A study of adverse cutaneous drug reactions in the department of dermatology of a teaching hospital in Jamnagar, India

Background: Adverse drug reactions cause significant morbidity and mortality in health care set up. They are responsible for a significant number of hospital admissions. The data for adverse cutaneous drug reactions (ACDRs) is limited our country. Thus, the present study emphasises on the need of an effective adverse drug reaction reporting programme.Methods: A prospective study to assess the ACDRs in Dermatology department was conducted in a teaching hospital of India. Male to female ratio, most common class of drug, individual drugs causing ACDRs, common types of ACDRs were studied. Other parameters like causality assessment, preventability and seriousness of ACDRs were also studied.Results: A majority of the patients (38%) with ACDR were in the age group of 25-44 years followed by 45-64 years (31%). The rate of ACDRs was more in males (54%). The most frequent ACDR reported was maculopapular rash (38%), followed by urticaria (19%) and fixed drug eruptions (12%). Most of the reactions (93%) were bizarre/ unpredictable in nature. Amongst drug groups, antimicrobials (48%) were most frequently associated with ACDRs followed by NSAIDs (30%) and antiepileptics (12%).  Most of the reactions (94%) were mild-moderate in nature. Only 9% of ACDRs reported in this study were preventable. Paracetamol was the most common offending drug followed by cotrimoxazole, ibuprofen, amoxicillin, phenytoin in decreasing order. Causality assessment found ACDRs in probable category (68%) using WHO-UMC criteria.Conclusions: It is important to monitor and report adverse drug reactions in order to promote safe and rational use of medicines

Drug utilization study in neonatal intensive care unit of a tertiary care teaching hospital

Background: Sick and pre-term neonates are admitted in neonatal intensive care units (NICU) and treated. A great care needs to be taken to use drugs in neonates due to the immaturity of their body functions. There is a lack of standard drug prescribing guideline in children, especially neonates because; safety and efficacy for a majority of drugs have not been established in them. The objectives of the study were to evaluate the drug utilization pattern in NICU of a teaching hospital and to identify problems in drug utilization and suggest measures, if needed.Methods: A prospective, observational study was carried out in NICU for duration of one year. Demographic details like age, sex, birth weight, duration of hospitalization was recorded from the case files of neonates. The morbid condition, treatment with drugs and other supportive modalities were recorded. The outcome of treatment was also noted. WHO drug utilization core indicators were also evaluated.Results: Out of 623 admissions in NICU, 56% were males. There were 56% of neonates who were born pre-term. The maximum used drugs were Vitamin K (73%) and antibiotics (64%). The antibiotics were mainly from penicillin and aminoglycoside groups. Respiratory distress syndrome (19%) and neonatal sepsis (16%) were the most common causes for admission. Out of total admissions, 64% were discharged following recovery, while, 12% had expired.Conclusions: Drugs usage in neonates should be minimal and should be prescribed from essential drug list. Antibiotic policy needs to be formulated for hospitals to minimize antibiotic usage and prevent development of resistance