Search

Objectives: The aim of the study was to evaluate a drug utilization pattern and use of potentially inappropriate medications (PIMs) among geriatric patients admitted to a medical intensive care unit (MICU) of a tertiary care teaching hospital. Methods: A prospective and observational study was conducted among geriatric patients admitted to a MICU of a tertiary care teaching hospital. The data relevant to study variables were collected in a pre-designed case record form. Evaluation of a drug utilization pattern was carried out using WHO core drug prescribing indicators, and the use of PIMs among patients was evaluated using the Beers criteria 2019. Results: The average duration of stay in MICU per patient was 6.98±1.82 days. Hypertension and diabetes mellitus were the two most common comorbidities found in the geriatric patients. Average 10.29±3.46 drugs were prescribed per patient. Average 0.77±0.08 antibiotics were prescribed per patient. Nearly half of the drugs were prescribed in the form of parenteral formulations. About 14.6% of the prescribed drugs were found to be potentially inappropriate according to Beer’s criteria 2019. Conclusion: The majority of the drug classes were prescribed to geriatric patients for the appropriate indications. Prescribing PIMs to geriatric patients was common. The Beers criteria have not yet found their way into mainstream clinical practice.

Metronidazole, a commonly used antiprotozoal and antibacterial medication is usually a safe and rarely reported to cause serious side effects. Major nervous side effects are peripheral ones, while central toxicity is rare. Following the discontinuation of the medication, clinical improvement is seen in the most cases. A 62 years old female patient was presented to hospital after experiencing the symptoms of an unsteady gait, difficulty in walking, impaired coordination of arms and legs, slurring of the speech, headache, tingling and numbness of both the feet and ascending limb weakness following intake of 400 mg metronidazole TDS daily for 2 months. The motor system examination revealed reduced muscle power, and DTR (Deep tendon reflex) was found to be 2+, except ankle reflex absent, while examination of sensory system showed, decrease pain and joint vibration sense up to the neck with absent planter reflex. The axial magnetic resonance imaging study of the brain showed bilateral symmetric hyperintensity involving both dentate nuclei in FLAIR image. The patient’s clinical conditions, on the other hand was deteriorated even after the discontinuation of the medication, hence injection methylprednisolone was given as an empirical therapy and was proved to be successful, and patient was recovered completely.

Background: Medication can cause an injury in the esophagus by local and systemic effect, leading to esophagitis. Many such medications have been identified as a cause of pill-induced esophagitis. This study was performed to evaluate the clinical and endoscopic findings of pill-induced esophagitis.Methods: This was retrospective observational study, conducted among patients diagnosed endoscopically with pill-induced esophagitis at Ansh gastroenterology clinic, Ahmedabad, India, from April 2017 to March 2021. The data of these patients were recorded in pre-designed case record form by evaluating their past medical records.Results: Total 90 patients were diagnosed with pill-induced esophagitis. Retrosternal chest pain (68.9%), odynophagia (41.1%), dysphagia (25.6%), and epigastric pain (14.4%) were common clinical findings. The major culprit medications were antibiotics, and NSAIDs (non-steroidal anti-inflammatory drugs). Common esophageal endoscopic findings were ulcer (84.4%), erosion (17.8%), and active ulcer bleeding (12.2%). Kissing ulcers were observed in the majority (46.7%) of cases. The majority of ulcer and erosion were located in middle third of the esophagus. All the patients were recovered within 6 to 10 days after treatment with PPIs (proton pump inhibitors) and/or antacids, and withdrawal of the causative medication.Conclusions: Pill-induced esophagitis commonly manifests as retrosternal chest pain, odynophagia and dysphagia, and endoscopy reveals kissing ulcer and erosion in the majority of cases. The condition can be treated with PPIs and/or antacids, and withdrawal of the offending medication.