Utilization pattern of antibiotics and drug related problems in the orthopedic department at a tertiary care hospital: a prospective study

Background: Antibiotics are generally prescribed for both prophylactically and to treat ongoing infections in the orthopedic department. Assessment of prescribing pattern at regular interval is essential to avoid inappropriate use of drugs. Objectives: To know the utilization pattern of antibiotics and drug related problems like adverse drug reactions (ADR) and drug-drug interactions (DDI) in hospitalized patients. Materials and Methods: A cross-sectional study was conducted among hospitalized patients using WHO Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) methodology for one month duration in orthopedic department at a tertiary hospital. Standard data collection forms were used to collect the data. Descriptive statistics were used for analyzing the data. Results: Out of 196, most of patients (72.96%) were male and most of patients (34.69%) were from the age group 21-30 years. A total of 782 drugs were prescribed during study period and among them 262 were antibiotics. None of the drugs were prescribed in generic name. Ceftriaxone (33.58%) was the most frequently prescribed antibiotic. Average cost of drug therapy per patient was NPR 3125.7. DDD/100 bed-days were highest for Cefixime (27.9).  A total of 233 ADRs were suspected in 64 patients (32.6%). Thrombophlebitis (26.2%) was the commonest ADR. Potential DDI were found in 51 patients (26.02%). The most common interacting pairs were Cefuroxime and Rabeprazole (15 encounters). Conclusion: Generic prescribing is urgently needed for cost minimization. The prevalence rate of ADR occurrence and DDI was high. The study finding benefits the hospital policy makers to formulate and address policies for rational use of antibiotics. Keywords: Adverse Drug Reactions; Antibiotics; Cost; Drug Utilization; Drug-Drug interactio

Prevalence of multidrug-resistance and blaVIM and blaIMP genes among gram-negative clinical isolates in tertiary care hospital, Kathmandu, Nepal

Background and Objectives: Carbapenems have been the choice of antibiotics for the treatment of infections caused by multidrug-resistant bacteria. The main objective of this study was to determine the prevalence of carbapenemase (blaVIM and blaIMP) producing isolates among Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. Materials and Methods: A total of 1,151 clinical samples were collected from the patients visiting Annapurna Neurological Institute and Allied Science and Annapurna Research Centre, Kathmandu, between June 2017 and January 2018. Antibiotic susceptibility testing (AST) was performed on the Enterobacteriaceae, P. aeruginosa and A. baumannii isolates using the Kirby-Bauer disk diffusion method. The modified Hodge test (MHT) was performed on the carbapenem-resistant isolates to confirm carbapenemase production. DNA was extracted and then screened for blaVIM and blaIMP genes by multiplex PCR. Results: Of the total 1,151 clinical samples, 253 (22.0%) showed positive growth. Of them, 226 (89.3%) were identified as Enterobacteriaceae, P. aeruginosa, and A. baumannii. Among the 226 isolates, 106 (46.9%) were multidrug-resistant. Out of the 106, 97 (91.5%) isolates showed resistance to at least one of the carbapenem used. Among the 97 carbapenem-resistant isolates, 67 (69.1%) showed the modified Hodge test (MHT) positive results. blaVIM and blaIMP were detected in 40 and 38 isolates respectively using multiplex PCR assay. Conclusion: This study determined a high prevalence of MDR and carbapenem resistance among Enterobacteriaceae, P. aeruginosa, and A. baumannii as detected by the presence of blaVIM and blaIMP genes. This study recommends the use of rapid and advanced diagnostic tools along with conventional phenotypic detection methods in the clinical settings for early detection and management of drug-resistant pathogens to improve treatment strategies

How to reduce household costs for people with tuberculosis : a longitudinal costing survey in Nepal

The aim of this study was to compare costs and socio-economic impact of tuberculosis (TB) for patients diagnosed through active (ACF) and passive case finding (PCF) in Nepal. A longitudinal costing survey was conducted in four districts of Nepal from April 2018 to October 2019. Costs were collected using the WHO TB Patient Costs Survey at three time points: intensive phase of treatment, continuation phase of treatment and at treatment completion. Direct and indirect costs and socio-economic impact (poverty headcount, employment status and coping strategies) were evaluated throughout the treatment. Prevalence of catastrophic costs was estimated using the WHO threshold. Logistic regression and generalized estimating equation were used to evaluate risk of incurring high costs, catastrophic costs and socio-economic impact of TB over time. A total of 111 ACF and 110 PCF patients were included. ACF patients were more likely to have no education (75% vs 57%, P = 0.006) and informal employment (42% vs 24%, P = 0.005) Compared with the PCF group, ACF patients incurred lower costs during the pretreatment period (mean total cost: US$55 vs US$87, P < 0.001) and during the pretreatment plus treatment periods (mean total direct costs: US$72 vs US$101, P < 0.001). Socio-economic impact was severe for both groups throughout the whole treatment, with 32% of households incurring catastrophic costs. Catastrophic costs were associated with ‘no education’ status [odds ratio = 2.53(95% confidence interval = 1.16–5.50)]. There is a severe and sustained socio-economic impact of TB on affected households in Nepal. The community-based ACF approach mitigated costs and reached the most vulnerable patients. Alongside ACF, social protection policies must be extended to achieve the zero catastrophic costs milestone of the End TB strategy

[[alternative]]Application of Recycled Material and Super Plasticizer on the construction of Pervious Pavement

[[abstract]]　　透水混凝土是水和空氣通過其中的混凝土。滲透性混凝土由很少或幾乎沒有的細骨料組成，會產生10-25％的空隙以使水易於排出，考慮到其出色的抗壓強度性能，儘管其具有很高的抗壓強度，但其卓越的特性卻與傳統方法相似，主要目的是獲得足夠的孔隙率和良好的抗彎強度。不同比例的細骨料粉為水泥混凝土重量的0％，5％，10％，15％，20％，25％，30％和35％，該研究中使用了少量的高效減水劑。研究發現，透水路面的雨水管理和環境效益是無可辯駁的，它們反映了低影響發展（LID）的原理。對獲得的變化進行了壓縮，滲透性，滲透和磨損測試。將樣品保存在室溫下固化。[[abstract]]　　The pervious pavement concrete is the concrete that approves water and air passing through it. pervious concrete consists of little or fine aggregates, which create voids 10-25 percent to enable the ease drain of water, considering its exceptional characteristics in terms of good compression strength and overall performance regardless of increased interconnected voids porous interlocking blocks is developed in a similar way to the common method.　　The fundamental purpose is to acquire enough porosity with properly flexural strength. The best combination powder in various at the proportion is 0%, 5%, 10%, 15%, 20%, 25%, 30% and 35% by means of weight of cement concrete, a small quantity of superplasticizer is used in this investigation. The find out about observed that storm water administration and additionally advantages for environmental, the preceding pavements are irrefutable and they reflect the principals of low impact development (LID). The bought editions have been examined for compression, permeability, and infiltration and abrasion test. The samples are kept for curing at room temperature

Antibiotic utilization in community–A literature review

Antibiotic is major health problem in the developing and developed countries. Appropriate use of antibiotic provides the benefit of cost-effective, clinical therapeutic effect, decreased drug-related toxicity and the development of antibiotic resistance. In Mongolia, around 80% of antimicrobial drugs are purchased without a prescription from retail pharmacies. In Asian countries, 50-90% of pharmaceutical medicines transactions are occur in private retail pharmacy mostly in community The literature review was conducted to study the antibiotic utilization in community. Literature review is conducted with the variety of literature from 1994 to 2018. The search was done in Hinari, Google, Google Scholar, PubMed for articles published in English using the keywords “use of antibiotic in community, Antibiotic AND resistance AND community AND developing country AND developed country, Pattern of antibiotic use AND community AND developing AND developed country,survey study on antibiotic use and antibiotic resistances in community, and self-medication antibiotic use. Antibiotic utilization in Latin America from 1997-2007 revealed that use of antibiotic was increased in Peru (70.6%), Venezuela (43.0%). Study on irrational use of antibiotic in an urban slum community in Lagos, Nigeria suggested that 63.4% slum community was found to be non-adherence to the antibiotic therapy. Study from Peshawar, Pakistan on self-medication with antibiotic suggested most commonly used of antibiotics were amoxicillin/clavulanic acid (45%), ciprofloxacin (31%), sulfamethoxazole/ trimethoprim (18%), and clarithromycin (5%). Self-medication with antibiotic among dental students in Kathmandu suggested most frequently use of antibiotics were amoxicillin, metronidazole, azithromycin, ciprofloxacin and amoxicillin and clavulanic respectively.Antibiotic resistance patterns of common Gram negative pathogens isolate from urinary tract infection in Ethiopia noted that the resistance rate of E. coli pathogens was high with common antibiotics like tetracycline, ampicillin, amoxicillin and nalidixic acid. Similarly, these pathogens were low resistance with nitrofurantoin, gentamycin and trimethoprim-sulfamethoxazole. Conclusively, there were high antibiotic use and resistance which is huge global problem and require special attention

A Simulated Patients Survey on Antibiotic Dispensing Practice among Medicine Retailer: A Pilot Study

Introduction: In developed countries, half of the antibiotics consumed in community are considered to be based on incorrect indications and most common indications are viral infections. Antibiotic dispensing practice without prescription by the community pharmacies staff are inappropriate. An antibiotic is a prescription only medicines which can not be bought without prescription from various community pharmacies and drug store in many countries Objective: To study about dispensing practice of antibiotics among medicine retailer in Butwal and Bhairahawa cities. Method: The simulated patient method was used in this study. Purposively selected 18 pharmacies 9 from each city in this study. Dispensing and counselling practice of antibiotics were assessed. Result: Most common therapeutic categories drugs dispensed by medicine retailers were antihistamine 24 (35.29 %), NSAIDs 17 (25%), ANS 14 (20.58%) and antimicrobial 12 (17.64 %). Average numbers of drug per prescription are found to be 3.77. Similarly, Average numbers of antibiotic per prescription 0.66 like name of medicine, strength, how to take, drugdrug interaction or food-drug interaction and storage condition of individual drug given to patient. However, drug information like duration of drug and frequency of dose of individual drug. Conclusion: Antibiotic is easily available as OTC in the market. The medicine information given to simulated patient by medicine retailer to the simulated patient was insufficient. Implementing policy and strict monitoring required to this overcome. In addition, Department of drug administration work shop, training about drug information and counselling of medicines to medicine retailer may improve the situatio

Molecular Characterization of Streptococcus agalactiae Isolates from Pregnant Women in Kathmandu City

Introduction. Group B streptococci (GBS) are globally recognized as one of the leading causes of neonatal sepsis and meningitis and is also known to cause adverse pregnancy outcomes such as stillbirths and miscarriages. Thus, detailed investigation of GBS in pregnant women has special significance in public health related researches. Objectives. The present study is aimed at evaluating the prevalence of GBS colonization among pregnant women in Kathmandu city. Methods. The study was carried out among 125 pregnant women at their trimester (35–37 weeks) (during the time period between January and June in 2018). The prevalence was determined by the culture method in HiCrome Strep B Selective Agar Base and then by using the PCR technique. The serotypes were evaluated by multiplex PCR analysis, while the antibiotics susceptibility tests were performed using the disk diffusion method. Results. Among 125 samples studied, GBS were recorded in 24 samples (implying a prevalence of 19.2%). Furthermore, using the multiplex PCR, among 24 GBS-positive samples, 13 (54.17%) were found to be typeable while 11 (45.83%) were nontypeable. The most abundant serotype recorded in this study was type III (33.33) while the serotypes IV, V, VI, VII, and VIII were not found. Conclusion. The isolates were sensitive towards some antibiotics such as linezolid and ceftriaxone 100%, whereas penicillin 50% and vancomycin 75% but were resistant to tetracycline and ertapenem. Serotype III was found to be predominant in the samples collected during the study period. The observed prevalence was significantly associated with the gestational period, whereas no relationship was found for other risk factors