An evaluation of knowledge, attitude and practices about prescribing fixed dose combinations among postgraduates of a rural tertiary health care teaching hospital

Background: Fixed dose combinations (FDCs) is a combination product of two or more active pharmacological ingredients (APIs) in a single dosage form. There is lot of debate over rationality and irrationality of FDCs presently. This study was focused on medical postgraduates to evaluate their knowledge, attitude and practices about prescribing fixed dose combinations as they are the physicians who are future practitioners and it is up to them to misuse it or use it judiciously by prescribing rationally. The objective of the study was to evaluate knowledge, attitude and practices about prescribing fixed dose combinations among postgraduate medical students.Methods: A cross-sectional questionnaire based study was conducted among postgraduate medical students of AIMS, B G Nagar, Nagamangala, Mandya, Karnataka, India.Results: Total respondents were 124. 81 participants (65.32%) were males and 43 participants (34.67%) were females. 73.38% of participants were aware of the term FDCs. Improvement in patient’s compliance (68.54%) and improved efficacy of individual drugs (62.09%) were the advantages of using FDCs and irrational prescription of FDCs leading to drug resistance (70.96%) and difficulty in dose adjustments of individual drugs (54.83%) were the disadvantages mentioned. Knowledge of banned FDCs was lacking. More than half (58%) of them were not able to mention a single banned FDC in India. Medical representatives (45.16%), Internet (27.41%), textbooks (15.32%) were the most common sources of information of FDCs. Amoxicillin with clavulanic acid was the most common prescribed FDC (60.2%).Conclusions: Majority of the postgraduates have the knowledge about general aspects of FDCs, their advantages and disadvantages. However, knowledge about rational or irrational drugs, banned FDCs and availability of essential list is lacking. It is required that the concepts of rational drug use should be implemented in undergraduate curriculum vigorously and to strengthen their knowledge and skills to prescribe rationally

Anti-rabies vaccination induced hepatotoxicity - a case report

Anti-rabies vaccination plays a pivotal role in decreasing the incidence of rabies, a deadly zoonotic viral infection. Adverse effects are significantly reduced and administration became ease on substitution of conventional neuronal vaccination with new non neuronal one. Hepatotoxicity is mainly attributed to many chemicals and drugs, but not so for vaccinations. Here is an isolated case of hepatotoxicity, observed in an old lady, who was administered post exposure anti-rabies prophylaxis treatment .Causal relationship found was probable with widely used standard methods. Her course of the disease was uneventful and her clinical and biochemical status returned back to normal. So anti-rabies vaccination could be hepatotoxic and hence looked for it during its administration

Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4

Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report

Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens-Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4