Variation of cost among anti-malarial drugs available in Indian market

Background: There are numerous brands of antimalarial existent in the market. Expensive drugs could result in financial drain that causes reduced compliance or even non-compliance. Non-adherence to therapy could consequently cause partial treatment that leads to higher morbidity and in certain cases mortality too. Thus this evaluation was conducted to measure the cost disparity of malaria therapy.Methods: The maximum and minimum price of each brand of the drug in Indian rupee rate was noted by using the latest edition of current index of medical specialities. The cost ratio and the percentage cost variation for individual drug brands were calculated.Results: The analysis of data reflected a considerable cost variation among antimalarial drugs. Chloroquine DS 500 mg showed the highest cost ratio and cost variation (cost ratio=15.3 and % cost variation=1434). Overall injectable antimalarials showed considerable cost variation as compared to oral antimalarial agents.Conclusions: The maximum variation shown by oral antimalarial was found to be for chloroquine DS 500 tablet. But there was significant price variation among injectable antimalarial. Injectable antimalarials are often the choice of drug when dealing with critically ill malaria patients specially when suffering from complicated malaria. So, such significant price variation creates burden on poor patients economically which leads to non-compliance and hence increased morbidity and mortality due to incomplete treatment.

Cost variation analysis of parenteral antibiotics in Indian pharmaceutical market

Background: The objective of the present study was to analyse price differences between parenteral antibiotics available in a tertiary care teaching hospital.Methods: The study was done in the Department of Pharmacology of S. D. M. College of Medical Sciences, Dharwad, Karnataka. Latest volume of current index of medical specialties or Indian Drug Review was used to analyze the prices of parenteral antibiotics.Results: Overall, prices of 17 single drug antibiotics available in 37 strengths marketed and 8 fixed-dose combinations available in 16 strength marketed were analyzed. It was observed that the maximum cost variation among the single ingredient parenteral antibiotic was with cefpirome 1000 mg. The price difference being Rs. 283 and the cost variation being 90.7%. The minimum price variation was seen with Ampicillin 100 mg of Rs. 4.3 and the cost variation being 40.2%. Additionally the highest price difference was also seen teicoplanin 400 mg i.e., Rs. 610 and its cost variation being 68.5%. Among the fixed-dose combination (FDC抯) the maximum price variation was observed in the combination of cefoperazone+sulbactum 1000+1000 of Rs. 340. Whereas the cost variation of the same was 212.5 %. The minimum price variation among the FDC抯 was of the combination of ceftriaxone 250 mg + tazobactum 31.25 mg Rs. 3.3 and its cost variation being 7.9 %.Conclusions: Pharmacoeconomics facets must be taken into deliberation by healthcare practitioners while prescribing antibiotics to the patients for infectious disease treatment. This will assist compliance, reduce antibiotic resistance and treatment failure.

Drug usage pattern of antimicrobials in elderly hypertensive, diabetic in-patients with or without impaired renal function

Background: Hypertension (HTN) and diabetes mellitus (DM) are the primary contributors to renovascular mortality and morbidity including chronic kidney diseases. Additionally, these patients are in frequent need of an antimicrobial agent. Drug utilisation studies (DUS) are prospective tools in the assessment of health care systems. The objective of the present study was to analyse the prescription pattern of anti-microbials in elderly hypertensive diabetic in-patients with or without renal impairment in a tertiary hospitalMethods: The study population comprised of 165 hypertensive diabetic in-patients at Shri Dharmasthala Manjunatheshwara (SDM) Hospital. Questionnaire based evaluation was carried out and prescriptions of patient with HTN and DM at and above the age of 60 years irrespective of gender were included.Results: Among anti-microbial agents, other ? lactam antibacterial were the most commonly prescribed class of drugs (40.85%) which was similar in patients with impaired renal function (21.8%).Conclusions: There was a significant increase in the number of anti-microbial agents and other drugs in the patients with impaired renal function when compared to patients with normal renal function (p <0.05).

Drug usage pattern of anti-hypertensive drugs in elderly diabetic, hypertensive in-patients with or without impaired renal function in a tertiary care hospital

Background: Hypertension (HTN) and Diabetes mellitus (DM) are the leading contributors to the cardiovascular mortality and morbidity. Drug utilisation studies (DUS) are potential tools in the evaluation in health care systems. Objectives was to analyse the drug usage pattern of anti-hypertensives in elderly hypertensive diabetic in-patients in a tertiary hospital. To analyse drug usage pattern of anti-hypertensives in elderly hypertensive, diabetic in-patients with renal impairment in a tertiary hospital.Methods: The study population consisted of 165 hypertensive diabetic in-patients at Shri Dharmasthala Manjunatheshwara (SDM) Hospital. Questionnaire based study was conducted and prescriptions of patient with HTN and DM at and above the age of 60 years irrespective of gender were included.Results: Our study revealed that angiotensin receptor blockers (ARBs) were the most commonly prescribed (42.4%) class of anti-hypertensive drugs. In patients with impaired renal function also ARBs were the most common class prescribed (22.0%). Out of 35 anti-hypertensive fixed drug combinations (FDCs) prescribed the most frequent combination was combination with an ARBs (85.7%). There was a significant increase in the number of anti-hypertensive drugs prescribed in patients with impaired renal function when compared to patients without impaired renal function (p <0.05). The cost index was high, and the percentage cost variation was more than 100% in most of the anti-hypertensive drugs prescribed.Conclusions: This study shows that the most commonly prescribed anti-hypertensive drug class was ARBs in patients with and in patients without impaired renal function.

Clostridium Difficile-Associated Diarrhea: A Review.

Clostridium difficile–associated diarrhea (CDAD) has become a major public health problem. The offending pathogen is acquired by the fecal-oral route from an environmental source or by contact with an infected person or health care worker who serves as a vector. Alteration of the intestinal microflora, frequently by antibiotics, generates a favorable environment results in the proliferation of C. difficile. The pathogen is not invasive but produces two toxins, A and B, that lead to severe inflammation of the colonic mucosa manifested as profound diarrhea, fever, abdominal pain, and leukocytosis. A new hypervirulent strain of C. difficile has become prevalent in the United States, Canada, and the United Kingdom. Identified by pulsed-field gel electrophoresis (PFGE), this strain is called North America PFGE type 1, abbreviated as NAP-1, and characteristically generates large amounts of toxins A and B, in addition to a binary toxin, and is associated with higher morbidity and failure of antibiotic therapy. Mild cases of CDAD may respond to withdrawal of antibiotic therapy, however the majority of patients require C. difficile-specific antimicrobial therapy. The US FDA has approved oral vancomycin for treatment of CDAD, but reluctance to use this antibiotic due to the fear of developing vancomycinresistant organisms in the hospital setting has made metronidazole the recommended first-line therapy for mild to moderate disease. Some newer studies show a high rate of failure, due to infection by NAP-1 or to the presence, in hospitals, of geriatric patients with more concurrent illnesses who may also have been treated with many broad-spectrum antibiotics. The recurrence rate after initial successful treatment can be as high as 20-30%, depending on the initial treatment. A more C. difficile-targeted non-absorbable bacterial RNA polymerase inhibitor, fidaxomicin (also known as OPT-80 and PAR-101), has recently been approved in the US with initial efficacy similar to vancomycin and a lower recurrence rate. Some additional agents that have shown efficacy in humans are nitazoxanide, bacitracin, teicoplanin, and fusidic acid. Rifaximin, polymers that bind C. difficile toxin, monoclonal antibodies to toxins, and preventive measures such as toxoid vaccines are under investigation. Interventions for treatment of recurrences include repeated vancomycin or fidaxomicin courses, probiotics, rifaximin, intravenous immunoglobulin and fecal transplants. Measures for preventing the spread of the pathogen, appropriate diagnostic testing, and treatment may avert morbidity and mortality due to CDAD.