This study analyzed 2,000 antibiotic prescription records from Bangladesh to evaluate rational antibiotic prescribing practices. It found that the majority (63%) of patients visited unlicensed village healthcare workers due to their widespread availability. The most commonly prescribed antibiotic classes were cephalosporins (36%), macrolides (25.5%), and quinolones (21%). However, 81% of prescriptions lacked clinical tests to justify antibiotic use. Only 66.5% of patients completed their full antibiotic course. The study concludes that irrational antibiotic prescribing in Bangladesh contributes to growing antibiotic resistance and calls for national treatment guidelines and public education programs.
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Inappropriate drug use in hospitalized elderly patients of medicine and cardi...Apollo Hospitals
National committee on quality assurance, USA convened an expert consensus panel and identified the list of drugs which should be avoided in the elderly people. This resulting list of drugs after 2003 beers criteria were added to the 2006 Health Plan Employer Data and Information Set (HEDIS) to assess the drug prescribing in elderly people.
A study on prescription pattern and rational use of statins in tertiary care ...SriramNagarajan16
Objectives
Our objectives are to evaluate prescription pattern and rational use of statins in a tertiary care corporate hospital.
Methodology
It was a prospective observational study conducted for a period of 6 months and included various departments of 300
bedded multi specialty tertiary care corporate hospital. A total of 200 patients were included and the study criteria
was inpatients and induvial more than 18 years of either gender who are prescribed with HMG-CoA reductase
inhibitors.
Results
In the present study 200 patients belonged to the age group of above 18 years, out of which about 65% were male
and 35% were female. Atorvastatin (67%) was prescribed mostly and Rosuvastatin (29.5%) was also used.
Conclusion
It is finally concluded that Rational and prophylactic use of statins can reduce further complications of Diabetes
Mellitus (DM) and cardiac events.
Statins treatment is favourable in long term treatment of diseases, it is most effectively used in treatment of serious
disease conditions which has shown its immense therapeutic role in treatment
A Cross Sectional Study of Ethnic Differences in Occurrence and Severity of A...iosrphr_editor
Non-steroidal anti-inflammatory drugs are the most widely used "over the counter" medication all over the world despite their complications in different major organs. Present studies envisaged for knowing the occurrence and severity of adverse drug reactions from NSAIDs in different ethnic communities of Sikkim. A cross sectional study was undertaken in the medicine outpatients department of a secondary and tertiary care hospital. The patients belonging to Nepalese, Bhutias, Lepchas ethnic communities and others community (settlers from other parts of India) were included to analyzed the data based on the age and gender, ethnicity and ADRs, drugs and ADRs. Severity assessment was done using Hartwing and Siegel scale and causality assessment by Naranjo scale. Total 109 cases of ADRs, predominating in female were detected. Nepalese were the most affected and Gastrointestinal tract (GIT) being the most affected organ in them. Diclofenac showed maximum number of ADRs in all the communities. Maximum number of cases occurred on single day use (40.36%) of drugs. All the cases were belonging to the "possible category" and the maximum being the mild (72.48%) in nature. It is advisable to consider the ethnic/racial differences equally with other factors, to improve the safety and efficacy of a drug.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
Comparative evaluation of 2g single dose versus conventional dose azithromycin in uncomplicated skin and skin structure infections. Indian Journal Of Pharmacology. August 2015;Vol. 47; Issue 4
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
This presentation will cover information about polypharmacy in older populations. The presentation will allow explain the use of technology such as HomeMeds as a tool to prevent adverse reactions in older populations.
Homeopathic and conventional treatment for acute respiratory and ear complain...home
Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H) and 720
conventional (C) treatment. The majority of patients in both groups reported their outcome after 14 days of treatment
as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing). In the perprotocol
set (H: 576 and C: 540 patients) similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further
subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C:
84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40
(0.89–2.22) in children and 0.92 (0.63–1.34) in adults. Adjustments for demographic differences at baseline did not
significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both
treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon
homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Adverse drug reactions occurred more
frequently in adults of the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p = 0.0032), whereas in
children the occurrence of adverse drug reactions was not significantly different (H: 2.0%; C: 2.4%, p = 0.7838).
Prescribing practices of antibiotics in outpatient setting of a tertiary care...SriramNagarajan19
Antibiotic resistance is a form of drug resistance whereby certain sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR) and the issue is the subject of ongoing investigation these days. The present study observed the rationality of antibiotics prescribed in an outpatient setting in a tertiary care hospital.
A prospective cohort study was conducted for 2 months on the patients who were prescribed antibiotics in a tertiary care hospital in outpatient setting. The prescriptions of patients were evaluated with respect to the medical condition of the patient. A total of 500 prescriptions were evaluated for rationality out of which 240 prescriptions (48%) were rational and 260 prescriptions (52%) were found to be irrational. The misuse of antibiotics continues to haunt the health care system of Pakistan and pose a threat of pandemic of bacterial resistance due to irrational use. Interventions by clinical pharmacists in the given situation are the need of the hour.
Preliminary study of Prescription audit for evaluation of prescribing pattern...SriramNagarajan16
Prescription audit is necessary to know the art of prescription practices to improve rational pharmacotherapy.
Present study is an observational study and was undertaken from August 2018 to October 2018 for which data
was collected from Medical OPD. Prescribing is a technique with an expert academic pharmacological
knowledge.
Irrational prescribing leads to diminished therapeutic outcome. The present study is the first preliminary one at
Pandit Jawaharlal Lal Nehru Govt. Medical College and Hospital, Chamba- HP Before July 2016, it was a
district hospital College. It is a hilly district and caters the need of 5 Lakh people. A total of 420 prescriptions
were analyzed. These prescriptions comprised of 3000 drugs. Average drugs prescribed per patient were 7.3 .
male and female ratio was 40% and 60% respectively. More prescription were carried out in the age group of 51
- 60 yrs. Prescriptions in generic were only 3.65% fixed dose combination was used in 300 prescriptions and
comprised of 71.4% drugs. Oral prescriptions were used maximally and intravenous medication was minimally
used. Multivitamin prescriptions were observed in bulk.
When a psychiatric patient is diagnosed, the practitioner selects a medication therapy from a variety of therapeutic approaches and according to the severity and condition of a patient; through peer evaluation. This requires the writing of a prescription. Prescribing accounts for a large proportion of errors [1]: Medication errors, problems related to strength and frequency of medication, quantity per dose, instructions for use, total quantity to be dispensed, dosage form etc; if absent, can cause great deal of patients’ harm. Medicines are a key component of healthcare and errors relating to medication, may impact on patient’s safety [1-4].
Human errors can be understood through a lot of suggested models and frameworks but the findings vary from country to country [5,6]. Prescribing errors are harmful to the patients and in worst cases they may lead to fatality. To avoid errors in prescriptions and its amelioration at the time of writing; is the easiest way of prevention of prescription errors [6-10]
Theories of human error states that, “a series of planned actions may fail to achieve their desired outcome because the plan itself was inadequate or because the actions did not go as planned. The definition reflects this distinction, including failures both in the prescribing decision and the prescription writing process” [5]. In 2005, Department of Health in the United Kingdom planned to reduce prescribing errors by 40% [10]. Such initiatives are also required in a developing country like Pakistan. Apparently, psychiatrists know a little about prescribing errors. Irrational drug therapy can cause patient’s harm by exacerbation or prolongation of illness, distress and higher costs [8] in some cases. Irrational prescribing is a global problem and may also be regarded as "pathological" prescribing [9].
All prescriptions must include the name, address, specialty and signature of the prescriber as well as the name, sex, and age of the patient and the strength, quantity, dose, frequency, dosage form and instructions for use of the medication [11–15]. The dispensing system of Pakistan is different than some other countries. The medication is available in already packed in containers etc by the pharmaceutical industries, to be dispensed. There is no option of refill instructions to the pharmacist etc. Adherence by the physician to good quality prescribing will minimize errors and ultimately improve patient’s care. Prescribing errors can occur as a result of errors in haste, poor concentration to the patient or attendant (in case the patient is unable to deliver the correct information), decision-making or the prescription-writing process. Incorrect prescribing habits are common unfortunately [16-20].
The purpose of this study was to investigate drug prescriptions of Psychiatry for the essential elements of prescriptions mentioned above, and to study the prescribing trends in psychiatric practice in Peshawar area, Pakistan.
Comparative evaluation of 2g single dose versus conventional dose azithromycin in uncomplicated skin and skin structure infections. Indian Journal Of Pharmacology. August 2015;Vol. 47; Issue 4
Journal club presentation: by RxVichuZ!! ;)RxVichuZ
My 97th powerpoint... deals with the comparative study of efficacy of piperacillin-tazobactam, as compared to meropenem in the treatment of ESBL(Extended spectrum beta-lactamases) infections.
A summarized insight has been provided, using research article from JAMA.
This presentation will cover information about polypharmacy in older populations. The presentation will allow explain the use of technology such as HomeMeds as a tool to prevent adverse reactions in older populations.
Homeopathic and conventional treatment for acute respiratory and ear complain...home
Data of 1,577 patients were evaluated in the full analysis set of which 857 received homeopathic (H) and 720
conventional (C) treatment. The majority of patients in both groups reported their outcome after 14 days of treatment
as complete recovery or major improvement (H: 86.9%; C: 86.0%; p = 0.0003 for non-inferiority testing). In the perprotocol
set (H: 576 and C: 540 patients) similar results were obtained (H: 87.7%; C: 86.9%; p = 0.0019). Further
subgroup analysis of the full analysis set showed no differences of response rates after 14 days in children (H: 88.5%; C:
84.5%) and adults (H: 85.6%; C: 86.6%). The unadjusted odds ratio (OR) of the primary outcome criterion was 1.40
(0.89–2.22) in children and 0.92 (0.63–1.34) in adults. Adjustments for demographic differences at baseline did not
significantly alter the OR. The response rates after 7 and 28 days also showed no significant differences between both
treatment groups. However, onset of improvement within the first 7 days after treatment was significantly faster upon
homeopathic treatment both in children (p = 0.0488) and adults (p = 0.0001). Adverse drug reactions occurred more
frequently in adults of the conventional group than in the homeopathic group (C: 7.6%; H: 3.1%, p = 0.0032), whereas in
children the occurrence of adverse drug reactions was not significantly different (H: 2.0%; C: 2.4%, p = 0.7838).
Prescribing practices of antibiotics in outpatient setting of a tertiary care...SriramNagarajan19
Antibiotic resistance is a form of drug resistance whereby certain sub-populations of a microorganism, usually a bacterial species, are able to survive after exposure to one or more antibiotics; pathogens resistant to multiple antibiotics are considered multidrug resistant (MDR) and the issue is the subject of ongoing investigation these days. The present study observed the rationality of antibiotics prescribed in an outpatient setting in a tertiary care hospital.
A prospective cohort study was conducted for 2 months on the patients who were prescribed antibiotics in a tertiary care hospital in outpatient setting. The prescriptions of patients were evaluated with respect to the medical condition of the patient. A total of 500 prescriptions were evaluated for rationality out of which 240 prescriptions (48%) were rational and 260 prescriptions (52%) were found to be irrational. The misuse of antibiotics continues to haunt the health care system of Pakistan and pose a threat of pandemic of bacterial resistance due to irrational use. Interventions by clinical pharmacists in the given situation are the need of the hour.
According to WHO, Drug utilization research is defined as ‘the marketing, distribution, recommendation and utilize of drugs in a society, with particular focus on the resulting medical, social and economic results. In many developed countries, a number of studies about utilization of drug have been conducted, which indicates a wide proof of irrational drug use. The drug use indicators are considered as objective measures that can be extended to identify practices of medicines utilization in any health facility, country or an entire region. To check the drug utilize pattern in Primary Health Care (PHC) facilities of Bhakkar district Punjab Pakistan. Using WHO core drug use indicators, a prospective cross-sectional descriptive study was carried out in health facilities of Bhakkar district. A total of 40 prescriptions were analyzed. The average age of patients visiting HC centers was 33.11 years (female 35.79; male 30.40). 3.65 was the average number of prescribed drugs. 27% was the percentage of encounters with at least one prescribed antibiotic whereas 35% was the percentage of encounters with at least one prescribed injection prescribed, which was low. 25% is the total percentage of drugs given using generic names was noticed. The average consultation and dispensing time of 40 prescriptions was 2.02 minutes and 42.52 seconds. The study demonstrates that trend toward irrational practice mainly on use of antibiotics and non-generic prescribing in most of health facilities studied. Patient care given by health facilities studied was inadequate and thus for encouragement of rational drug use practice, an effective intervention program is recommended.
Evaluation of Prescribing Patterns of Antibiotics in General Medicine Ward in...ijtsrd
Knowledge about antibiotic utilization and resistance patterns of most common microorganisms are unavailable in tertiary care hospitals. To assess the pattern of antibiotic utilization and outcome of patients in a General Medical Ward, all positive blood cultures BC over a 4 month period from July 2019 to October 2019 were retrospectively reviewed. Sixty five positive BC were recorded in which patients 43 males and 22 females . 72 of the patients received antibiotics before or soon after obtaining the BC, and ceftriaxone was the most frequently prescribed antibiotic 41.93 , either alone or in combination with other antibiotics. The bacteraemia was due to gram positive cocci in 60.46 of cases, gram negative rods in 30.23 , and gram positive rods in 9.30 . Positive BC due to contamination was not included. The most common gram positive cocci were Staphylococcus epidermidis, followed by S. aureus, while the most common gram negative bacilli were Brucella species, Proteus mirabilis, and Klebsiella sp. The suspected sources of the bacteraemia were respiratory 21.2 , urinary 19.2 , or skin 19.2 . A subsequent change in the antibiotics regimen was done in 69.76 cases after BC results became available with no apparent effect on the outcome. Adding Cefotaxime, Amoxicillin clavulonic acid, piperacillintazobactum, vancomycin and clindamycin was the most frequent change done 19.4 for each equally . Complications developed in 69.76 of patients, with 88.66 of them suffering from sepsis shock. 69.23 of the patients improved and 30.77 expired death was related to infection in 87.5 of cases. In conclusion, most bacteremia in the medical ward of the hospital were due to gram positive cocci, which should be considered in antibiotic selection prior to BC. Vageeshwari Devuni | Debabrata Chaudhary "Evaluation of Prescribing Patterns of Antibiotics in General Medicine Ward in a Tertiary Care Hospital" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-1 , December 2019, URL: https://www.ijtsrd.com/papers/ijtsrd29618.pdf Paper URL: https://www.ijtsrd.com/pharmacy/pharmacology-/29618/evaluation-of-prescribing-patterns-of-antibiotics-in-general-medicine-ward-in-a-tertiary-care-hospital/vageeshwari-devuni
It is very important to incorporate clinically relevant practicals into the undergraduate pharmacology practical (UGPP) curriculum. Various medical colleges in the state of Gujarat have included clinical practicals in their UGPP curriculum. [2] Rai has recommended the inclusion of the 'P-drug' concept in the UGPP curriculum.
The conference of experts on the rational use of drugs, convened by the World Health Organization in Nairobi in 1985, stated that: "Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time, at the lowest cost to them and their community." This goal can be achieved by acquiring knowledge of the principles of rational drug usage during undergraduate training. This correspondence emphasizes the importance of this concept.
» What is a P-drug?
The drugs you are going to prescribe regularly and with which you will become familiar are called P(ersonal)-drugs. The P-drug concept includes the name of a drug, dosage form, dosage schedule and duration of treatment for a specified condition. Due to varying availability and cost of drugs, different national formularies and essential drug lists, medical culture and individual interpretation of information, P-drugs differ from country to country and between doctors.
There are four reasons that indicate why a P-drug should never be the one that has been suggested or dictated by clinical teachers, senior colleagues or by sales representatives: a) the latest and the most expensive drug is not necessarily the best, the safest or the most cost-effective, b) by developing one's own set of P-drugs, one can learn to handle pharmacological concepts and drug-related data in an effective manner, c) by compiling one's own set of P-drugs, one can prescribe alternatives when the P-drug cannot be used and d) one has the final responsibility for his / her patient's well being, which he / she cannot pass on to others. While physicians can and should draw on expert opinion and consensus guidelines, they should always think for themselves.
» Example for selecting a P-drug for acute amoebic dysentery Top
Amoebiasis is one of the common infections encountered in clinical practice and it is relatively easy to understand the pathophysiology as well as the treatment of amoebiasis. Therefore, we have selected the example of acute amoebic dysentery and analyzed it in consultation with standard textbooks of pharmacology.
overuse and misuse of antibiotic put all of us at danger, and help to develop drug-resistant bacteria, so-called superbugs. which ultimately increase the cost of health care. so the third world countries are facing a burden of an extra charge of expenditure and unusual death
Assessment of drug utilization and rational drug use on WHO indicationZaibaFathima8
This is a study done in the outpatient department for a short period of time to recognize the drug utilized and use of rational drug use based on WHO indicators under the guidance of Dr. GOPINATH S, M Pharm., Ph.D.,
by Prabhavathi S co. B Pharmacy final year project.
Antibiotic Stewardship: Current status and implications in IndiaJindal Chest Clinic
Antibiotic Stewardship: Current status and implications in India. This presentation gives an overview of Antibiotics: components, prescription, selection etc.
A systemic review on antibiotic use evaluation in paediatricsJing Zang
Drug utilization is the marketing, distribution, prescription, and use of drug in a society, with special emphasis on the resulting medical, social and economic consequences. Antibiotics are valuable discoveries of modern medicine and their definitive and or appropriate use has led to a decline in the morbidity and mortality associated with various infectious diseaseswhile inappropriate use of antibiotics can increase morbidity, mortality, patient cost and bacterial antibiotic resistance.Antimicrobial agents are among the most commonly prescribed drug in Paediatrics. Because of an overall rise in health care costs, lack of uniformity in drug prescribing and the emergence of antibiotic resistance, monitoring and control of antibiotic use are of growing concern and strict antibiotic policies should be warranted. The caution use for antimicrobial agents is very important as their unavailability or resistance can be life threatening. Irrational drug use is a common practice in developing countries. In India, clinician often prescribe three or four drugs to treat the most trivial conditions for the sake of satisfying the patients need to receive drugs or the drug sellers need for profit. Thus drug use evaluation studies are required for all drugs in general and particularly for antibiotics.
Antibiotics are most common therapeutic agents used in hospitals across world, however, microbial world is becoming resistant day by day, posing special challenges to clinicians specially working in ICU set ups. There are multiple ways to curb this menace, if approached together in antibiotic stewardship way, can bring about wonders and retain therapeutic potentials of these drugs.
Similar to Pprescribing practice-of-antibiotics-for-outpatients-in-bangladesh-rationality-analysisp-1983 (20)
serum Bilirubin and some Hematological parameters in Patients with Presenile ...MatiaAhmed
Cataract is the leading cause of reversible blindness and visual impairment.
It may be associated with G6PD deficiency and can produce hemotytic manifestations.
Eosinophils and Eosinophil Products in Bronchial AsthmaMatiaAhmed
Eosinophits are known to be an indirect marker of airway inflammation in asthma. tt is
known since long that the total eosinophil count reflects asthmatic activity and is useful for
regulating steroid dosage and for early detection of exacerbations.
Wife baftering is known all over the world among all state of the society. lt is an impact in the
civilized progressive society of the Western world as in the society of ours.
Efficacy of AST/ALT Ratio for Assessment of Liver Fibrosis in chronic Hepatit...MatiaAhmed
chronic liver disease due to hepatitis B infection is a common problem in our country' The
sole method of accurate diagnosis is liver biopsy, which is an invasive technique associated
with complications, and is expensive
Allergen Skin Test Reactivity and Eosinophilia in Adult Bronchial Asthmatic P...MatiaAhmed
Asthma affects more than 100 million people worldwide. lncreased morbidrty
include increased exposure to indoor allergens and environmental pollutants
agonist, under-use of anti-inflammatory mediators and limited education about healu' care
Knowledge and Perception on Noncommunicable diseases (NCDs) among Health Prof...MatiaAhmed
The rapid rise of Noncommunicable diseases represents one of the major
health challenges to global development in the 21st century. Among the 20 Grand
Challenges in Chronic NCDs the priority focuses of area is to explore the level of knowledge
and perception among health professionals and its determinants
Comparative Study of Serum Electrolytes among Treated Diabetic SubjectsMatiaAhmed
This study was designed to investigate the measurements of serum levels of Na+
, K+
, Mg2+
and Ca2+ and their changes with serum glucose levels. Thirty treated diabetic patients (diet
/ OHA), aged between 23 to 27 years and having BMI of 17.9 to 22.54 kg/m2
were selected
randomly from the outpatient department of BIRDEM.
A Gase of Road Traffic Accident in the Perspective of Forensic MedicineMatiaAhmed
A young male of 28 yrs was involved with road traffic accident while crosslng road. The
victim expired on the spot. Police sub inspector from shabag thana made the inquest
report & brought the dead body to the Dhaka Medical College morgue. Post mortem
examination was done.
Faculty Development Strategy is An Essential Element for Quality TeachingMatiaAhmed
Faculty Development Strategy is An Essential Element
for Quality Teaching
Quality teacher is an essential commodity for production of quality graduates, and quality
graduates contribute to health standard of a community as such of a country.
Lesson Plan
Basics and Principles
Lesson Planning is a large part of being organized and a key feature of a competent
teacher. It is a special skill that is learnt in much the same way as other skills. Careful
lesson planning can help to ensure the successful running of courses. Incorporating best
practices in teaching and learning into the design process will help students to meet their
learning objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
2. Abu Syed Md Mosaddek, et al., American Journal of Pharmacology
Remedy Publications LLC. 2018 | Volume 1 | Issue 1 | Article 10082
are not completing the complete dosage regimen of antibiotics, if
it is given in cold and general fever or even in other complicated
infectious diseases.
The study of prescribing pattern of antibiotics infers to monitor,
evaluate, and suggest modifications in the practitioner's prescription
habits, so as to make patient care reasonable and effective [7]. The
knowledge about antibiotic utilization patterns is necessary for a
constructive approach to problems that arise from multiple antibiotic
usages. It is extremely important that institutions and hospitals
should have an antibiotic policy and ensure that the best choices are
made by individual prescribers [8].
The aim of this study is to analyze and justify whether antibiotics
are being prescribed rationally or irrationally for outpatients as
well as to indicate the prevalence of most prescribed antibiotics in
Bangladesh.
Materials and Methods
The observational study was carried out in the department of
pharmacology, Uttara Adhunik Medical College (UAMC) during the
period January 2016 to December 2017. Fifty medical students (4th
year) of UAMC of the 2015 to 2016 academic year were divided into
5 groups. Each group was asked to collect 400 prescriptions of the
registered physicians, specialists and quacks (village health personnel)
from different area of Dhaka City. Total 2,000 prescriptions were
collected during their academic year.
Written consent was taken from each patient during this study.
Data were collected from the patients by random selecting the patients
who came to buy the drugs from the medicine shops. The patients
who were unconscious/mentally retarded, who were suffering with
psychiatric diseases and who were admitted into hospitals were
excluded from the study. Few questionnaires were excluded during
the data analysis because of inadequate information.
Results
From this study it was found that averagely 29% patients visited
Bachelor of Medicine & Bachelor of Surgery (MBBS) doctors, 63%
visited (Quack doctors) whereas only 8% visited Bachelor of Dental
Service (BDS) doctors. The highest percentage of patients paid a visit
to quack doctor and the lowest percentage of patients paid a visit to
BDS doctors shown in Table 1.
Among the patients 61% were male and 39% were female. In
this study, males were prescribed 22% more antibiotics than females
shown in Table 2.
Children aged from ‘0’ years to 15 years old took the highest
percentage of antibiotics (55.25%) followed by people aged above 60
years (33.25%) whereas young people aged 16 to 60 years took the
least percentage (11.50%) of antibiotics shown in Table 3.
The reasons for taking the antibiotics were due to suffering
from upper respiratory tract infections (32%), cold and fever (28%),
diarrhea (15%), STDs (4.50%), HTN (6.5%), UTIs (5%), Diabetes
(3%), lower respiratory infections (2%) and others diseases (4%)
(Table 4).
The average highest prescribed antibiotic groups were
cephalosporin (36.00%) macrolides (25.50%) quinolones (21.00%)
penicillins (10.00%) and metronidazole (9.80%) respectively (Table
5). This antibiotic was prescribed for the patients suffering mainly
from infections like Respiratory Tract Infections (RTI), Urinary Tract
Infections (UTI), Diabetes, etc.
Single antibiotic was prescribed in 28.50% of prescription whereas
two or more antibiotics were prescribed in 11.50% of prescriptions.
A 55.25% prescriptions contained complete information regarding
dosage form, 65.00% had complete direction for antibiotics use and
81.00% prescriptions had no laboratory clinical test for prescribing
antibiotics. A 66.5% patients completed full course of antibiotics and
the percentage of recovery from disease was 66% whereas significant
percentage of patients (34%) complained side effects after taking the
prescribed antibiotics (Table 6).
Discussion
Highest percentage of patients (63%) visited village health care
personel because of the presence at root level in Bangladesh where
patients found them easily, a lot of village doctor's practice there. Due
to low facilities and life status, very few MBBS doctors are found away
from Dhaka city that is reflected in the survey results. Quack doctors
Variable Frequency of prescriptions (%) n=2000
MBBS 580 (29%)
BDS 160 (8%)
Village healthcare personel (Quack) 1260 (63%)
Table 1: Prescriptions obtained from different health care professionals.
Gender distribution Frequency (%) n=800
Male 488 (61%)
Female 312 (39%)
Table 2: Gender variability of participants prescribed with antibiotics.
Age distribution (years) Frequency (%) n=800
0-15 442 (55.25%)
16-60 90 (11.25%)
>60 268 (33.50%)
Table 3: Age distribution of respondents prescribed with antibiotics.
Name of diseases Frequency (%) n= 800
Cold and fever 224 (28%)
Upper respiratory infection 256 (32%)
Diarrhea 120 (15%)
STDs 36 (4.5%)
HTN 52 (6.5%)
UTI 40 (5%)
Diabetes 24 (3%)
Lower respiratory infection 16 (2%)
Other diseases 32 (4%)
Table 4: Reasons for visiting doctors.
Name of prescribing antibiotics Frequency (%) n=800
Cephalosporin 288 (36.00%)
Macrolides 204 (25.50%)
Quinolones 168 (21.00%)
Metronidazole 80 (10.00%)
Penicillins 60 (7.50%)
Table 5: Prescribed antibiotic groups.
3. Abu Syed Md Mosaddek, et al., American Journal of Pharmacology
Remedy Publications LLC. 2018 | Volume 1 | Issue 1 | Article 10083
are abundant in village and patients have to pay minor fees for their
visit, as a consequence highest percentage of patients visited Quack
doctors.
Males were prescribed (61%) more antibiotics than females
(39%). Higher prevalence of antibiotics in males also had been
observed in previous studies conducted in Nepal and Bangladesh
[7,9]. Antibiotics prescription rates in this study were found to be
particularly high in the pediatric (55.25%) and geriatric populations
(33.50%) perhaps because these populations are more prone to
infections [10]. Furthermore, established guidelines suggest that
antibiotics should not be the choice of treatment in most diarrhea
cases and they should be used if infection with bacteria is observed
[11,12].
In our research it was found that cephalosporins accounted
36.00% of total antibiotic prescriptions which is high as compared
to the study conducted in Nepal and Turkey but low than India
[7,8,13]. The highest uses of antibiotics were cefixime, cefuroxime
and ceftriaxone for respiratory infections and other infections. This
probably explains why ceftriaxone and cefixime have abnormally high
resistances [14,15]. Acute respiratory tract infection was the condition
associated most frequently with prescription of antibiotic, a result
which substantiates findings from other Asian countries [8,16,17].
Results are also consistent with findings in China, where low-severity
illness was a major reason for giving children antibiotics [16]. This
is probably a result of aggressive marketing policies of Bangladeshi
Pharmaceutical Companies on the physicians combined with
inadequate knowledge of current treatment guidelines. The second
highest prescribed antibiotics were macrolides. The third highest
prescribed quinolones (21.00%) were levofloxacin, sparfloxacin and
ciprofloxacin which is high compared to study conducted in India
and Nepal [7,8].
In Bangladesh many doctors are not prescribing antibiotics
following the prescription guidelines of antibiotics. As a result,
sometimes antibiotics are being prescribed irrationally here to
give quick relief of the patients without taking consideration of the
patient’s disease condition. This is because antibiotics are the most
commonly used and misused drugs by patients and prescribers
[18]. Physicians prescribe maximum antibiotics for outpatients in
Bangladesh without clinical test (81%) and without giving complete
direction for antibiotic use (35%) but the percentage of patient’s
recovery from diseases were 66%. This is because of the physician’s
long service experiences as well as the broad spectrum nature of the
prescribed antibiotics. This kind of antibiotic prescription habit of
physicians may increase the misuse of antibiotics and resistance as
well. Hospitals also account for antibiotic misuse worldwide due to
non-evidence based practice [19-23]. Our survey based research also
reveals that significant percentage of patients receiving antibiotics
in Bangladesh which is relevant to the reports on antibiotic usages
in other parts of Asia, Europe or America because antibiotics are
considered as the second most prescribed drugs in the world, only
next to the drugs indicated for cardiovascular diseases [9,10,24-26].
In a study in Vietnam in 1997, researchers discovered that more
than 70% of patients were prescribed with inadequate amounts of
antimicrobials for serious infections. In Turkey, 15% to 20% of all
prescribed drugs were antibiotics. In China, researchers found that
63% of antimicrobials selected to treat proven bacterial infections
were simply the wrong choice. The same is true even for the countries
like Canada and the United States which developed their antibiotic
usage control mechanisms. In these countries, it is estimated that
physicians also over-prescribe antibiotics (50%) [13].
Conclusion
Because of irrational use of antibiotics leads to the spread
of bacterial resistance to antibiotics and develops complicated
health problems, our findings have important implications for
public education and the enforcement of regulations regarding the
prescription of antibiotics in Bangladesh. The study also urges the
physician to be more professional and careful when antibiotic is
prescribed for the outpatients. Effective strategies should be taken by
the Government of Bangladesh to reduce the use of antibiotics which
could include the development of policies to support the judicious
use of antibiotics, strengthen the control of antibiotics selling and to
implement educational campaigns for rational prescribing.
References
1. Rubin RP. A brief history of great discoveries in pharmacology: in
celebration of the centennial anniversary of the founding of the American
Society of Pharmacology and Experimental Therapeutics. Pharmacol Rev.
2007;59(4):289-359.
2. Park SH. Is Antibiotic resistance microorganism becoming a significant
Variable Response pattern Frequency n =800 Percentage (%)
Pattern of antibiotics Single antibiotic 570 71. 25%
Prescription Information on dosage form
Multiple antibiotics 230 28. 75%
Complete 442 55.25%
Incomplete 300 37.50%
Not mentioned 58 7.25%
Information about the direction for antibiotic use
Complete direction 520 65%
Incomplete direction 280 35%
Laboratory clinical test for prescribing antibiotics
With test 152 19
Without test 648 81%
Completion of full antibiotic course
Yes 532 66.50%
No 268 33.50%
Patient’s compliance
Recovery from diseases 528 66%
Incompliance 272 34%
Table 6: Prescription and usages pattern of antibiotics.
4. Abu Syed Md Mosaddek, et al., American Journal of Pharmacology
Remedy Publications LLC. 2018 | Volume 1 | Issue 1 | Article 10084
problem in acute cholangitis in Korea? Clin Endosc. 2012;45(2):111-2.
3. Faryna A, Wergowske GL, Goldenberg K. Impact of therapeutic guidelines
on antibiotic use by residents in primary care clinics. J Gen Intern Med.
1987;2(2):102-7.
4. Gonzales R, Bartlett JG, Besser RE, Hickner JM, Hoffman JR, Sande
MA. Principles of appropriate antibiotic use for treatment of nonspecific
upper respiratory tract infections in adults: background. Ann Intern Med.
2001;134(6):490-4.
5. Hiramatsu K, Hanaki H, Ino T, Yabuta K, Oguri T, Tenover FC.
Methicillin-Resistance Staphylococus aureus clinical strain with reduced
vancomycin susceptibility. J Antimicrob Chemother. 1997;40(1):135-6.
6. Padmaja U, Adhikari P, Pereira PA. Prospective Analysis of Adverse
Drug reactions in a South Indian hospital. Online J Health Allied Sci.
2009;8(3):12.
7. Shankar RP, Partha P, Shenoy NK, Easow JM, Brahmadathan KN.
Prescribing patterns of antibiotics and sensitivity patterns of common
microorganisms in the Internal Medicine ward of a teaching hospital in
Western Nepal: A prospective study. Ann Clin Microbiol Antimicrob.
2003;2:7.
8. Remesh A, Salim S, Gayathri AM, Nair U, Retnavally KG. Antibiotics
prescribing pattern in the in-patient departments of a tertiary care hospital.
Pharma Pract. 2013;4(2):71-6.
9. Vaccheri A, Bjerrum L, Resi D, Bergman U, Montanaro N. Antibiotic
prescribingingeneralpractice:StrikingdifferencesbetweenItaly(Ravenna)
and Denmark (Funen). J Antimicrob Chemother. 2002;50(6):989-97.
10. Chang SC, Chang HJ, Lai MS. Antibiotic usage in primary care units in
Taiwan. Int J Antimicrob Agents. 1999;11(1):23-30.
11. Diagnosis and Treatment of Respiratory illness in children and adults.
ICSI. 2008.
12. Guidelines for New Diarrhea Treatment Protocols for Community Based
Healthcare Workers-A generic guide to be translated into country specific,
indigenous languages using appropriate local terminology-Center for
Population. Health and Nutrition of the Bureau for Global Programs, Field
support and Research of the U.S. Agency for International Development
(USAID).
13. Karabay O, Özdemir D, Güçlü E, Yıldırım M, İnce N, Küçükbayrak A, et al.
Attitudes and behaviors of Family Physicians regarding use of antibiotics. J
Microbiol Infect Dis. 2011;1(2):53-7.
14. Rashid A, Chowdhury A, Sufi HZR, Shahin AB, Muazzam N. Infections by
Pseudomonas aeruginosa and Antibiotic Resistance pattern of the isolates
from Dhaka Medical College Hospital. Bangladesh J Med Microbiol.
2007;1(2):48-51.
15. Taslima TL, Sabita RR, Donald JG. Multiple antibiotic resistance mediated
by plasmids and integrons in uropathogenic Escherichia coli and Klebsiella
pneumoniae. Bangladesh J Microbiol. 2007; 24(1):19-23.
16. Bi P, Tong S, Parton KA. Family self-medication and antibiotics abuse for
children and juveniles in a Chinese city. Soc Sci Med. 2000;50(10):1445-50.
17. Okumura J, Wakai S, Umenai T. Drug utilization and self-medication in
rural communities in Vietnam. Soc Sci Med. 2002;54(12):1875-86.
18. Chambers HF. General Principles of antimicrobial therapy. In Goodman
and Gillman's The pharmacological basis of therapeutics. 11th ed. Edited
by: Brunton LL, Lazo JS, Parker KL. New York: McGraw-Hill, USA.
2006;1095-111.
19. Stein CM, Todd WT, Parirenyatwa D, Chakonda J, Dizwani AG. A survey
of antibiotic use in Harare primary care clinic. J Antimicrob Chemother.
1984;14(2):149-56.
20. Aswapokee N, Vaithayapichet S, Heller RF. Pattern of antibiotic use in
medical wards of university hospital, Bangkok, Thailand. Rev Infect Dis.
1990;12(1):136-41.
21. Kunin CM, Johansen KS, Worning AM, Daschner FD. Report of a
symposium on use and abuse of antibiotics worldwide. Rev Infect Dis.
1990;12(1):12-9.
22. Zara C, Alerany C, Verger G. Use of restricted antibiotics in primary care.
DICP. 1991;25(6):662-7.
23. YangYH,FuSG,PengH,ShenAD,YueSJ,GoYF,etal.Abuseofantibiotics
in China and its potential interference in determining the etiology of
pediatric bacterial diseases. Pediatr Infect Dis J. 1993;12(12):986-8.
24. Elaine L, Lin SX, Cabilia GD. Antibiotic Use in Hispanic Households, New
York City. Emerg Infect Dis. 2003;9(9):1096-102.
25. Dimiņa E, Kūla M, Caune U, Vīgante D, Liepiņš M, Zeidaka L, et al.
Repeated prevalence studies on antibiotic use in Latvia, 2003-2007. Euro
Surveill. 2009;14(33).
26. Tünger O, Dinç G, Ozbakkaloglu B, Atman UC, Algün U. Evaluation of
rational antibiotic use. Int J Antimicrob Agents. 2000;15(2):131-5.