Polymyxin B has resurged in recent years as a last resort therapy for Gram-negative multidrug-resistant (MDR) and extremely drug resistant (XDR) infections. Understanding newer evidence on polymyxin B is necessary to guide clinical decision making. Here, we present a literature review of polymyxin B in Gram-negative infections with update on its pharmacology.
A bstract Background This study presents a real-world scenario for prescription pattern, efficacy, and safety data on the current clinical use of intravenous fosfomycin in critically ill patients in Indian settings. Patients and methods This was a retrospective cohort study conducted for a period of 10 months among critically ill patients admitted to hospital's critical care unit. The primary objective of the study was to analyze the prescription pattern of intravenous fosfomycin, and the secondary objective was to evaluate the safety profile and patient outcomes. Results A total of 309 patients were enrolled, and they were diagnosed with bacteremia (45.3%), pneumonia (15.85%), septic shock (14.24%), and urinary tract infections (UTI) (13.91%). The average dose of fosfomycin given was 11.7 ± 4.06 gm/day. The average duration of the therapy was 4.85 ± 3.59 days with a median duration of 4 days. Fosfomycin was given at 8 hourly dosing frequency to maximum (45.6%) cases. Hypokalemia was the most observed adverse event. The overall survival was seen in 55% of patients. Conclusion Our data suggest that UTI, infection caused by Escherichia coli, and a daily dose of >12 g were associated with better clinical outcomes. The overall survival of critically ill patients receiving fosfomycin was 55%. How to cite this article Zirpe KG, Mehta Y, Pandit R, Pande R, Deshmukh AM, Patil S, et al . A Real-world Study on Prescription Pattern of Fosfomycin in Critical Care Patients. Indian J Crit Care Med 2021;25(9):1055–1058.
Iron deficiency is the most common nutritional deficiency leading to anemia in pregnancy. Conventionally, non-heme form of iron salts has been the mainstay of treatment. However, patient compliance is an important concern with existing oral iron therapy due to gastrointestinal side effects. Heme iron, a better bioavailable and tolerable form of iron can be suitable form of iron for supplementation in pregnancy. Evidence suggests its utility in pregnancy for treatment of iron deficiency anemia with benefits extending to postpartum period. Effective transfer across placenta to fetus further supports its utility in pregnancy. This review discusses in details the absorption kinetics along with clinical evidence on efficacy, safety, and tolerability of heme-iron supplementation in iron deficiency anemia of pregnancy.
Acne is one of the most common skin diseases seen in clinical practice and is caused by multiple factors. Epidemiological data on acne are limited from developing countries. Using a questionnaire survey, the epidemiological data of acne were evaluated with a view to establishing possible contributing etiological factors in dermatology practice in India. Out of 6409 patients included in the study 45% were male and 55% were female. The mean age of the patients was 24.64 years. Smoking habit was reported in 14% of the patients while high glycemic diet (HGD) was seen in half of the cases. Of respondents, 41% knew that acne was due to increased sebum production and blockade of pilosebaceous units whereas 35% had due to excessive cosmetic use. Grade II acne was predominant (47%) and majority of the patients had inflammatory papular acne (51%). The presence of hyperpigmentation (35%) and scarring (29%) was considered to be a reflection of the severity of the acne. Moisturizers and cleansers were one of the most common supportive measure of acne management. Cleansers were prescribed for 53% of the patients whereas 43% of the patients were prescribed moisturizers. Amongst topical treatment, adapalene and BPO combination (34%) was the most commonly prescribed combination followed by adapalene & clindamycin combination (29%). Monotherapy was not commonly prescribed. Most of the patients were managed with combination therapy. Isotretinoin was most commonly prescribed medication in all grades of acne comprising of 40% of the patients. This study presents the demographic features and clinical characteristics of acne in dermatology office practice in India.
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