Acamprosate with dual mechanism of action as glutamate antagonist and GABA agonist can be a potential target to decrease the severity of sensorineural tinnitus.Objective:(1)To study the effectiveness of acamprosate in providing subjective relief and objective improvement in patients having tinnitus of sensorineural origin. (2) To evaluate the adverse events related to the use of acamprosate and also determine the change in quality of life (QOL) parameters.Materials and Methods:The study was randomized double-blind, placebo controlled, crossover. Forty adult subjects (>18 years of age), of either sex with tinnitus of sensorineural origin, were administered either acamprosate 333 mg TDS or matched placebo for a period of six weeks followed by a washout period of one week. Drug therapy was switched for another six weeks in consonance with the crossover design. The effect of acamprosate and placebo on subjective relief and objective improvement was evaluated by using modified tinnitus severity, QOL scores and audiometry with tinnitus matching in frequency and loudness.Results:At the end of the study, the drug had shown a statistically significant improvement in reducing the tinnitus score in 92.5% of the patients and placebo with an improvement in 12.5% of the patients. The drug was well tolerated without any serious drug reactions.Conclusion:Acamprosate is an effective drug in treating the severity of sensorineural tinnitus without causing much of the side effects.

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Infectious diseases form the major health-care burden for the developing world and antimicrobials prove to be the magical drugs to combat this. The discovery of antimicrobial agents was boon for the global health-care system and the wonderful cure by antimicrobials shifted the disease trends from infectious to life-style diseases in the developed world. Sudden appearance of the antimicrobial resistance hampered the whole success; and this situation is further complicated by the dry pipeline of antimicrobial development. Now, this is heading the world towards the "preantibiotic" era. The development of new antimicrobials is not able to match pace with the speedily growing antimicrobial resistance. Development of new active pharmaceutical principles is a difficult and costly practice. The other approach to achieve the same is by rejuvenating the existing antimicrobials. These contemporary novel approaches include bacteriophage therapy, fecal microbiota transplantation, antimicrobial peptides, combination drug therapy and antimicrobial adjuvants to combat antimicrobial resistance forms the main stay of discussion of this article.

Introduction: Cutaneous adverse drug reactions (ADRs) are the most frequently occurring ADRs to drugs. These reactions have a varied morphology and are responsible for significant mortality and morbidity. The aim of this study is to characterize the morphological patterns of cutaneous ADRs and to determine the incriminating agents. Method: The study was carried out in the Dermatology, Venereology and Leprosy department, Guru Nanak Dev Hospital, Government Medical College, Amritsar from 1 st March 2014 to 31 st May 2015. World Health Organization-Uppsala monitoring centre (WHO-UMC) causality scale was used to determine the causality of cutaneous ADRs and severity was assessed using Hartwigs severity scale. Results: In the present study, the highest incidence of cutaneous ADRs was in the age group of 31-40 years (25.0%), and more frequently in female patients (54.2%). Antimicrobials were the most commonly implicated drugs (37.5%) followed by Non-Steroidal Anti-inflammatory drugs (NSAIDs) (25.0%), various combination drugs (10.0%), corticosteroids and antiepileptics (6.6%). The most commonly observed morphological pattern was of Fixed drug eruptions (33.3%) followed by maculopapular rash (30.8%) and Steven Johnson Syndrome (5.8%). Causality assessment was certain, probable and possible for 1.6%, 93.3% and 41.5% of the reactions, respectively. 109 cases were of level 3 severities, 10 cases to level 4 severities and one case of level 7 where ADR was responsible for death in one patient. Discussion: Most of the adverse drug reactions are preventable, provided the drugs are used rationally. Antimicrobials were the most common causative group and fixed drug eruption was the most frequently encountered morphological pattern. Therefore it is imperative that in each patient the risk of drug administration should be weighed against the expected therapeutic benefit.

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Drug-induced liver injury is a major health problem. Its predominant forms include acute hepatitis, cholestasis, and a mixed pattern. Ceftriaxone is a third-generation cephalosporin and is widely used in the postoperative period due to its wider spectrum, longer half-life, and better tissue penetrability. Earlier cases of high aminotransferase levels and hepatitis have also been reported with the use of ceftriaxone. Here we report a case of cholestatic hepatitis with intravenous ceftriaxone.

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