Javedh Shareef

Introduction:Diabetic foot ulcer and infections are one of the major complications in diabetic patients leading to frequent hospitalization and increased mortality. Knowledge about the microbes that cause infections will be helpful for providing appropriate antimicrobial therapy. Aim:To evaluate the bacteriological profile of patients with diabetic foot ulcers and their antibiotic susceptibility pattern. Methodology:A cross-sectional study was carried out for a period of eight months in the Department of surgery in patients with diabetic foot ulcer at a tertiary care teaching hospital. Patient data relevant to the study were collected using a standard data collection form designed as per the need of the study. Details of the organisms isolated and susceptibility pattern were collected from microbiology department. Results:A total of 122 pathogens were identified from 71 patients with male (63.38%) predominance over females (36.61%). Out of the 71 patients, 38 (53.52%) patients had monomicrobial infections and 33 (46.47%) patients had polymicrobial infections. Of the total 122 organisms, 79(64.75%) organisms were found to be gram negative organisms and 43(35.24%) were gram positive. Pseudomonas aeruginosa found in 22 (18.03%) patients was the predominant pathogen isolated followed by Klebsiella pneumonia found in 18 (14.75%) patients. The gram-positive organisms isolated showed maximum susceptibility towards antibiotics Teicoplanin and Linezolid while the gram-negative organisms showed susceptibility to Imipenem, Meropenem, and Piperacillin/Tazobactum combination. Conclusion:The study showed a preponderance of gram-negative bacilli among the isolates from the diabetic foot ulcers. It is recommended that antimicrobial sensitivity testing is necessary for initiating appropriate antibiotic regimen which will help to reduce the drug resistance and minimize the healthcare costs.

Uter database of hospital pharmacy department. The difference between the maximum and minimum prices of various brands manufactured by different companies with the same drug was analysed, and percentage variation and the cost ratio in the prices was estimated. Statistical Analysis Used: Descriptive statistics such as frequency and percentage. Results: Overall, prices of 15 single drug antibiotics available in 24 strengths marketed in 68 brands and 7 fixed-dose combinations available in 15 strength marketed in 49 brands were analysed. The maximum price variation and highest cost ratio between brands of single drug parenteral antibiotics were found to be more in amoxicillin 250 mg (270.43%) with cost ratio (1:3.7) and minimum in ceftazidime 2000 mg (5.26%) with cost ratio (1:1.05). In the case of fixed-dose combinations of parenteral antibiotics, the highest cost ratio (1:4.20) and percentage price variation (320.84) was found to be with cefoperazone 500 mg + sulbactam 500 mg combination, and the lowest cost ratio (1:1.11) and the percentage price variation (11.44) were found to be amoxicillin 600 mg + clavulanate 600 mg combination. The percentage price variability of 12 brands was 0%–25%, and for 26 brands, it was 50%–75%. For 13 brands, percentage price variability was >100%. Conclusions: Pharmacoeconomics aspects should be taken into consideration by healthcare practitioners while prescribing antibiotics to the patients for infectious disease management which will facilitate compliance, minimise antibiotic resistance and treatment failure....

Introduction: Diabetes mellitus is a chronic disease affecting multiple organ systems leading to significant morbidity and mortality. Objectives: To assess the impact of pharmacist led interventions in the quality of life in patients with type 2 diabetes mellitus. Methods: A prospective, interventional study carried over a period of 12months from October 2014-September 2015 in general medicine outpatient department of a tertiary care teaching hospital. A total of 106 Patients who fulfilled the study criteria were randomized into intervention group (55 patients) and usual care groups (51 patients) and completed the study. Patient information leaflet and medication counselling was provided to intervention group by the clinical pharmacist. Quality of life scores were collected by using Audit of diabetes dependent quality of life questionnaire to both the groups at the beginning and at the end of the study. In a group of 30 patients in the intervention group glycosylated haemoglobin was recorded at baseline and final follow up. These quality of life scores and glycaemic levels (fasting plasma glucose and post prandial plasma glucose) were obtained and compared between both groups at the end of the study. Results: The intervention group showed an improvement in the quality of life score from-2.69±1.53 at the baseline to-1.92±0.59 at the final visit (p<0.05). The average HbA1c values decreased from 9.15±1.37 to 7.21±0.844 in the intervention group (p<0.05). There was a significant decrease in the post prandial blood glucose from 260.30±93.43 to 165.19±33.44 and fasting blood glucose from 163.45±56.03 to 114.45±18.87 from the baseline value to the final follow up in the intervention group (p<0.05). Conclusion: The study shows that clinical pharmacist guided appropriate interventions were found to be effective in achieving better glycaemic control and better quality of life in patients with diabetes mellitus.