Search

Background: Antimicrobials are most commonly prescribed drugs worldwide. Around 50% of the prescriptions of antimicrobial drugs are either not needed, inappropriate or in wrong doses. With the widespread use of antimicrobial agents (AMAs), the prevalence of resistance has increased. To evaluate the prescription pattern and utilization of AMA in ear, nose, throat (ENT) outpatient department (OPD) of Tertiary Care Hospital, Nanded. Methods: This prospective study was conducted in ENT OPD of Dr. Shankarrao Chavan Government Medical College, Nanded over a period of 3 months. During this period, approximately 1100 patients visited ENT OPD and 600 prescriptions were evaluated. The excluded patients were of post-operative follow-up and of patients undergoing medical examination for fitness and handicap certificate. Data were collected by using specially designed case report form. Appropriateness of AMA was assessed by Kunin’s modified criteria. Results: Total 600 prescriptions were analyzed out of which (91%) consist of AMA. Most of them reported with upper respiratory tract infections (URTI) (30.4%), chronic suppurative otitis media (21.4%), acute suppurative otitis media (10.4%), tonsillitis (3.3%), sinusitis (2.7%), and others (15%). Amoxicillin (43.9%) was preferred AMA followed by ciprofloxacin (30.6%), cotrimoxazole (5.8%), azithromycin (3.2%), doxycycline (3.2%) cefixime + clavulanate (3.2%), and amoxicillin + clavulanate (1.8%). Single antibiotic was preferred in all prescriptions. In the concomitant medications, antihistaminics were prescribed in 97.22% of patients, non-steroidal anti-inflammatory drugs in 94.96% of patients, and antacids in 87.76% of patients. Fixed-dose combinations were used in 10% of prescriptions. Brand names of AMA were used in 10% of prescriptions. As per the Kunin’s modified criteria, 83% of patients received AMA therapy appropriately, while 17% patients inappropriately. Conclusions: Amoxicillin is the most common AMA prescribed and URTI is the most common diagnosis made. All AMAs should be prescribed only when needed and should be used in proper dose and for proper duration. Institution wise antibiotic policy should be used to contain resistance. Proper training and regular orientation programs of the juniors’ doctors for judicial use of AMAs will foster the habit of rational prescribing of AMA.

Background: Acne and scabies are significant skin diseases and treatment of which carries major economic burden in Indian scenario. We planned study to compare safety, efficacy, and economy of treatment modalities of scabies for permethrin, benzyl benzoate, and ivermectin and acne for doxycycline and azithromycin. Hence, we can provide better treatment option for acne and scabies based on cost-effectiveness, efficacy, and safety. Aims and Objectives: This study aims to study therapeutic efficacy and cost-effective analysis of treatment in acne vulgaris and scabies. Materials and Methods: A multicentric, prospective observational study was carried out with patients attending the outpatient department of 32 health-care centers of Wardha district. One hundred and forty-eight patients of acne and 124 patients were screened, of which 108 patients of acne and 120 patients of scabies were analyzed for therapeutic efficacy. Of 120 scabies patients, 52 patients took benzyl benzoate lotion, 48 patients received permethrin cream, and 20 patients received tablet ivermectin. In acne, 60 patients received tablet azithromycin and 48 patients received tablet doxycycline. Cost-effective analysis was done. Results: In scabies, efficacy was near 93% for all therapeutic agents, but benzyl benzoate (INR 15.01 per case) and ivermectin (INR 16.07 per case) are more cost effective than permethrin (INR 21.55 per case). In acne, azithromycin (62.2%) and doxycycline (60%) showed similar efficacy, but doxycycline (INR 112 per case) is more cost effective than azithromycin (INR 216 per case). Conclusion: Therapeutic efficacy was similar for all therapeutic agents in both acne and scabies. Benzyl benzoate and ivermectin are more cost effective than permethrin in scabies. In acne, doxycycline is more cost effective than azithromycin.

Chlorpromazine N-oxide, fluphenazine N 4 ’-oxide, prochlor-perazine N 4 ’-oxide, sulforidazine N -oxide, and trifluoperazine N 4 ’-oxide were synthesized by oxidation of the designated nitrogen atom in the N- 10 side chain of the respective parent drug with 3-chloroperoxybenzoic acid. In the case of trifluoperazine, a stepwise increase in the amount of oxidant yielded the N 1 ,N 4 -dioxide and N 1 ’, N 4 ’,S-trioxide. The N’,S- dioxides of chlorpromazine and sulforidazine were obtained by hydrogen peroxide oxidation of the appropriate parent drug.

Background: Drug-induced hepatotoxicity is a potentially serious adverse effect of antituberculosis treatment (ATT) regimens containing isoniazid, rifampicin and pyrazinamide. Many in vitro and in vivo studies revealed that honey possess antioxidant property and hepotoprotective property but there is no systematic work available to test the effect of honey on antitubercular drugs induced hepatotoxicity in rats. Hence present study was carried out to explore the prophylactic and therapeutic effect of honey with its antioxidant activity against hepatotoxicity induced by antitubercular drugs (Isoniazid, Rifampicin and Pyrazinamide) in albino rats. Methods: Hepatotoxicity in rats treated with antitubercular drugs (Isoniazid, Rifampicin and Pyrazinamide) was studied by assessing parameters such as Serum alanine aminotransferase (ALT), Serum aspartate aminotransferase (AST), Serum total protein, Serum Malondialdehyde (MDA) and Serum Superoxide dismutase activity (SOD). The effect of Honey as co-administration and administration after establishment of hepatotoxicity on above parameter was investigated. These biochemical observations were supplemented by Histopathological examination of liver. Results: Honey significantly reversed changes in serum levels of AST, ALT, MDA, SOD, total protein and also histopathological changes produced by Antitubercular drugs. It was found that honey significantly prevented as well as reversed Antitubercular drugs induced hepatotoxicity and antioxidant activity. Conclusions: The results of present study show that honey has significant prophylactic and therapeutic value against antitubercular drugs induced hepatotoxicity.

Fixed drug eruptions are common cutaneous adverse drug reactions, commonly caused by anticonvulsants, antibiotics and analgesics. Here, we report a case of a 27-year-old male of fixed drug eruptions due to Aspirin which was used in treatment of headache.

Two new procedures are described for the preparation of di- and tetra-deuterated 10-[[3-[4-(2-hydroxyethyl)-1-piperazinyl]propyl]]-2-trifluoromethyl-10H-phenothiazine (fluphenazine). Deuterium was introduced in either the 1- or the 1- and 3-positions of the propyl side chain by reduction with deuterated borane in tetrahydrofuran of the appropriately substituted N-10 amide or amido ester. The isotopic purity of the synthesized deuterated products was greater than 99%.

For the separate development of radioimmunoassay procedures for thioridazine and its two major active metabolites, mesoridazine and sulforidazine, three haptens, respectively, 2-methylthio-, 2-methylsulfinyl-, and 2-methylsulfonyl-substituted 10-[2-[1-(2-carboxyethyl)-2-piperidinyl]ethyl]-10H-phenothiazine, were synthesized and characterized. Thioridazine hapten was coupled to bovine serum albumin, whereas the haptens for mesoridazine and sulforidazine were coupled to porcine thyroglobulin. The number of hapten residues per mole of carrier protein was determined in each case by an ultraviolet spectrophotometric method. Polyclonal antibodies to each hapten-protein conjugate were obtained in rabbits, and titers of the antisera were checked by evaluating their binding characteristics to the appropriate tritiated analyte. A hapten for the ring sulfoxide metabolite of thioridazine was also synthesized.

Antisera to fluphenazine sulfoxide were raised in New Zealand white rabbits to an immunogen synthesized by covalent linkage of bovine serum albumin to 10-[[3-[4-(4-carboxybutyl)-1-piperazinyl] propyl]]-2-trifluoromethyl-10H-phenothiazine 5-sulfoxide. With use of an antiserum, a radioimmunoassay for fluphenazine sulfoxide was developed that is able to quantitate 0.156 ng ml-1 using only a 200 microliter plasma sample with a coefficient of variation less than 5%. The antiserum had negligible cross-reactivities to fluphenazine (less than 1%) and its important metabolites, such as fluphenazine N4'-oxide (1%), 7-hydroxyfluphenazine (less than 1%), and N4'-deshydroxy-ethylfluphenazine (1%). The cross-reactivities with structurally similar phenothiazine 5-sulfoxides, such as those of trifluoperazine, prochlorperazine, perphenazine, and N4'-deshydroxyethylfluphenazine, were considerable, such that the antiserum can be used to develop a quantitative radioimmunoassay for any of these compounds. The reported radioimmunoassay was found to be suitable and adequate to quantitate fluphenazine sulfoxide in the plasma of patients treated with oral or intramuscular fluphenazine.