Arathi S Nair

Chronic Kidney Disease (CKD) characterized by progressive decline in Glomerular Filtration Rate (GFR), is major public health issue associated with morbidity and mortality. Anaemia is one of the most common problems causing morbidity in patients with CKD while they are on dialysis.  Erythropoietin is a major advance in the management of anaemia in CKD which stimulates erythropoiesis by increasing proliferation and maturation of erythroid progenitors and thereby treats anaemia. Prescribing pattern, effectiveness and cost of erythropoietin therapy in patients with chronic kidney disease. This was a Prospective and Observational study conducted for 06 months after obtaining IEC from Apollo Multi-Specialty Hospital, Bengaluru. Patients were enrolled based on enrolment criteria. Data were analysed using suitable statistical tool. Of 152 patients enrolled, 77 (50.65%) patients were in the age group ≥ 60 years, second generation ESAs was mostly prescribed 119(78.28%) than third 01(0.65%) and first 32(21.05%). Significant increase in Haemoglobin, RBC, PCV was observed. We have demonstrated that ESAs were prescribed majorly in Nephrology compared to medicine department. Second generation ESAs were prescribed mostly, darbepoetin alfa 40mcg were preferred over other doses. The changes in Hb, PCV and RBC were significant suggesting ESAs as effective. The side effects reported were less, common and mostly unrelated to ESAs. Based on these finding, we suggest that ESAs is prescribed majorly in Nephrology and is effective and safe in managing anaemia of CKD.

Tigecycline is the first member of a synthetic analogue of tetracycline, known as a glycylcyline. Like other tetracyclines, tigecycline is a broad spectrum bacteriostatic agent. It inhibits protein synthesis by binding to the bacterial 30S ribosomes. Tigecycline has activity against both gram-positive and gram-negative bacteria. It also has activity against many multidrug resistant organisms including methicillin-resistant Staphylococcus aureus (MRSA), Pencillin-resistant Step to coccus pneumonia (PRSP) Vancomycin resistant Enterococcus species (VRE) and extended- spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiellapneumoniae. Tigecycline was approved for use in the United States in 2005.It is currently indicated inpatients 18 year of age and older for the treatment of complicated skin and skin structure infections and intra-abdominal infections due to sensitive organisms. Tigecycline is available in vials of 50 mg for parenteral use under the brand name Tygacil. The recommended dose is 100 mg intravenously initially, followed by 50 mg every 12 hours for 5 to 14 days depending on the severity and site of the infection. The Food and Drug Administration had issued a black box warning due increased risk for death in patients who received tigecycline with certain severe infections. The increased mortality rate is associated with patient who treated for hospital-acquired pneumonia, particularly ventilator-associated pneumonia. The cause of excess deaths is uncertain, but it is likely that most deaths related to the progression of the infection. A reduced dosage is recommended for patients with severe underlying liver disease.