Miscellaneous Drugs Research Articles

AN ANALYSIS OF ANTIMICROBIAL AND ANTIDIABETIC FIXED DOSE COMBINATIONS BANNED IN INDIA

Objective: National regulatory authority reviewed various fixed-dose combinations (FDCs) in view of doubtful rationality status and subsequently 349 FDCs were banned in 2018. This study was conducted to analyze the antimicrobial and antidiabetic FDCs banned by the Central Drugs Standard Control Organization in India. Methods: Data were collected from the report of drugs technical advisory board subcommittee. Banned antimicrobial and antidiabetic FDCs were assessed for the following parameters – number of active pharmacological ingredients, routes of administration and dosage forms, indications for marketing, reasons for banning, and pharmacological group of FDCs. Results: Seventy antimicrobial and 25 antidiabetic FDCs were analyzed. These FDCs contained 2–7 drugs, available mostly as tablets (51.42%, 100%) in antimicrobial and antidiabetic groups, respectively. Antimicrobial FDCs were marketed most for respiratory tract infections and infection and inflammatory conditions of the skin (17, 24.28% each) while antidiabetic FDCs were marketed for Type 2 diabetes mellitus (14, 56%). The reasons for ban were pharmacodynamic (68.57%, 16%) and pharmacokinetic (20%, 40%) mismatches, lack of evidence of efficacy (7.14%, 36%), and safety concerns (4.28%, 8%) in antimicrobial and antidiabetic groups, respectively. In antimicrobial FDCs, the most common combination was that of an antibacterial with other miscellaneous drugs (like zinc, Vitamin E, serratiopeptidase, etc.) (19, 27.14%) whereas antidiabetic FDCs most commonly had biguanide with thiazolidinedione and sulfonylurea (7, 28%). Conclusion: There is a need for scrutiny of other FDCs in larger interests of patient care and prescribers should be made aware about recently banned FDCs to promote rational pharmacotherapy.

Development of Hospital Formulary for an Emergency Drug List in Tertiary Care Teaching Hospital

Background: In an emergency situation, timing is an important factor that requires sound knowledge about the patient's health condition, diagnosis, and treatment, as well as the administration of an appropriate drug at the appropriate time, which helps save a patient’s life. To ease the workflow, we decided to develop an emergency drug formulary. The study aims to develop a hospital formulary for an emergency drug list and compare it with the WHO standard formulary and the National Formulary of India. Methods: A prospective observational study was carried out at Vivekananda General Hospital, Hubballi, for a period of six months. A monograph of emergency drugs was drafted based on the needs of the hospital and prepared by referring to various different sources of data. The developed hospital formulary was made into electronic copies and handbooks, and a review was obtained from healthcare professionals. Results: The results showed that there were 130 drugs in the emergency drug formulary. It includes various categories of medication given in the case of different emergency conditions (cardiac emergencies, neurological emergencies, endocrine emergencies, poisoning emergencies, respiratory emergencies, fluid and electrolyte emergencies, and miscellaneous emergency drugs). While comparing the contents of the monograph with other formulary monographs, we found that the formulary that we had developed was more effective. There were five fixed-dose combinations (FDCs), 27 drugs that are safe to use during pregnancy, 84 drugs that should be used with caution while pregnant, and 1 drug that was contraindicated. We also found that there were 59 drugs that were compatible with breastfeeding; 63 needed to be used with caution; and 12 should be avoided during breastfeeding. Conclusion: The developed emergency formulary acts as a quick reference, helps in selecting the appropriate drug at the appropriate dose and time, and also helps in selecting low-cost alternative brands.

Assessment of prescribing pattern and adverse drug reaction in patients receiving anticoagulant therapy: A prospective observational study.

Cardiovascular diseases (CVD) are the leading cause of death worldwide as well as a major blockade to sustainable human development. It is among the leading causes of morbidity and mortality. Anticoagulants are among the most essential life-saving drugs that are generally used in cardiology for the prevention and treatment of many CVD. To assess the prescribing pattern and adverse drug reaction (ADR) in patients receiving anticoagulant therapy for cardiac diseases. This was a Prospective Observational study conducted in the Department of Cardiology, SRM Medical College Hospital and Research Center, Kattankulathur including 88 patients for 6 months. Out of the 88 patients, the majority were males (73%) compared to females (27%), and the prevalence of CVD was found to be higher in patients above 40 years of age. Various categories of drugs prescribed to the patients were antiplatelets (14.88%), anticoagulants (8.79%), antianginal (13.82%), antihypertensives (15.7%), antihyperlipidemic (7.83%), thrombolytics (0.68%), Ionotropic agents (2.13%), antibiotics (5.31%), and other miscellaneous drugs (36.61%). The anticoagulant dosage regimens prescribed to the patients were categorized into monotherapy (9%), combinational therapy with antiplatelets (38%), and triple therapy (53%). The most commonly prescribed anticoagulant to the patients was Heparin (93.41%), followed by Warfarin (5.49%) and lastly Rivaroxaban (1.10%) respectively. From the details of the prescriptions analyzed, the average number of drugs per patient (prescription) was found to be 11.7. Heparin was found to be the most commonly used anticoagulant, Combination therapy of antiplatelets and antihypertensives was observed in most of the prescriptions, which is more effective than a single therapy. Polypharmacy was encountered in the study with an average number of 11.7 drugs per prescription. Several anticoagulant-related drug interactions were identified and there were two adverse drug reactions with Heparin. The prescribing pattern can be improved by reducing the number of drugs prescribed.

A study of cutaneous adverse drug reactions in a tertiary care hospital

Background: Cutaneous reactions are the most common types of adverse drug reactions (ADRs). Drugs administered systemically are the important causes of cutaneous ADRs (CADRs). The physicians should be familiar with these CADRs so that it would help in early recognition and prompt withdrawal of drug. For this, a good knowledge about the pattern, frequency, and causative agents of dermatological adverse reactions in our hospital is needed. Aims and Objectives: This study was done to reveal the pattern, frequency, and most common drugs causing dermatological ADRs in our institution. There is no such study done about the CADRs reported in our institution; so far, hence, this study was done. Materials and Methods: In this study, the CADRs identified and reported by the dermatologist in the dermatology out-patient department as well in patients admitted in the dermatology ward were studied. Results: The common CADRs were urticaria 42.3%, erythematous lesions 34.6%, Stevens–Johnson syndrome 15.3%, hyperpigmentation 7%, and maculopapular rash 7%. Among the different groups of drugs, antibiotics is at the top of the list with 31.3%, followed by antitubercular drugs 24.2%, antiretroviral drugs 21.3%, antiepileptic drugs 10%, and other miscellaneous drugs. Conclusion: Early recognition of various CADRs is essential so that the offending drug is recognized and stopped immediately. This can also help in prevention of ADRs.

Analgesic Efficacy and Safety of Local Infiltration Following Lumbar Decompression Surgery: A Systematic Review of Randomized Controlled Trials.

This systematic review aims to appraise available clinical evidence on the efficacy and safety of wound infiltration with adjuvants to local anesthetics (LAs) for pain control after lumbar spine surgery. A database search was conducted to identify randomized controlled trials (RCTs) pertinent to wound infiltration with analgesics or miscellaneous drugs adjunctive to LAs compared with sole LAs or placebo. The outcomes of interest were postoperative rescue analgesic consumption, pain intensity, time to first analgesic request, and the occurrence of adverse events. Twelve double-blind RCTs enrolling 925 patients were selected for qualitative analysis. Most studies were of moderate-to-good methodological quality. Dexmedetomidine reduced analgesic requirements and pain intensity within 24 h postoperatively, while prolonged pain relief was reported by one RCT involving adjunctive clonidine. Data on local magnesium seem promising yet difficult to interpret. No clear analgesic superiority could be attributed to steroids. Τramadol co-infiltration was equally effective as sole tramadol but superior to LAs. No serious adverse events were reported. Due to methodological inconsistencies and lack of robust data, no definite conclusions could be drawn on the analgesic effect of local infiltrates in patients undergoing lumbar surgery. The probable positive analgesic efficacy of adjunctive dexmedetomidine and magnesium needs further evaluation.

The Optical Properties of Dy<sup>3+</sup> Doped LaPO<sub>4</sub> Phosphors Prepared by Solid State Reaction Method

Luminescent nanomaterials are used in everyday life due to their employment in distinct fields of science and technology, like cathode ray tubes (CRTs), flat panel display devices, temperature sensors, lasers, solar-cells, biological imaging, and solid-state lighting but also as carriers for miscellaneous therapeutic drugs. We have prepared dysprosium Dy3+ (0.5 mol %) doped lanthanum phosphate (LaPO4) phosphor by solid state reaction method. The excitation spectra of synthesized phosphor at 595 nm monitoring were composed of broadband and a series of sharp peaks, the strongest excitation peak at 254, 271, and 350 nm. The main emission spectra of samples under 254, 271, and 350 nm excitation are Dy3+ (0.5 mol %) doped LaPO4 phosphor observed at 477 and 573 nm corresponding to blue and yellow color. The broadband emission is the characteristic of the allowed f-h transition of Dy3+ ions. The corresponding emission band is observed due to the (blue emission) 4f9/2→6h15/2, (yellow emission) 4f9/2→6h13/2 transition of Dy3+ ions. All the samples have been characterized by X-ray powder diffraction (XRD), scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and photoluminescence (PL) techniques.

Risk reduction and pharmacological strategies to prevent progression of aortic aneurysms

ABSTRACT Introduction While size thresholds exist to determine when aortic aneurysms warrant surgical intervention, there is no consensus on how best to treat this disease before aneurysms reach the threshold for intervention. Since a landmark study in 1994 first suggested ß-blockers may be useful in preventing aortic aneurysm growth, there has been a surge in research investigating different pharmacologic therapies for aortic aneurysms – with very mixed results. Areas Covered We have reviewed the existing literature on medical therapies used for thoracic and abdominal aortic aneurysms in humans. These include ß-blockers, angiotensin II receptor blockers, and angiotensin-converting enzyme inhibitors as well as miscellaneous drugs such as tetracyclines, macrolides, statins, and anti-platelet medications. Expert Opinion While multiple classes of drugs have been explored for risk reduction in aneurysm disease, with few exceptions results have been disappointing with an abundance of contradictory findings. The vast majority of studies have been done in patients with abdominal aortic aneurysms or thoracic aortic aneurysm patients with Marfan Syndrome. There exists a striking gap in the literature when it comes to pharmacologic management of non-Marfan Syndrome patients with thoracic aortic aneurysms. Given the differences in pathogenesis, this is an important future direction for aortic aneurysm research.

A Cross-sectional Study of Acneiform Eruptions at a Tertiary Center

Background: Acneiform eruptions represent 1% of all drug-induced skin reactions following exposure to drugs such as hormones, vitamins, halogens, anti-tubercular drugs, neuropsychotherapeutic drugs, immunomodulating agents, and other miscellaneous drugs. Aim: The aim of the study was to identify the topical, inhalational, intralesional, and systemic drugs causing acneiform eruptions. Materials and Methods A total of 46 patients presenting with acneiform eruptions were studied with detailed drug history. Conclusions: Acneiform eruption is a relatively common and often misdiagnosed entity. Systemic steroids are the most common cause of acneiform eruption.

17749 Investigating the relationship between rosacea and use of vasodilatory medications in a hospital-wide population

Frequent and intense flushing is known to play a role in the pathogenesis of rosacea. Though a common side effect of antihypertensive medications includes flushing, to date the association between the effects of antihypertensive medications on peripheral vessels and rosacea is not well understood. A retrospective cohort study of data on patients seen at the University of Iowa Hospitals and Clinics with a diagnosis of hypertension and/or a diagnosis of rosacea was undertaken. Out of a total of 162,480 patients diagnosed with hypertension, 2200 patients also had a known diagnosis of rosacea. From these 2200 with rosacea, it was found that 1750 (79.5%) had received this diagnosis within 6 years of starting vasodilator therapy for hypertension. For the purpose of this study, vasodilator therapies included calcium channel blockers, beta-blockers, alpha-blockers, ACE inhibitors, and other miscellaneous drugs with vasodilatory effects. Further analysis showed that individuals taking vasodilator medications had a significantly increased likelihood of developing rosacea over a 1-year period (RR 1.25, 95% CI 1.2-1.29, P < .0001), and an even higher risk over a 6-year period (RR 1.41, 95% CI 1.37-1.46, P < .0001). Understanding this relationship may help in guiding antihypertensive selection via risk stratification for dermatologic complications.

Update on pharmacotherapy in psychodermatological disorders

Psychodermatological (PD) conditions encountered in dermatologic practice include primary psychiatric conditions such as delusions of parasitosis or secondary psychiatric conditions such as anxiety and depression due to dermatologic disease. The psychotropics include antipsychotic agents, anti-anxiety agents, antidepressants, and miscellaneous drugs such as anti convulsants. Anti psychotics are further divided into first-generation and second-generation drugs. Currently, second-generation drugs e.g., risperidone are preferred over first-generation drugs e.g., pimozide in delusional infestation owing to the side effect profile of the latter. Anti-anxiety agents include benzodiazepines used in acute anxiety and buspirone in chronic anxiety disorders. They are frequently prescribed along with antidepressants. Although dependence and necessity of tapering is a problem with benzodiazepines, delayed onset of action is a feature of buspirone. The commonly used antidepressants in dermatology include selective serotonin reuptake inhibitors (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), selective serotonin norepinephrine reuptake inhibitors (venlafaxine, desvenlefaxine, and duloxetine), norepinephrine dopamine reuptake inhibitors (bupropion), tricyclic antidepressants (doxepin, amitriptyline, imipramine, and clomipramine), and tetracyclic antidepressants (mirtazapine). Miscellaneous drugs include anticonvulsants such as gabapentin and pregabalin, naltrexone, and N-acetyl cysteine. The principles of PD treatment are first establish the psychiatric diagnosis, followed by initiating drug treatment. The choice of drugs is dependent on multiple factors such as side-effect profile, drug interactions, and co-morbid conditions. Usually, drugs are started at a low dose and gradually increased. A literature search was done in Pubmed, Google Scholar, and Medline databases, and articles on treatment were analyzed.

Analysis of prescription pattern of antibiotics among patients with respiratory tract infections at a tertiary care hospital

Respiratory tract infections are very common in developing countries like India. The main objective of the present study is to analyze prescription pattern of antibiotics given to outpatients with respiratory tract infections visiting our Hospital and to assess the rationality of these prescriptions given, using World Health Organisation core drug prescribing indicators. A total of 423 prescriptions were analysed after screening for inclusion and exclusion criteria. The number of males were 271 (64%) and females 152 (36%). 232 (54.84%) patients belonged to &gt;60 years age group. Among the various respiratory tract infections, 148 patients (34.98%) were diagnosed to have Chronic Obstructive Pulmonary Disease (COPD), 141 patients (33.33%) Pulmonary Tuberculosis, 71 patients (16.78%) Bronchial Asthma, 34 patients (8.03%) Pneumonia and 29 patients (6.85%) had Upper Respiratory Tract Infections (URTIs). The total number of drugs prescribed were 2368 out of which 447 (18.87%) were mucolytics/expectorants, 433 (18.28%) antibiotics, 350 (14.78%) bronchodilators, 332 (14.02%) corticosteroids, 295 (12.45%) Antitubercular Treatment Category (ATT CAT) drugs, 209 (8.82%) antacids, 112 (4.72 %) anti histamines, 98 ( 4.13%) vitamin tablets, and 92 (3.88) miscellaneous drugs. The most commonly used mucolytic/ expectorant was a fixed dose combination of acebrophylline+ acetylcysteine (327). The most common corticosteroid prescribed was Prednisolone (217). The antibiotics that were commonly prescribed were azithromycin (122), doxycycline (84), ciprofloxacin (82), cefpodoxime + clavulanic acid (61), ceftriaxone (32), amoxicillin + clavulanic acid (27) and piperacillin+ tazobactam (8). Ranitidine (184), levocetrizine (68) or fexofenadine (36), vitamin b complex (79) were the most commonly prescribed antacid, antihistamine and vitamin tablet respectively. The drug formulations prescribed were oral 1842 (77.78%) , inhalations 375 (15.83%), injections 55 (2.32%), syrup 37 (1.56%), gel 36 (1.52%), powder 23 (0.97%). An average of 5.59 drugs was prescribed per prescription. Percentage of drugs prescribed by generic name was 456 (19.3%). Percentage of encounter with antibiotics prescribed was 94%. Percentage of encounters with injection was 9.25%. Percentage of drugs from NLEM was 40.09%. Percentage of fixed dose combinations prescribed were 13.38% . In our study it is observed that more number of drugs can be prescribed from National List of Essential Medicines. Prescription of drugs by generic name also needs improvement. Since the study is done on outpatient setting , culture and sensitivity reports might not be readily available. So choosing an antibiotic might be a dilemma for the physician. There is hence a need for educational programmes in order to facilitate rational use of antibiotics and promote sensible use of available resources. Every hospital should also follow standard treatment guidelines taking into consideration the sensitivity pattern of the organisms in the locality to promote rational prescribing. This study serves to spotlight the current prescribing trends in patients with respiratory tract infectons visiting our hospital.

Relationship functioning and substance use in same-sex male couples

BackgroundResearch suggests that substance use among partnered sexual minority men will be inversely associated with the quality of dyadic functioning. We tested whether dimensions of relationship functioning implied within Couples Interdependence Theory (e.g., rewards, costs, barriers, alternatives, investment, and comparison to an ideal) predicted drug use and problematic alcohol use consistent with this hypothesis. MethodsThis study utilized baseline data from a sample of 70 couples recruited in the New York City area. All participants were cis-gender male and 18 or older. In each couple, at least one partner reported recent drug use, at least one was aged 18 to 29, and at least one was HIV negative. Participants provided demographic information; completed measures of relationship functioning and problematic alcohol use; and reported recent (past 30 day) drug use. ResultsActor-partner interdependence models were calculated. The use of miscellaneous recreational drugs (excluding marijuana) was positively associated with participants’ perception of rewards, costs, and barriers to leaving and negatively associated with comparisons to an ideal, alternatives, and investment. In addition, partner perceptions of rewards were positively associated with this outcome. AUDIT scores were negatively associated with comparison to an ideal; and positively associated with partner perceptions of alternatives. Relationship functioning was unrelated to marijuana use. ConclusionsThese findings provide support for the hypothesis that relationship functioning and substance use are related. Couples Interdependence Theory implies such an assumption and it underlies many couples-based approaches to drug use intervention. These findings point to the potential utility of integrating relationship skill building into substance use interventions for partnered sexual minority men.

Steroid therapy in drug induced acute interstitial nephritis- Retrospective analysis of 83 cases

Drug-induced acute interstitial nephritis (DIAIN) is a common cause of acute deterioration of renal function. Early diagnosis and discontinuation of the offending drug usually lead to recovery of renal function. Steroid administration further hastens the recovery. However, the outcome of steroid-treated DIAIN is not well studied in the Indian scenario. We aimed to study the clinical profile and one-year renal outcome of DIAIN patients treated with steroids. We performed a retrospective study in biopsy-proven acute interstitial nephritis (AIN) and presumptive DIAIN patients who did not respond to discontinuation of the offending drug after five days of the diagnosis of AIN. Eighty-three DIAIN patients were included who were treated with 500 mg of methylprednisolone for three consecutive days followed by prednisolone of 0.5-1 mg/kg tapered over four to six weeks. We evaluated clinical profile, serum creatinine (SCr), and need of renal replacement therapy at the end of one year. We divided the patients into two groups: 1st as complete responders group (CR) when SCr is <1.5 mg/dL at the end of one year and 2nd as incomplete responders (IR) when it is ≥1.5 mg/dL and evaluated the outcome between two groups. In total, there were 39 (47%) CR and 44 (53%) were IR. Diabetes mellitus, present in a significant number of cases 27 (33%) was associated with poor response to steroids. Most common offending agents recognized were antibiotics (34%), nonsteroidal anti-inflammatory drugs (25%), herbal medications (13%), proton pump inhibitors (10%), and miscellaneous drugs (18%). There was no correlation between drug category and response to steroids. Interstitial fibrosis in renal biopsy was associated with poor response to steroids (4 cases in CR and 35 cases in IR, P ≤0.0001). Neutrophilic predominance in biopsy was associated with favorable response to steroids. Initial SCr and initial the requirement of dialysis support was not helpful in predicting the response to steroids and final recovery.

Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. 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, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

Prescription Pattern In Hypertensive Patients In A Tertiary Care Teaching Hospital, Dhaka, Bangladesh

Background: Irrational drug prescribing is a common practice globally; it results in increased morbidity, mortality &amp; economic burden on society. Drug utilization studies are an important tool to promote rational prescribing.Aims &amp; Objective: To study on drug prescribing pattern in hypertensive patients.Materials and Methods: A drug utilization study was conducted in hypertensive patients by the department of cardiology in OPD at Shaheed Suhrawardy Medical college hospital for 6 months. 645 prescriptions were evaluated for prescribing pattern by using WHO drug use indicators.Results: 645 prescriptions were analyzed. A total of 1828 drugs were prescribed. 697 (38.13%) antihypertensive, 243 (13.30%) anti diabetics, 174 (9.52%) non-steroidal anti-inflammatory drugs (NSAIDs), 154 (8.44%) statins, 114 (6.24%) thyroid hormone, 54 (2.95%) anti-anxiety/ antidepressants and 392(21.44%) miscellaneous drugs were prescribed. 697 antihypertensive drugs were prescribed. 234 (33.57%) angiotensin receptor blockers (ARBs), 117 (16.79%) angiotensin converting enzyme (ACE) inhibitors, 95 (13.63%) Beta blockers, 83 (11.91%) Calcium channel blockers 168 (24.10%) Fixed dose combinations (FDCs) of antihypertensive were included. 2.83 drugs were prescribed per prescription. 225 (32.28%) antihypertensive were prescribed from essential medicine list.Conclusion: Most commonly prescribed drugs were ARBs and ACE inhibitors. Rational prescribing requires consideration to dose and duration and interaction with other medications.J Shaheed Suhrawardy Med Coll, December 2016, Vol.8(2); 39-43

INHALATION THERAPY - APPROACHES AND CHALLENGES

Inhalation therapy is an effective way for local and systemic delivery of miscellaneous drugs for pulmonary and non-pulmonary diseases. The inhalation therapy aims to target specific cells or regions of the lung, bypassing the lung’s clearance mechanisms and thereby providing high retention of the drug for longer periods. It helps in improved penetration of intravenously administered antibiotics into lung parenchymal tissue and bronchial secretions, and as a result, their potential systemic toxicity is reduced when given over prolonged periods of time. The advancement in device technology supports the development of more efficient therapy in the form of delivering finer particles into the lung in large doses. Therefore, meticulous daily management of lung disease, together with prompt, aggressive treatment of exacerbations can be achieved through inhalation to preserve lung function. This review summarizes the features of inhalation delivery devices, their advantages and limitations, challenges in formulation and brief description of novel technologies currently marketed.

Study of drug utilization and antimicrobial prescription pattern of indoor paediatrics cases in tertiary care hospital

Background: Infectious disease represent a major cause of mortality and morbidity in India. Pattern of use of antibiotics need to be studied separately as they vary from adult, however there is limited data is available, Therefore the aim of our study is to observe the drug utilization and antimicrobial prescription pattern and drug utilization in department of pediatrics at our tertiary care hospital.Methods: This was a prospective observational study carried out among indoor patients admitted to paediatric ward after obtaining approval by Institutional Ethics Committee. Written informed consent obtained from a parent or legal guardian of participants.Results: 100 patients were enrolled. The maximum number of antibiotics were prescribed from cephalosporin class (75; 43.6%) out of which ceftriaxone (42;56%), Cefixime (20;26.6%), cefotaxim (11;14.6%), cefpodoxime (3;4%), cefazolin (1;1.33%). The majority of cephalosporins were prescribed in Gastrointestinal tract infections (60.66%) followed by respiratory (27.2%) and least in cvs (2.66%), secondly higher group of antimicrobial prescribed was from Aminopenicillin class accounting of (36; 21.9%) which includes amoxiclav (35;97.2%), ampicillin (1;2.7%) and other beta lactamase (3;1.7%) consisting meropenem (2;66.7%), piperacillin with tazobatcam (1;33.3%). The majority of aminopenicillin were prescribed in respiratory tracts infections and very less in other systems. Miscellaneous drugs used in respiratory conditions were bronchodilator, systemic steroid and nasal decongestant; in CNS disorders antiepileptic and diuretics; in cardiovascular disease NSAID, inotropic, antihypertensive, diuretics; in genitourinary tract infections alkalizing agent and steroid and in GIT disorders minerals, rehydration fluids, antispasmodic probiotic were used.Conclusions: We conclude that commonly prescribed drugs were from 3rd generation cephalosporins followed from extended spectrum penicillin with β lactmase inhibitor. Majority of the antimicrobials are used empirically.

Study on drug usage pattern of anxiolytics in psychiatric department in a tertiary care teaching hospital at Dehradun, Uttarakhand, India

Background: Psychopharmacology is a rapidly growing field, in which the number of patients is continuously increasing. Newly introduced drugs are projected as the better alternative to the traditional psychiatric medicines. The utilization and consequences on real life effectiveness and safety of antianxiety drugs in actual clinical practice need continuous monitoring. Aim of the present study was to analyze the pattern of various anxiolytic drugs prescribed to the patients in psychiatric department of a tertiary care teaching hospital.Methods: The present study was conducted by the department of pharmacology, in the department of psychiatry at SGRRIM and HS, Dehradun, for a period of 6 months from June 2016 to December 2016. Prescriptions of patients diagnosed with anxiety were analysed, using WHO drug use indicators.Results: A total of 603 prescriptions with anxiety disorder were collected. The mean age was 35.46±0.88 years. Majority of the patients were in 31-50 years age group 309 (51.24%). Male:Female ratio was 1:0.69. Disease pattern observed during the study were 177 (29.35%) generalized anxiety disorder, 147 (24.38%) depression, 99 (16.42%) obsessive compulsive disorder (OCD), 81 (13.43%) psychotic illness, 63 (10.45%) bipolar disorders and 36 (5.97%) patients categorized as others category respectively. A total of 1974 psychotropic drugs were prescribed, 654 (33.13%) antianxiety drugs, 648 (32.83%) antidepressants, 240 (12.16%) antipsychotics, 198 (10.03%) antiepileptics and 234 (11.85%) miscellaneous drugs were prescribed. 552 (91.54%) patients received monotherapy and 51 (8.46%) were given polytherapy of anxiolytics. All (100%) anxiolytics were orally prescribed. A total of 30 fixed dose combinations (FDCs) of anxiolytics were prescribed. The numbers of anxiolytics per prescription were 1.085. The anxiolytics prescribed from National Essential Medicine List 2015 were 555 (84.86%). The percentage of anxiolytics with brand names were 618 (94.5%).Conclusions: Most of the prescriptions were rational but there is a need to encourage prescribing by generic names so that more cost-effective and rational treatment can be provided to the patients.

An Assessment of Availability, Cost and Rationality of Serratiopeptidase Preparations in India

Background and Objectives: Serratiopeptidase is available as an oral preparation. The effectiveness of this enzymatic preparation is questionable. Despite this fact, serratiopeptidase is prescribed for a variety of inflammatory conditions. The study was conducted to determine the availability, cost and rationality of serratiopeptidase preparations available in Indian market. Materials and Methods: Serratiopeptidase preparations were assessed for total number, composition, strength and cost. Data were collected from ‘The Drug Today’ of the years 2009 (October–December) and 2015 (April–June). The rationality of preparations was assessed on validated 6-point scoring criteria. An extensive literature search was made using evidence-based print and electronic databases for the studies on efficacy and safety of serratiopeptidase. Results: A total of 642 serratiopeptidase preparations were available in the year 2009, which increased to 647 in 2015. Eighty percent preparations were fixed-dose combinations (FDCs) with either non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, muscle relaxants or miscellaneous drugs. Of all FDCs, 96% preparations were combinations with one or more NSAIDs. Single drug preparations showed a decline from 19.9 to 12.3%. Serratiopeptidase was available in strengths from 2.5 to 50 mg. The cost of 10 mg dose of serratiopeptidase preparations ranged between Rs. 1.35 and Rs. 8.16. The cost of FDCs was more than that of single non-serratiopeptidase agent. FDCs scored poorly on rationality assessment scale in both years, and an increase in irrational preparations was observed. Conclusion: Too many serratiopeptidase preparations are available. Evidence on their efficacy and safety is lacking. The rationality of available FDCs of serratiopeptidase is poor. The availability of expensive FDCs of unknown efficacy and safety is an important contributory factor for the irrational use of drugs.

Miscellaneous Drugs and Male Reproduction.

In addition to main categories of medications believed to have negative impacts on male reproduction, there are a number of miscellaneous drugs with some evidence for such adverse reactions. Because of its widespread use and over-the-counter availability, the H2 receptor antagonist cimetidine is most concerning. As a competitive antagonist at androgen receptors, it can impact the HPG axis and semen quality. In this chapter, we review the studies of this drug and other histamine H2 receptor antagonists in men and experimental species. Several other medications are concerning and the evidence for negative effects on reproduction are covered: colchicine, domperidone, hydroxyurea, metformin, metoclopramide, mifepristone, retinoids, and statins.