Prescribing pattern of angiotensin receptor blocker: a study of errors and drug-drug interactions

Prescriptions comprising multi-drug therapy mostly illustrate the prescribing error. The phenomenon of error is bonded with human inaccuracy. The erroneous practice is observed in under developed countries like Pakistan, Bangladesh and also in developed ones. Consequently drug-drug interaction is one of the most common error associated with potentially serious adverse response even death. Accordingly the present study was conducted to assess the prevalence of prescribing errors and drug-drug interactions in out-patients receiving angiotensin receptor blockers. The study was done with population size one hundred fifty prescriptions obtained from different out-patient settings in Karachi. The prescriptions were screened for prescribing errors and risk factors for drug-drug interactions. Drug-drug interactions were recognized by Micromedex.2.0.Drug-Reax®database. The most common type of error was omission error. These errors were patient's age, weight and diagnosis found in 51.3%, 97.3% and 74% of prescriptions, respectively. The prevalence of drug-drug interaction was 38%. A total of 746 drugs were prescribed with an average of 5 drugs per prescription and 450 medication errors were detected. Majority of the interaction were moderate [19.33%], others were minor [14%] and major [6%] in severity. Patients who prescribed many drugs [more than 5 drugs in a while] had a higher risk of developing drug-drug interactions [OR=4.76; 95% CI=2.30-9.64; p=0.0001*].The study data reports the occurrence of prescribing errors in Karachi and also necessitate the need of clinical pharmacist's services in health care system. The step will help to minimize the risk factors by having the drug prescriptions reviewed by the pharmacists

Some novel piperidine analogues having strong alpha glucosidase inhibition

The idea of this study is based on the marvelous fact of nojirimycin and deoxy nojirimycin, naturally occurring from piperidine class and having their role as alpha glucosidase inhibitors. In the present work some hydroxyl piperidine analogues have been synthesized and analysed for their hypoglycemic effect through glucosidase inhibition owing to the structural resemblance with nojirimycin. The activity was done by spectral absorbance analysis using acarbose as standard. Two analogues [I and IV] were found to pose excellent activity having 87.4 and 54.7% inhibition respectively, hence strengthening the idea of studying piperidine analogiues as glucosidase inhibitors due to structural similarity with nojirimycin

Phenotypic expression and prevalence of multi drug resistant extended spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae in Karachi, Pakistan

The aim of the present study was to evaluate the prevalence rate of ESBL producing Gram negative isolates of E. coli, K. pneumoniae and P. mirabilis, to determine the association of various factors with ESBL production and therapeutic options for the treatment. Total 352 isolates were subjected for identification of ESBL by double disc synergy test. Antimicrobial susceptibility was performed using CLSI guidelines and statistical association between ESBL/Non ESBL producers were determined by chi square at significant level of 0.05. A total of 96 isolates were ESBL positive [27%], females were 67% whereas males were 33%. E. coli was most prevalent pathogen [82%] followed by Klebsiella pneumoniae [17%]. Furthermore 75% of ESBL associated infections were urinary tract infections. 95% of ESBL producing isolates were multidrug resistant and tazobactam/piperacillin combination and imipenem are good choices with 100% and 97% susceptibility respectively. E coli [OR 2.83, 95% CI 1.585-5.072, RR 2.22, p 0.0004] and K. pneumoniae [OR 0.52, 95% CI 0.285-0.952, RR 0.609, p 0.032] were significantly associated with ESBL production. The spread of ESBL producing multidrug resistant E. coli and K. pneumoniae has increased and proper screening for ESBL identification is needed because of limited therapeutic antibiotic choices

Prevalence of mecA: Genotyping screening of community acquired- MRSA isolates in Karachi, Pakistan

Among resistant nosocomial and community pathogens, MRSA has become the most serious pathogen, causing life threatening infections worldwide. In S.aureus, quick and exact recognition of methicillin [cefoxitin] resistance has become essential. The benchmark for MRSA identification among S.aureus is the detection of the mecA gene that causes the expression of protein [PBP2a] culpable for classic â-lactam resistance. However, the utter reliance on amplification of mecA gene as a hallmark in confirmation of methicillin [cefoxitin] resistant S. aureus is the matter of distrust by some investigators. The current investigation designed to analyse the prevalence of mecA gene among phenotypically positive MRSA isolates using molecular method and to correlate its prevalence to conventional techniques. Furthermore, antimicrobial sensitivity of mecA positive staphylococci was determined by Kirby Baeuer method. For this purpose, 201 clinical staphylococcal specimens were recovered from various diagnostic laboratories in Karachi City, Pakistan. Phenotypic existence of methicillin resistance in S. aureus was observed to be 51.7%. In contrast, when organisms were subjected for amplification of mecA gene by PCR, mecA positive isolates were 36/104 [35%] MRSA isolates. Current work raise question towards the usefulness of molecular identification of mecA gene in confirmation of methicillin resistance without correlating with conventional methods. Therefore, it is essential to consider the other possible resistance mechanisms for Beta-lactams that may interact with mecA gene in the development of methicillin resistance mechanism in Staphylococcus

Development and validation of HPLC method for the determination of Candesartan in human plasma

Candesartan [CAN], an ARB-blocker, antihypertensive, was analyzed in human plasma by a simple, accurate and precise RP-HPLC [reverse phase-High performance liquid chromatography assay method which was then validated for its accuracy, specificity and precision. The mobile phase has a constitution of acetone, diethylamine and distilled water, while Phosphoric acid was used to adjust the pH to 2.5 +/- 0.1. This mobile phase was run at 1.1ml/min and the fluorescence wavelength was set to 392 nm. A C-18 HPLC, column particle size [5 [micro]m] Mediterranean Sea ® L x 1.D. 25cm x 4.6 mm [Supelcosil] , with auto sampler injection volume of 30[micro]l ,an internal standard Valsartan was utilized for chromatographic detection. Candesartan took a retention time of 6 +/- 0.5 minutes. This method was validated by the parameters of selectivity, accuracy, precision, repeatability, reproducibility, recovery, linearity and stability. Candesartan's calibration curves were found to be linear in the range of 200ng/ml to 3.125ng/ml and the coefficient of determination [r2] was found to be 0.99. Analytical recovery obtained was above 88%. Hence, this method has been found to be useful for determining Candesartan in plasma

Biowaiver studies of metronidazole tablets [400mg]: an alternative to In-vivo bioequivalence studies

The aim of the study was to investigate the dissolution behavior of commercially available brands of metronidazole and to provide basic tool to evaluate the comparative effectiveness and interchangeability of generic brands under biowaiver conditions. The dissolution test for six brands of metronidazole 400mg tablets was performed and physical controls were analyzed. Basket Rack methods at 100rpm were used to estimate release pattern of drug. Pharmaceutical parameters of tablets were analyzed. In order to evaluate dissolution profiles, multiple point dissolution were performed and calculated 85.96 +/- 0.41 to 90.56 +/- 0.93 % within 15 minutes in pH 1.2,85.50 +/- 1.40 to 88.99 +/- 0.80% in pH 4.5 and 85.37 +/- 1.94 to 92.79 +/- 0.89% in pH 6.8 dissolution medium respectively. Five different kinetics have been studied to predict and evaluate the acceptability level of drug release. The results show that Hixson-Crowell, first-order and Weibull demonstrated the drug release with R2

Development and validation of reversed phase HPLC method for quantification of water insoluble API

In the present work a specific, accurate, precise, and reproducible UV-HPLC method was developed and validated for the analysis of Aceclofenac. This method involved elution of Aceclofenac in a mobile phase which is composed of buffer pH 6.8 [i.e. using 0.01N KH2PO4] and HPLC grade Acetonitrile [60:40]. Separation of the analyte was achieved using HPLC isocratic pump attached to the UV-VIS detectorC18, guard column and C18 column. The injection volume was 20 micro L, detected at 274 nm; flow rate: 1mL/min. Standard calibration curve was measured and found linear from 0.1 to 40 micro g/ml. The validation parameters were measured according to FDA guidelines and successful results were obtained. The presented analytical method could be employed for pharmacokinetic studies

Chromatographic method development and validation for the determination of valsartan in biological fluid

A swift, precise and simple HPLC bioanalytical technique with UV detection was established and validated for quantitative estimation of valsartan in human plasma. The analyte was separated from plasma by protein precipitation with acetonitrile and chromatographically separated on Zorbax SB-C18 [5 micro m, 4.6mm x 15cm] column. The solvent mixture system consisting of acetonitrile, water and glacial acetic acid [40:59:1 v/v], was pumped using isocratic mode at 1mL/min flow rate. Samples' detection of drug was made spectrophotometrically at a wavelength of 264nm. The analyte response was instituted to be linear from 0.06 to 8 micro g/mL with a regression value of 0.999. The accuracy of the proposed method was ranged between 97.2-100.3% with 5% RSD. The analytical recovery [>95%] was consistently observed and satisfactory sample stability was also found at different environmental conditions. In conclusion the reported bio-analytical method is easy and robust that was successfully utilized in estimation of valsartan in a pharmacokinetic study

MRSA: Prevalence and susceptibility pattern in health care setups of Karachi

This assessment aims to determine the prevalence of methicillin resistance and multidrug resistance [MDR] among the clinical isolates of Staphylococcus aureus and antimicrobial susceptibility profile of methicillin resistant Staphylococcus aureus [MRSA] to the frequently prescribed antibiotics in Karachi. Isolates of MRSA, recovered from various clinical samples were included in this prospective, cross-sectional study from Jan 2015 to June 2017. Agar diffusion method was employed according to the protocols of Clinical Laboratory Standards Institute. Out of total 346 S.aureus strains, the frequency rate of MRSA was 52 % [n = 180]. MRSA infection was found higher among the age group 21-30 years i.e. 30% [n=54], followed by 20 % [n=36] in 31-40 years. Frequency of MRSA percentage in male and female was and 70 % and 30 % respectively. MRSA was more frequently observed in blood 20 % [n=36]. MRSA showed high resistance [100 %] to Oxacillin and Cefoxitin while 25% Vancomycin resistant S. aureus [VRSA] isolates and 25% Teicoplanin resistance were also reported. MRSA exhibited 16% resistance to Minocycline. It was concluded that MRSA pose a challenging threat to public health in Karachi. In addition, MDR should be periodically checked to avoid treatment failure