A New Fixed Dose Combination of Ceftriaxone + Sulbactam + Disodium Edetate for Definitive Treatment of Infections Due to Piperacillin/ Tazobactam Resistant Bacteria: A Retrospective Efficacy and Pharmacoeconomic Study.

Objective: Present retrospective study was aimed to analyze comparative efficacy of fixed dose combination (FDC) (ceftriaxone + sulbactam + disodium edetate) and meropenem used alone or in combinations with other antibiotics for management of intensive care unit (ICU) patients suffering with infections from piperacillin-tazobactam (pip-taz) resistant bacteria and to assess the costs associated with respective therapies. Methodology: Patients records were collected and their demographic characteristics, infection types, co-morbidities, antibiotic therapy, dosage, treatment duration microbial and clinical success rates were evaluated. Effectiveness and costs analysis between antibiotic regimens were estimated in Indian rupees (INR). A total of 136 patients data treated at a tertiary-care hospital was analyzed. These 136 patients included 28, 18, 19, 17, 31 and 23 patients of urinary tract infection (UTI), blood stream infection (BSI), community acquired infection (CAI), skin structure infection (SSI), intra-abdominal infection (IAI) and ventilator associated pneumonia (VAP), respectively. Out of 136 patients, 56 patients received FDC and another 80 patients were administered with meropenem empirically. Results: Clinical cure observed was 71.42% and 67.50% in FDC and meropenem groups, respectively. The patients in whom meropenem and FDC treatment regime failed to show improvement, colistin was given as an additional cover, which resulted in clinical cure of 86.95% and 85.71% patients respectively. Comparative cost expenditure analysis of these two drug treatment regimens revealed that, the overall treatment cost for patients cured with antibiotic regimen containing meropenem was 107.39% more than that of FDC. The strongest contributors of the increase in treatment costs were cost of antibiotic, number of dosages, average treatment duration and clinical failure rates. Conclusion: Infections with pip-taz resistant bacteria are frequent in ICU patients and the present study demonstrates that FDC has comparatively similar efficacy as that of meropenem which is considered as an appropriate option to treat pip-taz resistant cases. Pharmacoeconomic analysis clearly advocates in favor of FDC as a cheaper and safer alternative to meropenem to treat ICU patients with infections caused due to pip-taz resistant bacteria.

Ocular dirofilariasis in Dubai, UAE.

A rare occurrence of ocular subconjunctival dirofilariasis in a 53-year-old healthy Indian male working in Dubai, UAE presenting with an acute red eye is reported. Surgical excision under topical anesthesia was carried out uneventfully in the outpatient clinic. The live worm removed from the subconjunctival space was identified as Dirofilaria repens on the basis of microscopic examination and histopathology. Surgical excision of subconjunctival dirofilariasis is safe in an outpatient setting and curative precluding the need for further systemic antihelminthics.

Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma.

PURPOSE: To establish the safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma. METHODS: We studied 109 consecutive patients who underwent planned simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma by a single surgeon from January 1990 through December 1999. The main outcome measures were postoperative intraocular pressure (IOP), corneal clarity and diameter, visual acuity, bleb characteristics, time of surgical failure and complications. Postoperative complications including endophthalmitis and anaesthetic morbidity and mortality were also analysed. RESULTS: The series consisted of 218 primary combined trabeculotomy-trabeculectomy surgeries during 109 anaesthesias. The mean follow-up period was 16.33 +/- 16.22 months. The IOP reduced from 26.4 +/- 5.9 mmHg to 13.5 +/- 4.5 mmHg, with a mean percentage reduction of 46.2 +/- 23.7 (P < 0.0001). The success (IOP < 16 mmHg) probabilities were 90.9%, 88.0% and 69.3% at first, second and third year respectively (Kaplan-Meier analysis). The success probability of 69.3% obtained at third year was maintained till 6 years of follow-up. One hundred and sixty six (76.1%) eyes had significant corneal oedema. Postoperatively, the cornea cleared in 93 (57.8%) eyes. Clinically, well functioning blebs were present in 114 of 171 eyes (66.6%). Postoperatively, 18 (8.3%) eyes developed shallow anterior chamber and 6 (33.3%) of them required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Of the anesthetic complications, apnea occurred in 17 (15.6%) patients and all were successfully resuscitated. The most serious post-anaesthetic complication was cardio-pulmonary arrest that occurred 5 hours postoperatively following aspiration during feeding in one child; this child could not be resuscitated. Two children had delayed recovery (2 and 4 hours respectively). The child who had delayed recovery by 2 hours survived and has completed 3 years of follow-up while the other child expired 48 hours later. CONCLUSION: Simultaneous bilateral primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma. It obviates the need for long second anaesthesia with its attendant risks. It offers several other benefits to the patients and families.