Analysis of drugs prescribed in emergency medicine department in a tertiary care teaching hospital in southern Rajasthan

Background: Emergency medicine department of a tertiary care hospital is one of the busiest department and most challenging one for the attending physician. Patients here are in critical condition and treating doctors have to take fast decisions and actions so there are always chances of error in prescribing drugs. Therefore this study was planned with an intention to analyse drug utilization in patients admitted in emergency medicine department using WHO core prescribing indicators.Methods: A prospective observational study on drugs prescribed in emergency medicine department in a tertiary care hospital was conducted for a period of three months. Data was extracted from 450 patients’ case records in a preformed performa after taking approval from institutional ethics committee. Data was analysed by using Microsoft excel. 2010.Results: 1080 drugs were prescribed in the 450 prescriptions analysed, average being 2.40 drugs per prescription. Analgesics, proton pump inhibitors and antibiotics were the highly prescribed drugs and commonest routes of administration used were intravenous and intramuscular. Approximately 93% drugs belonged to either or both the WHO and National essential drug lists.Conclusions: The results of the study disclosed both rational and irrational drug utilization. No polypharmacy was observed but 80% drugs were prescribed by brand name. Utilization of drugs belonging to essential drug lists indicates judicious use of drugs by our clinicians. Smaller sample size and lack of estimation of cost of treatment are the limitations of this study. Hence more data must be generated for accurate analysis

A study of antinociceptive effect of venlafaxine in albino mice

Background: Serotonin and norepinephrine are important neurotransmitters involved in pain inhibition in descending pain inhibitory tracts. Venlafaxine being an antidepressant exerts its mechanism mainly by inhibiting reuptake of serotonin and norepinephrine like Tramadol. The objectives were to study the antinociceptive activity of Venlafaxine and its comparison with Pethidine.Methods: A total of 32 Swiss albino mice were divided into 4 groups with 8 animals in each group. Group 1 received normal saline as control in dose of 5ml/kg i.p, Group 2 received Pethidine as standard in dose of 30mg/kg s.c, Group 3 received Venlafaxine as in dose of 10mg/kg i.p and Group 4 received Venlafaxine in dose of 22.5mg/kg. Tail flick test and hot plate test were used for evaluating antinociceptive activity. All animals were subjected to the above mentioned tests before and 30 minutes after the administration of the drugs. Results were subjected to suitable statistical analysis.Results: The results from the above mentioned tests showed that Venlafaxine in dose of 10mg/kg showed significant antinociceptive activity as compared to normal saline (p <0.05) but was not comparable to Pethidine (p >0.05). Venlafaxine in dose of 22.5mg/kg showed significant antinociceptive activity as compared to normal saline (p <0.05) and activity was comparable to Pethidine.Conclusions: Venlafaxine in both the doses showed significant antinociceptive activity in acute models of pain in animals

Efficacy and safety of various drugs used for the treatment of nonneurogenic lower urinary tract symptoms in tertiary care hospital

Background: Lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) are common in elder men. Previously surgical treatment was mainstay of treatment of BPH. But now number of drugs alone or combined are clinically used for this disorder. Primary aim was to study the prescribing pattern of different drug therapies and their role in treating LUTS/BPH by evaluating their efficacy and safety in tertiary health care centre.Methods: An observational study including 78 male patients ≥45 years, newly diagnosed with LUTS from April 2014 to May 2015. Patients were followed up every 4 weeks for 3 months after the drug has been prescribed. Efficacy assessment was done on basis of change in IPSS score over 12 weeks. Data was expressed in percentage and Mean ±SD.Results: Mean age of Patients was 64.94 years. Alpha blockers are mainstay prescribed drug either as monotherapy (48.7%) or with 5 alpha reductase inhibitor-dutasteride (38.4%) and with antimuscarinic –Tolterodene (12.8%). Among alpha blockers Tamsulosin (58.97%) was most commonly prescribed, followed by Silodosin (20.5%) and Alfuzosin (20.5%). All drug treatment results in significant improvement with dizziness being the most common adverse event. A subgroup analysis in symptoms was done comparing alpha blockers. All alpha blockers have near about similar efficacy with no significant difference.Conclusions: Alpha blockers are main drugs prescribed in management of LUTS/BPH with near about similar efficacy of all alpha blockers

Amoxicillin induced toxic epidermal necrolysis: a case report

Adverse reactions are the recognized hazards of drug therapy and they can occur with any class of drugs and many studies revealed that the incidence is more in case of antibiotics. Amoxicillin is a broad spectrum, bactericidal, beta lactam antibiotic, commonly used to combat various infections. Penicillin group of drugs are known to cause cutaneous drug eruptions especially in paediatric population. Most of the time, these eruptions are mild in nature, however, sometimes they represent the early manifestation of rare, severe drug-induced cutaneous reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Toxic epidermal necrolysis (TEN) is a rare, life threatening dermatological disorder that is usually induced by medications. Seventy percent of the cases of TEN are drug induced, most commonly implicated drugs being anticonvulsants, antibiotics and non-steroidalanti-inflammatory drugs (NSAIDS). Here, we report a case of toxic epidermal necrolysis induced by amoxicillin in a 12 year old male patient. Treatment with strong antibiotics, immunosuppressant and other supportive measures helped in recovery of the patient. The case is being reported to emphasize the need for efficient pharmacovigilance in order to motivate adverse drug reaction reporting so as to gather more and more data regarding adverse drug reactions. Through this report, we also seek the support of every-one concerned, to detect and, if possible, prevent adverse reactions to drugs

A prospective study of pattern of prescription for acne vulgaris in a tertiary care hospital: an observational study

Background: Acne vulgaris is a common dermatological disorder of the pilosebaceous unit affecting younger age groups but presenting usually at puberty and is of cosmetic concern. There are various treatment modalities available ranging from topical/oral anti-acne preparations to hormonal therapy depending on the severity of acne. Use of synthetic retinoid is highly regulated due to its potential for severe adverse events, primarily teratogenicity. There is a need for periodic prescription auditing. By providing feedback to the prescribers to formulate the guidelines enhances therapeutic efficacy by rational use, minimizes the adverse effects and cost of treatment. Objectives: to assess the prescription pattern for Acne vulgaris.Methods: A medication details and prescribers information are collected in pre-designed proforma along with the demographic details from 210 study subjects after personal briefing about the study. The data was analyzed using SPSS.Results: Out of 210 prescriptions of acne patients, majority were in between 21-40 years (48.09%), M:F ratio was1:1.41, female were 58.57% when compared to males 41.43%. Topical agents accounted for 54.13% and 36.36% of oral antibiotics (most common was azithromycin). Fixed dose combinations accounted for 4.39% and concomitantly administered drugs (antihistaminics, proton pump inhibitors, H2 blockers, emollients and skin protective agents) accounted for 53.82% of the prescribed drugs.Conclusions: Drug utilization study periodically can be an eye opener for the prescribers to prescribe the drugs in a rational way and it could reduce the prescription error and minimizing the untoward effects will subsequently reduce the cost of treatment

An evaluation of knowledge, attitude and practice of pharmacovigilance among interns in a tertiary care teaching hospital of North Maharashtra

Background: Adverse Drug Reactions (ADRs) are considered as one of the leading cause throughout the world resulting in significant increase in mortality and morbidity, therefore its monitoring is very essential in today's practice of medicine. Spontaneous reporting of ADRs have played a major role in the detection of unsuspected, serious and unusual ADRs previously undetected during the phases of clinical trials. Under-reporting of ADRs is considered as one of the major hurdle for the success of pharmacovigilance. Aims and objectives were to assess the knowledge, attitude and practice of pharmacovigilance among interns in a tertiary care teaching hospital.Methods: A cross sectional, observational, questionnaire based study was carried out using a predesigned Knowledge Attitude Practice (KAP) questionnaire. Study was conducted after the permission of Institutional Ethical Committee (IEC). The study included 100 interns who had completed at least ten months of their internship. The KAP questionnaire was assessed and analyzed and data was presented as percentages.Results: On an average only 31.17% interns answered correctly related with knowledge about pharmacovigilance. 88.63% interns agreed that ADRs reporting is necessary. According to 85.22% interns, pharmacovigilance must be taught in details to healthcare professionals. Only 34.09% had ever seen the ADR reporting form. Only 17.04% interns had knowledge about how to report ADR?Conclusions: Our study revealed that there was lack of awareness related with knowledge, attitude and practice of pharmacovigilance among the interns. There is need of implementation of pharmacovigilance awareness programs for undergraduates

A prospective observational study of prescription pattern of drugs used in the treatment of osteoarthritis in a tertiary care hospital

Background: Treatment of Osteoarthritis aims at reducing pain and improving mobility. NSAIDS are commonly prescribed for symptomatic relief despite well documented adverse effects. Paracetamol with its better safety profile is recommended as the initial analgesic of choice. Osteoarthritis has significant socio-economic impact on the patients and not many studies are available to reflect upon the prescription pattern of drugs in Osteoarthritis. Hence, this study was chosen to generate important feedback to the clinician. The objectives of the study were to study the prescribing pattern of drugs used in the treatment of Osteoarthritis in Tertiary care hospital.Methods: Prescription for 300 osteoarthritis patients collected cross-sectional for 6 months from orthopedic out-patient department were analyzed.Results: 60% of females were affected. Average age of study was 56.46+/- 7.4 years. Knee joint (87.33%) was most commonly affected joint. Average number of drugs prescribed was 2.62 +/- 0.76. Out of 786 drugs prescribed 45.8% were NSAIDs. Paracetamol was underutilized.Conclusions: Paracetamol was underutilized while other NSAIDs were over prescribed

A comparative study of probiotic, prokinetic based triple therapy with USFDA regimen in the eradication of Helicobacter pylori in a tertiary care hospital

Background: Helicobacter pylori infection has been associated with peptic ulcer disease, gastric carcinoma and gastric mucosa associated lymphoid tissue (MALT) lymphoma. Its eradication is important and current regimens are associated with antibiotic resistance, side effects and poor patient compliance. Probiotics supplementation can overcome the above problem and additions of prokinetics improve dyspepsia symptoms and thereby improve patient compliance. So the aim of the study was to compare efficacy and safety of standard United States Food and Drug Administration (USFDA) regimen with probiotic, prokinetic based novel regimen.Methods: 100 patients diagnosed with H. pylori infection were randomly assigned into two eradication regimen groups viz., group A and group B. Group A received standard USFDA regimen, amoxicillin 1 gm, lansoprazole 30 mg and clarithromycin 500 mg twice a day for 2 weeks and group B received a probiotic and prokinetic itopride 50 mg thrice daily, pantoprazole 40 mg, amoxicillin 1 gm and clarithromycin 500 mg twice daily for 2 weeks. Patients with Rapid Urease Test (RUT) and histopathology reports negative for H. pylori were considered as eradicated and then the percentage of eradication rate in both groups was compared.Results: H. pylori eradication rates were more in group B compared to group A (84% vs 70%, p =0.096 at 95% CI). The occurrence of side effects was less in group B compared to group A (30% vs 46%, p= 0.099). Diarrhoea was statistically less in group B compared to group A (p< 0.05).Conclusions: Probiotics supplementation increases eradication rates of anti H. pylori therapy and improves tolerability by reducing side effects especially diarrhoea. Prokinetics and probiotic based novel regimen improved dyspepsia symptoms and patient compliance