Antibiotic trends in acute febrile illness

Background: Acute febrile illness has various etiologies. Different antimicrobials are used for different causes of fever to treat and there are interpersonal variations in prescription of antimicrobials. Therefore this study aims at to analyze the trends in the antimicrobial prescription in patients of acute febrile illness due to various etiologies in the medicine department of a tertiary care hospital.Methods: It is a record based observational study that was carried out at NKP salve institute of medical sciences and RC, Nagpur. 200 case record files of patients admitted with a diagnosis of acute febrile illness in the dept. of Medicine due to various etiologies were analyzed. Antibiotics prescribed for various causes of acute febrile illness like respiratory tract infections, urinary tract infection, gastrointestinal infection, malarial infections, septicemia, meningitis, pyrexia of unknown origin etc. were noted and data was analyzed for prescription pattern of antimicrobials.Results: Out of 200 patients of febrile illness the common clinical conditions for which antibiotics were prescribed were respiratory tract infections (upper respiratory tract infection 25.5% and lower respiratory tract infection 14%), acute gastroenteritis (20%), and urinary tract infection (13.5%) followed by, pyrexia of unknown origin (8.5%), viral fever (8%), malaria (7%), hepatitis A (1.5%), meningitis (1%) and rickettsial infection (1%). The commonly prescribed antibiotics were ceftriaxone in (19.37%) and cefixime (15.93%) followed by coamoxiclav (12.5%), azithromycin (11.87%), doxycycline (10.31%), ofloxacin and ornidazole (8.43%), levofloxacin (6.25%), ofloxacin (4.68%), ciprofloxacin (1.87%), artesunate (3.75%), artemether and lumefantrine (4.37%) and valacyclovir (0.625%).Conclusions: Our study concluded that most common disease for which antibiotics prescribed were respiratory tract infection and gasterointestinal infections. Most common antibiotic used were third generation cephalosporins especially ceftriaxone and cefixime

Transient left ventricular apical ballooning and exercise induced hypertension during treadmill exercise testing: is there a common hypersympathetic mechanism?

<p>Abstract</p> <p>Objective</p> <p>To describe two cases of Takotsubo like myocardial contractile pattern during exercise stress test secondary to hypertensive response.</p> <p>Background</p> <p>Treadmill exercise testing is known to cause sympathetic stimulation, leading to increased levels of catecholamine, resulting in alteration in vascular tone. Hypertensive response during exercise testing can cause abnormal consequences, resulting in false positive results.</p> <p>Cases</p> <p>We present the cases of two patients experiencing apical and basal akinesis during exercise stress echocardiography, in whom normal wall motion response was observed on subsequent pharmacologic stress testing. The first patient developed transient left ventricular (LV) apical akinesis during exercise stress echocardiography. Due to high suspicion that this abnormality might be secondary to hypertensive response, pharmacologic stress testing was performed after three days, which was completely normal and showed no such wall motion abnormality. Qualitative assessment of myocardial perfusion using contrast was also performed, which showed good myocardial blood flow, indicating low probability for significant obstructive coronary artery disease. The second patient developed LV basal akinesis as a result of hypertensive response during exercise testing. Coronary angiogram was not performed in either patient due to low suspicion for coronary artery disease, and subsequently negative stress studies.</p> <p>Results</p> <p>Transient stress induced cardiomyopathy can develop secondary to hypertensive response during exercise stress testing.</p> <p>Conclusion</p> <p>These cases provide supporting evidence to the hyper-sympathetic theory of left ventricular ballooning syndrome.</p