K.V. Ramanath

Steroids are widely prescribed and used by practitioners due to powerful anti-inflammatory and immunosuppressive actions1. So, care should be exercised in the rational selection of steroids2. Hence this study was carried out to asses the prescribing pattern of steroid usage. This was a prospective, observational and an intervention study.The patient data was collected in well design data collection form and subjected to descriptive statistical analysis 165 cases assessments shows, the mean age of inpatient & out patient was 56.58/55.10 years and male patients were more in both the groups. The occupational results showed Farmers and businessman’s were more followed by House wife. 52.9% IP - 54.1% OP were alcoholics, 58.7% IP - 73.8% OP were smokers. Steroids were used more in respiratory diseases like COPD [18.2% IP /85.2% OP] , Acute bronchitis  [24.0% inpatients] and Bronchial Asthma [11.5% IP/ 9.9%OP]. Among steroids, Budesonide [64.4%IP/ 85.2%OP ] was frequently used followed by Prednisolone [(5.7%IP/ 14.8%OP ], and Dexamethasone 6(5.7%) and Hydrocortisone 25 (24.2%) in IP. 50.0% Nebulization forms were  used widely, followed by Injection(29.8%), 85.2%  OP was  used Inhalers, 55.8% IP& 14.8% (OP) prescriptions had steroidal drug interactions.  81.8% inpatients were counseled correct use of steroids. The mean hospital stay of inpatients was 6.11 with SD of 4.86 days. This study showed that the prescribing of steroids was rational &. Patient counseling services were helped them to understand their therapy, disease. Even though the drug interactions observed with the steroids, benefits of therapy were noticed more.

The present study was carried out to monitor, estimate the prevalence and consequences of ADRs on treatment of TB and to assess causality, predictability, preventability and severity of the ADRs. A prospective observational and active surveillance study was conducted over a period of 9 months. Each reported ADR was assessed for its causality, severity, predictability and preventability as per standard algorithms. The management and outcome of ADRs were determined. A total of 128 ADRs (in 53 patients) were identified out of which the prevalence of ADRs in female was found to be 31.58% and 29.66% in male patients. The causality assessment by Naranjo’s scale showed that out of 128 ADR’s, 128 (100%) ADR’s were probable and based on WHO probability assessment scale 119(92.97%) were possible where as 9(7.03%) were probable. Preventability assessment showed that 125 (97.66%) were not preventable and 03 (2.34%) were definitely preventable. Severity Assessment by Modified Hartwig and Siegel Scale showed that 82 (64.06%) ADRs were mild and 46(35.94%) ADRs were moderate. 128(100%) were found to be predictable. Majority of the ADRs were recovered without giving symptomatic treatment. The study concluded that there is a need of a system for proper monitoring of ADRs caused by anti-TB drugs in RNTCP centre.  The counselling of patients for timely prevention, detection and management of ADRs will helps in further ADR occurrence minimisation.