A prospective study of the pattern of non-antimicrobial drug use in neonatal intensive care management in a tertiary care hospital

Background: Neonatal intensive care management (NICM) may be required for high risk or critically ill neonates for survival or stabilization. NICM involves the use of different classes of drugs, and the pattern of use mainly determined by the prevailing clinical conditions and complications, and the desired therapeutic objectives. The objective of this study was to study the pattern of drug use in NICM, criteria for drug selection and dose individualization, to assess the efficacy and safety of medications and record drug interactions.Methods: The pattern of drug use was assessed prospectively in 150 consecutive subjects admitted to NICU. The number of drugs used, therapeutic class, dose, route, frequency and duration of administration, criteria for selection were recorded. The efficacy and safety of the medications was assessed by the treatment outcome and by observing for any adverse events or drug interactions.Results: Different therapeutic classes of drugs were used as per the prevailing clinical conditions or complications. The total number of drugs used was 23. Different classes of drugs were used for specific indications. The treatment outcome was very good in most of the subjects and no drug related adverse events or interactions were observed.Conclusions: Most of the problems and complications in high risk and critically ill neonates can be prevented or controlled by judicious use of several classes of drugs, properly chosen and individualised to the given situation, without producing serious adverse events and interactions. Drugs play an important role in improving the outcome

A prospective analysis of the cost-effectiveness of alfuzosin, tamsulosin and silodosin for 12 weeks in benign prostatic hyperplasia

Background: Benign prostatic hyperplasia (BPH) is usually seen in men above 45 years. α-blockers (alfuzosin, tamsulosin and silodosin) form the mainstay of pharmacological management of symptomatic BPH and may differ in their efficacy, tolerability and treatment costs. The present study compares them prospectively to evaluate the most cost-effective α-blocker in the management of BPH.Methods: Ninety subjects diagnosed with symptomatic BPH were randomised to receive alfuzosin, tamsulosin or silodosin and were followed up at 2, 4, 8 and 12 weeks after treatment initiation. Effectiveness was assessed by rate of treatment success and number of symptom free days (SFDs). Treatment related direct medical, direct non-medical and indirect costs were analysed both from patient and third-party perspective. Cost-effectiveness was assessed using average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER).Results: With rate of treatment success as the outcome measure, alfuzosin had the least ACER, followed by tamsulosin and silodosin. With number of SFDs as the outcome measure, alfuzosin had the least ACER followed by silodosin and tamsulosin. An additional INR 3982 and INR 30 were required per extra success and extra SFD respectively with alfuzosin when compared to tamsulosin. Alfuzosin dominated silodosin as a more cost-effective option in achieving treatment success. However, an additional INR 231 was required to achieve an extra SFD with silodosin.Conclusions: Compared with tamsulosin and silodosin, alfuzosin seems to be the most economical α-blocker in the management of BPH, both from patient and third-party perspective.Short duration of study of 12 weeks was a limitation in the present prospective study

Pattern of drug use in the management of psoriasis in a tertiary care hospital: a prospective study

Background: Psoriasis is a chronic skin disease, characterized by chronic and recurrent scaly plaques with itching. The treatment modalities for psoriasis include topical, systemic, and phototherapy (PT). The pattern of therapy may vary depending upon the type, severity, and duration of the disease. As there are few reports in the Indian literature regarding the pattern of drug use in psoriasis and evaluating the efficacy and patient compliance to treatment, the present study was conducted.Methods: This was a prospective, observational study conducted on121 newly diagnosed and untreated patients with psoriasis, who attended Dermatology outpatient department of a tertiary care hospital. The severity of the disease was assessed by baseline psoriasis area severity index (PASI) score. Most of the patients were treated with topical therapy consisting of glucocorticoids (GC) monotherapy or combination with, salicylic acid, calcitriol and coal tar. Systemic therapy and PT were considered only for severe cases of psoriasis with baseline PASI score >4. The patients were monitored every 2 weeks for 3 months.Results: The topical medications induced effective resolution of lesions in most of the patients, along with adequate symptomatic relief. The response to GC monotherapy was found significant (90.47%; p4. Regular follow-up is required not only to monitor the treatment response, but also to ensure good patient compliance by proper counseling

Impact of the educational session on knowledge and attitude toward palliative care among undergraduate medical, nursing, and physiotherapy students: a comparative study

Background: Palliative care forms an integral part in the treatment of terminally-ill patients. To care for dying patients requires a thorough medical education, which is lacking in today’s undergraduate curriculum. The objective was to compare the attitude and knowledge about palliative care among the undergraduates of medical, nursing, and physiotherapy before and after an educational session on palliative care.Methods: A pre-validated 20-point questionnaire on attitude and knowledge about palliative care was distributed to 2nd year medical (22), nursing (28) and physiotherapy (20) students before and after palliative care educational session. Results obtained were compared within and in between the groups. Paired t test was used for within the group and one-way ANOVA for in between the group comparison. p-value <0.05 was considered to be statistically significant.Results: All groups showed statistically significant improvement in knowledge, attitude, and pain management scores following palliative care educational session. The pre-session evaluation showed that physiotherapy students had better knowledge and attitude about palliative care. Pre-educational assessment of knowledge about pain management was similar among the three groups statistically. After the session, mean improvement in palliative care knowledge scores was more in medical, followed by physiotherapy and nursing students. On inter-group comparison, statistically significant improvement in knowledge scores was seen in medical and physiotherapy students compared with nursing students. All three groups showed statistically similar improvement in attitude and pain management scores.Conclusion: Significant improvement was seen in attitude and basic knowledge about palliative care in the students following an educational session. Therefore, including palliative care in the curriculum enables them to deliver appropriate end-of-life care to patients

A prospective study on adverse drug reactions in outpatients and inpatients of medicine department in a tertiary care hospital

Background: No pharmacotherapeutic agent is completely free from noxious and unintended effects and thus adverse drug reactions (ADRs) are inevitable consequences of drug therapy. Incidence of ADRs in Indian population ranges between 1.8% and 25.1%. However, ADR reporting in India is inadequate. Developing awareness inpatients and healthcare professionals (HCPs) will help in reducing the ADRs, its suffering and socioeconomic impact. Hence, the present study of ADR monitoring in the outpatients and inpatients of the medicine department in a tertiary care hospital is undertaken. The main objective of this study was to assess the ADR reporting patterns in outpatient and inpatient of medicine department. The study was also aimed to assess the causality, severity, and preventability of these ADRs and comparison between spontaneous reporting by HCP and patient self-reporting of suspected ADRs.Methods: This study was a prospective observational study conducted in 111 consecutive patients who experienced ADRs in the department of medicine. The study plan included analysis and assessment of the clinical pattern, spectrum of ADRs reported based on causality, severity, preventability factors. The impact of ADRs on emotional, occupational, and social life of patients was evaluated. The assessments were compared between patient reporting and HCP reporting of ADRs.Results: The clinical spectrum of ADRs ranged from the more common mild reactions such as skin rashes, itching, nausea, and vomiting to moderately severe reactions prolonging the hospital stay. The predominant causative drugs were antimicrobials, antiretrovirals, non-steroidal anti-inflammatory drugs and antihypertensives. The majority of ADRs were probable in causality assessment, moderate in severity and probably preventable. Comparison of ADR reporting between patient and HCP revealed that ADRs reported by patient’s been less in incidence, similar in qualitative analysis to HCP with very elaborative narration and highlighted emotional and occupational impact due to ADRs than HCP reports.Conclusion: A wide range of ADRs are possible in medicine department. Adequate awareness of ADR reporting and precautions, while prescribing drugs are essential. Including patients as additional reporters of suspected ADR may add to the benefit of pharmacovigilance

Prospective, non-randomized, parallel group, comparative observational study to compare maternal and neonatal outcome after regional and general anesthesia for Lower Segment Caesarean Section

Background: LSCS is a routine obstetric procedure performed under general anesthesia (GA) or regional anesthesia (RA). Choice of anesthesia depends on factors like gestational age, parity, co-morbidities, urgency of situation, etc. Both GA and RA involve the use of various medications which may influence maternal and neonatal outcome. As there are few studies comparing maternal and fetal outcome in RA and GA for LSCS in Indian population, the present study was taken up. Objectives of the study was to compare the maternal and neonatal outcome after RA and GA for LSCS.Methods: 60 subjects with indications for LSCS were assigned non-randomly into two groups, 30 for GA and 30 for RA, at the discretion of anesthesiologist. The demographic, anthropometric and clinical data was recorded for all subjects. The maternal outcome after RA and GA for LSCS was assessed by parameters like maternal blood loss, postoperative pain, postoperative nausea and vomiting, maternal satisfaction and neonatal outcome by parameters like birth weight, APGAR scores and NICU admissions. The maternal and neonatal outcome between the two groups was compared.Results: All subjects had clear indications for CS. In most of the subjects it was undertaken as an emergency procedure. GA was preferred in high risk subjects. Maternal blood loss, postoperative pain, NICU admissions, need for resuscitation was less under RA compared to GA. There was no difference in PONV, maternal satisfaction, birth weight and need for intubation.Conclusions: LSCS under RA showed a more favourable maternal and neonatal outcome

Adverse drug reactions in paediatric patients in a tertiary care hospital in India: a prospective observational single centre study

Background: Adverse drug reactions (ADRs) are a major source of concern in adult and paediatric population. Monitoring ADRs in children is vital as they differ from adults in pharmacokinetic and pharmacodynamics responses. Strict ethical guidelines in clinical trials result in extrapolation of data from studies done in adults. Further, ADRs reported in adults do not predict those in children. Incidence of ADRs in children is 2.9% emphasizing the need for systematic monitoring. Studies at institutional level can generate valuable data among paediatric population. Hence, the current study was taken up to assess the clinical pattern of ADRs, their causality, severity and preventability.Methods: This is a prospective observational single centre study. Suspected cases of ADRs were collected and assessed for the clinical pattern, causality, severity and preventability factors along with gender-wise distribution.Results: A total of 118 ADRs were reported in our study. Most of the ADRs (46.67%) occurred below 1 year of age with male preponderance (53.4%). Skin was the most common organ involved (91.5%). Majority (78.8%) of ADRs were due to anti-infectives for systemic use (J). Vaccines were the most commonly implicated agents (55.9%) followed by antibiotics (22.9%). Severe reaction like DRESS syndrome was reported due to antiepileptics (including levetiracetam) requiring hospitalisation. Majority of ADRs were probable (92.4%), moderate (73.7%) and definitely preventable (61%).Conclusions: A wide range of ADRs are possible in paediatric population. Adequate knowledge about ADRs is essential and caution has to be exercised even while prescribing drugs which are considered safe in children

Impact of educational session on knowledge and attitude towards antimicrobial prescribing and awareness about antimicrobial resistance among undergraduate medical, dental and nursing students: a comparative study

Background: Educational interventions targeting undergraduate medical students provide a great opportunity to strengthen the efforts to promote rational prescribing and to decrease antimicrobial resistance. A better understanding of knowledge and beliefs of students about issues of antimicrobial use and resistance, and analysing the improvement after educational session, can assist in devising an effectively tailored educational intervention. The objective of this study was to comparison of knowledge and attitude about antimicrobial prescribing and awareness about resistance amongst medical, dental and nursing undergraduates before and after an educational session on antimicrobial use and resistance.Methods: A pre-validated questionnaire on knowledge and attitude about antimicrobial use and resistance was distributed to second year medical (80), dental (61) and nursing (37) students before and after an educational session. Results obtained were compared within and between the groups by using paired t-test and one-way ANOVA respectively. P-value<0.05 was considered to be statistically significant.Results: All groups showed statistically significant improvement in knowledge and attitude scores following the session on antimicrobial use and resistance (P<0.001). Post-session attitude scores of medical students were better than that of dental and was statistically significant (P=0.006). The pre-session evaluation showed that medical students had better knowledge and attitude about antimicrobial use and resistance as compared to dental (P<0.001) and nursing students(P<0.001).Conclusions: Significant improvement in attitude and basic knowledge following an educational session about antimicrobial prescribing and awareness about antimicrobial resistance in undergraduate students suggest establishment of special course on rational prescription of antimicrobials in undergraduate curriculum

A prospective analysis of the cost-effectiveness of alfuzosin, tamsulosin and silodosin for 12 weeks in benign prostatic hyperplasia

Background: Benign prostatic hyperplasia (BPH) is usually seen in men above 45 years. α-blockers (alfuzosin, tamsulosin and silodosin) form the mainstay of pharmacological management of symptomatic BPH and may differ in their efficacy, tolerability and treatment costs. The present study compares them prospectively to evaluate the most cost-effective α-blocker in the management of BPH.Methods: Ninety subjects diagnosed with symptomatic BPH were randomised to receive alfuzosin, tamsulosin or silodosin and were followed up at 2, 4, 8 and 12 weeks after treatment initiation. Effectiveness was assessed by rate of treatment success and number of symptom free days (SFDs). Treatment related direct medical, direct non-medical and indirect costs were analysed both from patient and third-party perspective. Cost-effectiveness was assessed using average cost-effectiveness ratio (ACER) and incremental cost-effectiveness ratio (ICER).Results: With rate of treatment success as the outcome measure, alfuzosin had the least ACER, followed by tamsulosin and silodosin. With number of SFDs as the outcome measure, alfuzosin had the least ACER followed by silodosin and tamsulosin. An additional INR 3982 and INR 30 were required per extra success and extra SFD respectively with alfuzosin when compared to tamsulosin. Alfuzosin dominated silodosin as a more cost-effective option in achieving treatment success. However, an additional INR 231 was required to achieve an extra SFD with silodosin.Conclusions: Compared with tamsulosin and silodosin, alfuzosin seems to be the most economical α-blocker in the management of BPH, both from patient and third-party perspective.Short duration of study of 12 weeks was a limitation in the present prospective study