RESUMO
Background: Pain is the most common complaint in hemodialysis patients. Tramadol had become analgesic of choice in these patients, and its prescription is increasing day by day. With this background, we evaluated the prescribing trends of tramadol in patients undergoing maintenance hemodialysis.Methods: A total of 70 prescriptions were audited to assess the prescribing trends of tramadol (usually prescribed as a combination of 37.5 mg tramadol and 325 mg of paracetamol two times a day). Included prescriptions were from both male and female patients above 18 years of age undergoing maintenance hemodialysis. Demographic, clinical and medication use were recorded from the patients.Results: The mean age of patients was 48±11.7 years, duration of dialysis 2.2±1.4 years. Tramadol consumptions were observed in 40/70 (56%) of patients. Majority of tramadol consumption was found in 30/40 (75%) males, 23/40 (59%) between 40-59 years and 28/40 (70%) undergoing two dialyses per week and 13/40 (32.5) were diabetics. During our exploratory analysis, we found that 15/40 (38%) of tramadol users, were concurrently prescribed with clonidine as add on antihypertensive. We noticed that the tramadol pill count during the preceding week was 81 in patients concurrently using clonidine and 139 in the patients who were not using clonidine (p>0.05).Conclusions: In our study, tramadol consumptions were observed in 56% of patients. We also noticed analgesic interaction between clonidine and tramadol.
RESUMO
Background: Impetigo is a contagious bacterial skin infection that affects both adults and children. Topical antibacterials such as mupirocin and fusidic acid are the most commonly used in both primary and secondary impetigo. Clinical trials have shown high efficacy of retapamulin in the treatment of secondary impetigo. However, its use in primary impetigo is limited. To this purpose, we compared the safety, efficacy and adherence to treatment of fusidic acid with retapamulin in primary impetigo.Methods: A total of 50 patients with a clinical diagnosis of primary impetigo, between 2-12 years of age, having <10 lesions, 3/5 signs and symptoms, skin infection rating score ?4 and pus score ? one were involved. Patients who were having secondary impetigo leions were excluded. Twenty-five patients received 2% fusidic acid cream three times a day, and the remaining 25 patients received 1% retapamulin ointment two times a day for seven days. Skin Infection Rating Scale (SIRS) was used to assess the severity of disease at baseline and end of treatment. Clinical success was considered when SIRS score of zero each for pus, crust and pain and 0/1 each for erythema and itching. Clinical failure is a SIRS score of ?1 for pus.Results: Baseline disease characteristics such as a number of lesions, the severity of disease (SIRS) and pus scores were statistically similar between the two groups. The clinical improvement observed with both fusidic acid and Retapamulin (20/25, 80%) and (21/25, 84%) treatments was not statistically different (p>0.05). Both drugs were well tolerated.Conclusions: Both fusidic and retapamulin showed similar clinical success in patients with primary impetigo. Since fusidic acid has anti-inflammatory property and its treatment is cost-effective, it can be considered as first-line treatment and retapamulin in fusidic acid-resistant impetigo.