Retrospective survey on efficacy of cefixime-ofloxacin 400 milligram sustained release fixed-dose combination tablet for enteric fever in community settings of India

Background: The World Health Organization (WHO) estimate for annual global incidence of typhoid fever, about 21 million cases, is probably an underestimate because of poor diagnostics. Multi-drug resistant (MDR) isolates and nalidixic resistant isolates have limited the choice of oral drugs available for the treatment of typhoid fever. Recently the Indian regulatory authority approved an oral fixed dose combination (FDC) of cefixime and ofloxacin for the treatment of typhoid fever.Methods: Retrospective survey was planned to observe the efficacy of cefixime-ofloxacin 400 mg sustained release (SR) FDC tablet for enteric fever in community settings of India. Family physicians involved in the management of enteric fever cases were selected across 4 zones (East, South, West, and North) each by convenient sampling to have uniform representation of population across the country. Each physician was given survey questionnaire booklet containing survey forms.Results: Total 78 family physicians participated in the survey with 881 completed questionnaire forms. Hypertension, diabetes were present in 83% (N=244) patients with comorbid conditions. One hundred and fifty four (17.4%) cases revealed history of relapse or recurrence. Fever clearance rate of 97% was observed in overall evaluable population. Sub analysis in high risk cases (relapse/recurrence) showed equally good response to the combination as cases without defervescence on day 3 and day 7 were only 21.4% and 1.3% respectively.Conclusions: Based on the present study we believe that cefixime-ofloxacin 400mg SR FDC to be an appropriate choice in the management of resistant enteric fever cases, especially in presence of comorbid conditions like hypertension or diabetes which adds to excess pill burden

NEBULIZED GLYCOPYRRONIUM AND FORMOTEROL, BUDESONIDE AEROSOL AERODYNAMIC ASSESSMENT WITH VIBRATING MESH AND COMPRESSOR AIR NEBULIZER: ANDERSON CASCADE IMPACTOR STUDY

Vibrating mesh nebulizers (VMN) demonstrate improved efficiency for delivery of inhaled aerosol solutions or suspensions as compared to compressor devices. The added advantages of compactness, portability and functioning as noise-free device makes them of incremental value in Home or Ambulatory settings while managing Severe Obstructive airway disease or delivery of maintenance medications in these cases. This further circumvents the need for multiple devices thereby further improving patient compliance and convenience while delivering acute or maintenance formulations including Glycopyrronium (GLY) and Formoterol (FRM)/Budesonide(BUD) nebulizing solution formulations. To further assess the clinical role and feasibility of FRM-BUD formulation delivery kinetics  with or without GLY nebulizing solution through VMN and jet  nebulizers for In- & outpatient settings, 2 comparative in-vitro lung deposition studies were carried out utilizing Anderson Cascade impactor at 30 L/min; deposited drug concentrations in different stages were suitably collected and estimated by HPLC. Post-hoc analyses with p<0.05 was considered statistically significant for intergroup differences on FRM/BUD and GLY delivered through VMN or Compressor devices.  The calculated mean fine particle dose for FRM & BUD delivered by VMN or jet nebulizer showed no statistical difference. However the mean fine particle fraction for BUD delivered by VMN was significantly better compared to jet nebulizer than that for FRM. The Residual volume at 10 mins was significantly higher with jet nebulizer. The optimal APSD for GLY nebulizing solution admixture with FRM/BUD suspension delivered through VMN and Jet nebulizer offers a clinically relevant strategy for High risk COPD cases in Acute or Home settings