Current trends in treatment of hypertension in Karachi and cost minimization possibilities.

OBJECTIVE: This study finds out drug usage trends in Stage I Hypertensive Patients without any compelling indications in Karachi, deviations of current practices from evidence based antihypertensive therapeutic guidelines and looks for cost minimization opportunities. METHODS: In the present study conducted during June 2012 to August 2012, two sets were used. Randomized stratified independent surveys were conducted in doctors and general population - including patients, using pretested questionnaires. Sample sizes for doctors and general population were 100 and 400 respectively. Statistical analysis was conducted on Statistical Package for Social Science (SPSS). Financial impact was also analyzed. RESULTS: On the basis of patients' doctors' feedback, Beta Blockers, and Angiotensin Converting Enzyme Inhibitors were used more frequently than other drugs. Thiazides and low-priced generics were hardly prescribed. Beta blockers were prescribed widely and considered cost effective. This trend increases cost by two to ten times. CONCLUSION: Feedbacks showed that therapeutic guidelines were not followed by the doctors practicing in the community and hospitals in Karachi. Thiazide diuretics were hardly used. Beta blockers were widely prescribed. High priced market leaders or expensive branded generics were commonly prescribed. Therefore, there are great opportunities for cost minimization by using evidence-based clinically effective and safe medicines.

Pharmacokinetic study of cephradine in Pakistani healthy male volunteers.

To observe and discuss the difference in the pharmacokinetics of cephradine in Pakistani population with the reported data of other ethnic origins. A Single group pharmacokinetic study was conducted having six healthy male volunteers of 20-24 years of age. Blood samples were collected at appropriate times up to 7 hours. Plasma concentrations of cephradine was determined by HPLC technique and pharmacokinetic parameters were determined by both compartmental and noncompartmental methods using Kinetica ver 4.4.1 and Winnonlin ver 5.01. Peak plasma concentration was 11.49+/-1.73 microg/ ml achieved at 0.76+/-0.12 hr, after the administration of 250 mg cephradine to fasting volunteers. Area under the serum concentration-time curve was found to be 16.4+/-1.71 g.hr/ ml. Absorption, distribution, disposition and elimination half lives were calculated as 0.183 +/- 0.038 hr, 0.248 +/- 0.143 hr, 2.126 +/- 0.341 hr and 0.441+/-0.193 hr respectively where as the volume of central compartment and total body clearance were found to be 9.65+/-3.78 L and 15.4+/-1.89 L/hr. The plasma concentration time curves showed the absorption rate constant was 3.968 +/- 0.05 hr(-1), disposition rate constant was 0.333+/-0.05 hr(-1), distribution rate constant was 3.64+/-2.18 hr(-1) and elimination rate constant was 1.738+/-0.468 hr(-1). The value of micro-constants i.e. K(12) (central to peripheral compartment) and K(21) (peripheral to central compartment) were found to be 1.529+/- 1.499 hr(-1) and 0.704 +/- 0.44 hr(-1) respectively, where as MRT and AUMC were calculated as 2.04+/-0.09 hr and 35.92+/-1.86 hr(2) microg/ ml. The findings showed that the results of Pakistani subjects are slightly different when compared with the reported data of other ethnic origin.

Paediatric nosocomial infections: resistance pattern of clinical isolates.

Hospital acquired infections are transmitted to patients by hospital personnel and other patients, or they may arise from patient's own endogenous flora. Children are one of the most susceptible subjects associated in the hospital-acquired infections and have a higher prevalence rate for infections. This problem is at its extremes in developing countries like Pakistan where in most of cases the severity depends on the hygienic conditions of the Hospitals and lack or lapse of infection control measures. To have a surveillance type of data in this regard, one hundred and twenty four isolates of Pseudomonas aeruginosa/Pseudomonas species, Staphylococcus aureus (MRSA/MSSA) and Klebsiella species, that are commonest among the nosocomial infection causing organisms, were collected from pediatric hospital settings in Karachi. A study of incidence and resistance pattern by Kirby Baur disc diffusion method, with selected antimicrobials, was carried out. These isolates were resistant against most antimicrobials tested. Drugs like mmipenem, meropenem, amikacin, vancomycin (especially in MRSA or BRSA), Fucidic acid (for burns and other infections) and some of the 3rd generation cephalosporins were found quite effective.

Antimicrobial activity of Penicillins in common paediatric infections.

Pediatric bacterial infections are very rapidly growing in developing countries. Bacterial resistance to antimicrobial agents is a serious problem in the treatment of Pediatric bacterial infection. One of the most effective ways to control antibiotic resistance, is the development of surveillance programs. For this purpose isolates were collected from paediatric wards of different hospitals. The result shows that isolates were highly resistant against majority of selected antibiotics with increase in the MIC's. In Penicillin group, the most effective agent is Amoxicillin and Clavulanic acid, more than 90% isolates of Staphylococcus aureus were susceptible while other agents, as Cloxacillin, Ampicillin and Amoxicillin alone shows moderate activity against Staphylococcus aureus and Escherichia coli.

Comparative antimicrobial evaluation of Cephalosporins and Quinolones in common paediatric infections.

More than 90% of world's children are born each year in the developing world. Each year 12.9 million children die. Twenty eight percent of death are caused by pneumonia, 23% by diarrheal disease and 16% by vaccine-preventable diseases. Thirty-five thousand die each day, most from common and preventable problems. Health and illness are the result of a complex dynamic of environmental, social, political and economic factors. Bacterial resistance to antimicrobial agents is a continuing serious problem in the treatment of infections. Although this problem was recognized shortly after the commercial introduction of antimicrobial agents, it means that resistance is now emerging at a more rapid rate than ever before. To start with, during the present study an effort has been made to accomplish this task, 84 clinical isolates of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were collected from different hospitals in Karachi. An in vitro study of these isolates was carried out by Agar dilution method using eleven antimicrobial agents and their combination (Lorian, 1991). Among Cephalosporins, third generation Cephalosporin, Cefotaxime was highly effective against Gram positive and Gram negative bacteria. Cefotaxime was active against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. 1.19% isolates of Staphylococcus aureus, 19% isolates of Escherichia coli and 10% isolates of Pseudomonas aeruginosa were resistant against Cefotaxime. In Quinolone group, Ofloxacin was highly active against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. Whereas 28% isolates of Staphylococcus aureus, 26% isolates of Escherichia coli and 11% isolates of Pseudomonas aeruginosa were resistant to Ofloxacin. Twenty six percent isolates of Staphylococcus aureus and 58% isolates Escherichia coli were resistant against Ciprofloxacin.

Resistance pattern of different aminoglycosides against Gram positive and Gram negative clinical isolates of Karachi.

Microbial resistance to majority of the available antimicrobial agent is a serious and global problem. Due to heavy and discriminate usage of antibiotics, high prevalence of drug-resistant bacteria in the indigenous fecal flora, poor standards of sanitation, lack of education and prevalence of malnutrition. This problem is at its extreme in developing countries like Pakistan. For this various Aminoglycosides were tested against different Gram positive and Gram negative isolates. The results showed that these isolates were resistant against most of these antibiotics with increase in MIC's. In Aminoglycoside group Tobramycin was the most effective agent against Staph. aureus and E. coli with MIC90s of 1 microg/ml and 2 microg/ml, while against Klebsiella and P. aeruginosa its activity was moderate to low. Amikacin showed highest activity against P. aeruginosa, E. coli and Klebsiella species with MIC90s of 4 microg/ml and 8 microg/ml. Kanamycin and Streptomycin were not active against the tested isolates.