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India has been titled the capital of antimicrobial resistance in the world with the centre for disease dynamics, economics andpolicy (CDDEP) predicting two million deaths in India by 2050. As per the World Health Organisation抯 global priority pathogen list of 2017, methicillin resistant Staphylococcus aureus(MRSA)has been classified as a 慼igh priority� pathogen due to its association with increased mortality rate, rising prevalence of resistance and increased burden on healthcare settings. A recent report by Indian Council of Medical Research signifies the exponential rise in the prevalence of MRSA in India, from 29% in 2009 to 39% in 2018. Serious MRSA infections are commonly associated with poor clinical outcomes coupled with increased hospitalisation stay and cost. Therefore, early identification and appropriate empiric treatment of MRSA plays a crucial role in healthcare settings. However, the constant rise in multi-drug resistance to the currently available anti-MRSA agents as well as their compromised safety profile limits its clinical use to manage severe MRSA infections. This review article explores the implications of severe MRSA infections and inappropriate empirical therapy on the clinical as well as economic outcomes. In addition, it also highlights limitations of the currently available anti-MRSA agentsand the need for newer agents to manage multi drug resistant (MDR)gram positive infections.
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Background:Drug use evaluation is an ongoing systematic process designed to maintain the appropriate medication during & after dispensing in order to assure appropriate therapeutic decision making andpositive patient outcome. Methods:An institutional based cross-sectional study design was conducted to analyze drug use of vancomycin by using medication charts and medical note of patients that were admitted in the medical ward of Yekatit 12 Hospital Medical College. Data was analyzed using SPSS version 20. Patients who were admitted from medical ward and whose age were≥18years were eligible provided that they take Vancomycin during the study period were included and Patients with medical records of insufficient or illegible information’s were excluded. Structured check list was used for data collection, and the samplesize was 169. Convenience sampling technique was used.Results:Among 169 patients 136(80.5%) had empiric treatments, the remaining 33(19.5%) had specific treatments. Among 169 patients 61(36.1%) hadInfection during his/her stay in hospital of which 47(77%) were hospital acquired pneumonia, 169 patients 39(23.08%) had Vancomycin indication for hospital acquired pneumoniafollowed by 21 (12.4%), 21(12.4%), meningitis and PCP respectively. The finding indicated that only 135(79.9%) were appropriate regarding frequency, 124(73.4%) were appropriate regarding dose, 104(61.6%)were appropriate regarding duration, and the appropriate indication were only 128(75.7%).Conclusions:Vancomycinewas mostly indicated as empiric therapy and only 135(79.9%) were appropriately prescribed with respect to frequency, 128(75.7%) were appropriate regarding indication and 124(73.4%) were appropriate regarding to dose, 104(61.6%) were appropriate regarding to duration. All physicians should prescribe drugs according to the guidelines.
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Objective. To find out whether the causes of upper GI bleeding in our center in a developing country differed from developed countries. Methods. Children presenting to our center with upper GI bleeding from March 2002 to March 2007, were retrospectively evaluated. Informations were retrieved from patient’s history and physical examination and results of upper GI endoscopy regarding etiology of bleeding, managements, use of medications which might predispose patient to bleeding, and the mortality rate. Results. From 118 children (67 boys; with age of 7.7±4.7 yrs) who underwent upper GI endoscopies, 50% presented with hematemesis, 14% had melena and 36% had both. The most common causes of upper GI bleeding among all patients were gastric erosions (28%), esophageal varices (16%), duodenal erosions (10%), gastric ulcer (8.5%), Mallory Weiss syndrome tear (7.8%), duodenal ulcer (6.8%), esophagitis (1.7%) and duodenal ulcer with gastric ulcer (0.8%). The causes of bleeding could not be ascertained in 20.5% of cases. No significant pre-medication or procedure related complications were observed. Endoscopic therapy was performed in 13.5% of patients. In 14.4% of patients, there was a history of consumption of medications predisposing them to upper GI bleeding. Two deaths occurred (1.7%) too. Conclusion. The findings in the present study showed that half of upper GI bleedings in pediatric patients from south of Iran, were due to gastric and duodenal erosions and ulcers. This study concludes that the causes of upper GI bleeding in children in our center of a developing country, are not different from those in developed ones.