Empirical Antibiotic Prescription Pattern among Patients in a Nigerian Tertiary Hospital, is There Evidence of Irrationality?

Background:Resistance to antibiotics is spreading rapidly around the world with its associated morbidity and mortality. Infections are becoming increasingly difficult to treat resulting in increasedcost of medical care. In low income countries with high infectious disease burden, antibiotic resistance is reported to be accelerated by irrational prescriptions in health facilities. In the absence of adequate resources, many clinicians engage in empirical antibiotic prescriptions some of which their appropriateness is questionable. There is need for laboratory evidence to justify empirical antibiotic use in the light of increasing resistance to commonly prescribed antibiotics.Aims:This study aims to determine empirical antibiotic prescription pattern and to determine rationality using resistance profile of common bacterial isolates inhospitals.Methods:Antibiotic prescriptions in the NHIS department and antibiogram records were obtained from pharmacy and laboratory records respectively. Analysis was carried out using descriptive statistics and comparison between antibiotics prescribed and their respective resistance pattern were compared to determine rationality.Resultsand Discussion:The Penicillins and Quinolones were the most prescribed class of antibiotics and resistance range between 30 –90% and 3 –23% respectively. Resistance to other antibiotics was high thus making empirical prescriptions irrational in most of the cases. These findings have been consistently reported in several studies so widespread empirical antibiotic prescriptions are not in tandem with principles of rational drug use.Conclusion:Antibiotic resistance is common among hospital isolates, so there is need to emphasize that prescriptions be based on laboratory evidence of microbial sensitivity

Treatment of Renal Proteinuria by Traditional Chinese Medicine and Its Mechanism / 中国实验方剂学杂志

Chronic kidney disease (CKD) refers to abnormal renal structure and function for more than 3 months, and is characterized by abnormal urine, blood and kidney structure. As an important clinical manifestation of CKD, proteinuria is closely related to glomerular damage. It is not only a pathological manifestation of CKD, but also an important pathological factor to accelerate the development of CKD. After thousands of years of development, traditional Chinese medicine (TCM) has a systematic theoretical foundation and rich clinical experience in the treatment of CKD. By referring to the treatment principles and methods of "leakage of vital essence", "low back pain", "asthenia", "blood urine" and "edema" in TCM, the general treatment principle of proteinuria is to coordinate the body Yin and Yang and restore the balance of Yin and Yang. Specific methods include removing blood stasis, sweating, urinating, invigorating the spleen and strengthening the kidney, smoothing liver and activating collaterals, and removing dampness and detoxification. Both ancient and modern physicians have established effective prescriptions according to the treatment principles and methods. Modern studies have showed that the mechanism of TCM to reduce proteinuria is mainly to improve the pathological manifestations of large area fusion of podocyte processes and complete disappearance of poddout, up-regulate the expression of nephrin and podocin, regulate immune, alleviate systemic inflammation, and improve the serum superoxide dismutase (SOD)level and the ability of the body to remove free radicals. The method and mechanism of treating renal proteinuria are discussed from three aspects:classical prescriptions, empirical prescriptions and the Chinese patent medicine. It provides a theoretical reference for the clinical treatment of chronic kidney disease, reducing the excretion of proteinuria and improving the clinical symptoms of the patients.

Efficacy and safety of № I Empirical Prescription for Chronic Prostatitis in the treatment of type Ⅲ refractory chronic prostatitis / 中华男科学杂志

<p><b>Objective</b>To evaluate the efficiency and safety of № I Empirical Prescription for Chronic Prostatitis (№ I EPCP) in the treatment of type Ⅲ refractory chronic prostatitis.</p><p><b>METHODS</b>We randomly assigned 53 cases of type Ⅲ refractory chronic prostatitis with damp-heat and blood stasis to an experimental and a control group to receive № I EPCP at 1 dose per day and saw palmetto extract at 160 mg bid), respectively, all for 8 weeks. Before and after 4 and 8 weeks of treatment, we obtained The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) scores, Traditional Chinese Medicine Syndrome Scores (TCMSS), maximum urinary flow rate (Qmax), average urinary flow rate (Qavg), Hamilton Depression Rating Scale (HAMD) scores and Hamilton Anxiety Rating Scale (HAMA) scores, and compared them between the two groups of patients.</p><p><b>RESULTS</b>Totally 48 of the patients completed the medication and follow-up, 25 in the experimental and 23 in the control group. Compared with the baseline, the NIH-CPSI scores after 8 weeks of treatment were significantly decreased in the experimental (27.82 ± 7.25 vs 15.46 ± 4.77, P <0.05) and the control group (25.98 ± 6.47 vs 21.06 ± 5.74, P <0.05), and so were the TCMSSs (24.64 ± 9.82 vs 16.42 ± 6.33 and 9.15 ± 3.74, P <0.05, and 23.67 ± 8.73 vs 18.55 ± 5.92 and 13.48 ± 4.45, P <0.05); the Qmax at 8 weeks were dramatically increased in the experimental group (［18.45 ± 7.81］ vs ［23.44 ± 8.73］ ml/s, P <0.05) and the control (［17.58 ± 6.92］ vs ［21.26 ± 8.32］ ml/s, P <0.05), and so was the Qavg (［11.27 ± 5.33］ vs ［16.51 ± 7.36］ ml/s, P <0.05 and ［10.66 ± 5.82］ vs ［13.44 ± 6.16］ ml/s, P <0.05); the HAMD scores were remarkably reduced in the experimental group (22.74 ± 6.37 vs 17.62 ± 5.71 and 12.54 ± 5.22, P <0.05) and the control (23.55 ± 7.14 vs 22.34 ± 6.88 and 21.62 ± 5.63, P <0.05), and so were the HAMA scores (21.37 ± 7.15 vs 18.42 ± 6.35 and 14.63 ± 7.11, P <0.05 and 20.54 ± 6.77 vs 19.87 ± 6.24 and 19.42 ± 7.04, P <0.05). No obvious adverse reactions were observed in either of the two groups during the medication.</p><p><b>CONCLUSIONS</b>№ I EPCP deserves promotion and clinical application for its definite effectiveness and safety in the treatment of type Ⅲ refractory chronic prostatitis with damp-heat and blood stasis.</p>

Antibiotic Treatment in Pediatric Primary Care

It has become apparent that infants and children are not small adults. Usually, they suffer from a different array of infectious diseases. The disposition of antimicrobial agents in their bodies is different and is often their response to drug therapy. And, there are substantial differences in these variables even among pediatric age groups. The intelligent use of antimicrobial agents in children requires more than simple extrapolation of observations made in adults. So, we need a very intensive research effort into the pharmacodynamic and kinetic and response to antimicrobial drugs in the pediatric patients. Also, the frequent empirical antibiotic use has led to increased resistance to certain antimicrobial groups. Appropriate prescription of antibiotics in primary care is influenced by several factors in the antibiotic use by general practitioners. An empirical prescription guideline based on the pharmacoepidemiology of resistance, recommending the use of potent and effective antibiotics that are less influenced by resistance to the marker, may help counter the spread of resistance in the community.