DRUG UTILIZATION AND ECONOMIC IMPACT OF ANTICOAGULANTS IN UNSTABLE ANGINA/ NON- ST ELEVATION MYOCARDIAL INFARCTION IN KARACHI

Objective: The present study was designed to evaluate drug utilization and the economic impact of anticoagulants for the treatment of unstable angina (UA)/non-ST elevation myocardial infarction (NSTEMI) in Karachi.Methods: A prospective study of prescriptions was conducted in private and public tertiary care hospitals (University of medical education and research) situated in Karachi. The purpose of prescriptions review was to examine the utilization and cost analysis of anticoagulants (enoxaparin, dalteparin and fondaparinux) in hospitalized patients of UA/ NSTEMI during treatment course of 2-8 days. Information of prescribed drugs was obtained from the medical records whereas patient demographics and socioeconomic status were reported through patients/relatives interviews. Data of 487 UA/NSTEMI patients admitted were analyzed during the study period of 2013-2014.Results: Data of 487 UA/NSTEMI hospitalizations demonstrated the increased number of prescriptions for enoxaparin, it was found to be widely used anticoagulant in the public and private organizations in Karachi. Enoxaparin attributed by 70% of drug utilization comparative to 24.8% fondaparinux and 5.1 % dalteparin. Though, economic contribution was in favor of fondaparinux by reducing total drug cost of $21 with enoxaparin and$ 32 in contrast of dalteparin on the basis of once daily dose in the conservative management of unstable angina/non-ST elevated myocardial infarction.Conclusion: In patients with unstable angina (UA)/non-ST elevation myocardial infarction (NSTEMI), enoxaparin was found to be most widely prescribed low molecular weight heparin (LMWH) among other available alternatives. However, economic assessment considered fondaparinux as cost saving therapeutic agent for initial conservative management of 2-8 days, added financial benefits over current therapies in the treatment of UA/NSTEMI.Â

AMOXICILLIN AND TETRACYCLINE ACTIVITY AGAINST STAPHYLOCOCCUS AUREUS AND PROTEUS MIRABILIS

Objective: Present investigation was undertaken to evaluate the susceptibility and resistance pattern of clinical isolates causing different types of infections and to compare the efficacy of antibiotics namely amoxicillin and tetracycline. Methods: The in-vitro antibacterial activity and resistance patterns of these two well known antibiotics were studied and compared by using the disk diffusion method. For this, one hundred and thirty four clinical isolates comprising of, Staphylococcus aureus (103) and Proteus mirabilis (31) and information were taken regarding patient age, sex and bacterial organism isolation were collected from different local pathological laboratories and hospitals according to the zones (east Karachi, west Karachi, south Karachi and north Karachi) of Karachi (Pakistan) during the time period of February 2015 to June 2015. Results: Out of the sample analyzed, resistant pattern of one hundred and thirty four (134) clinical isolates of Staphylococcus aureus (103) and Proteus mirabilis (31) were studied by using amoxicillin and tetracycline and the results are among 103 samples of Staphylococcus aureus 4(3.9%) sample showed sensitivity, no clinical isolates showed intermediate response and 99 (96.1%) sample exhibited resistance against amoxicillin while, 84 (81.6%) sample of Staphylococcus aureus were sensitive against tetracycline, 6(5.8%) showed intermediate response and 13(12.6%) were resistant to the tetracycline 30 µg while, 2 (6.5%) clinical isolates showed sensitivity towards Proteus mirabilis, 19(61.31%) showed resistance and 10 (32.3%) showed intermediate resistance against amoxicillin. On the other hand, tetracycline showed 3(9.7 %) resistance against Proteus mirabilis, 26(83.9%) showed sensitivity and 2 (6.5%) clinical isolates showed intermediate resistance. Conclusion: overall results of the present study showed that the antibacterial activity of tetracycline is more as compare to amoxicillin. Amoxicillin is not the first choice to treat the infections against Proteus mirabilis and Staphylococcus aureus because they showed resistance 96.1% and 61.3% against Proteus mirabilis as compare to tetracycline is the first choice to treat infection which is caused by Staphylococcus aureus and Proteus mirabilis because they showed 81.6% sensitivity against Staphylococcus aureus and 83.9% sensitive against tetracycline

SURVEY BASE STUDY ON CURRENT TREND OF TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN KARACHI

Objective: Community-acquired pneumonia (CAP) is a potentially serious infection that results in various general physicians (GP) visits and hospital admission every year. The prime objective of this research was to find the current trend of treatment of community-acquired pneumonia in Karachi.Methods: It was a prospective survey conducted in all districts of Karachi. A Questionnaire was filled by distinctive specialities of doctors in an outpatient setting in Karachi. A preliminary test questionnaire was used to collect the data directly from distinctive specialities of doctors in outpatient setting in Karachi. Total 500 doctors were selected from distinct districts of Karachi with convenient random sampling.Results: Majority (33.8%) of the respondents recommended complete blood count and chest x-ray for diagnosis of community-acquired pneumonia in an outpatient setting. Most (76%) of the respondents recommended nebulization for the management of community-acquired pneumonia in an outpatient setting. 31% and 25.4% of the physicians recommended clarithromycin as 1st line antibiotic therapy in adults and children for the management of a community-acquired pneumonia patients in outpatient setting.55.6% of the physicians recommended two-week duration of antibiotic therapy for the management of CAP in outpatient setting.Conclusion: This is clearly indicated by this study that deviation from the standard guideline is observed in the management of community-acquired pneumonia in Karachi. These deviations from the highly recommended guideline can results excess cost and inappropriateness of the management of the disease of community-acquired pneumonia. There is a need that the physician should take a decision of therapy according to the standard guidelines for the treatment of CAP in an outpatient setting.Â

DIRECT COST OF TREATMENT OF DIABETES MELLITUS TYPE 2 IN PAKISTAN

Objective: Diabetes is a serious illness. It is a key and growing threat to the health of the global world. The prime concern of this research was to estimate the cost-of-illness of type 2 diabetes in Karachi, a major metropolitan city of Pakistan. This study was performed on the basis a community perspective to calculate the economic burden of diabetes mellitus type 2 in Pakistan. Methods: This study was conducted in all districts of Karachi, the patients were taken from all economic segment of society from low income group, average revenue and high revenue group. A preliminary test questionnaire was used to collect the data directly from patients and in some locations conducted interviews with patients due to lack of understanding and un-educated patients. The total of 885diabetes patients was selected with convenient random sampling. Results: The average direct cost of all these expense bear by diabetic patient in Pakistan is Pak Rupees Rs.5542 per month. The cost range starts from Rs. 650/month to 20000 per month on the basis of patient economic condition and disease state. The average appointment fee of a physician, laboratory test and medicines came to Rs. 700/visit, 400/test, and 1100/visit precisely. The average travel and food spent was Rs.200/visit and 1000/month. Medicine accounted for largest cost followed by consultation with the physician. Conclusion: This is clearly indicated by this study that considerable cost is amounted by diabetes, it is suggested that a huge amount of resources could be prevented by taking care, initial understanding of the disease and a decrease in diabetes co-morbidities and complications through better diabetes mellitus treatment. Very extensive and cost-effective programs should be started to maximize health benefits and to diminish the prevalence of this epidemic

COMPARISON OF IN VITRO ANTIBACTERIAL ACTIVITY OF LEVOFLOXACIN AND GATIFLOXACIN

ABSTRACT Clinical isolates including Staphylococcus.aureus, Escherichia coli, Klebsiella pneumonia, Pseudomonas.aeruginosa and Salmonella.typhi were obtained from different pathological laboratories and medical center were included in the study.Comparison of in vitro antibacterial activity of levofloxacin and gatifloxacin was carried out by ICLS reference Disk diffusion (Kirby-Bauer) method. An attempt has been made to measure the zone of inhibition produced by Levofloxacin and Gatifloxacin against these clinical isolates. Comparison of susceptibility results indicated that both Levofloxacin and Gatifloxacin has excellent in vitro antibacterial activity but gatifloxacin had relatively broad spectrum of activity against most of clinical isolates tested its mean that Gatifloxacin is more effective than Levofloxacin. On the basis of present study it can be evaluated that levofloxacin and gatifloxacin were two very good antibacterial agent in the field of antimicrobial chemotherapy but different clinical isolates had started to develop resistance to those antibiotics, w/c is alarming because if organism started to develop resistance to these antibiotics than we will be left with no other choice of antibiotics

SYNERGISTIC COMBINATIONS OF BROAD SPECTRUM ANTIBIOTICS AGAINST ACINETOBACTER SPP

Objective: The present study was aimed to investigate the resistant pattern of Acinetobacter spp. against 4 broad spectrum antibiotics and the synergistic activity between 3 different combinations of antimicrobials.Methods: For conducting research we obtained 52 sample of bacterial spp. from different infection sites of patients admitted to tertiary care hospital. The procedure was carried out in two parts. At first the Kirby Bauer Disc Diffusion Method was adopted to evaluate resistance pattern according to CLSI standards. 08 broad spectrum antibiotics were used. In second part of the study the synergistic activity between different combinations of selected antibiotics were estimated by Double Disc Synergy Method.Results: It was evident that male patients were highly infected by Acinetobacter spp. The organism was found responsible for infecting the respiratory tract of elderly patients at high rate. Colistin and Polymixin effectively inhibited Acinetobacter spp. 98% each. On contrary, it was found to be highly resistant against β-lactam (98%). Cephalosporins, Quinolones, Aminoglycosides, Carbapenem were also proven inactive when used alone. All the isolates when subjected to DDS test. Highest synergy was observed between combinations of Fosfomycin-Polymixin (90.38%), Almost 52% isolates were successfully inhibited when the combination of Colistin and Fosfomycin was checked. However, more than 61% isolates showed the highest resistance when the Polymixin-Imipenemwere used together. However, all the tested combinations were highly effective against Acinetobacterisolates obtained from tracheal aspirate.Â

Development of Evidence-Based Disease Education Literature for Pakistani Rheumatoid Arthritis Patients

Rheumatoid arthritis affects 0.5% to 1% of the population globally and is one of the most common causes of disability. Patient education plays a key role in improving treatment outcomes. The purpose of this study was to discuss the process involved in designing an evidence-based disease education literature for rheumatoid arthritis patients of Pakistan in Urdu language with culturally relevant illustrations. A study was conducted to develop disease education literature using Delphi consensus, content validity, and patient feedback. A panel of experts comprised of university professors and health care experts, including health practitioners and pharmacists as well as a social scientist, was set up to assess the need. Eight patients were randomly selected and were asked to give their feedback. Their feedback was incorporated in the development process. The entire process was carried out in eight steps. A disease education literature for patients of rheumatoid arthritis was developed and edited in the form of a booklet. The booklet contained evidence-based information that must be provided to patients in both Urdu and English languages with culturally relevant illustrations. The availability of such literature is significant, as it enables the patients to seek knowledge at home at their convenience. This home-based knowledge support is as helpful as any other means of medical care. The developed literature is planned to be used in further studies which will evaluate its impact in improving knowledge of RA patients