drugs (FDC). Material and methods: Five antibiotic combination tablets [Cefadroxil plus Clavulanic acid (500:125 mg), Cefuroxime plus Clavulanic acid (500 : 125 mg), Cefixime plus Clavulanic acid (200 : 125 mg), Cefixime plus Ofloxacin (200 : 200 mg) and Cefixime plus Azithromycin (200 : 500 mg)] were tested for antimicrobial action against different microorganisms after their successful incubation for 18 hours at 37°C. Broth dilution or agar dilution methods were used to evaluate susceptibility of microorganisms. Results: 􀁺 Minimum inhibitory concentration (MIC) of Cefadroxil in combination with clavulanic acid reduced by 25%, 29%, 85% and 50%, against S. aureus, K. pneumonia, H. influenzae and S. pneumoniae respectively. 􀁺 No reduction was seen in MIC of Cefuroxime against S. aureus, K. pneumonia, H. influenzae, E. coli or S. pneumoniae after addition of Clavulanic acid. 􀁺 MIC of Cefixime against S. pneumoniae reduced from 0.2 to 0.14 when combined with Clavulanic acid. 􀁺 MIC of Ofloxacin against K. pneumoniae, E.coli and S. pneumoniae reduced by 82%, 50% and 85% respectively in combination with Cefixime. 􀁺 MIC of Cefixime against E.coli, S. typhi and S. pneumoniae reduced by 95%, 90% and 40% respectively in combination with Ofloxacin. 􀁺 MIC of Cefixime against S. typhi and S. pneumoniae reduced by 33.33% and 60% respectively with addition of Azithromycin. 􀁺 MIC of Azithromycin against S. typhi reduced by 70% after addition of Cefixime. Conclusion: Combination of Cefixime and Ofloxacin improves susceptibility of E. coli and S. pneumoniae. Addition of Azithromycin or Ofloxacin improves susceptibility of S. typhi against Cefixime. MIC of Azithromycin also improves with addition of Cefixime. Addition of Clavulanic acid improves antimicrobial action of Cefixime against S. pneumoniae and Cefadroxil against S. aureus, K. pneumonia, H influenza and S. pneumonia.

Coverage and Compliance of Mass Drug Administration for Elimination of Lymphatic Filariasis in Bijapur District, Karnataka.

Background: Lymphatic Filariasis (LF) is the world's second leading cause of long-term disability. The current estimate reveals that 120 million people in 83 countries of the world are infected with LF parasites and more than 20% of the world's population are at risk of acquiring infection. The present study was con-ducted to assess the program effectiveness of the 2-drug strategy in terms of actual coverage, compliance rates of MDA against filariasis in the district along with the reasons for non-compliance. Objectives: To eval-uate independently the MDA Programme against Filariasis with respect to its coverage and compliance among the community. To know the reasons for non-compliance. Materials and Methods: A Community based Cross-Sectional Study was conducted in Bijapur District. A total of four clusters, one urban and three rural clusters were selected randomly. All the sampled eligible population who belong to the MDA campaign area were included. The eligible population did not include pregnant and lactating women, children below two years of age and seriously ill persons. The data were collected in pretested Performa, tabulated using Microsoft Excel 2013 and analysed using OPENEpi software. Results: The demographic profile of the study sample is as follows, 67.6% of the population were in the age group of 14-60 years. Male to female ratio was equal. 66.48% of the study population were from rural area and 33.52% were from urban area. 81.63% of the population received the drugs. 79.21% of the population consumed the DEC and Albendazole tablets. 14.60% of the sample population did not consume. Major reasons for not taking tablets were fear of side effects (56.67%) and 22.50% forgotten to take the tablets. Conclusions: The effective coverage was below the target (85%). The overall coverage was better in rural areas compared with urban areas.

Evaluation of the analgesic and anti-inflammatory activity of fixed dose combination: Non-steroidal anti-inflammatory drugs in experimental animals.

Background: In India, a number of fixed dose drug combinations of non-steroidal anti-inflammatory drugs (NSAID's) are available, often as over-the-counter products. These combinations are being prescribed too. Evidence for efficacy of NSIAD fixed dose combination is lacking. Objectives: The current study was undertaken to assess the analgesic and anti-inflammatory efficacy of these combinations over their individual components. Materials and Methods: The study used three NSAIDs viz; paracetamol, ibuprofen and diclofenac sodium, alone or in combination with paracetamol. Animals were divided into six groups with six animals in each group. Analgesic activity was tested by writhing test and paw edema model was used to assess the anti-inflammatory activity. The test drugs were administered orally 30 min prior to injecting 0.6% solution of glacial acetic acid intraperitoneally for writhing test. For paw edema test, after 30 min of drugs administration, animals were injected with 0.1 ml of 1% carrageenan in subplanter region for inducing inflammation. Paw volume was again measured at baseline and after 3 h of subplanter injection of 1% carrageenan. Results: The analgesic and the anti-inflammatory activity of paracetamol and ibuprofen combination were significantly greater than the individual agents when used alone. However, no significant difference in the analgesic or anti-inflammatory activity was found between diclofenac sodium and its combination with paracetamol. It was observed that diclofenac sodium was the most efficacious of the analgesics tested. Combining paracetamol with diclofenac did not show superior analgesic activity compared to diclofenac alone (P = 0.18). Conclusion: Combining paracetamol with ibuprofen enhances analgesic/anti-inflammatory activity over their individual component but potentiation of analgesic activity of diclofenac was not seen when paracetamol was added to it.

Adjuvant chemotherapy with six cycles of AC regimen versus three cycles of AC regimen followed by three cycles of Paclitaxel in node-positive breast cancer.

Context: Antracycline-Cyclophosphamide (AC) along with Paclitaxel/Docetaxel, either in combination or sequential regimens, is showing superior results than Anthracycline-containing regimens. Aims: This study was designed to determine whether adding Paclitaxel to a standard adjuvant chemotherapy regimen AC for breast cancer patients would prolong the time to recurrence and survival. Settings and Design: Randomized, prospective, open-labeled, single-institutional study. Materials and Methods: Fifty stage II breast cancer patients accruing 25 patients in each arm, treated between July 2007 and January 2010, were included in the study. Initial surgical treatment was Modified Radical Mastectomy. Systemic therapy was to have begun within 4-6 weeks of the patient's surgery. In the control arm, all the patients were treated with six cycles of adjuvant chemotherapy with AC regimen repeated at an interval of 3 weeks. For the study arm, the patients received adjuvant chemotherapy with three cycles of AC regimen followed by three cycles of Paclitaxel, repeated at an interval of 3 weeks. All the patients of both the arms received locoregional external beam radiotherapy (EBRT) after the entire course of chemotherapy. All the hormone receptor-positive patients received Tamoxifen. Statistical Analysis Used: Statistical analysis was performed using the chi-square test and the Kaplan Meier survival analysis with the log-rank (Mantel-Cox) test. Results: Adding Paclitaxel to AC resulted in a statistically significant disease-free survival. The overall survival was also improved significantly. The toxicity profile in both the arms was comparable. Conclusions: In early and node-positive breast cancer, the addition of three cycles of Paclitaxel after completion of three cycles of AC improves the disease-free and overall survival.

Pre - emptive epidural analgesia with bupivacaine, deltiazem and ketamine singly or in combination - A Randomised Trial.

Background: A randomized control study was designed to compare postoperative epidural analgesia by preemptive use of epidural administration of local anesthetic- bupivacaine alone and in combination with NMDA blocker- ketamine or calcium channel blocker- diltiazem singly or both in combination . Medhods: Sixty female patients in age group 35-50 yrs with ASA grade I and II, posted for open abdominal hysterectomy were randomly distributed in four groups after ethical committee approval and written consent. They were given epidurally 0.4 ml /kg of 0.5 % Bupivacaine in Control group, 0.4 ml /kg of 0.5 % Bupivacaine + Ketamine 5mg in BK group , 0.4 ml /kg of 0.5 % Bupivacaine + Diltiazem 10 mg in BD group and 0.4 ml /kg of 0.5 % Bupivacaine + Ketamine 5 mg + Diltiazem 10 mg in BKD group. Results: BK group had significant pain free period (8.8 ± 1.37) post operatively as compared to rest three groups (P < 0.01). BD group (5.8 ± 0.94) also had comparable pain relief.BKgroup needed three to four number of top-up's in first 24 hours (3.37 ± 0.46) where as BD group needed five to seven number of top-up's in next 24 hours (5.93 ± 0.70) (P < 0.01). BK group and BKD group patients were sedated resulting in reduced number of top-ups required in first 24 hours. Conclusion: Ketamine and diltiazem were found to be synergetic with bupivacaine for preemptive epidural analgesia. Diltiazem was better option over ketamine when sedation is not desirable.

Morphine-midazolam combination dose for presurgical analgesia in children

We have examined the use of presurgical morphine-midazolam combination in 80 children aged 2-10 y undergoing repair of hypospadias. They were allocated randomly, in a double-blind study, to receive one of four morphine-midazolam combination doses [n = 20 each]; [group I: 76 mg/kg each] [group II: 75 mg/kg morphine, 50 mg/kg midazolam]; [group III: 50 mg/kg morphine, 75 mg/kg midazolam]; [group IV: 50 mg/kg each]. Drugs were given after induction of anesthesia and before the start of surgery. Observational scoring system, using crying, movement, agitation, posture and localization of pain as scoring criteria, was used to assess the children during their stay in the recovery room together with their sedative and/or analgesic requirement. Pre-surgical morphine-midazolam administration produced stable hemodynamic variables with satisfactory postoperative analgesia suggesting 75 mg/kg dose of both morphine and midazolam as upper permissible dose, and 50 mg/kg each as lower effective dose

Nasal low dose ketamine combined with midazolam for paediatric premedication

Sixty Children aged from three to six years scheduled for tonsillectomy or bilateral insertion of tympanotomy tubes under general anaesthesia were studied. The patients were randomly allocated into two groups where group [A] received a combination of intranasal ketamine [2 mg/kg] and midazolam [0.1 mg/kg] and group [B] received placebo [normal saline]. Anaesthesia was induced with 5% halothane and 100% 02 via face mask, subjects given intranasal combination of ketamine-midazolam were more likely to separate willingly from their parents at or before 10 minutes compared to patients given placebo. 60% of patients given this combination separated at 4 minutes compared to 20% of patients given placebo. The quality of subsequent halothane induction was excellent in 70% of patients given this combination and adequate in the remaining 30%. In 70% of patients given placebo induction was unacceptable. There were no incidents of any behavioral changes or psychological disturbances in patients given this intranasal combination. No statistically significant difference as regards recovery time was recorded between both groups. It can he concluded that nasal low dose ketamine combined with midazolam provides an effective paediatric premedication with regard to sedation and mask acceptance. It has rapid action with no prolongation of recovery time and no instances of emergence phenomena. Nasal ketamine- midazolam combination offers an alternative to intramuscular or per rectum routes for preanaesthetic sedation in young children aged from three to six years

Doseamento do flurbiprofeno com hidróxido de sódio / Flurbiprofen assay with sodium hydroxide

Flubiprofeno, antiinflamatório näo-esteróide derivado de ácido fenilalcanóico, eficaz no tratamento de artrite reumatóide e enfermedades relacionadas, foi determinado quantitativamente por volumetria com hidróxido de sódio, usando-se fenolftaleína como indicador