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Objective: The objective of this study is to assess drug utilization pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in a tertiary care teaching hospital, Raipur, Chhattisgarh., Materials and Methods: A prospective, cross-sectional observational study was conducted in the outpatient department during 2-month period. After informed consent, the patients visiting pharmacy shop with a prescription were enrolled in the study. Their demographic details and prescription data were recorded in a case record form. The data were analyzed to determine the drug utilization pattern of NSAIDs, using the World Health Organization (WHO) prescribing indicators., Results: A total of 600 prescriptions were analyzed. Of them, NSAIDs were prescribed in 30.83% encounters. In general, nonselective COX inhibitors were most commonly prescribed. The most commonly prescribed form of NSAID was paracetamol (39.45%). The percentage of NSAIDs prescribed with generic names were almost identical (91.15%), whereas the percentage of NSAIDs prescribed from the National List of Essential Medicine (India) - 2015 (49.72%) was not identical with the WHO standard (100%) which serves as an ideal. In 13.51% encounters, a fixed-dose combination (FDC) of NSAIDs was prescribed. Co-administration of gastroprotective agent with NSAIDs was observed in 24.32% encounters., Conclusion: The prescribing practices of NSAIDs indicate some deviation from the WHO standard. In addition, FDCs of NSAIDs with gastroprotective agents as well as other NSAIDs was also prescribed, which are irrational. This baseline data will be useful to plan further targeted research and to improve prescribing practices at the center. Various strategies such as face-to-face periodic training programs of prescribers, establishing drug and therapeutic committee; drug information centers; and drug bulletins can serve beneficial in improving prescribing practices., Competing Interests: There are no conflicts of interest. more...

Background: Antimicrobial prophylaxis should be used in circumstances where efficacy has been demonstrated and benefits outweigh the risk. Each hospital must have an antibiotic policy that is implementable and fully adhered to., Methods: A prospective observational study was conducted in 209 patients, admitted to wards of various surgical departments including surgery, obstetrics & gynaecology (O&G), otorhinolaryngology (ENT) and orthopaedics. Relevant antimicrobial use data of each patient was collected in a customized Case Record Form (CRF) from day one until patient was discharged., Results: Majority of the patients were young adults between 19-39 years of age. Preoperative antibiotics were given in 151 and postoperative antibiotics were prescribed in all. Third generation cephalosporins was the most frequently prescribed group. The selection of antibiotics by different departments varied greatly and many prescribed (n=85) two antibiotics for preoperative prophylaxis. Average duration of surgical prophylaxis was 6.25 days. In 90 patients, preoperative antibiotic was administered before 3 hours., Conclusion: Despite routine interactive academic activities, pattern of antibiotic used was not as per guidelines suggested by competent authorities. Interventions are warranted to promote the development, dissemination and adoption of evidence based antibiotic policy. The policy should be simple, clear, noncontroversial, clinically relevant and implementable. The constant monitoring with periodic audit to ensure adherence is warranted., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.) more...

The need to revise the curriculum for the postgraduate course (M.D.) in Pharmacology has been perceived by the academicians in India since quite some time. The changing professional requirements of the graduating students, the current scenario vis a vis animal experimentation and the emphasis of the Medical Council of India on a competency based curriculum has triggered this felt need. In spite of the fact that most medical institutions and universities in India offer postgraduate courses in pharmacology, the curriculum lacks uniformity with extreme variations observed at some places. This article attempts to analyze the existing curricula in pharmacology in India and suggest modifications that could be recommended to the suitable regulatory bodies for implementation. A revision of objectives in the three domains of learning, development of skills that help develop suitable competencies, adoption of teaching learning methods in addition to the conventional methods, and a rethink on the assessment methods have been recommended. Development and validation of alternatives skill-based modules in lieu of animal experiments are recommended. Additional skills like medical writing and communication skills, professionalism and ethics, multi and inter-disciplinary integration and collaboration and a wider exposure of students to the pharmaceutical, academic, regulatory and research institutions for onsite learning were also recommended to fulfill their future career requirements. more...

Unlabelled: Antibiotic surveillance initiatives are limited in resource-constrained settings. In the present study, a quantitative comparison of antibiotic use rates for suspected infections in 2 hospitals in India was performed using the "focus of infection" approach to identify targets for quality improvement in antibiotic prescription patterns in hospitalized patients., Methods: This observational study was carried out in one teaching and one nonteaching hospital. All the patients with suspected bacterial etiology were included. Data on the prescribed antibiotics and the focus of infection were prospectively collected using a structured questionnaire. Each diagnosis was further reviewed and confirmed by an independent consultant. The prescribed antibiotics were coded according to the World Health Organization Anatomic Therapeutic Classification (ATC) index with the defined daily dose (DDD) methodology. Focus-specific DDDs were calculated per hundred patient days (DDD/HPD)., Results: A total of 6026 patients were included from 72 participating physicians out of available 75 physicians. Overall antibiotic prescribing was higher by 5 percentage points in the teaching hospital (95%) than in the nonteaching hospital (90%). Quinolones (ciprofloxacin constituting 86% of DDD/HPD) were the highest prescribed class in the teaching hospital, and third-generation cephalosporins (with ceftriaxone and ceftriaxone/sulbactam constituting 40% and 28% of the DDD/HPD, respectively), in the nonteaching hospital. The targets identified for improvement were the following: longer than recommended duration of prophylaxis and lack of distinction between prophylaxis and therapy among surgical patients; irrational antibiotic prescribing in gastroenteritis; overuse of quinolones and lack of use of penicillin in pneumonia; overuse of quinolones and lack of use of doxycycline and macrolides in genital infections; and overreliance on antibiotics for treating skin and soft tissue infections., Conclusions: Providing a quantitative comparison of antibiotic use rates for suspected infections, using the "focus of infection" approach along with the ATC/DDD methodology, appears appropriate for identifying targets for quality improvement with regards to antibiotic prescribing. more...

Background: We prospectively explored prescribing patterns, with an emphasis on seasonal and hospital differences, for adults and children under 5 y of age reporting to the outpatient clinics of 2 hospitals (1 teaching hospital and 1 non-teaching hospital) in Ujjain, India., Methods: The study was done over 15 months from November 2007 to February 2009, covering 4 seasons (2 winters, 1 summer and 1 rainy season). The treating consultant completed diagnosis prescribing forms for first consultations with outpatients for selected infectious disease complaints (n = 5623). Antibiotics were coded according to the World Health Organization, Anatomic Therapeutic Chemical classification with defined daily dose (ATC/ DDD). All DDD were calculated per 1000 patients per diagnosis (DDD/TPD)., Results: The study covered 80% of all first consultations. Antibiotics were prescribed to 66.3% (3732/5623) of patients. Indications of antibiotic prescribing were respiratory tract infections (42.9%), vaginal discharge (24.2%), urinary tract infections (11.5%), skin and soft tissue infections (10.5%), diarrhoea (9.4%), dysentery (1.2%) and prophylaxis (0.6%). The most commonly prescribed antibiotic group was the quinolones. The antibiotic prescribing rate differed by diagnosis, age group, education, hospital and season, and was 11.3 percentage units less in the teaching hospital compared to the non-teaching hospital (p < 0.001). The study showed higher prescribing of broad-spectrum antibiotics in the non-teaching hospital, with a peak-prescribing rate (75%) during the summer, while the teaching hospital had a peak prescribing rate (70%) during the rainy season., Conclusions: The peak prescribing rates during the summer and rainy season probably reflect the higher diagnostic and follow-up uncertainties faced by the treating physicians. The method used in this study could be used in busy outpatient settings. more...

Male albino rats weighing between 150-225 gm fasted over night but freed having water ad libitum were used to assess the diuretic efficacy of intramuscular aminophylline and frusemide separately and concurrently after intraperitoneal 10 ml of distilled water loading. The normal rate of diuretic weight loss was less augmented by aminophylline and more augmented by frusemide. The diuretic response was more by the concurrent intramuscular administration of aminophylline and frusemide in comparison with that due to either drug alone. However, the observed diuretic response of the two drugs administered concurrently was lesser (infraadditive) than the sum of the individual diuretic response (additive). more...