Drug Of First Choice Research Articles

What is the role of montelukast in asthma treatment?

Asthma is a common chronic pulmonary disease worldwide. Inhaled glucocorticoids are the most effective therapeutic agents in treatment of asthma and are therefore the first drug of choice in asthma treatment. Antileukotrienes are alternative controller drugs in management of asthma especially in patients who cannot use inhaled glucocorticoids effectively due to compliance problems or poor inhaler techniques.

Sustainable treatment of glaucoma patients with cardiovascular diseases

As life expectancy increases, the incidence of glaucoma is expected to rise worldwide. The review presents data on the comorbidity and polypharmacy of old and senile patients with glaucoma. Such patients also often have polypathia: on average, they have 6.3±0.6 concomitant somatic diseases. Approximately one in five glaucoma patients receives both a systemic and local beta-blocker ( ВВ ). Parallel use of local and systemic drugs in glaucoma patients is likely to cause drug interaction, increase side effects and contribute to an earlier onset of the tachyphylaxis. The selectivity of oral and local ВВ is one of the factors contributing to the prediction of their additive effect. The data on the expediency of prescribing brimonidine as the first-choice drug for glaucoma and hypertension patients who were previously prescribed systemic ВВ are presented.

Survival study of treatment adherence by patients given oral glycopyrrolate for hyperhidrosis following treatment failure with oral oxybutynin.

Oral anticholinergics such as oxybutynin (OOx) and glycopyrrolate (OGly) are frequently used in the management of hyperhidrosis. Although OOx is considered currently the anticholinergic drug of first choice, OGly is a safe and effective alternative if OOx fails. The aim of this study was to identify the main variables associated with treatment adherence by patients receiving OGly, for whom previous treatment with OOx had failed. A prospective study was conducted of patients with hyperhidrosis receiving treatment with OGly in the period 2012 to 2019. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. A total of 58 patients (41 women), with a mean age of 35.9 years, were included in the study. The median follow-up period was 32 months. At 3 months, 70.7% of the patients had responded to treatment (excellent response: 75.6%), and adverse effects were reported by 70.7%. At 12 months, 53.4% had responded (excellent response: 74.2%), with adverse effects in 70.9%. The variables associated with poorer adherence were affected areas: palms of the hands, soles of the feet and armpits. The only variable associated with greater adherence was the generalized presence of hyperhidrosis. Our results provide valuable insights into the outcomes achieved when OGly is used to treat hyperhidrosis.

Imprinted Contact Lenses for Ocular Administration of Antiviral Drugs

A variety of ocular diseases are caused by viruses, and most treatments rely on the use of systemic formulations and eye drops. The efficient ocular barriers that oppose antiviral drug penetration have prompted the development of improved topical delivery platforms. The aim was to design hydrogel contact lenses endowed with an affinity for acyclovir (ACV) and its prodrug valacyclovir (VACV), first-choice drugs against herpes simplex virus (HSV) ocular keratitis, and that can sustain the release of therapeutic doses during daily wearing. Functional monomers suitable for interaction with these drugs were screened using computational modeling. Imprinted and non-imprinted hydrogels were prepared with various contents in the functional monomer methacrylic acid (MAA) and characterized in terms of swelling, transmittance, mechanical properties, and ocular compatibility (hen’s egg test on chorioallantoic membrane (HET-CAM) assay). The values were in the range typical of soft contact lenses. Compared to ACV, the capability to load VACV was remarkably higher due to stronger electrostatic interactions with MAA. The advantages of the imprinting technology were evidenced for VACV. Stability of VACV loading solution/hydrogels under steam heat sterilization and subsequent drug release was investigated. Permeability studies through bovine and porcine cornea and sclera of the drug released from the hydrogels revealed that VACV accumulates in the cornea and can easily cross the sclera, which may facilitate the treatment of both anterior and posterior eye segments diseases.

Intravenous paracetamol in comparison with ibuprofen for the treatment of patent ductus arteriosus in preterm infants: a randomized controlled trial

Our aim was to assess the efficacy and safety of intravenous (i.v.) paracetamol vs. i.v. ibuprofen for the treatment of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants. This is a multicenter randomized controlled study. Infants with a gestational age of 25+0–31+6 weeks were randomized to receive i.v. paracetamol (15 mg/kg/6 h for 3 days) or i.v. ibuprofen (10-5-5 mg/kg/day). The primary outcome was the closure rate of hsPDA after the first treatment course with paracetamol or ibuprofen. Secondary outcomes included the constriction rate of hsPDA, the re-opening rate, and the need for surgical closure. Fifty-two and 49 infants received paracetamol or ibuprofen, respectively. Paracetamol was less effective in closing hsPDA than ibuprofen (52 vs. 78%; P = 0.026), but the constriction rate of the ductus was similar (81 vs. 90%; P = 0.202), as confirmed by logistic regression analysis. The re-opening rate, the need for surgical closure, and the occurrence of adverse effects were also similar.Conclusions: Intravenous paracetamol was less effective in closing hsPDA than ibuprofen, but due to a similar constriction effect, its use was associated with the same hsPDA outcome. These results can support the use of i.v. paracetamol as a first-choice drug for the treatment of hsPDA.Trial registration:Clinicaltrials.gov: NCT02422966, Date of registration: 04/09/2015; EudraCT no: 2013-003883-30.What is Known:• The successful closure of patent ductus arteriosus with oral paracetamol has been recently reported in several preterm infants, but only one randomized controlled study investigated the efficacy of intravenous paracetamol.What is New:• Intravenous paracetamol is less effective in closing hsPDA than ibuprofen, but have a similar constriction effect.• These results can support the use of i.v. paracetamol as a first-choice drug for the treatment of hsPDA.

The incidence of thrombotic events with idarucizumab and andexanet alfa: A systematic review and meta-analysis

IntroductionDirect thrombin inhibitor, dabigatran and factor Xa inhibitors, apixaban, edoxaban, and rivaroxaban (DOACs/NOACs), are currently the first-choice drugs in some indications. Life-threatening bleeding occurring during DOACs treatment may benefit from the use of reversal agents, however there are some concerns regarding potential rebound thrombotic events. In this systematic review we aimed to estimate the incidence of thrombotic events in patients treated with idarucizumab or andexanet alfa. MethodsThis systematic review included all prospective and retrospective studies, enrolling patients that received specific antidotes (idarucizumab, andexanet alfa and cirapantag) for anticoagulation reversal, published until October 2019 in CENTRAL, MEDLINE and PsycINFO. Studies in healthy individuals and those with less than 10 patients were excluded. The primary outcome was the incidence of thrombotic events and the secondary outcome was all-cause mortality. Studies screening and data extraction was performed in duplicate by reviewers. A random-effects meta-analysis was performed using the Freeman-Tukey transformation of the data. The results are expressed in percentages, with 95%-confidence intervals (CI), limited between 0 and 100% due to the data transformation. ResultsOverall 16 studies with 1774 patients were included (13 studies enrolling 1384 patients that received idarucizumab; 3 studies enrolling 390 patients that received andexanet alfa; cirapantag studies were not found). The pooled incidence rate of thrombotic events in the patients treated with specific antidote was 5.5% (95% CI 2.0–10.1%) until 30–90 days. The incidence of all-cause mortality was 13.3% (95% CI 9.6–17.5%). ConclusionsIn patients requiring idarucizumab or andexanet alfa to reach haemostasis, our data shows that there were 5.5% thrombotic events. The causality of harm associated to antidotes remains to be established due to the design of studies without a control group.

Using Q-methodology to understand the perspectives and practical experiences of dermatologists about treatment difficulties of cutaneous leishmaniasis

BackgroundDuring the outbreak of cutaneous leishmaniasis in the Kurdistan Region of Iraq that started in 2015, the course of the disease and the treatment were not consistent with the available literature. Physicians, particularly dermatologists, faced challenges with treating the cutaneous leishmaniasis lesions with high rates of treatment failure and resistance to treatment. We used Q-methodology to understand the range and diversities of opinions and the practical experiences of dermatologists about the treatment difficulties of cutaneous leishmaniasis.MethodsThis Q-methodology study was carried out in Erbil, Kurdistan Region of Iraq, and involved 37 dermatologists. A set of 40 statements related to different aspects of difficulties and uncertainties of treating cutaneous leishmaniasis was prepared. The dermatologists were requested to distribute the 40 statements into a scaled grid of nine piles from least agree to most agree. We applied by-person factor analysis using PQMethod 2.35 for the data analysis.ResultsThe analysis revealed two different viewpoints about the treatment of cutaneous leishmaniasis and a consensus viewpoint. The first viewpoint emphasized the use of sodium stibogluconate-based combination therapy, concerns with treatment failure, and lack of compliance with the treatment. The second viewpoint emphasized the lack of standard treatment and advances in the treatment of cutaneous leishmaniasis. There was a consensus between both groups of respondents about many aspects of the treatment of cutaneous leishmaniasis, including considering sodium stibogluconate the first drug of choice for cutaneous leishmaniasis treatment.ConclusionsThis study revealed a diversity of viewpoints and uncertainties about the effectiveness of the available treatment modalities and treatment difficulties and failure. Interrupted supply and poor quality of the available drugs and lack of a standard and advanced treatment are the main problems facing the treatment of cutaneous leishmaniasis. More research is required to determine the best treatment modalities for the different types of cutaneous leishmaniasis. There is a need for the development of treatment guidelines specific to the Iraqi context with a particular focus on the treatment of the resistant and atypical cases of cutaneous leishmaniasis.

The role of renin–angiotensin–aldosterone system inhibition in the regression of hypertensive left ventricular hypertrophy: the evidence of the last three decades

Hypertension is a leading cause of cardiovascular mortality and morbidity. The development of left ventricular hypertrophy (LVH) in hypertension is an independent predictor of adverse cardiovascular outcomes. Conversely, regression of LVH is associated with better prognosis. Lowering of blood pressure in patients with hypertension is the unequivocal determinant of regression of LVH. Unless otherwise contraindicated, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are drugs of first choice in patients with essential hypertension with LVH. In this article, we summarise the preclinical and clinical evidence of the last 3 decades that established the preferential use of ACEIs/ARBs in hypertensive heart disease.

Efficacy of Tokishakuyakusan add-on therapy with low-dose oral contraceptive pills on endometriosis patients with dysmenorrhea.

Tokishakuyakusan (TSS) is representative of popular Kampo medicines for Japanese women to treat dysmenorrhea, irregular menstruation and menopause. Current hormonal treatments and low-dose oral contraceptives (OCs) used as a first-choice drug for primary symptoms, however, have a high incidence of adverse events without improving patients' satisfaction. We evaluated the efficacy of TSS as additional treatment on the quality of life (QOL) of patients taking OCs with reduced therapeutic satisfaction. Twelve patients treated with OCs for endometriosis were enrolled. TSS (7.5 g/day) in combination with OCs were given for three menstrual cycles. The main outcome was the degree of QOL assessed using the Endometriosis Health Profile-30 (EHP-30). Secondary outcomes were the Menstrual Distress Questionnaire (MDQ), patient's satisfaction using a Likert scale and cold feeling-visual analogue scale (VAS). In EHP-30, significant changes by TSS with OCs in each menstrual cycle were not found, although the scores for pain and emotional well-being tended to decrease. In MDQ, water retention in the premenstrual phase was improved. With regard to cold feeling-VAS, 61.6 mm at pretreatment decreased to 31.3 mm at the endpoint. Average Likert scale values after TSS treatment declined from 4.3 to 2.6. Cold feeling and patient's satisfaction have improved. Although the influence of TSS add-on therapy on QOL was moderate, possible improvement of cold feeling and menstruation-related symptoms was suggested.

Advances in diagnosis, classification, pathophysiology, and management of trigeminal neuralgia.

Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.

Molecular interactions of praziquantel drug with nanosurfaces of sepiolite and montmorillonite

Praziquantel drug is nowadays in continuo study to overcome adverse biopharmaceutical properties as drug of first choice for the treatment of the human schistosomiasis. Meanwhile, sepiolite and montmorillonite have been studied experimentally as low-cost nanocarrier to design new praziquantel delivery systems. In this work, the interactions between the drug and clay minerals surfaces are studied at molecular level by computational methods. The optimization of the adsorption of praziquantel in sepiolite nanochannels and in the montmorillonite interlayer space has been studied by using force fields based on empirical interatomic potentials and at quantum mechanical level. The results showed the main interactions between the drug and both clay minerals surfaces at the confined spaces of these minerals, and favorable adsorption energies of the praziquantel-clays complexes were obtained. Therefore, theoretical calculations allow knowing how the drug is adsorbed in the clays and in the case of the montmorillonite how many molecules of the drug are adsorbed in the interlayer space of the mineral according to the experimental data.

Seasonal allergic rhinitis and its control with antihistamines in an outpatient practice.

Allergic rhinitis (AR) is a significant social and medical problem of modern healthcare. The treatment of patients with AR is based on a stepwise approach, the purpose of which is to fully control the symptoms. The first stage drugs of choice are oral non-sedative antihistamines of the second generation. A study was conducted to evaluate the effectiveness of Allerway and drugs containing cetirizine to control the symptoms of seasonal AR (SAR) in an outpatient practice. The data obtained in the framework of a multicenter prospective noninterventional study (the short name of the study is LEVADA) were analyzed. Data were collected at 5 centers using scales for assessement of the symptoms of allergic rhinitis: rTNSS, miniRQLQ, visual analog scale and the Epworth sleepiness scale. The dynamics of SAR symptoms was assessed using the rTNSS scale (24 hours) after 7 and 14 days of treatment. A total of 100 patients were included in the study; 97 patients completed the study. Of these, 46 (47.42%) were women and 51 (52.57%) were men aged 18 years. The average duration of the diagnosis of SAR in patients before inclusion in the study in the Allerway group was 97.485.51 months (about 8 years), in the cetirizine group 107.0114.62 months (about 8.9 years), p=0.641. The efficacy of regressing the intensity of SAR symptoms on the rTNSS scale was demonstrated to be (average and average error) 2.920.11 points in the group of patients taking Allerway and 2.930.11 points in the group of patients taking cetirizine. After 7 days, there was an increase in the proportion of patients with a complete absence of the main symptoms of SAR: nasal congestion, rhinorrhea, itching in the nose. In the group of patients taking Allerway in 44 out of 49 patients (89.8%), it was noted that on average, after 39.414.35 minutes, symptom relief was observed in 42 of 48 (87.5%) patients, and in patients taking cetirizine, relief of rhinitis symptoms was noted during 44.013.76 minutes. An improvement in the quality of life was noted by reducing the severity of symptoms on the miniRQLQ scale by 44.315.29 points in the Allerway group and by 45.013.03 in the group receiving cetirizine. It was shown that the use of Allerway (at a dose of 5 mg, once a day) and preparations containing cetirizine (at a dose of 10 mg, with a single dose per day), allows to achieve a positive clinical effect in the treatment of patients with SAR (seasonal allergic rhinitis) in outpatient practice within 7 and 14 days with a high level of safety and compliance.

Perfil de sensibilidade antifúngica de isolados clínicos obtidos de onicomicose aos antifúngicos convencionais

Onicomicoses são afecções micóticas de unhas ocasionadas por fungos patogênicos, dermatófitos, não-dermatófitos e principalmente por espécies do gênero Candida. Fungos leveduriformes causam infecções em unhas, devido à sua capacidade de invasão ao hiponíquio, borda proximal e por disseminação vascular ou linfática, representando um importante problema de saúde pública mundial. Com o propósito de compreender a baixa eficácia de tratamento para onicomicoses e modificações fenotípicas causadas por mecanismos de resistência esse estudo teve por objetivo avaliar o perfil de susceptibilidade de isolados clínicos de onicomicoses do gênero Candida a antifúngicos convencionais. O ensaio de sensibilidade aos antifúngicos para diferentes cepas e isolados clínicos obtidos da micoteca do Laboratório de Atividade Antibacteriana e Antifúngica de Produtos Naturais e Sintéticos Bioativos foi realizado pelo teste de difusão em disco. Diante dos resultados observados pode-se inferir que os isolados apresentaram alto grau de resistência aos fármacos azólicos, considerados medicamentos de primeira escolha no tratamento de onicomisose. Portanto, o conhecimento prévio de análises in vitro pode auxiliar na farmacoterapia de onicomicose e no monitoramento de prevalência do perfil de suscetibilidade aos antifúngicos convencionais e como perspectiva deve-se utilizar outros testes de susceptibilidade aos antifúngicos e técnicas moleculares para uma melhor compreensão de fenótipos de resistência.

Influence of Prenatal Methamphetamine Abuse on the Brain.

Methamphetamine (MA), a psychostimulant, has become a serious problem in recent years. It is one of the most widely abused psychostimulants in the world. In the Czech Republic, ecstasy is the most commonly used non-cannabis drug, followed by hallucinogenic fungi, LSD, MA, cocaine, and finally heroin. The prevalence of the usage of all addictive substances is highest in the age category of 15–34. Approximately 17.2% of registered drug addicts, both male and female, in the Czech Republic use MA as their first-choice drug. This group consists mostly of women who are unemployed and addicted to MA (85%). Almost half of the addicted women switched to MA from other drugs in the course of pregnancy. Psychostimulants such as amphetamine and its synthetic derivate MA induce feelings of calm and happiness by suppressing anxiety and depression. When MA is abused for longer periods, it mimics symptoms of mania and can lead to the development of psychosis. MA is often abused for its anorectic effect, its simple preparation, and compared to heroin and cocaine, its low price. There are significant differences in the susceptibility of users to the stimulant, with reactions to MA fluctuating from person to person. Molecular mechanisms related to the variable response among users might represent an explanation for increased addiction-associated bipolar disorder and psychosis. Currently, there is limited information regarding genetic mechanisms linked to these disorders and the transmission of drug addiction. As such, animal models of drug addiction represent significant sources of information and assets in the research of these issues. The aim of this review is to summarize the mechanism of action of methamphetamine and its effect on pregnant addicted women and their children, including a detailed description of the anatomical structures involved.

Subthreshold doses of guanosine plus ketamine elicit antidepressant-like effect in a mouse model of depression induced by corticosterone: Role of GR/NF-κB/IDO-1 signaling

Augmentative treatment is considered the best second-option when a first-choice drug has partial limitations, particularly by allowing antidepressant dose reduction. Considering that ketamine has significant knock-on effects, this study investigated the effects of a single coadministration with subthreshold doses of ketamine plus guanosine in a corticosterone (CORT)-induced animal model of depression and the role of anti-inflammatory and antioxidant pathways. CORT administration (20 mg/kg, p.o. for 21 days) increased the immobility time in the tail suspension test (TST) and the grooming latency in the splash test (SPT), as well as reduced the total time of grooming in the SPT. These behavioral alterations were accompanied by impaired hippocampal slices viability, elevated immunocontent of nuclear factor-kappa B (NF-κB) and indoleamine-2,3-dioxygenase 1 (IDO-1), and reduced immunocontent of glucocorticoids receptor (GR), glutamate transporter (GLT-1), nuclear factor-erythroid 2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1) in the hippocampus. CORT also decreased the thioredoxin reductase activity in the hippocampus, while reduced the glutathione reductase activity and non-protein thiols levels in both hippocampus and prefrontal cortex. In addition, elevated content of malondialdehyde and protein carbonyl was also observed in the hippocampus and prefrontal cortex of CORT-treated mice. Of note, a single administration of ketamine (0.1 mg/kg, i.p.) plus guanosine (0.01 mg/kg, p.o.) attenuated the depressive-like behavior and hippocampal slices impairments induced by CORT. The behavioral response obtained by the combined administration of these drugs was paralleled by the reestablishment of the CORT-induced molecular alterations on hippocampal GR, NF-κB, IDO-1, and GLT-1 immunocontent. Moreover, CORT-induced alterations on the antioxidant enzyme activity and oxidative stress markers were partially restored by ketamine plus guanosine treatment. Taken together, these findings suggest that guanosine might potentiate the effects of ketamine on inflammatory and oxidative markers that are elevated in depression.

USE OF VALPROIC ACID FOR THE TREATMENT OF NEUROPSYCHIATRIC SYMPTOMS IN ACQUIRED BRAIN INJURIES

Acquired brain injuries are often accompanied by a series of neuropsychiatric disorders. A wide range of pharmacological agents are used to treat neuropsychiatric symptoms. However, a more indepth review of the agents used indicates that there are in fact relatively few procedures recommended for use. Anticonvulsants including valproic acid, are of particular interest. This research aimed to assess the efficacy and safety of valproic acid, as based on a naturalistic observation of patients with various forms of acquired brain injury and who had displayed neuropsychiatric symptoms. The study group consisted of individuals (N = 43) who were treated with valproic acid as the first choice of drug. Both the initial dose and its size during further treatment, as well as the treatment method, were determined based on medical indications. The mental state of the patients was assessed twice: at the time of enrolment for the study and after 12 months. The Cohen-Mansfield Agitation Inventory (CMAI) was used for the assessment. In addition, the degree of cognitive dysfunction was assessed during the baseline study using the MMSE scale. Eventually, 24 individuals were accepted for statistical analysis. They were re-examined after 12 months and took only valproic acid during that period. 24 out of 43 individuals qualified for the study completed the 12-month observation period. 11 respondents were excluded from the study due to their inappropriate tolerance. The reported side effects were of a temporary nature (except for hair loss) and of a mild or moderate intensity. It was observed that aggressive and impulsive behaviours were significantly reduced in the study group. The positive therapeutic effect concerned all categories in the CMAI scale, except for verbal aggression. The therapeutic effect of the valproic acid was varied depending on the degree of cognitive impairments. Statistical significance for higher MMSE scores was obtained only for the category of non-aggressive verbal disorders. On the other hand, in the case of lower MMSE scores a significant reduction was observed both in the categories of non-aggressive and aggressive physical behaviours, as well as for the overall CMAI scale result. The results obtained seem to indicate a satisfactory efficacy and acceptable tolerance of valproic acid in the treatment of the neuropsychiatric symptoms accompanying acquired brain injuries.

REPURPOSING OR SECONDARY USE OF KNOWN DRUGS

Repurposing of drugs was most often a strategic approach, though by “serendipity” in few instances. Early practice of pharmacovigilance in USA, led to near ‘serendipitous’ addition to market value for many “first use” drugs. Glaxo-Welcome’s Bupropion brand “Wellbutrin” was first approved for treatment of depression. While “Wellbutrin” received an average response in the anti-depression segment, pharmacovigilance reports to FDA was perplexing. Patients gave conflicting response. While a few wanted to change to another drug, many others wanted to continue the use of the prescribed drug even after being advised to stop. The reason when investigated, was that the patients felt the urge to discontinue smoking, which was acceptable to some, while not to others. When this finding was received by the FDA from multiple specialists, Glaxo-Welcome was asked to conduct a full study on a priority basis. Consequently, FDA granted a fast track approval for use of Bupropion for smoking cessation. Antidepressant “Wellbutrin” opened up new pathway for smokers to “kick the Butts” through its second use “Avatar”, in form of “Zyban” for smoking cessation and become the first global breakthrough drug of choice for this second use. Pharmacovigilance helps in developing a road map for secondary use.

Multicenter survey on mesalamine intolerance in patients with ulcerative colitis.

Although oral mesalamine is the first-choice drug for treating mild-to-moderate ulcerative colitis (UC), some patients show symptoms of intolerance, including exacerbation of diarrhea and abdominal pain. The present study clarified the current state and clinical courses of patients with mesalamine intolerance. Patients who were diagnosed with UC and administered oral mesalamine at eight hospitals in Japan with a follow-up period exceeding 1year were analyzed. Sixty-seven (11%) of 633 patients showed intolerance to at least one formulation of oral mesalamine. The frequency of mesalamine intolerance has increased in recent years, rising from 5.3% in 2007-2010 to 9.1% in 2011-2013 and 16.2% in 2014-2016. The most common complications were the exacerbation of diarrhea (n=29), a fever (n=25), and abdominal pain (n=22). Readministration of mesalamine/sulfasalazine was attempted in 43 patients, mostly with other types of formulation of mesalamine, and more than half of these patients proved to be tolerant. The risk factors for mesalamine intolerance were female gender (odds ratio [OR]=1.83; 95% confidence interval [CI], 1.08-3.12), age<60years old (OR=2.82; CI, 1.19-8.33), and pancolitis (OR=2.09; 95% CI, 1.23-3.60). There were no significant differences in the use of anti-tumor necrosis factor-α agents, colectomy, or steroid-free remission at the last visit between patients with and without mesalamine intolerance. Mesalamine intolerance is not rare, and its frequency has been increasing recently. The prognosis of patients with mesalamine intolerance did not differ significantly from that of those without intolerance.

A prospective observational study of drug prescription pattern of antibiotics in diabetic foot ulcer in tertiary care teaching hospital

Background: Our aim was to study a prescribing pattern of antibiotics used in diabetic foot ulcer (DFU).Methods: 50 patients were selected by inclusion and exclusion criteria basis. It was a prospective observational study conducted in Department of Surgery, Rajah Muthiah Medical College Hospital (RMMCH), Annamalai University.Results: This study reveals that male patients 60% are more prone to develop diabetic foot ulcer than the female patients 40%. Patients of 50 to 60 age group 32% has higher prevalence of DFU. The most commonly prescribed antibiotics are metronidazole 48% and cefotaxime 48% followed by piperacillin and tazobactam combination 30%, ciprofloxacin 20%, linezolid 18%, amoxicillin and clavulanic acid combination 12%, cefixime 6%, clindamycin 4%, amikacin 4%, faropenam 4%, ceftriaxone 2%, amoxicillin 2%, gentamicin 2%, cefoperazone sodium and sulbactam combination 2%.Conclusions: Lack of antibiotic sensitivity test leads to growth of organism, wrong antibiotic selection and irrational use of antibiotics. And also observed patient developed resistance to linezolid antibiotic when used as a first choice of drug to treat diabetic foot infection including methicillin-resistant Staphylococcus aureus (MRSA) infected patients.

P1689COMPARISON OF NON-STEROIDAL ANTI-INFLAMMATORY DRUGS(NSAIDS) AND/OR PAINKILLERS USE BY KIDNEY (KTRS) AND HEART TRANSPLANT RECIPIENTS (HTRS)

Abstract Background and Aims Solid organ transplantation (SOT) has become the therapy of choice for the treatment of end-stage organ failure. The non-steroidal anti-inflammatory drugs (NSAIDs) and over-the- counter (OTC) painkillers are ofenly used. In a group of SOT recipients, co-morbidities and immunosuppression interactions significantly increase the risk of side effects. The aim of the study was to analyze the frequency and reasons of the NSAIDs and/or painkillers use by renal (RTRs) and heart transplant recipients (HTRs). Method This cross-sectional study was perfomed in randomly selected 388 RTRs and 286 HTRs aged from 18 to 82 years. The original annonymus questionnaire consisting of 32 questions related to health status and NSAIDs and/or analgesics use was applied. Questionnaire was distributed in paper-form and completed with the participation of medical worker either in transplant cardiosurgical or renal transplantation center. “R” v. 3.6.1. was used for statistical analysis and p-value &amp;lt;0.05 was considered significant. Results 674 patients were surveyed. All patients: 34,3% (n=231) women and 65,7% (n=443) men in the mean age of 62.27 years completed the questionnaire. 70% (n=451) of respondents declared using NSAIDs and/or analgesics. Furthermore, 87% of participants declared using OTC painkillers. The most frequent causes for using analgesics are listed in Table 1. 68,5% of our SOT recipients declared that they were informed by their doctor about consequences of other drugs used with immunosuppression. 69,9% of HTRs comparing to 54,3% of RTRs ask their doctor before taking analgesics. Nevertheless, the survey also showed that every third patient (31,5%) was not sufficiently informed. Acetaminophen was the first-choice drug taken by 67,6% of patients (Fig. 1). Only 20% of patients declared not using NSAIDs and/or analgesics at all. Conclusion The result of our study indicates high frequency of NSAID and painkillers usage by RTRs and HTRs. Considering potentially harmful influence on transplanted organs, the costs of transplantation and post-trasplant care, the awareness of drug- related side effects or interactions and patients compliance need to be highlighted.