Increased antimicrobial resistance against azithromycin during COVID: role of irrational utilization.

Objectives: To assess the use of azithromycin during coronavirus disease-2019 pandemic and its impact on antimicrobial resistance in an urban setting. METHODS: The retrospective, cross-sectional study was conducted on two different data sets. The first data set was of inpatients (N = 300) during the first wave of COVID 19 i.e. January to December, 2020. Data was collected from tertiary care hospitals in Karachi between October 2021 and November 2022 after approval from the ethics review committee of Ziauddin University, Karachi. Drug utilisation evaluation was done using a structured and validated tool. The treatment protocols were evaluated by comparing against the coronavirus disease-2019 treatment protocol 2020 and the guidelines issued by the Medical Microbiology and Infectious Diseases Society of Pakistan. Second data set comprised of the consumption data (obtained from pharmacies for both inpatients and outpatients) as well as the antimicrobial resistance, (obtained from antibiogram collected from the microbiology departments of the participating hospitals). This data was taken for the period of three years i.e. 2019 (Pre-COVID) to 2021 (Post-first wave of COVID) to establish trends of both consumption and antibiotic resistance. Data was analysed using SPSS 20. RESULTS: Of the 300 patients, 207(69%) were males and 93(31%) were females. There were 162(54%) adults with mean age 40.06±10.48 years, followed by 120(40%) geriatrics with mean age 70.37±6.94 years, 18(6%) paediatrics with mean age 13.5±3.60 years. All patients were given Azithromycin empirically followed by culture sensitivity test in 21% cases only. Comparison with COVID treatment protocols revealed the non-compliance of just 3%. However, in case of Community Acquired Pneumonia (CAP), sinusitis, typhoid and urethritis, comparison with MMIDSP guidelines revealed non-compliance of 95%, 22%, 75% and 100% respectively. Moreover, in 11% of patients, it was administered for conditions not recommended by guidelines. Furthermore, the Antibiogram exhibited percent increase in resistance against azithromycin. CONCLUSIONS: Enhanced consumption and irrational use of azithromycin during the coronavirus disease-2019 pandemic most likely contributed to increase in antimicrobial resistance.

Light transmission properties of pharmaceutical liquid bottles and evaluation of their photoprotective efficacy.

The light sensitive pharmaceutical dosage forms are well protected from light by packing in light protective bottles especially the colored glass and plastic bottles. In the present study the transmission characteristics of transparent glass bottle, amber glass bottle, polyvinyl chloride amber plastic bottle (PVC) and low density polyethylene semi-opaque plastic bottles (LDPE) (empty and drug filled) have been evaluated and the data compared for compliance with Pharmacopoeial limits of percentage transmission. The variations in thickness affect the amount of light transmitted through the bottles. For an average thickness, the transmission of bottles was not uniform indicated the effect of manufacturing variables on the transmission of light. The drug filled bottles showed an increase in light transmission probably as a result of interaction between drug and bottle components. The leaching of any coloring agents from glass bottles or the pigments from plastic bottles into the solution during storage appeared to increase the transmission of light which could be detrimental to photosensitive drugs in a formulation. The light protective efficacy of bottles was in the order: Semi-opaque plastic (LDPE) > amber plastic (PVC) > amber glass. The photoprotection of aqueous solution of riboflavin as a model compound in these bottles has been studied and its shelf-lives and stability ratio were determined.