Background: Typhoid fever is a public health concern in developing countries. Developed countries have also been influenced due to tourism. The drugs used for treating typhoid fever can and have been rendered unusable due to resistance. Monitoring and updating the Salmonella antibiogram is needed to prevent therapeutic failures. This study confirms to the same goal.Methods: This study was conducted retrospectively in a tertiary care hospital in North Kerala with data collected from 2013 to 2017. Years were categorized into four quarters to analyze seasonality. Positive blood culture samples of adults, identified to be Salmonella typhi or paratyphi were subjected to antimicrobial sensitivity.Results: 37 Salmonella isolates were included. July-September quarter was found to have maximum incidence of typhoid fever followed by April-June quarter. All isolates were 100% sensitive to ceftriaxone, chloramphenicol, and amoxicillin-clavulanic acid. Sensitivity lacked for nalidixic acid (48.65%), ciprofloxacin (48.65%) and levofloxacin (70.27%). Sensitivity to ampicillin and cotrimoxazole was 86.49% and 91.89%. Azithromycin efficacy was good overall (94.59%) with resistant isolates emerging in final year of this study.Conclusions: Monsoon is most conducive for typhoid fever occurrence followed by summer. This study confirms utility of ceftriaxone and futility of quinolones and fluoroquinolones in typhoid fever treatment. Azithromycin has started showing emergence of resistance. Ampicillin and cotrimoxazole cannot be relied upon due to variability in sensitivity patterns. Chloramphenicol showed full efficacy throughout the study period which is encouraging. Amoxicillin-clavulinic acid, surprisingly was 100% effective throughout study period. However, no contemporary data is available for comparison.
Background: Prescribing errors are a subset of medication errors which have a potential for grave harm to the patient. Identification and acknowledgement of such errors can ameliorate much of this danger. Studies of prescribing errors are sparse in India. Such studies, whatever have been conducted, mainly focus on the out-patients or the patients on discharge. Hence, this study was undertaken to study the prescribing errors in prescriptions generated for patients admitted in wards of a corporate hospital in North India.Methods: The prescriptions for in-patients admitted in wards were analyzed for different types of prescribing errors in individual drug orders and prescription as a whole.Results: The prescribing error rate was found to be 3.3% in this study. Of all errors, errors leading to delays in patient care (i.e. Errors of prescription writing) (54.54%) and erroneous copying of the prescription to the drug chart by junior/ resident doctors (Transcription errors) (31.31%) were found to be the major causes of prescribing errors in this study. Of the former category, prescribing a wrong strength (24.24%) and illegible drug orders (12.12%) were the most numerous error subtypes. Errors leading to sub-optimal patient care (i.e. Errors of decision making) were least identified of which Therapeutic duplication (12.12%) was the most common subtype.Conclusions: The error rate found in this study is comparable to the data available from developed countries. However, there are significant differences in the occurrences of error subtypes found in this study as compared to the studies of the west.
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