Oral Preparations Research Articles

Iron Therapy in Chronic Kidney Disease: Days of Future Past.

Anemia affects millions of patients with chronic kidney disease (CKD) and prompt iron supplementation can lead to reductions in the required dose of erythropoiesis-stimulating agents, thereby reducing medical costs. Oral and intravenous (IV) traditional iron preparations are considered far from ideal, primarily due to gastrointestinal intolerability and the potential risk of infusion reactions, respectively. Fortunately, the emergence of novel iron replacement therapies has engendered a paradigm shift in the treatment of iron deficiency anemia in patients with CKD. For example, oral ferric citrate is an efficacious and safe phosphate binder that increases iron stores to maintain hemoglobin levels. Additional benefits include reductions in fibroblast growth factor 23 levels and the activation of 1,25 dihydroxyvitamin D. The new-generation IV iron preparations ferumoxytol, iron isomaltoside 1000, and ferric carboxymaltose are characterized by a reduced risk of infusion reactions and are clinically well tolerated as a rapid high-dose infusion. In patients undergoing hemodialysis (HD), ferric pyrophosphate citrate (FPC) administered through dialysate enables the replacement of ongoing uremic and HD-related iron loss. FPC transports iron directly to transferrin, bypassing the reticuloendothelial system and avoiding iron sequestration. Moreover, this paper summarizes recent advancements of hypoxia-inducible factor prolyl hydroxylase inhibitors and future perspectives in renal anemia management.

Thermosensitive hydrogels for vaginal delivery of secnidazole as an approach to overcome the systemic side-effects of oral preparations

Secnidazole (SEC) has been suggested as an alternative agent against Trichomonas vaginalis to overcome the adverse effects, antimicrobial resistance problems and poor adherence to the currently available therapy. Once no topical formulation may be found in the market until now, SEC was incorporated in thermosensitive bioadhesive systems to extend the contact time in the mucosa and to avoid a systemic drug disposition. Formulations containing 20% poloxamer 407, 1% poloxamer 188 and 1 or 2.5% chitosan showed suitable sol-gel transition temperature (> 30 °C), presenting a fast gelation time (100-115 s). Rheological, dynamic light scattering and infrared spectroscopy analysis suggested molecular interactions among polymers. Chitosan increased the mucoadhesion strength of the formulations. In addition, hydrogels showed a tendency to decrease the drug transport rate through mucosa when compared to the control. Mucin was also added onto mucosa for a more realistic simulation of permeability/retention. In the presence of this agent, hydrogels containing chitosan reduced the permeability/retention of the drug in approximately 2.0-fold when compared to the control. Therefore, the hydrogels presented suitable characteristics to remain in the vaginal environment, which would result in effective local treatment of trichomoniasis.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Awareness and Willingness to Use HIV Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Rwanda: A Cross-Sectional Descriptive Survey.

Chinese Expert Consensus on Clinical Application of Oral Ginkgo biloba Preparations (2020).

Chinese Expert Consensus on Clinical Application of Oral Ginkgo biloba Preparations (2020).

Investigation of the Physical, Chemical and Microbiological Stability of Losartan Potassium 5 mg/mL Extemporaneous Oral Liquid Suspension.

Extemporaneous oral liquid preparations are commonly used when there is no commercially available dosage form for adjustable dosing. In most cases, there is a lack of stability data to allow for an accurately assigned shelf life and storage conditions to give greater confidence of product safety and efficacy over its shelf life. The aim of this study was to evaluate the physical, chemical and microbiological stability of an extemporaneous oral liquid suspension of losartan potassium, 5 mg/mL, used to treat paediatric hypertension in Our Lady’s Children’s Hospital Crumlin, Ireland. The losartan content of extemporaneous oral suspensions, prepared with and without addition of water, was measured by UV and confirmed by HPLC analysis. Suspensions were stored at 4 °C and room temperature (RT) and were monitored for changes in; pH, colour, odour, re-dispersibility, Total Aerobic Microbial Count, Total Yeast and Mould Count and absence of E. coli. Results showed that suspensions prepared by both methods, stored at 4 °C and RT, were physically and microbiologically stable over 28 days. Initial losartan content of all suspensions was lower than expected at 80–81% and did not change significantly over the 28 days. HPLC and NMR did not detect degradation of losartan in the samples. Suspensions prepared in water showed 100% losartan content. The reduced initial losartan content was confirmed by HPLC and was related to the acidic pH of the suspension vehicle. Physiochemical properties of the drug are important factors for consideration in the selection of suspension vehicle for extemporaneous compounding of oral suspensions as they can influence the quality, homogeneity and efficacy of these preparations.

Comparison of Five Oral Cannabidiol Preparations in Adult Humans: Pharmacokinetics, Body Composition, and Heart Rate Variability

Data supporting the physiological effects of cannabidiol (CBD) ingestion in humans are conflicting. Differences between CBD preparations and bioavailability may contribute to these discrepancies. Further, an influence of body composition on CBD bioavailability is feasible, but currently undocumented. The aims of this study were to: (1) compare the pharmacokinetics of five oral CBD preparations over 4 h; (2) examine the relationship between body composition and CBD pharmacokinetics; and, (3) explore the influence of CBD on heart rate variability. In total, five preparations of CBD, standardized to 30 mg, were orally administered to 15 healthy men and women (21–62 years) in a randomized, crossover design. Prior to and 60 min following CBD ingestion, heart rate variability was determined. Body composition was assessed using dual energy X-ray absorptiometry. Peak circulating CBD concentration, time to peak concentration, and area under the curve was superior in a preparation comprising 5% CBD concentration liquid. Fat free mass was a significant predictor (R2 = 0.365, p = 0.017) of time to peak concentration for this preparation. Several heart rate variability parameters, including peak frequency of the high frequency band, were favorably, but modestly modified following CBD ingestion. These data confirm an influence of CBD preparation and body composition on CBD bioavailability, and suggest that acute CBD ingestion may have a modest influence on autonomic regulation of heart rate.

Comparison of art outcome in frozen embryo transfer cycle using oral estradiol valerate and estradiol transdermal gel

Aim: Endometrial preparation with exogenous estrogen is a common practice in frozen embryo transfer (FET) cycles. The aim of this study was to compare the clinical outcome of oral estradiol valerate versus transdermal estrogen (17-β estradiol) gel in FET cycles. Materials and Methods: A prospective pilot study was carried out at a tertiary fertility clinic after Ethics Committee approval from January 2018 to December 2018. It included 103 infertile women who underwent FET cycles. Either oral estradiol valerate or transdermal 17-beta estradiol was used for endometrial preparation. Combination was used in case of breakthrough bleeding or if optimal endometrial thickness was not achieved. Baseline demographic parameters and details of the stimulation protocol and embryogenesis in fresh cycle were noted. In the FET cycle, the patient was seen on day 2 of menstrual cycle, where baseline ultrasound (USG), estradiol, and progesterone levels were done. If normal, the patients were given either oral or dermal preparation. The patient was seen again on day 9 for endometrial thickness and if required again after 2 days till endometrial thickness was 9 mm. If optimal endometrial thickness was not achieved or there was breakthrough bleeding, combination of both oral and dermal preparation was used. Once the endometrial thickness was 9 mm or more, progesterone was started, and ET was done on day 5. On the day of progesterone initiation, endometrial thickness, endometrial volume by 3D, and Doppler indices [pulsatility index (PI), resistance index (RI), peak systolic velocity (PSV)] were noted. The primary outcome of the study was clinical pregnancy rate (CPR) and live birth rate (LBR). Results: There was no statistical difference in any of the demographic parameters in groups A and B. In group C, the pregnant patients were younger with higher body mass index and follicle-stimulating hormone and lower anti-Mullerian hormone and antral follicle count when compared with those who did not conceive. Demographics of the fresh cycle did not show any significant difference in dose and duration of stimulation, fertilization, cleavage, and blastulation rate in group A. In group B, the fertilization rate was significantly higher in the pregnant group (0.001), whereas the other parameters were similar. In group C, the pregnant group required more dose and days of stimulation and had lower oocytes retrieved but had a higher blastulation rate. In the hormone replacement therapy (HRT) cycle, there was no difference in the mean duration of HRT in groups A and B but was significantly higher in group C when compared with group A. The CPR with oral estradiol valerate, transdermal gel, and combination therapy was 34.85%, 35%, and 52.94%, respectively. The LBR with oral estradiol valerate, transdermal gel, and combination therapy was 25.76%, 30%, and 47.06%, respectively. Though the CPR and LBR were higher in group C, it did not reach statistical significance and this could be due to small sample size. There was no difference in the abortion rate (oral 7.58%, gel 5%, combination 5.88%) between the three groups. The implantation rate (oral 26%, gel 25.8%, combination 29.03%) in the three groups was also similar. There was also no statistical difference in the endometrial thickness, volume, and blood flow between the three groups. The cut-off values for Doppler indices for a positive pregnancy were as follows: Group A—PSV: >8.7, RI: <0.99, PI: >1.54; Group B—PSV: >5, RI: <0.72, PI: >2.1; Group C—PSV: >5.6, RI: <0.64, PI: >1.29. Conclusion: Both the oral estradiol valerate and transdermal 17-beta estradiol were equally effective for optimal outcome in an FET cycle in HRT. Those not responding to single preparation may benefit from combination therapy. Transdermal 17-beta estradiol gel may be of use in those patients who have breakthrough bleeding with oral preparation which may be due to hepatic bypass effect.

The effect of ferric citrate hydrate as an iron replacement therapy in Japanese patients with iron deficiency anemia

Patients with iron deficiency anemia (IDA) need to take oral iron preparations, which serve as the first-line treatment in IDA, for several months in order to replenish body iron stores after the improvement of anemia. However, existing oral iron preparations have concerns regarding its long-term use due to side effects, such as gastrointestinal symptoms. Previous clinical studies have shown that ferric citrate hydrate (FC) exhibits sufficient therapeutic efficacy in patients with IDA and lowers the risks of nausea and vomiting in comparison with existing oral iron preparations. In this study, we evaluated the efficacy and safety of FC administration at doses of 500 and 1,000 mg/day for up to 24 weeks as iron replacement therapy in patients with IDA. The results of this study showed that both the doses of FC improved anemia and iron-deficiency conditions and led to sufficient iron replacement response in most patients with IDA. No safety concerns were identified. Therefore, FC is expected to be a novel oral iron preparation for patients with IDA.

Factors associated with the persistence of oral 5-aminosalicylic acid monotherapy in ulcerative colitis: a nationwide Norwegian cohort study.

Background:Oral 5-aminosalicylic acid (5-ASA) is the mainstay treatment of ulcerative colitis (UC) and therapy with oral 5-ASA is associated with beneficial outcomes. We have examined factors associated with the persistence of oral 5-ASA treatment in a national cohort of UC patients.Methods:Patients with newly diagnosed UC from 2010 to 2014 using oral 5-ASA monotherapy were identified by combining data from the Norwegian Patient Registry and the Norwegian Prescription Database. The median follow-up time was 1029 days. Drug persistence was defined as duration of oral 5-ASA preparation as monotherapy. Non-persistence of a oral 5-ASA preparation as monotherapy was defined as stopping oral 5-ASA, initiation of any further anti-inflammatory treatment including a course of glucocorticoids and a change to another oral 5-ASA preparation. Drug persistence was analyzed using the Kaplan–Meier method and influence of covariates on drug persistence was analyzed with the Cox proportional hazard model.Results:A total of 3421 patients were identified. The overall median 5-ASA drug persistence was 179 days. In univariate analyses, persistence was associated with preparation type and high-dose treatment, while oral glucocorticoid use or hospitalization around the start of oral 5-ASA were associated with shorter 5-ASA persistence. In multivariate analyses, oral glucocorticoids [HR 1.67 (1.54–1.80), p < 0.005] and hospitalization around start of 5-ASA [HR 1.23 (1.14–1.34), p < 0.005] were associated with non-persistence, whereas high dose (⩾3 g/day) 5-ASA was associated with longer persistence [HR 0.68 (0.65–0.71), p < 0.005].Conclusion:High-dose treatment with oral 5-ASA was associated with longer persistence of oral 5-ASA monotherapy, whereas the presence of factors indicating more severe disease around initiation of 5-ASA monotherapy was associated with a shorter persistence.

Safety and efficacy of sodium picosulfate, magnesium oxide, and citric acid bowel preparation in patients with baseline renal impairment or diabetes: subanalysis of a randomized, controlled trial.

Background:Selecting a bowel preparation for patients with renal impairment or diabetes requires special consideration. We aimed to describe the effect of baseline renal impairment or diabetes on the safety, efficacy, and tolerability of low-volume sodium picosulfate, magnesium oxide, and citric acid (SPMC) ready-to-drink oral solution bowel preparation.Methods:A post hoc secondary analysis was performed from a randomized, assessor-blinded study of SPMC oral solution bowel preparation in participants with mild or moderate baseline renal impairment or diabetes. Primary efficacy endpoint (‘responders’) was the proportion of participants with ‘excellent’ or ‘good’ ratings on a modified Aronchick Scale (AS). Secondary efficacy outcomes were the quality of ascending colon cleansing from the Boston Bowel Preparation Scale (BBPS), and selected results from the Mayo Clinic Bowel Prep Tolerability Questionnaire. Safety assessments included adverse events (AEs), adenoma detection, and laboratory evaluations.Results:Similar overall colon cleansing was demonstrated in the subgroups, with >85% of participants in any subgroup rated as responders by the AS, and >92% of participant responders by the BBPS. Most participants reported a tolerable bowel preparation, regardless of baseline renal impairment or diabetes history. Safety of SPMC oral solution was similar between all subgroups and the overall cohort. For the mild renal impairment, moderate renal impairment, and diabetes subgroups, respectively, commonly reported, drug-related AEs were nausea (2.6%, 5.3%, 1.4%) and headache (2.2%, 2.6%, 4.3%).Conclusions:Ready-to-drink SPMC oral solution demonstrated efficacious colon cleansing in patients with baseline mild/moderate renal impairment or diabetes, with a tolerable bowel preparation reported by most.Clinical Trial Registration:ClinicalTrials.gov identifier: NCT03017235

Role of mechanical and oral antibiotic bowel preparation in children with Hirschsprung's disease undergoing colostomy closure and pull-through.

BackgroundMechanical and oral antibiotic bowel preparation (MOABP) has been performed routinely before colorectal surgery in children, but the necessity was questioned recently. We evaluated the utility of MOABP in children with Hirschsprung’s disease (HSCR) undergoing colostomy closure and pull-through.MethodsThe medical records of pediatric patients with HSCR who underwent colostomy closure and pull-through in a single center from January 2010 to January 2020 were reviewed. The use of MOABP was noted. The incidence of postoperative complications, duration of postoperative antibiotic therapy, total hospital cost and length-of-stay were compared between patients receiving MOABP and no bowel preparation (NBP).ResultsA total of 64 patients were included in the study: 33 received MOABP and 31 had NBP. The respective postoperative complications in the MOABP and NBP groups were: intra-abdominal infection (18.2% vs. 29.0%), wound infection (9.1% vs. 16.1%), anastomotic leak (0 vs. 0), intestinal obstruction (6.1% vs. 0) and enterocolitis (3.03% vs. 12.90%). The duration of antibiotic therapy was 4.91±4.21 and 5.23±3.77 days (P=0.75) and hospitalization was 18.21±7.26 and 16.26±6.63 days (P=0.27) respectively. The total hospital cost in the MOABP group (4,720.14±1,858.89 USD) was higher than in the NBP group (3,749.06±2,009.97 USD) (P=0.049).ConclusionsWe did not find any clear benefit of MOABP in children with HSCR before colostomy closure and pull-through. However, a multicenter randomized controlled trial is needed to more definitely determine the best preoperative approach for children with HSCR.

Current status and issues in clinical use of opioids

In Japan, 14 opioids with a variety of dosage forms, such as oral preparation, injection, transdermal patch, transmucosal and suppository are clinically available as analgesics, and their use properly depends on the type and degree of pain and patient condition. Fundamentally, strong opioids are restricted to only treatment of cancer pain, while the indication of fentanyl transdermal patch and oxycodone tamper resistant tablet has been expanded for the treatment of non-cancer chronic pain. In US, the additional indication of opioids to chronic pain has led to prolongation and generalization of opioid use, which may contribute to "opioid crisis" in which opioid-related death strikingly increased due to opioid abuse and overdose-induced respiratory depression. Currently, opioid-related abuse and death have not been evident in Japan, while abuse of antitussive opioids (codeine and dihydrocodeine) are recently seen as a problem, which may suggest the sense of guilt to abuse legally-uncontrolled drugs (ex. weak opioids, antitussives or hypnotics) may be low in Japanese. In this review, I will summarize current status and issues in clinical use of opioid analgesics, and will talk about the necessity and expectation for development of novel analgesics without serious adverse reactions such as addiction and respiratory depression.

Glutathione: The master antioxidant – Beyond skin lightening agent

Glutathione is a thiol-containing tripeptide which is considered as a master antioxidant. Found naturally in fresh leafy vegetables, fruits, and nuts, commercially available preparations of glutathione have been found to be useful in number of medical conditions such as central nervous system disorders, autism, cardiovascular system disorders, peripheral vascular disorders, diabetes and its complications, liver disease, acquired immunodeficiency syndrome/human immunodeficiency virus, and chronic obstructive pulmonary diseases. With regards to the dermatologic disorders, some studies have highlighted the role of glutathione as a skin-lightening agent. The studies on use in other diseases such as psoriasis, pemphigus vulgaris, acne vulgaris, rosacea, etc., are limited and need to be explored more. Glutathione is available as oral preparations (pills, sublingual tablets, solutions, syrups, and sprays), parenteral forms (intravenous [IV] preparations), topical formulations (creams, soaps, and facewashes). The major drawback of oral form of glutathione is its low bioavailability in humans. To overcome this drawback, sublingual tablets and oral liposomal glutathione have been made available. However, the number of studies evaluating its efficacy and safety are less in number. This review article has been written to highlight the role of glutathione in various dermatologic disorders apart from skin-lightening agent.

Quality and Toxicity Assessment of some Oral Liquid Herbal Formulations (Agbo) consumed in Abuja, Nigeria

Aim: To evaluate the microbiological quality and toxicity potential of commonly consumed oral herbal liquid preparations (Agbo) in some areas of Abuja, Nigeria. Methods: Herbal liquid preparations (Agbo) were collected from different locations of the Municipal Area of Abuja, Nigeria. Samples were analyzed for elemental content using Flame method of Atomic Absorption Spectrophotometer (FAAS). Microbiological quality assessment was determined by suitability and sterility testing and the contaminants were characterized to genera level. A number of the samples (20 %) were subjected to in vitro hemolysis testing using mammalian (goat) blood. Results: Minerals like Chromium (Cr) and Manganese (Mn) were found to be absent, while Calcium (Ca), Copper (Cu), Iron (Fe), Potassium (K), Sodium (Na), Magnesium (Mg), Lead (Pb) and Zinc (Zn) were detected at variable concentrations. Some samples (11 %) contained Lead (Pb) above WHO permissible limit. Samples (60 %) were found to be contaminated with Bacillus, Staphylococci, Escherichia coli, Pseudomonas, Salmonella and Proteus in addition, Microsporum, Rhizopus, Aspergillus and Yeast were also found. In vitro hemolysis showed that 50 % of the samples had hemolysis values above 50 % and one (1) of the samples had a considerably high value (> 100 %) revealing the substantial extent of red blood cell lysis due to these Agbo preparations. Conclusion: This study is a pointer to the potential harm that consumption of Agbo can cause especially because it is purported to be safe and regularly consumed in liberal amounts.

Objective Resident Characteristics Associated with Performance on the Ophthalmic Knowledge Assessment Program Examination.

Background To determine objective resident characteristics that correlate with Ophthalmic Knowledge Assessment Program (OKAP) performance, as well as to correlate OKAP performance with Accreditation Council for Graduate Medical Education (ACGME) milestone assessments, written qualifying examination (WQE) scores, and oral board pass rates. Methods Review of administrative records at an ACGME-accredited ophthalmology residency training program at an urban, tertiary academic medical center. Results The study included data from a total of 50 resident physicians who completed training from 2012 to 2018. Mean (standard deviation) OKAP percentile performance was 60.90 (27.51), 60.46 (28.12), and 60.55 (27.43) for Years 1, 2, and 3 examinations, respectively. There were no statistically significant differences based on sex, marital status, having children, MD/PhD degree, other additional degree, number of publications, number of first author publications, or grades on medical school medicine and surgery rotations. OKAP percentile scores were significantly associated with United States Medical Licensing Examination (USMLE) Step 1 scores (linear regression coefficient 0.88 [0.54-1.18], p = 0.008). Finally, continuous OKAP scores were significantly correlated with WQE ( r s = 0.292, p = 0.049) and oral board ( r s = 0.49, p = 0.001) scores. Conclusion Higher OKAP performance is correlated with passage of both WQE and oral board examinations during the first attempt. USMLE Step 1 score is the preresidency academic factor with the strongest association with success on the OKAP examination. Programs can utilize this information to identify those who may benefit from additional OKAP, WQE, and oral board preparation assistance.

Efficacy and Tolerability of Oral Iron Protein Succinylate in the Treatment of Iron Deficiency Anemia in Adults with Diverse Pathologies

An increasing number of prevalent conditions in the adult population associated with absolute or/and functional iron deficiencies (ID) may predispose to iron deficiency anemia (IDA). Oral iron formulations, especially ferrous salts, are generally regarded as the first line therapies for adult-onset ID and IDA according to several current guidelines. However, they have been frequently associated with gastrointestinal side effects, and with a subsequent high treatment discontinuation. Iron protein succinylate (IPS) is an iron complex containing 5% of ferric iron engulfed in a succinylated casein shell that precipitates in acid pH and becomes soluble at neutral to alkaline pH, gradually releasing iron into the intestinal lumen, and, hence, overcoming the gastric and intestinal problems of the ferrous compounds, as well as improving intestinal iron absorption. Besides, IPS has shown to prevent the up regulation of the expression of hepcidin or to induce its expression at a smaller extent when compared with ferrous sulphate (FS). This narrative review addresses the efficacy and safety profiles of IPS for the treatment of ID and IDA in adult patients with a wide range of clinical conditions, such as preoperative and postoperative ID, elderly ID, Chronic Kidney Disease (CKD), Hypothyroidism, regular blood donors, and ID developed in young athletes. In conclusion, IPS compares favorably in efficacy and safety with other currently available oral iron preparations, showing a fast and steady improvement in hematologic parameters (that reflect a better iron absorption), and a lower incidence of adverse events.

The overbearing physiological changes marring iron indices interpretation in response to iron therapy during pregnancy

Background: Iron deficiency anemia (IDA) is most common cause of anemia in pregnancy. In order to prevent this iron supplementation is routinely practiced as a prophylactic measure in pregnant women all over. The biochemical parameters assessed in IDA comprise an iron profile evaluation which consists of estimation of serum ferritin, serum iron, total iron binding capacity(TIBC), serum transferrin levels and calculation of transferrin saturation. These biochemical parameters are subjected to variations due to maternal adaption phenomenon. Aim: In the current study we have chosen three iron indices, serum iron, serum TIBC and transferrin saturation percent to note their performance in diagnosing and monitoring the response to iron therapy in pregnant women. Methodology: The study population are thirty- six pregnant women in their early second trimester, who are diagnosed with mild iron deficiency anemia (Hemoglobin between 9 and 11 g %). Iron parameters, serum iron, serum TIBC and transferrin saturation levels were analyzed in these women. They are then given oral iron preparation in the form of Ferrous sulphate for a period of twelve weeks. After this the Hemoglobin level, serum iron, TIBC and transferrin saturation levels are re-analyzed in these women. Results: The hemoglobin levels increased (p= 0.002). as expected after oral iron intake. Serum iron levels improved from 58.19±39.07 to 64.78±34.96 μg/dl. Serum TIBC value before supplementation 234.22±134.49 increased to 437.33±94.95 after, which contradicts the expected pattern seen in response to therapy in general population. Similarly absurdity prevails in transferrin saturation index levels which dropped from 36.8 ± 31.8 to 16.3 ± 10.6. Conclusion: The iron status during pregnancy is highly influenced by the maternal changes. And a blind interpretation of the report can lead to erroneous diagnosis. The interpretation of values should be based on the trimester specific reference ranges during pregnancy.

Assessment of Erythropoiesis-Stimulating Agents for Anemia Treatment among Chronic Kidney Disease Patients: A Descriptive, Retrospective Study

Background: Renal anemia is a cause of significant morbidity, and to lesser extent mortality in patients with chronic kidney disease (CKD), the leading causes of anemia in CKD primarily are the lack of erythropoietin (EPO) and iron. Thus, effective management is possible using oral and intravenous (IV) iron preparation and genetically engineered erythropoiesis-stimulating agents such as EPO. This study aimed to assess the effect of EPO in the treatment of anemia among hemodialysis (HD) patients. Methods: A descriptive, retrospective hospital-based study was conducted in Elshaheeda Salma Hospital, Khartoum, Sudan. All patients who were anemic or had a history of anemia and undergoing HD during the period (January to June 2018) were recruited. Data were collected using a checklist and analyzed with the Statistical Package for the Social Sciences software. Results: A total of 191 anemic patients were included: 60% of them were males, and more than half of the participants were aged between 41 and 65 years. Clinically, the average duration of the dialysis among participants was 7.7 ± 5 years, and 97% of them had two dialysis sessions per week. Patients were used either IV or subcutaneous injection of EPO. 8000 IU/week were the most prescribed (52.2%) EPO dose. Whereas, only 6% and 18% were taking 100 mg IV and 150 mg oral ferrous sulfate, respectively. Furthermore, 70% of them were taking 5 mg folic acid. Moreover, the mean hemoglobin level among the participants at the end of the study was 10 ± 2.1 g/dl. Conclusion: EPO was effective in treating renal anemia in HD patients. Among the studied patients, 8000 IU/week was the most frequently used dose. The present study highlights significant low adherence to international guidelines in the management of anemia in patients on HD.

Safety and efficacy of linezolid treatment in comparison with vancomycin for methicillin-resistant Staphylococcus aureus nosocomial infection: A prospective study in Mysore City, South India

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative agent of nosocomial infection in health-care setups causing morbidity and mortality. Treatment with vancomycin remains the standard protocol for the antibiotic treatment. However, the emergence of vancomycin-resistant strains has prompted the use of alternate drug therapies. Linezolid is the best alternative to combat this resistant strain. In the present study, we aim to evaluate the clinical evidence of linezolid treatment in MRSA-infected patients within Mysore city. METHODS: This prospective study assessed the efficacy of linezolid and vancomycin for the treatment of MRSA infections. Fifty patients who fit into the inclusion criteria were considered from four tertiary hospitals. Five milliliters venous blood (only once), pus, urine, sputum, and aspirates were collected from MRSA patients and evaluated by culture studies for its susceptibility to various antibiotics. RESULTS: Results of this study demonstrate that linezolid treatment as oral and intravenous preparations is as effective as vancomycin with 100% efficiency and fewer adverse effects (79 in 40 patients vs. 64 in 16 patients) for the treatment of MRSA nosocomial infection. The observed adverse effects includes local pain (P = 0.312) and thrombophlebitis (P = 0.005) with vancomycin; and anemia (P = 0.348) and thrombocytopenia (P = 0.313) with the use of linezolid. The findings were consistent with the existing knowledge database. CONCLUSION: The results from the study indicate that linezolid offers the same benefit as vancomycin with far fewer drawbacks.

Price variation analysis of various brands of cephalosporins available in Indian market

Background: Cephalosporins are one of the widely used groups of antibiotics worldwide. The price variation among different brands of same compound is one of the important factors influencing the compliance to treatment. Aim and Objectives: The present study was done with the aim to analyze the price variability pattern among the various brands of cephalosporins available in Indian Market by calculating the percentage price variation. Materials and Methods: Current Index of Medical Specialties July–October 2020 was used to review the prices of different brands of oral and parenteral preparations of cephalosporins with same strength available in Indian market. Cost ratio and percentage price variation among different brands were calculated. Results: In this study, noticeable price variation was found between different brands of cephalosporins. The numbers of brands for same strength formulations marketed by different companies were found to be ranging from 2 to 90 in this study. Among oral cephalosporins maximum percentage price difference was found for cefuroxime 500 mg −1396.53%, whereas the lowest percentage price difference was found to be for cefaclor 500 mg −17.69%. The maximum percentage price difference among the parenteral cephalosporins was found to be for cefuroxime 750 mg −1784.21% and the lowest percentage price difference was found to be for ceftazidime 250 mg + tazobactam 31.25 mg −0.92%. Conclusion: There exists a wide percentage price difference among the brands of cephalosporins marketed by different companies. Clinicians must consider socioeconomic background of their patients, while prescribing to reduce non-compliance and provide economical regimen for their patients.