Study of antimicrobial prescribing pattern in a tertiary care teaching hospital at Dehradun, Uttarakhand, India - A tool to teach clinical pharmacology to MBBS students

Background: Due to increasing resistance to a majority of antimicrobials, it becomes very necessary to teach undergraduate students, the future prescribers, about the judicious and rational use of antimicrobial drugs. The objective of this study was to impart the basic clinical skills to undergraduate MBBS students which will form an integral component of practising rational therapeutics.Methods: A total no of 737 cases were followed up by the 5th semester 2nd Professional MBBS students in the Department of Pharmacology at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIM and HS), Dehradun from June 2013 to July 2015. Patients were analysed on various WHO drug use indicators like drug formulations, drugs prescribed per prescription, Fixed dose Combinations (FDCs), drugs prescribed from National List of Essential Medicines (NLEM) and drugs prescribed by generic names.Results: A total of 737 prescriptions were analysed. Male: Female ratio was 1.74:1 (63.50%:36.50%). Majority of the patients 218 (29.58%) were in 16-30 years age group. A total of 1205 antimicrobials were prescribed. 304 (25.23%) cephalosporins were most frequent followed by 184(15.27%) penicillins, 176(14.61%) antitubercular drugs, 163(13.53%) nitroimidazoles, 143 (11.87%) fluoroquinolones, 102 (8.46%) aminoglycosides, 29 (2.41%) macrolides, 19 (1.58%) tetracyclines, 12 (1%) carbapenems, 11 (0.91%) antimalarials, 11 (0.91%) antihelminthics, 6 (0.50%) glycopeptides, 4 (0.33%) lincosamides and 41 (3.41%) miscellaneous antimicrobials. Most frequently prescribed antimicrobial was Ceftriaxone which was given in 97 (8.05 %) patients. A total of 424 (35.19%) oral antimicrobials, 777 (64.48%) injectable antimicrobials and 04 (0.33%) local/topical antimicrobial drugs were prescribed. 5.13 drugs per prescription and 1.64 antimicrobials per prescription were prescribed. 2100 (55.56%) drugs were prescribed from National List of Essential Medicine 2015 (NLEM 2015). 1177 (97.68%) antimicrobials were prescribed from NLEM. 1110 (92.12%) antimicrobials were prescribed by brand names. A total of 342 (28.38%); fixed dose combinations of antimicrobials were prescribed.Conclusions: Majority of the prescriptions revealed poly-pharmacy and a very high percentage of drugs were prescribed by their respective brand names. It is only by observing drug utilization patterns, current trends and common errors in prescriptions can be highlighted and rational prescription of antimicrobials can be taught to MBBS students

Comparative evaluation of beta-blockers with or without statins in the treatment of essential hypertension at a tertiary health care setup

Background: The effects of statins apart from their role as cholesterol lowering agents have prompted this study to evaluate their antihypertensive role. Beta-blockers (BB) are one of the most effective drugs in hypertension. The present study was designed for comparative evaluation of BB with or without statins in the treatment of essential hypertension in a tertiary health care setup.Methods: This study was conducted in 20 hypertensive patients by Pharmacology Department in Medicine outpatient department at SGRRIM and HS Dehradun for 1 year. Initially, patients were stabilized for 4 weeks by BB and then subdivided into 2 groups. Group I: BB (n=10) and Group II: BB+statins (n=10). Patients were followed up every 4 weeks for 16 weeks. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist hip ratio (WHR), body mass index (BMI) were done every visit. Lipid profile was done at 4 and 16 weeks. Analysis was performed using t test. p≤0.05 was significant.Results: At 4 and 16 weeks, SBP in Group I was 133.6±3.7 and 127±1.61 mmHg (p>0.05) and in Group II was 141.2±2.97 and 130.6±0.71 mmHg (p0.05) and in Group II was 84.6±1.39 and 83.8±1.45 mmHg (p>0.05), respectively. At 16 weeks intergroup SBP and DBP comparison was done, which was not significant (p>0.05). At 4 and 16 weeks improvement in lipid profile in Group I (p>0.05) was not significant, but a significant improvement in Group II (p0.05), respectively.Conclusions: Both groups showed significant improvement in BP. However, no significant difference was seen on intergroup comparison. Larger studies with more patients are needed to establish the role of statins in hypertension

COMPARATIVE EVALUATION OF AMISULPRIDE AND ESCITALOPRAM ON SHEEHAN’S DISABILITY SCALE AMONG DEPRESSION PATIENTS IN A TERTIARY CARE TEACHING HOSPITAL IN NEPAL

Introduction and Aim: Depression is an important global public health problem due to its relatively high lifetime prevalence and significant disability caused by it. The present study was conducted to compare improvement in functional outcome by Amisulpride and Escitalopram among depression patients using Sheehan’s Disability Scaling.Material and methods: The study was conducted in depression patients for 1 year in the Department of Neuropsychiatry, Nepalgunj Medical College & Teaching Hospital. A total of 117 depression patients were divided into 2 groups. Group I (58 patients) received Amisulpride tablet at a dose of 50 mg/day and Group II (59 patients) were given Escitalopram at a dose of 10 mg/day. The patients were required to follow up at 4, 8 and 15 weeks. The efficacy of the drugs was calculated by Hamilton depression rating scale (HAM-D). The improvement in functional outcome was compared between the two groups by using Sheehan’s Disability Scale (SDS). Appropriate statistical tools using GraphPadInstat 3.0 were used for analysis. p value < 0.05 was considered significant.Results: HAM-D score in group receiving Amisulpride at 0 and 15 weeks was 16.92±0.35 and 7.87±0.29 (p<0.0001). HAM-D score in group receiving Escitalopram at 0 and 15 weeks was 17.09±0.39 and 6.63±0.39 (p<0.0001). Sheehan’s Disability Score in group receiving Amisulpride at 0 and 15 weeks was 20.35±0.31 and 11.08±0.60 (p<0.0001). SDS score in group receiving Escitalopram at 0 and 15 weeks was 21.53±0.55 and 11.49±0.46 (p<0.0001). Intergroup comparison at 15 weeks was insignificant (p>0.05). Gastrointestinal disturbances, sexual disturbances, amenorrhea, lactation, agitation and insomnia were the commonly encountered adverse drug reactions.Conclusion: Both Amisulpride and Escitalopram showed improvement in Sheehan’s Disability Scale at the end of study period. But intergroup comparison showed no significant difference in the two groups.Key words: Depression, Amisulpride, Escitalopram, Sheehan’s Disability Scale (SDS)