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Objectives: In current clinical practice, utilization of Proton Pump Inhibitors (PPIs) has increased enormously as OTC drug as well as the commonly prescribed drug in majority of the prescriptions. PPIs are predominantly indicated in prescriptions for the purpose of prophylaxis of antibiotics and analgesics. The study aimed to assess the prescribing pattern of PPIs in the Department of General Medicine of a tertiary care hospital. Methods: This is a prospective observational study conducted in the Department of General Medicine for a period of 1 year from August 2017 to July 2018 to analyse the prescribing pattern of PPIs. The medication charts of both inpatients and outpatients of General Medicine department was reviewed. Core information such as demographic characteristics, diagnosis, and current medications were recorded. The patients were regularly monitored for drug – drug interactions. Results: Of 1019 prescriptions, 908 (89%) prescriptions were found to have PPIs. Pantoprazole 749 (82.49%) was the most commonly prescribed PPI followed by esomeprazole 124 (13.66%). The indications for PPI therapy were acute gastroenteritis 103 (11.34%), ulcers 7 (0.77%), gastro esophageal reflux disease 5 (0.55%), gastrointestinal bleed 3 (0.33%), ulcerative colitis 2 (0.22%), inflammatory bowel disease 1(0.11%), esophageal and gastric injury 1(0.11%) and gastric erosion 1 (0.11%). PPIs were found to be prescribed with antibiotics 681 (75%) followed by non-steroidal anti-inflammatory drugs 179 (19.7%). Conclusions: The study showed inappropriateness in prescribing patterns of PPIs leading to increased therapeutic burden and treatment cost. This necessitates formulation of standard therapeutic guidelines for rationalizing the utilization of PPIs.

Background: Antibiotics are extensively used for the treatment of minor, moderate both life threatening and minor infections. Irrational use of antibiotics increases the risk of bacterial resistance. Hence, the present study was aimed to assess the most commonly prescribed antibiotics in the Department of General Medicine in a tertiary care hospital. Methodology: A prospective observational study was carried out at the Department of General Medicine, M.S. Ramaiah Medical Teaching hospital, Bangalore, India over a period of five months from January 2015 to May 2015. Patient’s case sheets, treatment charts and laboratory investigation were used as the source of data. Results: The mean age of the study population and duration of hospitalization was 38.54±12.27 and 6.15±2.56 days respectively and the mean number of antimicrobials per prescription was 1.44±0.74. The total number of antibiotics prescribed was 197. The most commonly prescribed antibiotic classes were cephalosporin (62.43%) among which ceftriaxone was the most commonly prescribed drug. Conclusions: As antibiotics are the most commonly prescribed drugs therefore development of antibiotic use policy is very essential not only to prevent antibiotic resistance but also to reduce the treatment expenditure.

Bartonella quintana infection can cause severe disease that includes clinical manifestations such as endocarditis, chronic bacteremia, and vasoproliferative lesions of the skin and viscera. B. quintana bacteria is transmitted by the human body louse (Pediculus humanus corporis) and is associated with homelessness and limited access to hygienic services. We report B. quintana infection in 2 kidney transplant recipients in the United States from an organ donor who was experiencing homelessness. One infection manifested atypically, and the other was minimally symptomatic; with rapid detection, both recipients received timely treatment and recovered. B. quintana was identified retrospectively in an archived donor hematoma specimen, confirming the transmission link. Information about the organ donor’s housing status was critical to this investigation. Evaluation for B. quintana infection should be considered for solid organ transplant recipients who receive organs from donors with a history of homelessness or of body lice infestation.

Abstract Background The Meningitis/Encephalitis FilmArray® Panel (ME panel) was approved by the U.S. Food and Drug Administration in 2015 and provides rapid results when assessing patients with suspected meningitis or encephalitis. These patients are evaluated by various subspecialties including pediatric hospital medicine (PHM), pediatric emergency medicine (PEM), pediatric infectious diseases, and pediatric intensive care unit (PICU) physicians. The objective of this study was to evaluate the current use of the ME panel and describe the provider and subspecialty practice variation. Methods We conducted an online cross-sectional survey via the American Academy of Pediatrics Section of Hospital Medicine (AAP-SOHM) ListServe, Brown University PEM ListServe, and PICU Virtual pediatric system (VPS) Listserve. Results A total of 335 participants out of an estimated 6998 ListServe subscribers responded to the survey. 68% reported currently using the ME panel at their institutions. Among test users, most reported not having institutional guidelines on test indications (75%) or interpretation (76%). 58% of providers self-reported lack of knowledge of the test’s performance characteristics. Providers from institutions that have established guidelines reported higher knowledge compared to those that did not (51% vs. 38%; p = 0.01). More PHM providers reported awareness of ME panel performance characteristics compared to PEM physicians (48% vs. 27%; p = 0.004); confidence in test interpretation was similar between both groups (72 vs. 69%; p = 0.80). Conclusion Despite the widespread use of the ME panel, few providers report having institutional guidelines on test indications or interpretation. There is an opportunity to provide knowledge and guidance about the ME panel among various pediatric subspecialties.