A survey of knowledge, attitude and practice of adverse drug reaction monitoring among doctors in Western Odisha region

Background: Adverse drug reactions (ADRs) are the major cause of drug related morbidity and mortality. Pharmacovigilance is the science that plays an important role in the reduction of ADRs. Voluntary reporting of ADRs by healthcare professionals is an important tool in the success of pharmacovigilance program, but the same are scantly reported due to lack of awareness and knowledge among the physicians. So, the present study was conducted to evaluate the knowledge, attitude and practice (KAP) regarding ADR reporting among healthcare professionals at a tertiary care hospital.Methods: A questionnaire-based study containing 25 questions (knowledge- 18, attitude -2 and practice- 5) was conducted in 70 prescribers and time allotted to complete it was 1 week. Statistical analysis was done by using Graph Pad Prism version 6.01.Results: Out of 70 prescribers, only 50 (71.43%) responded. ADR reporting was considered very important by almost all of them, but actual practice was lacking as only 36% of consultants had reported any ADR. The higher grading was given to causes most important for reporting were patient safety, to identify safe drug and new ADRs. The main reasons for under-reporting were unavailability of reporting forms when needed, uncertain association and lack of knowledge about reporting procedure.Conclusions: The prescribers are aware of the importance of ADR reporting, but lack of awareness and knowledge are most common cause of under-reporting. So, there is need of pharmacovigilance awareness program to improve voluntary reporting of ADRs

Psychotropic drug utilization in psychiatric outpatient department of a tertiary care government hospital

Background: Mental disorders are associated with significant distress in social, occupational and other important activities. Of the ten health conditions contributing to the DALYs, four are psychiatric disorders.  Psychiatric disorders form an important public health priority and major causes of morbidity. Psychotropic drugs had a remarkable impact in psychiatric practice. The utilization, clinical practice, effectiveness and safety in real life situation need continuous study.Methods: A cross-sectional study was carried out by analyzing prescriptions of patients who visited the OPD of the psychiatry department of VIMSAR, Burla for a period of 4 months. Patients of all ages and both sexes were included in this study with exclusion of patients suffering from epilepsy and cases with uncertain diagnosis. The prescribing pattern was analyzed using WHO basic drug indicators.Results: Average number of drugs per prescription was 3.17. Bipolar affective disorder (BPAD) was the most common psychiatric condition (44%) with a male predominance followed by schizophrenia. Olanzapine was the most common antipsychotic used. The most frequently used fixed dose combination was tri-hexiphenydyl and risperidone. Prescribing frequency of different psychotropic drugs (antipsychotics, antianxiety, selective serotonin reuptake inhibitors, tricyclic antidepressant, mood stabilizers) were compared.Conclusions: The study advocated a rational use of psychotropic drugs with fewer deviations due to socio-economic status of patients and prescription practices of healthcare providers.

Measurement of antibiotic consumption in surgical ward of a tertiary care hospital

Background: Antibiotic resistance is a global health problem. Improper use of antibiotics leads to development of antibiotic resistance, side effects, superinfections and increase in treatment costs. There are few publications on antibiotic consumption. Serious morbidity and mortality are associated with postoperative wound infections. The use of peri or pre-operative antibiotics has resulted in a reduced risk of postoperative infection when appropriate principles of prophylaxis are applied.Methods: An observational study during a 2-month period was carried out in the department of surgery of Veer Surendra Sai Institute of Medical Science and Research, Burla. We utilized the administrative data for expression of antibiotic consumption using anatomical therapeutic classification (ATC) / defined daily dose (DDDs) methodology. The information included were drug names, strength, pharmaceutical form, quantity dispensed, total number of patients admitted during the study period and average length of stay. Each drug was then given a code according to the ATC classification. The number of DDDs and DDDs/100 bed days was calculated.Results: The most frequent antibiotic used was cephalosporin group with DDDs 62.70 DDDs/100 bed days (44.34%) followed by metronidazole with 23.10 DDDs/100 bed days (16.34%). Among cephalosporin group most common antibiotic used was ceftriaxone with 24.46 DDDs/100 bed days. The mean duration of stay was 7.2 days.Conclusions: The results of this study are similar to previous studies and it showed that there is irrational use of antibiotics as there is no antibiotic policy in our hospital. Drug utilization research should be carried out at frequent intervals to improve rational use of antibiotics

Drug utilization pattern of antidiabetic agents in a tertiary care hospital of western Odisha, India

Background: A changing life style in developing countries like India has increased the statistical figure of diabetes mellitus even among rural populations and younger age groups. Prevalence rate of diabetes in Odisha is about 10%. There is intensive polypharmacy as regards the treatment of diabetes mellitus which is not only affecting the quality of life of patients adversely by producing side effects including hypoglycemia but also taking a toll on the financial state of the poor people. With this background, this study was conducted to evaluate the drug utilization pattern of antidiabetic agents to facilitate rational use of drugs in this condition.Methods: This observational study was conducted in 230 patients for a period of 2 months in the department of general medicine at V. S. S. Institute of Medical Sciences and Research, Burla. After taking informed consent, the patient’s case records, prescriptions, investigational reports and co - morbidities were evaluated.Results: In our study, insulin was found to be the most commonly used antidiabetic agent both during hospital stay (80%) and also at the time of discharge (60%). Metformin with sulfonylurea was the most frequently prescribed oral anti diabetic combination in 9.5% of patients. Average cost of insulin therapy was rs. 80 per patient per month and of oral antidiabetic drug was rs. 45.66 per patient per month during hospital stay.Conclusions: The prescribing trend has been monotherapy with insulin followed by oral antidiabetic drugs in the form of glimepiride and metformin combination

Effectiveness analysis of antipsychotics in schizophrenia using psychometric scales: an observational study

Background: Schizophrenia is a commonest and one of the well known psychiatric disorders. Life expectancy of a patient with schizophrenia may be 20 to 30 years shorter than the general population. Long term antipsychotic therapy is usually required for the management of schizophrenia. It is not currently possible to predict which antipsychotic may be optimal for a given patient because there are still many debates about effectiveness and efficacy of atypical drugs over first generation antipsychotics. So, our aim is to assess the effectiveness of various antipsychotics by using various psychometric scales, which will be helpful to bring out better treatment options for schizophrenia patients.Methods: This was an observational questionnaire based study, conducted on patients of inpatient and outpatient Department of Psychiatry and Department of Pharmacology at VIMSAR, Burla, for a period of 24 months (September 2015 to August 2017). Patients of schizophrenia aged 18 years or above were subjected to clinical global impression – severity scale (CGI-S) and clinical global impression – improvement scale (CGI-I) questionnaire after taking informed consent. Then scores were calculated using non parametric test with Graph pad Prism version 6.0.Results: Out of the 90 cases, majority (60) of patients belonged to the middle (25 to 45 yrs) age group followed by 20 younger (45 yrs) patients. Both scales showed significant improvement with atypical antipsychotics as compared to first generation antipsychotics.Conclusions: Based on these findings, we can conclude that atypical antipsychotics are more effective than first generation antipsychotics. But further studies are needed to assist clinicians in making optimum treatment decisions

Drug utilization pattern and appropriateness of prescription in IPD geriatric patients in a tertiary care teaching hospital

Background: Drug utilization research provides insights into different aspects of drug use and drug prescribing such as pattern, quality, determinants and outcomes of drug use. Polypharmacy is considered to be hazardous for the elderly, because of their greater vulnerability to drugs and multiple drug use. Prescription of potentially inappropriate medications (PIMs) has been found to be a common cause of morbidity and mortality among the geriatric population and has necessitated the creation of criteria for the safe use of medicines among them. Objectives of the study were to assess the drug utilization pattern in geriatric patients and analyse their prescriptions as per the World Health Organization (WHO) core prescribing indicators and STOPP and START criteria.Methods: An observational, cross-sectional study was conducted from May 2019 to August 2019 in inpatient department of general medicine of VIMSAR, Burla. Prescriptions of ≥65 year patients were collected and documented by active surveillance from the medicine ward.Results: Majority of the patients were in age group of 65-75. Stroke is the more common comorbidities among geriatric population. Average number of medication per prescription is 5.42. About 78.74% of drugs are injectable. The percentage of antibiotics prescribed to patient is 27.75%. Based on STOPP criteria potentially inappropriate medications PIM is 7% and START criteria PIM is 29%.Conclusions: Our study suggests that prevalence of polypharmacy was high which is usually unavoidable in geriatric patients and less PIM is suggestive of adherence to WHO core prescribing indicators, and prescription of drugs as per STOPP and START guidelines are indicative of scope for improvement

Bronchoprotective effect of Zingiber officinale roscoe (Ginger) in guinea pigs

Background: To evaluate the bronchoprotective effect of aqueous extract of Zingiber officinale (AZO) in guinea pigs and compare the same with that of standard drugs.Methods: Guinea pigs of either sex weighing between 350 to 450 Grams were randomly divided into 13 groups, each group containing 6 animals. Bronchospasm was induced by placing guinea pigs in histamine exposition chamber and exposing them to either 0.25% of histamine acid phosphate or 10% acetyl choline through a nebuliser under 40mm Hg pressure. The time for development of asphyxia was noted. After two and half hours, the animals were administered orally with vehicle / drugs as per the following: Gr I- Normal saline 1ml/100 Grams, Gr II- Salbutamol 1.6mg/kg, Gr III- Chlorpheniramine maleate 0.8mg/kg, Gr IV to Gr VI- AZO 200, 400, and 800mg/kg, Gr VII- AZO 200mg/kg and Salbutamol 0.8mg/kg. For acetylcholine-induced Bronchospasm Gr III animals received atropine 2mg/kg and Gr VII was not taken, rest others remaining the same. After 1 hour of treatment, the animals were again exposed to histamine or acetyl choline aerosol. The exposition time for each animal was again noted and mean increase or decrease in exposition time were noted. The data were subjected to stastical analysis by using paired ‘t’ test. Percentage of protection was also calculated.Results: AZO at all the doses studied (except 200mg/kg), showed highly significant increase in exposition time against histamine-induced bronchospasm. Combination of AZO (200mg/kg) with salbutamol (0.8mg/kg) also produced augmented effect. But against Acetylcholine induced bronchospasm, AZO did not produce any significant protective effect at any of the doses.Conclusions: AZO produced significant dose dependant bronchoprotection against histamine induced bronchospasm which might be due to antihistaminic action

Utilization trends of drugs in patients admitted with ischemic heart disease in a tertiary care teaching hospital

Background: Coronary artery disease (CAD) takes the highest toll of lives across the world as well as India. Prompt diagnosis and effective treatment is lifesaving. Drug utilization studies scrutinize the appropriateness of treatment and provide favourable feedbacks to strengthen clinical practices. Several other studies have reported underuse of four evidence-based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD. Polypharmacy, injection overuse is some of the shortcomings. The objectives of this study was to describe treatment practices in terms of different disease spectrum and drug utilization (group-wise and individually) for inpatients with CAD using core prescription indicators by WHO.Methods: A cross-sectional study of 4-month duration was undertaken for patients with CAD admitted to cardiology indoor of a tertiary care hospital. A total no of 143 prescriptions was screened and analyzed.Results: Males (67.13%) were more in number than females (32.87%). Age group from (57-66) topped in frequency (61.05%) ahead of (67 to 76) group (38.46%). Average no of drugs per patient were 8.056±1.97 and 5.86±0.14 for cardiovascular drugs. Prescription in generics (45.49%), antibiotics (0.61%), fixed-dose combinations (FDCs) (0.52%) and injectables (28.47%) were noted. The most common categories of CAD were ST-segment elevated myocardial infarction (69.23%) followed by chronic stable angina (17.48%). Antiplatelets (100%), hypolipidemics (99.3%), antianginals (60.14%), β-blockers (37.06%) and ACE-I/ARBs (27.97%) were utilized. Drugs from the national list of essential medicines were 66.49%.Conclusions: Among four evidence-based drugs, use of β-blockers and ACE-I/ARBs were inappropriately low. Polypharmacy and overuse of Injectable drugs are noted

Drug utilization pattern of antimicrobials in intensive care unit of a tertiary care teaching hospital

Background: The intensive care unit is a setting where the multiple medications are prescribed to patients. Antimicrobials are heavily prescribed in the ICUs, which in turn enhance the risk of antimicrobial resistance, increase the side effects and increases the cost of treatment. Drug utilization study is a component of medical auditing that aims to monitor and evaluate the drug prescription patterns and to suggest necessary modifications in the prescribing practices to achieve rational therapeutic practice.Methods: A cross-sectional study was conducted in which data of patients admitted to ICU during the period from June 2019 to August 2019 was collected from the Medical Record Section of the hospital. Drug utilization pattern of antimicrobials in ICU was analyzed.Results: Out of 90 patients, 60 were males and 30 were females. The average duration of stay in ICU was 7.53 days. The most common antibiotic prescribed was ceftriaxone followed by piperacillin and tazobactam with DDD/100 bed days of 24.2 and 17.3 respectively.Conclusions: In this study, the results appeared to be similar to those reported in previous studies. However, prescription protocols need to be addressed to guide appropriate use of antimicrobials in the ICU setting. Therefore, it is necessary to conduct drug utilization research to understand the drug consumption and for implementation of protocols to improve the quality of healthcare.