Expelling antibiotic molecules out of the cell wall through multiple efflux pumps is one of the potential mechanisms of developing resistance against a wide number of antibiotics in Staphylococcus aureus. The aim of this study was to investigate the association between the antibiotic susceptibility profile and the prevalence of different efflux pump genes i.e., norA, norB, norC, mepA, sepA, mdeA, qacA/B, and smr in the clinical isolates of S. aureus. Sixty clinical isolates were collected from a tertiary level hospital in Bangladesh. The disc diffusion method using ten antibiotics of different classes was used to discern the susceptibility profile. polymerase chain reaction (PCR) was employed to observe the resistance patterns and to detect the presence of plasmid and chromosomal encoded genes. Among the clinical isolates, 60% (36 out of 60) of the samples were Methicillin-resistant Staphylococcus aureus (MRSA), whereas 55% (33 out of 60) of the bacterial samples were found to be multi-drug resistant. The bacteria showed higher resistance to vancomycin (73.33%), followed by ciprofloxacin (60%), cefixime (53.33%), azithromycin (43.33%), and amoxicillin (31.67%). The prevalence of the chromosomally-encoded efflux genes norA (91.67%), norB (90%), norC (93.33%), mepA (93.33%), sepA (98.33%), and mdeA (93.33%) were extremely high with a minor portion of them carrying the plasmid-encoded genes qacA/B (20%) and smr (8.33%). Several genetic combinations of efflux pump genes were revealed, among which norA + norB + norC + mepA + sepA + mdeA was the most widely distributed combination among MRSA and MSSA bacteria that conferred resistance against ciprofloxacin and probably vancomycin. Based on the present study, it is evident that the presence of multiple efflux genes potentiated the drug extrusion activity and may play a pivotal role in the development of multidrug resistance in S. aureus.
The pharmaceutical sector is one of the most promising sectors of Bangladesh. With a view to elimitate the improper dispensing practice as well as matching up to the advancing global standard of health care system, the Ministry of Health and Family Welfare (MHFW), Government of the People’s Republic of Bangladesh had launched the “Model Pharmacy” program in 2016. Our aim was to find out the perception of general people regarding model pharmacy and the study the overall impact in our healthcare system due to its inauguration. A survey was conducted among the major stakeholders of model pharmacy system such as patients, physicians, retailers and DGDA personnel and the data were correlated. All the stakeholders applauded the initiative. However, each section pointed out specific problems. According to the retailers, flexibility in the license getting process was a must as they found the process to be lengthy (31.43%), unnecessarily strict (22.86%) and corrupted (22.86%). The physicians felt the program needed more exposure and recommended campaigning (23.33%). Additionally, they recommended to build up databases of doctors (46.67%) and model pharmacies (50%) for the ease of collaboration between them and the retail pharmacists. Patients were in favor of introducing more model pharmacies (20%) and recruitment of A-grade Pharmacists (6.67%). DGDA personnel noticed the miscommunication between physicians, retail pharmacists and authority to be a major problem. All the stakeholders unanimously focused on regular monitoring of the program to make it a success. Beyond this discussion, we are hopeful that with adequate measures and continuous modification, the “Model Pharmacy” program would become successful in Bangladesh. Bangladesh Pharmaceutical Journal 23(2): 172-180, 2020
Cardiovascular disease (CVD) is one of the most prominent health issues responsible for global death currently. Just like the diverse causes of its pathophysiology, a plethora of medicines from different classes are used for the treatment and management of CVDs. However, in low and middle income countries like Bangladesh, it’s extremely difficult for patients to adhere to their treatment regimen consisting of multiple drugs from different classes as it is both expensive and inconvenient. In such scenario, a polypill or a combination of drugs containing different type of cardiovascular drugs could significantly improve the management of cardiovascular diseases in Bangladesh. Our aim was to get a real-life perspective of the prospect of commercially available polypill in Bangladesh keeping all its stakeholders such as patients, physicians and retailers in mind. A survey was conducted in two different cities (Dhaka and Comilla) and the data were correlated. We got positive response from patients, physicians and retailers. Also, the physicians came up with various combinations of drugs such as – ACEI (ngiotensin-converting enzyme inhibitors) and ARB (angiotensin II receptor blockers) (35%); ARB and CCB (calcium channel blockers) (25%) and ACEI and CCB (15%). However, disease patterns, available drugs and comorbidities in the two regions showed significant deviations as metro city based patients suffered from more severe form of CVDs. Therefore, further survey in different regions should be conducted to understand the overall disease pattern and to come up with optimum combinations for CVD patients. Beyond this discussion, it was evident that commercially available polypill has a great prospect in Bangladesh against CVDs. Bangladesh Pharmaceutical Journal 23(1): 17-25, 2020
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