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Formulation and in vitro characterization of Nystatin-Lidocaine oral gel

Due to changes in the practice of medicine such as the introduction of broad-spectrum antibiotics, immunosuppressive agents, transplants, in-dwelling catheters and the rise of morbid conditions such as diabetes, severe malnutrition in children and HIV/AIDS, the incidence of fungal infections especially candidiasis has increased. Candidiasis is a frequent cause of discomfort in the mouth, pain, altered taste and aversion to food. 

Currently, drug delivery systems such as bucco-adhesive tablets, mouthwashes, oral suspension and oral gels are used for a various conditions of the oral mucosa. These required repeated dosing to achieve optimum concentration at infection sites. Oral gels are preferred because they provide better drug absorption due to longer residence time and can be modified to give controlled release. By formulating nystatin-lidocaine oral gel that will hopefully be locally adsorbed for a longer period of time, hence have fewer dosing frequency than the oral solution.,while lidocaine numbs the pain on site with local lesions..

Nystatin-lidocaine gels were obtained using a two level, three model factorial experimental design. The concentration of carbopol 940 (at 0.25 and 0.7%), tween 20(at 0.5 and 2%) and glycerol (at 0.5 and 0.8%), were varied while the other excipients were held constant. From the formed gels, a 32 factorial design facilitated optimization of the formulations using the Design Expert® (version 12). The formulated gels were evaluated for quality by conducting analytical testing for drug content, spreadability, pH and viscosity. The analytical parameters tested were found to be fit-for-purpose.

Research Supervisors

Dr. Shital Maru and Dr.Alex Okaru

PRESCRIPTION ERRORS IN PEDIATRIC INPATIENTS WITH INFECTIOUS DISEASES AT MBAGATHI DISTRICT HOSPITAL

ABSTRACT

Background: Medicines are the most common health-care intervention, and the errors they cause are a preventable iatrogenic problem. Prescription errors are a type of medication errors in the choice of administration of drugs Literature suggests that children experience prescription errors three times more than adults. This study sought out to find the occurrence of prescription errors in one of the major public district hospitals in Nairobi County.

Methods: The study entailed prospective review of patient files of pediatric in-patients on antimicrobials aged 0-12 years at Mbagathi District Hospital pediatric ward between April and June 2019. Patient data was collected and reviewed for prescription errors.

Results: 206 participants (median age 9months) recruited. Common diagnoses included pneumonia (36.5%), acute diarrheal disease (21.5%), meningitis (10.3%), neonatal sepsis (7.3%), and malaria (4.7%). 502 antimicrobials were prescribed.  Antibacterials were most prescribed (87%). Most patients were on two antimicrobials (40.3%). Prescribing errors were 1298. Each prescription had at least one prescribing error. These were incomplete prescriptions (53.2%), dosing errors (25.3%), indication errors (10.9%) and documentation errors (10.6%).  Weight was a significant dosing error predictor that children receiving artesunate were 30.5 times more likely to be under-dosed (cOR=30.5: 95% CI: 9.3, 99.7, p=<0.001) an 28.7 times more likely to be overdosed (cOR 28.7: 95% CI: 1.95, 422.7, p=<0.001). Benzyl penicillin and ceftriaxone had most dosing errors.

Conclusion: The prevalence of prescribing errors was high. Interventions are in place to promote safe prescribing for pediatric patients.

Core Indicators of Appropriate Drug Use at Public Primary Healthcare Centers in Kisii County, Kenya

Background: Irrational drug use is a global problem. However, the extent of the problem is higher in low-income countries. This study sets out to assess and characterize drug use at the public primary healthcare centers (PPHCCs) in a rural county in Kenya, using the World Health Organization/International Network for the Rational Use of Drugs (WHO/INRUD) core drug use indicators methodology.

Methods: Ten PPHCCs were randomly selected. From each PPHCC, ninety prescriptions from October to December 2018 were sampled and data extracted. Three hundred (30 per PPHCC) patients and ten (1 per PPHCC) dispensers were also observed and interviewed. The WHO/INRUD core drug use indicators were used to assess the patterns of drug use.

Results: The average number of drugs per prescription was 2.9 (SD 0.5) (recommended: 1.6–1.8), and the percentage of drugs prescribed by generic names was 27.7% (recommended: 100%); the percentage of prescriptions with an antibiotic was 84.8% (recommended: 20.0–26.8%), and with an injection prescribed was 24.9% (recommended: 13.4–24.1%). The percentage of prescribed drugs from the Kenya Essential Medicines List was 96.7% (recommended: 100%). The average consultation time was 4.1 min (SD 1.7) (recommended: ≥10 min), the average dispensing time was 131.5 sec (SD 41.5) (recommended: ≥90 sec), the percentage of drugs dispensed was 76.3% (recommended: 100%), the percentage of drugs adequately labeled was 22.6%

(recommended: 100%), and the percentage of patients with the correct knowledge of dispensed drugs was 54.7% (recommended:

100%). Only 20% of the PPHCCs had a copy of KEML available, and 80% of the selected essential drugs assessed were available.

Conclusion: The survey shows irrational drug use practices, particularly polypharmacy, non-generic prescribing, overuse of antibiotics, short consultation time, and inadequacy of drug labeling. Effective programs and activities promoting the rational use of drugs are the key interventions suggested at all the health facilities.

ANTIMICROBIAL USE PATTERNS IN MBAGATHI HOSPITAL, NAIROBI-KENYA: A POINT PREVALENCE SURVEY

ABSTRACT

Background: Antimicrobials are indispensable in the practice of medicine. Their misuse is a great force behind the rapid growth of resistance, risk of serious drug reactions, poor treatment outcomes and waste of resources.  Rational use of antimicrobials is pivotal in curbing increasing resistance. 

Study objective: To establish antimicrobial use patterns in a Kenyan health care facility.

Methods: A Point Prevalence Survey was conducted in all wards. Universal sampling was employed. Patient demographics and clinical data were extracted from the patient files, treatment sheets, and laboratory reports.  Raw data was entered into EPI info. Descriptive and linear regression data analysis was conducted.

Results: A total of 185 patient records were sampled, 146 (78.9%) received at least one antimicrobial. Overall, 363 antimicrobials were prescribed during admission. Each participant was prescribed two antimicrobials on average. The most important risk factors for number of antimicrobials used were HIV status, prior hospitalization, catheterization and nutritional status. Antibiotics formed the biggest proportion of antimicrobials prescribed in Mbagathi Hospital (n=294, 81%) followed by antivirals (n=48, 13%). Most prescribed antimicrobial was ceftriaxone at 46% while the commonest indication for antimicrobial use was pneumonia (33%). Culture and sensitivity tests were only ordered in (n=7, 3.8%) of the cases.

Conclusion:  Prevalence of antimicrobial use was above the World Health Organization value of 30% or less. Ceftriaxone was used extensively. Empiric prescribing was rampant. The hospital medicines and therapeutics committee should set up an antimicrobial stewardship committee to ensure judicious use.

Key words: Antimicrobial, Antimicrobial resistance, Point prevalence survey