This is our final ppt on the pharmacy Practice Project. A hospital-based prospective study that mainly focused on 5 various departments at a tertiary care teaching hospital.

1. 1
“A COMPARISON STUDY ON PRESCRIBING PATTERN,
ASSESSMENT OF EFFICACY AND TOLERABILITY OF
PROTEOLYTIC ENZYMES WITH OR WITHOUT NSAIDs AT A
TERTIARY CARE TEACHING HOSPITAL.”
Presented By
170090654
170090656
170090658
170090690
UNDER THE GUIDANCE OF,
Dr. Sreeja PA & Dr. V Karthikeyan
M Pharm, Ph. D.
Professor
Dept. of Pharmacy Practice
Grace College of Pharmacy, Palakkad
UNDER THE CLINICAL GUIDANCE OF,
Dr. Shafeed T.P., MBBS, D.Ortho, DNB Ortho, MNAMS
Professor and HOD
Dept. of Orthopaedics
Karuna Medical College Hospital

2. INTRODUCTION
 Proteolytic enzymes (PE) also termed as Peptidase, proteases and proteinases
are capable of hydrolyzing peptide bonds in proteins. [1]
 Found in all living organisms, from viruses to animals and humans.
Eg: Plants – Papain and Bromelain
Animals – Pancreatic trypsin, chymotrypsin, pepsin and chymosin (rennet)
Microbial sources – Neutrase, Alkaline proteases. [2]
 There is already a large array of commercially used proteases ranging from
detergent additives to effective therapeutics.
 Target specificity and multiple quick substrate conversion are two main properties
which have made enzymes successful and popular over non-enzymatic drugs in
therapeutic areas.
2

3.  Initially obtained from natural sources, and due to pathogen released risks, now by
r-DNA technology.
 First USFDA approved, purified protease Urokinase P, provided a alternative to
surgical removal of emboli, was approved for clinical application in 1978.
 The USFDA has approved 12 protease therapies, a number of completely new
proteases are also in development.
 Proteases including collagenase, bromelain, trypsin and thermolysin have been
suggested for the debridement of wounds and burns and they are categorized under
Non- FDA Proteolytic Enzymes. [3]
 Proteolytic Enzymes are widely used to treat various indications such as Cancer.
Burns, wound debridement etc.
3
PROTEASES
Aspartate Cysteine Glutamate Metallo Serine Threonine

4. NEED OF THE STUDY
 Oral proteolytic enzymes are prescribed and marketed widely in India for their
applications, though not mentioned in British National Formulary, USP and other
standard books of pharmacology as a drug class.
 According to the studies, 98% of doctors felt that they are effective, but still its
efficacy is not proven.[3] So, we are conducting the study to evaluate the efficacy and
tolerability among patients prescribed with Proteolytic Enzymes.
 HYPOTHESIS OF THE STUDY:
 The hypothesis and expected outcome of our study is that Proteolytic enzyme when
given with combination of NSAIDs shows more efficacy with higher adverse effects
but when given alone shows efficacy with lesser adverse effects and well tolerated.
4

5. Sl
No.
Author Topic Objective Study
Method
Result and Conclusion
1 Ajay
Chandanwale
et al., (2016)
[4]
A randomized, clinical
trial to evaluate efficacy
and tolerability of
Trypsin: Chymotrypsin
as compared to
Serratiopeptidase and
Trypsin: Bromelain:
Rutoside in Wound
management.
To compare the
efficacy and
tolerability of three
oral enzyme
treatment groups – to
evaluate their healing
potential in surgical
wounds after
orthopedic surgery.
Randomized
prospective
study
Wound treatment with
Trypsin: Chymotrypsin
provides a better resolution of
inflammation such as the
improvement of erythema,
local irritation, discharge,
edema as compared to
serratiopeptidase and fixed
dose combination of trypsin,
bromelain and rutoside, thus
facilitating better wound
healing.
2 Dr. Tahani
Abdul- Aziz
Al-Sandook et
al.,(2014)
[5]
Clinical evaluation of the
efficacy of Orthal-forte
(Prolytic enzymes,
trypsin and
chymotrypsin) on
postoperative sequel
following the removal of
lower impacted third
molar.
A study was made to
assess the efficacy of
proteolytic enzyme
Orthal-forte on the
post- operative
sequelae of impacted
mandibular third
molar extraction.
Randomized
prospective
study
This study demonstrated that
Orthal - forte is an effective
and superior analgesic in the
treatment of moderate to
severe acute pain resulting
from third molar surgery with
good Anti-inflammatory
activity.
5
LITERATURE REVIEW

6. 3 Prafulla Mane
et al., (2011)
[6]
Comparison between the
pain relieving action of
Serratiopeptidase,
NSAIDs and combination
of both in the root canal
treatment patients
To compare the
efficacy of
NSAIDs,
Serratiopeptidase
enzyme and
combination of two
in the pain
relieving capacity
for root canal
treatment.
Observational
study
It was observed from the
study that NSAIDs and
Serratiopeptidase were
capable of reducing pain
whereas a combination of
two drugs exhibited
aggravation of pain in the
root canal patients.
Hence, it can be concluded
that there might be an
antagonistic relationship
between the two drugs.
4 Seiichi
Nakamura et
al., (2003)
[7]
Effect of the Proteolytic
enzyme serrapeptase in
patients with chronic
airway disease.
The proteolytic
enzyme
serrapeptase (SER)
is widely used in
clinical practice in
Japan. Effect of
SER on sputum
properties in
Chronic airway
Patients.
Randomized
Prospective
Study
SER may exert a beneficial
effect on mucus clearance,
sputum neutrophil numbers
and altering the
viscoelasticity of sputum
in patients with chronic
airway diseases.
6

7. 7
5 A. Mazzone
et al.,(1990)
[8]
Evaluation of Serratio-
Peptidase in Acute or
Chronic Inflammation of
Otorhinolaryngology
Pathology: a Multicenter,
Double-blind,
Randomized Trial versus
Placebo
The aim of the
present placebo-
controlled
multicenter study
was to evaluate the
efficacy and
tolerability of the
Serratiopeptidase in
the treatment of
ENT inflammatory
conditions.
Multicenter,
Double-blind,
Randomized
Trial
Treatment of patients
suffering from ENT
pathologies, including
laryngitis, catarrhal rhino
pharyngitis and sinusitis,
with Serratiopeptidase
produced a rapid effect
with a significant
improvement of symptoms
after 3 - 4 days.
It is concluded that
Serratiopeptidase has anti-
Inflammatory, anti-
oedemic and fibrinolytic
activity and acts rapidly on
localized inflammation.
6 L. Büttner et
al., (2013)
[9]
Efficacy and tolerability of
bromelain in patients with
chronic rhinosinusitis – a
pilot study
To evaluate the
efficacy, tolerability,
and impact on
quality of life (QoL)
of bromelain tablets
(500 FIP) in patients
with chronic
rhinosinusitis (CRS)
prospective,
open-label
observational
pilot study
Preliminary results
indicate good tolerability,
symptom control, and
improvement in QoL for
the treatment of CRS using
bromelain tablets (500
FIP).No adverse events
were observed

8. AIM & OBJECTIVES
 AIM
The purpose of study was to compare the efficacy and tolerability of Proteolytic
enzymes with or without NSAIDs at a tertiary care teaching hospital.
 OBJECTIVES
 To analyze the prescribing trends of Proteolytic enzymes.
 To compare the efficacy of Proteolytic enzymes with or without NSAIDs by
using Numerical Rating Scale (NRS) and PGART scale.
 To assess the tolerability of Proteolytic enzymes with or without NSAIDs by
PGATT.
 To conduct a survey among the Prescribers about their opinion regarding
proteolytic enzymes.
8

9. STUDY DESIGN:
Hospital based Prospective Observational Study.
STUDY SITE:
The study was carried out in the departments of general medicines, surgery, orthopaedics,
ENT and dental department at Karuna Medical College Hospital, vilayodi, chittur, which
is a 500 bedded tertiary care teaching hospital.
STUDY DURATION:
The study was done over a period of 6 months from November 2021- April 2022.
STUDY POPULATION:
All the prescriptions of both in-patients and out-patients prescribed proteolytic enzymes
with or without NSAIDs. 9
METHODOLOGY

10. STUDY CRITERIA:
INCLUSION CRITERIA
• Both sex of age 18 years and above.
• All In-patients and Out- patients entered with newly prescribed proteolytic
enzymes (trypsin, chymotrypsin, bromelain & serratiopeptidase) and
proteolytic enzymes with or without NSAIDs.
• The patients who were willing to participate in the study.
EXCLUSION CRITERIA
• Paediatrics, Psychiatrics, Pregnant and lactating women.
STUDY TOOLS:
 Data collection form
 Numerical Rating Scale (NRS)
 PGART
 PGATT
 Questionnaire for Prescribers.
10

11.  NUMERIC RATING SCALE (NRS) – 11 QUESTIONNAIRE:
 Proteolytic enzymes are mostly used for the anti – inflammatory action, wound
healing, analgesic, anti – edemic and fibrinolytic action.
 NRS – 11 Questionnaire is used to analyze the severity of pain due to different
indications that are treated by Proteolytic enzymes and proteolytic enzymes along
with NSAIDs.
 NRS is a validated Questionnaire [4]
 It includes 11 questions concerning the nature of pain.
 It allows the patient to choose one out of eleven questions indicating the severity of
the particular level of pain.
 The answers are assigned from 0 to 10.
 The scores are divided as:
0 (No pain)
1 - 3 (Mild)
4 - 6 (Moderate)
7 - 10 (Severe)
11

12. 12
 PGART
 Abbreviated as Patient Global Assessment of Response to Therapy (PGART).
 PGART scale is a validated scale [4]
 Assess the response of the patient at end of the therapy.
 It’s a 5-point scale.
Response Range
Excellent Response 1
Good Response 2
Average Response 3
No Response 4
Poor Response 5

13. 13
 PGATT
 Patient Global Assessment of Tolerability to Therapy (PGATT)
 Tolerability:
It is a complex concept defined by the International Conference on
Harmonization (ICH) as “the degree to which overt adverse effects can be tolerated by
the subject” (ICH E9).
 PGATT is a validated scale [4]
 Assessed the tolerability at the end of the therapy by interviewing the patient about
ADR and dropouts.
 It is a 5-point scale.
Tolerability Range
Excellent Tolerability 1
Good Tolerability 2
Average Tolerability 3
Poor Tolerability 4
Very Poor Tolerability 5

14. STUDY PROCEDURE
 Institution Ethics Committee (KMC/IHEC/02/Jan-2022) was taken prior to study.
 Written informed consent was taken from the patient for the study.
 A pre-designed data collection form was used to collect the necessary information like
the patient demographics, past medical and medication history, laboratory values,
treatment chart etc.
 Follow up at the End of the therapy was taken within 3-10 days through telephonic
interview.
 The efficacy of P Es were assessed by NRS and PGART scales.
 Tolerability of Patients to the P Es were measured by using PGATT scale.
 A survey was conducted among the prescribers to check their opinion about the
Proteolytic enzymes.
 Comparison of efficacy and tolerability of both the groups were done.
 All descriptive statistical analysis were performed using MS Excel.
 Chi-Square test was used for testing relationships between categorical variables [SPSS
(28.0.1)].
14

15. 15
1. AGE WISE DISTRIBUTION OF PATIENTS AMONG THE STUDY
POPULATION
Age group (In
years)
Number of
Patients (n = 77)
Percentage %
18 – 28 17 22.07
29 – 38 19 24.67
39 – 48 15 19.48
49 - 58 10 12.98
59 - 68 9 11.68
>69 7 9.09
22%
25%
19%
13%
12%
9%
18 – 28
29 – 38
39 – 48
49 - 58
59 - 68
>69
RESULTS

16. 16
2. GENDER WISE DISTRIBUTION OF PATIENTS AMONG THE STUDY
POPULATION
Gender Number of Patients
(n= 77)
Percentage %
Male 42 54.54
Female 35 45.45
• Studies conducted by Seiichi Nakamura et.al; (2003). Effect of the proteolytic
enzyme serrapeptase in patients with chronic airway disease. 8(3), 316–320. showed
similar results.
55%
45% Male
Female

17. 17
Department Number of Patients
(n=77)
Percentage %
In- Patients 12 15.58
Out- Patients 65 84.41
3. OUT-PATIENTS AND IN-PATIENTSWISE DISTRIBUTION AMONG
STUDY POPULATION PRESCRIBED WITH PE
16%
84%
In- Patients
Out- Patients

18. 18
4. DEPARTMENT WISE DISTRIBUTION OF PATIENTS AMONG THE STUDY
POPULATION
Department
Specialization
Number of Patients
(n=77)
Percentage %
Orthopaedics 44 57.14
Surgery 12 15.58
E N T 13 16.88
General Medicine 6 7.79
Dental 2 2.59
57.14
15.58 16.88
7.79
2.59

19. 19
Risk Factors No. of
Patients
(n=77)
Percentage
%
1. Medication
Allergy
2 2.59
2. Social Habits
a. Smoking
9 11.68
b. Alcoholic 9 11.68
c. Smoking +
Alcoholic
6 7.79
3. Co-morbidities
a. D.M
6 7.79
b. HTN 5 6.49
c. D.M + HTN 6 7.79
d. Bronchial
Asthma
3 3.89
e. Others (Each one
from DVT,
Hyperlipidemia,C
ancer and
Epilepsy).
4 5.19
5. RISK FACTORS OF THE PATIENTS AMONG THE STUDY
POPULATION
2.59
11.68 11.68
7.79 7.79
6.49
7.79
3.89
5.19

20. 20
6. INDICATIONS WISE DISTRIBUTION OF PATIENTS AMONG THE
STUDY POPULATION
Indications Number of Patients
(n=77)
Percentage %
Fracture 20 25.97
Inflammation + Pain 30 38.96
Wound +
Inflammation
8 10.38
Burns 1 1.29
Hernia + Pain 3 3.89
Arthritis + Pain 9 11.68
Cancer 1 1.29
Otalgia 5 6.49
• Swati B Jadhav, Neha Shah and Abhijit Rathi. Serratiopeptidase: Insights into
Therapeutic Applications. Biotechnology Rep (Amst). 2020 December; 28.

21. 21
7. MEDICATION DETAILS OF PE AMONG ENROLLED SUBJECTS
7.1 Patients prescribed with PE
Drug Number of
Patients
(n=77)
Percentage
%
FDC of PE alone 20 25.97
FDC of P E +
NSAIDs
57 73.41
26%
74%
FDC of PE alone
FDC of P E +
NSAIDs
7.2 Prescription Details of FDC of PE
Drugs Number of Patients
(n=20)
Percentage %
T. Enzomac (Trypsin,
Bromelain and
Rutoside)
16 80.0
T. Chymoral Forte
(Trypsin and
Chymotrypsin)
4 20.0

22. 22
FDC of PE + NSAIDs Number of
Patients
(n=57)
Percentage %
Aceclofenac + P E 15 26.31
Aceclofenac+
Paracetamol + P E
41 71.92
Diclofenac + P E 1 1.75
7.3 Prescription Details of FDC of PE + NSAIDs
Aceclofenac +
Serratiopeptidase
Aceclofenac+
Paracetamol +
Serratiopeptidase
Diclofenac +
Serratiopeptidase
26.31
71.92
1.75

23. 23
Drugs Number of
Patients (n=20)
Percentage %
Enzomac 7 35.0
Enzomac +
Zerodol P
2 10.0
Enzomac +
Hifenac D
8 40.0
Zerodol S 1 5.0
Chymoral Forte 1 5.0
Enzomac + Pruf -
P (Flupiritine 100
mg+ Paracetamol
325mg)
1 5.0
8. PRESCRIBING PATTERN OF PE AMONG PATIENTS WITH EACH
INDICATIONS
8.1 PRESCRIBING PATTERN OF PE FOR FRACTURE

24. 24
8.2 PRESCRIBING PATTERN OF PE FOR INFLAMMATION WITH PAIN
Drugs Number of
Patients (n=
30)
Percentage
%
Enzomac +
Hifenac D
10 33.3
Safronac SP 4 13.3
Enzomac 8 26.6
Zerodol SP 4 13.3
Enzomac +
Ultracet
2 6.6
Zerodol S 1 3.3
Enzomac +
Pruf P
1 3.3
33.3
13.3
26.6
13.3
6.6
3.3 3.3

25. 25
8.3 PRESCRIBING PATTERN OF PE FOR WOUND WITH INFLAMMATION
Drugs Number of
Patients
(n= 8)
Percentage
%
Enzomac +
Hifenac D
4 50.0
Chymoral
Forte
2 25.0
Zerodol SP 2 25.0
Enzomac + Hifenac D
Chymoral Forte
Zeradol SP
50
25
25

26. 26
8.4 OTHER INDICATIONS
Other Indications Drugs Prescribed Percentage %
Burns (n=1) Zerodol SP 100.0
Hernia + Pain (n=3) Zerodol SP 66.6
Chymoral forte +
Zerodol P
33.3
Arthritis + Pain
(n=9)
Enzomac + Hifenac
D
55.0
Enzomac + Pruf P 22.2
22.2
Enzomac
Cancer (n=1) Chymoral Forte 100.0
Otalgia (n=5) Safronac SP 60.0
Coolnac S 40.0

27. 27
NRS of Patients
administered with
FDC of PE alone (n
= 20)
Baseline Follow Up (End of
the therapy)
No. of
Patients
Percentag
e (%)
No. of
Patients
Percentag
e (%)
No Pain (0) 0 0 3 15.0
Mild (1-3) 0 0 17 85.0
Moderate (4-6) 17 85.0 0 0
Severe (7-10) 3 15.0 0 0
9. SEVERITY OF PAIN IN PATIENTS PRESCRIBED WITH FDC OF PE ALONE
0 0
85
15
15
85
0 0
No Pain (0) Mild (1-3) Moderate (4-6) Severe (7-10)
Baseline Percentage (%) Follow up (End of the therapy) Percentage (%)

28. 28
9.1 NRS status of patients prescribed with FDC of PE alone
Base Line End of the
therapy
Ρ - value
5.1±1.61 1.25±0.786 0.001
10. SEVERITY OF PAIN IN PATIENTS PRESCRIBED WITH FDC OF PE
WITH NSAIDs
NRS of Patients
administered with FDC
of PE + NSAIDs
(n= 57)
Baseline Follow Up (End of the
therapy)
No. of
Patients
(n=79)
Percentage
(%)
No. of
Patients
(n=79)
Percentage
(%)
No Pain (0) 0 0 20 35.08
Mild (1-3) 0 0 21 36.84
Moderate (4-6) 33 57.89 11 19.29
Severe (7-10) 24 42.10 5 8.77

29. 29
10.1 NRS status of patients prescribed with FDC of PE with NSAIDs
Base Line End of the therapy Ρ- value
6.12±2.07 2.00±2.39 <0.001
11. COMPARISON OF NRS SCORES OF PATIENTS PRESCRIBED WITH
FDC OF PE AND FDC OF PE + NSAIDS AT THE BASELINE VERSUS END
OF THE THERAPY
Medication
details
Base Line End of the
therapy
Ρ- value
FDC of PE
alone
5.1±1.61 1.25±0.786
<0.001
FDC of PE +
NSAIDs
6.12±2.07 2.00±2.39

30. 30
FDC of PE FDC of PE +
NSAIDs
P- value
2.40±0.82 1.92±0.96 <0.001
12. RESPONSE ASSESSMENT AMONG STUDY POPULATION BY PGART
SCALE
13. TOLERABILITY ASSESSMENT BY PGATT SCALE
13.1 TOLERABILITY ASSESSMENT FOR FDC OF PE AMONG STUDY
POPULATION
100
0 0 0 0
Excellent (1) Good (2) Average (3) Poor (4) Very Poor (5)

31. 31
Tolerability
Scale
Number of
Patients
(n=59)
Percentage
%
Excellent (1) 57 96.61
Good (2) 0 0
Average (3) 1 1.69
Poor (4) 0 0
Very Poor
(5)
1 1.69
13.2 TOLERABILITY ASSESSMENT OF FDC OF PE + NSAIDS AMONG
ENROLLED SUBJECTS
Excellent
(1)
Good (2) Average
(3)
Poor (4) Very Poor
(5)
96.61
0 1.69 0 1.69
 *Zerodol SP which contains Aceclofenac + Paracetamol+ Serratiopeptidase shows
poor tolerability than the others.

32. 32
14. QUESTIONNAIRE FOR PRESCRIBERS
14.1 DEPARTMENT WISE CLASSIFICATION OF THE PRESCRIBERS WHO
WERE PARTICIPATED IN THE SURVEY
Department Number of
Prescribers
Participated
(n = 16)
Percentage %
Ortho 4 25
Surgery 6 37.5
Dental 2 12.5
Paediatrics 2 12.5
Community
Medicine
1 6.25
Casuality 1 6.25
25
37.5
12.5 12.5
6.25 6.25

33. 33
Questionnaire Response
Yes No
Is proteolytic enzyme effective orally? 100% 0%
Are there any ADR in relation to the
drug?
43.75% 50%
Are they used as enteric - coated? 37.50% 56.25%
Are proteolytic enzymes an alternative to
NSAID therapy?
6.25% 93.75%

34. 34
14.2. PRESCRIBER’S OPINION ON MOST PREFERABLE PEs
Most preferable PEs Number of prescribers
(n = 16)
Percentage %
Trypsin: Chymotrypsin 8 50
Serratiopeptidase 8 50
50%
50%
Trypsin: Chymotrypsin Serratiopeptidase

35. 35
Medication Details Number of prescribers (n =
16)
Percentage %
P E in combination 13 81.25
FDC of P E + NSAID 3 18.75
14.3. PRESCRIBER’S VIEW ON THE PRESCRIBING TREND Of PE
81%
19%
P E in
combination
FDC of P E +
NSAID

36. 36
Medication details of
PE with NSAIDs
Number of prescribers
(n = 16)
Percentage %
PE + Diclofenac 4 25
PE + Aceclofenac+
Paracetamol
12 75
P E + Diclofenac
P E + Aceclofenac+ Paracetamol
25
75

37. 37
Uses of P Es Number of prescribers (n =
16)
Percentage %
Wound healing 6 37.5
Anti-Inflammatory 5 31.25
Analgesic + Anti
inflammatory
5 31.25
14.4. PRESCRIBER’S VIEW ON USES OF PE
37.5
31.25
31.25

38. 38
P Es show high ADR Number of prescribers (n
= 16)
Percentage %
No ADR 3 18.75
Serratiopeptidase 6 37.5
Trypsin: Chymotrypsin 1 6.25
Others 3 18.75
14.5. PRESCRIBER’S OPINION ON HIGH ADR SHOWING PE
18.75
37.5
6.25
18.75

39. 39
 Proteases have a bright future as a distinct therapeutic class with diverse clinical
applications.
 The study was designed as a Hospital-based Prospective Observational Study
carried out to study the prescribing trends of proteolytic enzymes in 79 patients
from orthopaedics, general medicine, dental, ENT, and surgery department for
various indications.
 A total of 79 patients were enrolled in the study that satisfied our inclusion criteria,
and 2 of them were dropout due to the severe gastric irritation and more negligible
therapeutic effect.
 We found a predominance of prescriptions with PE in the age group 29-38.
 Gender-wise distributions among subjects prescribed with PE showed a male
predominance over females.
 While analysing the patients in orthopaedics, most of the patients were treated for
pain & inflammation.
SUMMARY & CONCLUSION

40. 40
 Our study also found that PE were prescribed most as Fixed-Dose Combinations.
 80% of the patients were prescribed with FDC of Trypsin, bromelain, and rutoside
combination followed by FDC of trypsin and chymotrypsin.
 Comparison of the efficacy of Proteolytic enzymes with or without NSAIDs was by
using the Numerical Rating Scale (NRS).
 We compared the baseline NRS score with the end of the therapy NRS score by the
Chi-square method.
 We assessed the response to therapy by using the PGART scale and tolerability by
PGATT scale.
 We also conducted a survey among doctors regarding the rationality of prescribing
oral proteolytic enzymes in a tertiary care teaching hospital.

41. 41
 From our study, we concluded that rather than prescribing PE alone it is mostly
prescribed along with NSAIDs.
 FDC of Trypsin: Bromelain and Rutoside ( Enzomac) was commonly prescribed one.
 The most commonly prescribed department was Orthopaedics for fracture, pain and
inflammation.
 Among FDC of PE with NSAIDs the mostly prescribed one was Aceclofenac,
Paracetamol and Serratiopeptidase (Hifenac D).
 On comparison of efficacy between FDC of PE with or with out NSAIDs, we found a
statistical significant difference of the same. (p value = <0.01).
 On assessment of tolerability, 94.80% of the patients showed excellent tolerability.
 According to the Prescribers opinion, PE are effective but should be given along with
NSAIDs due to lack of studies related efficacy of PE.

42. 42
LIMITATION
 The limitation of our study was that mostly the PE were not given alone and the
study period was very less thus we recommend that further studies are required to
prove the tolerability.
PUBLICATIONS
Sl. No JOURNALS
1. Ameena K A*, Sreeja P A, Akshay S, Anas H, Mithun G, Shafeed T P. A
Prospective Study On Assessment Of Prescription Pattern Of Proteolytic
Enzymes At A Tertiary Care Teaching Hospital. International Journal of
Pharmacy Practice and Drug Research. 2022, 12(1):15-19.

43. BIBILOGRAPHY
1. Janos Andras Motyan, Ferenc Toth and Jozsef Tozer. Research Applications of
Proteolytic Enzymes in Molecular Biology. Biomolecules .2013; 3: 923-942.
2. Swati B Jadhav, Neha Shah and Abhijit Rathi. Serratiopeptidase: Insights into
Therapeutic Applications. Biotechnology Rep (Amst). 2020 December; 28: e00544.
3. Charles S Craik, Michael J. Page and Edwin L. Madison. Proteases as therapeutics.
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