Research Journal of Pharmacy and Technology

Liniya Sunny ¹, R. Lakshmi ¹, M. Vijayakumar ²

Affiliations
1 Department of Pharmacy Practice, Amrita School of Pharmacy, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, IN
2 Department of Cardiology, Amrita Institute of Medical Sciences and Research Centre, AIMS Health Sciences Campus, Kochi, Kerala, IN

Abstract

In developing countries, excess and indiscriminate use of antibiotics in community and hospital settings can lead to adverse effects primary to prolongation of therapy, harbour antibiotic resistance bacteria, rise in health expenditures and decrease quality of life. Antimicrobial resistance in the intensive care unit (ICU) has emerged as an important problem in this scenario. Recent studies revealed that antibiotic use is roughly ten times larger in ICU than in general wards. Research studies are required to gain suitable information concerning the use of antimicrobials (AMA) in ventilated patients which helps in improving the prescribing pattern of antimicrobial and also in executing infection control strategies in the therapy modification of such patients. There is barely limited data on antibiotic prescribing pattern in ventilated patients from India hence this study was carried out with an objective to know more about the antibiotic prescribing pattern and to analyze rationality among the prescriptions. This retrospective study was conducted in the Coronary care unit (CCU) of tertiary care hospital in South India from June 2014 to December 2014. The prescribing pattern of antimicrobials in patients aged between 10-90 years was studied. Total 33 AMA preparations were used either single or in combination. In the study, the commonly used AMAs were beta-lactam antibiotics, particularly ceftriaxone, levofloxacin followed by piperacillin + tazobactam (extended -spectrum penicillins + β-lactamase inhibitor) as single or combination therapy. Combination of AMAs was used in 54.3% of patients. In order to achieve good outcome right use of antibiotic at right time and right dose is required, based on general AMAs prescribing pattern and susceptibility pattern of pathogens, which aid to minimize the irrational employ of antibiotics and extra pressure for resistance.

Keywords

Antimicrobials Agents, Coronary Care Unit, Rational Use, Prescribing Pattern, Infection.

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S. Sreeni ¹, Nafiya Muhammed Zackariah ¹, R. Lakshmi ¹

Affiliations
1 Dept of Pharmacy Practice, Amrita School of Pharmacy, Kochi, Amrita Vishwa Vidyapeetham, Amrita University, IN

Abstract

Morvan's syndrome is a rare autoimmune disorder showing peripheral nervous system hyperexcitability accompanied by autonomic and central nervous system (CNS) hyperactivity. Peripheral hyperactivity includes clinical and electrophysiological evidence of painful cramps, myokymia and neuromyotonia. Acquired neuromyotonia manifests clinically in cramps, stiffness and fasciculation. Autonomic symptoms include hyperhidrosis, fluctuations in blood pressure, tachycardia. CNS hyperactivity include insomnia, agitation, hallucination, confusion, anxiety. We present a case of 48 year old female with morvan's syndrome with central, peripheral and autonomic hyperexcitability. Admitted with alleged history of seizure and was having memory disturbances, paraesthesia and perfused perspiration with palpitation. She tested strongly positive for CASPR2 antibodies and LHI1 antibodies. On the basis of symptoms like neuromyotonia, hyperhidrosis and insomnia with features of encephalopathy and indirect immunofluorescence the patient was diagnosed to have morvan's syndrome. Treatment was started Inj. Methylprednisolone 1gm IV, during this treatment the patient restarted dysautonomia features then intravenous immunoglobulin (IVIG) and T. Cellcept (mycophenolate mofetil) 1mg BD was given. She was managed symptomatically over time.

Keywords

Morvan’s Syndrome, Peripheral Nervous System, Myokymia, Neuromyotonia, Paraesthesia, Methylprednisolone, Intravenous Immunoglobulin.

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