A clinical study on the pattern of antimicrobial drug use and drug resistance in patients with ventilator-associated pneumonia in a tertiary care hospital.

CONTEXT: Ventilator-associated pneumonia (VAP) develops nearly in about one-third of the patients, 48 h after receiving mechanical ventilation. Common pathogens are Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter spp., Klebsiella spp., Escherichia coli, Proteus spp., Enterobacter spp. and Enterococcus spp. including multidrug-resistant pathogens. AIM: The study aims to assess the pattern of antimicrobial drug use in VAP and to assess the etiological organisms and their drug sensitivity and resistance pattern. SETTINGS AND DESIGN: Study participants admitted to Kempegowda Institute of Medical Sciences Hospital and Research Centre, Bengaluru, and who developed VAP were included in this prospective observational study. SUBJECTS AND METHODS: Bronchial secretions were subjected to microbiological analysis. The etiological organisms, their drug sensitivity and resistance pattern, and the outcome of drug therapy were recorded. The clinical course of the study participants was monitored till either the resolution of pneumonia or the demise of the participant. STATISTICAL ANALYSIS USED: Qualitative data were analyzed using the Chi-square test or Fischer's exact test and quantitative data using the independent t-test. RESULTS: Early VAP was seen in 91.7% and late VAP in 8.3% of the participants. The organisms isolated were S. aureus, Enterococcus spp., Acinetobacter spp., Klebsiella pneumoniae and P. aeruginosa. Majority of the study participants with early VAP (75%, n = 41) completely recovered from pneumonia and 80%, n = 4 participants with late VAP recovered completely. CONCLUSION: The organisms had a varied sensitivity and resistance pattern. The clinical outcome was multifactorial and its association with specific antimicrobial agents cannot be drawn.

A randomized, open-label, standard controlled, parallel group study of efficacy and safety of baclofen, and chlordiazepoxide in uncomplicated alcohol withdrawal syndrome.

BACKGROUND: Alcohol withdrawal syndrome (AWS) is a distressing condition, generally controlled by benzodiazepines (BZD's). Baclofen, a gamma-aminobutyric acid-B (GABAB) agonist, has also shown promising results in controlling AWS. As there are few studies comparing the efficacy and tolerability of chlordiazepoxide with baclofen, the present study was taken up. The objective of this study was to compare efficacy and tolerability of baclofen with chlordiazepoxide in uncomplicated AWS. METHODS: Sixty subjects with uncomplicated AWS were randomized into two groups of 30 each, to receive baclofen (30 mg) or chlordiazepoxide (75 mg) in decremented fixed dose regime for 9 days. Clinical efficacy was assessed by Clinical Institute Withdrawal Assessment for Alcohol-Revised Scale (CIWA-Ar) and tolerability by the nature and severity of adverse events. Lorazepam was used as rescue medication. Secondary efficacy parameters were Clinical Global Impression scores, symptom-free days, and subject satisfaction as assessed by visual analog scale. This study was registered with Clinical Trial Registry-India (CTRI/2013/04/003588), also subsequently registered with WHO's ICTRP clinical trial portal. RESULTS: Both baclofen and chlordiazepoxide showed a consistent reduction in the total CIWA-Ar scores. However, chlordiazepoxide showed a faster and a more effective control of anxiety and agitation requiring lesser lorazepam supplementation, and also showed a better subject satisfaction compared to baclofen. Both the drugs showed good tolerability with mild self-limiting adverse events. CONCLUSION: The present study demonstrates that baclofen is not as good as chlordiazepoxide in the treatment of uncomplicated AWS. However, baclofen might be considered as an alternative.

Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome.

OBJECTIVES: Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. MATERIALS AND METHODS: This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA) of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar) scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient's perspective and third-party perspective. RESULTS: The average cost-effectiveness ratio (ACER) in patient's perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03). CONCLUSION: Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.