Drug utilization study of antiepileptic drugs in the pediatric department, tertiary care hospital, Bangalore, India.

Objective: The main objective of the present study is to find out the loose links between prescription of medication and its utilization in the pediatric department, especially with drugs that belong to the antiepileptic medication category. Methodology: This prospective observational study was carried out for 6 months in the Department of Pharmacy Practice, Tertiary Care Hospital, Bangalore. The study was conducted on 100 patients receiving antiepileptic medication. The patient demographics and all medically relevant information were noted in a predefined data collection form. Results: The study showed that the maximum number of patients receiving antiepileptic medication belongs to the age group of 2-6 years. While comparing the prevalence of ADR levetiracetam, phenytoin and clobazam were identified which are associated with ADR. The highly prescribed drug was valproic acid and carbamazepine. The ADRs documented were loss of appetite, vomiting, anemia, and Steven-Johnson syndrome. Evaluation of prescription was performed, which is a major factor in drug-related ADRs. In the discussion part, various methods of improvement in the prevention of ADRs due to prescription error have been suggested which can improve drug utilization and precaution. An economic study was done in the end to put a light on the cost-effective treatment therapy which might improve patient adherence. Conclusion: It was concluded that valproic acid was a highly prescribed drug and carbamazepine was the second-most prescribed drug. It was found that majority of prescription was without a generic name and with inappropriate abbreviations.

Cotreatment with Furosemide and Hypertonic Saline Decreases Serum Neutrophil Gelatinase-associated Lipocalin (NGAL) and Serum Creatinine Concentrations in Traumatic Brain Injury: A Randomized, Single-Blind Clinical Trial.

Acute kidney injury (AKI) occurs both after traumatic brain injury (TBI) and after hypertonic saline administration; furosemide may be useful in preventing AKI indirectly. Serum neutrophil gelatinase-associated lipocalin (sNGAL) is superior to serum creatinine (sCr) in diagnosing early AKI. We compared the administration of hypertonic saline plus furosemide (HTS+F) versus hypertonic saline (HTS), using sCr and sNGAL to investigate kidney injury in patients with TBI. This randomized, single-blind clinical trial was conducted from August 2016 to July 2017 in a neurosurgical intensive care unit, and included patients with a Glasgow Coma Score (GCS) 7-13 and brain edema. One group (n = 22) received hypertonic saline 5% (100 mL over 60 min then 20 mL/h) plus furosemide (40 mg over 60 min then 0.05 mg/kg per hour) for 72 h. The other group (n = 21) received only hypertonic saline 5%, in the same dose as noted above. The sCr and sNGAL concentrations, GCS, and length of stay were measured. Mean ± SD differences were -51.15 (47.07) and 9.96 (64.23) ng/mL for sNGAL and -0.12 (0.22) and -0.005 (0.2) mg/dL for sCr in HTS+F group and HTS group respectively (both p < 0.001). The incidence of stage one AKI according to Improving Global Outcomes (KDIGO) criteria was 4.5% in the HTS+F group and 19.0% in the HTS group (p = 0.16). Hypokalemia was common in both groups. HTS+F group, compared with HTS group, was associated with lower concentrations of sCr and sNGAL. Incidence AKI (KDIGO criteria) did not have difference between groups.