The Beta Lactam Antibiotics as an Empirical Therapy in a Developing Country: An Update on Their Current Status and Recommendations to Counter the Resistance against Them.

In a developing country like India, where the patients have to bear the cost of their healthcare, the microbiological culture and the sensitivity testing of each and every infection is not feasible. Moreover, there are lacunae in the data storage, management and the sharing of knowledge with respect to the microorganisms which are prevalent in the local geographical area and with respect to the antibiotics which are effective against them. Thus, an empirical therapy for treating infections is imperative in such a setting. The beta lactam antibiotics have been widely used for the empirical treatment of infections since the the discovery of penicillin. Many generations of beta lactams have been launched with, the claims of a higher sensitivity and less resistance, but their sensitivity has drastically decreased over time. Thus, the preference for beta lactams, especially the cephalosporins, as an empirical therapy, among the prescribers was justified initially, but the current sensitivity patterns do not support their empirical use in hospital and community acquired infections. There is a need for increasing the awareness and the attitudinal change among the prescribers, screening of the antibiotic prescriptions, the strict implementation of antibiotic policies in hospital settings, restricting the hospital supplies and avoiding the prescriptions of beta lactams, a regular census of the local sensitivity patterns to formulate and update the antibiotic policies, upgradation of the laboratory facilities for a better and faster detection of the isolates, proper collection, analyses and sharing of the data and the encouragement of the research and development of newer antibiotics with novel mechanisms of action.

Hepatoprotective activity of Ocimum sanctum alcoholic leaf extract against paracetamol-induced liver damage in Albino rats.

BACKGROUND: There is a lack of reliable hepatoprotective drugs in modern medicine to prevent and treat drug-induced liver damage. Leaves of Sacred/Holy Basil, i.e. Green Tulsi (Ocimum sanctum), belonging to family Lamiaceae are used traditionally for their hepatoprotective effect. We wanted to evaluate the hepatoprotective activity of Ocimum sanctum and observe whether synergistic hepatoprotection exists with silymarin. MATERIALS AND METHODS: Albino rats (150-200 g) were divided into five groups. Groups A and B were normal and experimental controls, respectively. Groups C, D and E received the alcoholic extract of Ocimum Sanctum leaves (OSE) 200 mg/kg BW/day, silymarin 100 mg/kg BW/day and OSE 100 mg/kg BW/day + silymarin 50 mg/kg BW/day p.o., respectively, for 10 days. Hepatotoxicity was induced in Groups B, C, D and E on the eighth day with paracetamol 2 g/kg BW/day. The hepatoprotective effect was evaluated by performing an assay of the serum proteins, albumin globulin ratio, alkaline phosphatase, transaminases and liver histopathology. The assay results were presented as mean and standard error of mean (SEM) for each group. The study group was compared with the control group by one-way ANOVA, followed by Bonferoni's test. A P-value of <0.01 was considered significant. RESULTS: In groups C, D and E, liver enzymes and albumin globulin ratio were significantly (P < 0.01) closer to normal than in group B. Reduction in sinusoidal congestion, cloudy swelling and fatty changes and regenerative areas of the liver were observed on histopathological examination in groups C, D and E, whereas group B showed only hepatic necrosis. CONCLUSION: The Ocimum sanctum alcoholic leaf extract shows significant hepatoprotective activity and synergism with silymarin.

Sexual dysfunction with the use of antidepressants in a tertiary care mental health setting - a retrospective case series.

Sexual dysfunction affects patients' quality of life. It can occur secondary to physical or mental disorders, substance abuse and treatment with prescription drugs like antidepressants. We wanted to study the prevalence of sexual dysfunction associated with antidepressant use in the psychiatric unit of a tertiary care hospital and assess for causality, severity and preventability. We did a retrospective data collection from case records of patients on antidepressants from the Psychiatry outpatient clinic of a tertiary care teaching hospital during the period 1(st) January 2006 to 31(st) December 2006, excluding those with complaints of sexual dysfunction prior to treatment. Data are presented as a case series. Documented adverse events were subjected to analysis for causality, severity and preventability using Naranjo's, modified Hartwig and Siegel and modified Schumock and Thornton's Preventability scales respectively. Out of 169 patients, four patients developed sexual dysfunction (2.36%) associated with duloxetine, mirtazapine, trazodone and sertraline. We observed a possible causal relationship of mild to moderately severe ADR (sexual dysfunction) which was not preventable. Prevalence of antidepressant associated sexual dysfunction was lower than quoted in Western literature probably due to the retrospective nature of our study design. Active monitoring and intervention can greatly improve the quality of life and compliance to treatment.