Journal of Research in Pharmacy Practice

Abstract Objective: Pharmacists have a remarkable role in rational use of drugs by dissemination 
of drug information to guide patients, physicians, and policy makers. The present study was 
undertaken to evaluate the pharmacists’ view point about the main factors affecting current 
drug use pattern regarding rational drug use and the most effective strategies for improving 
and promoting rational drug use among pharmacists.
Methods: In a cross‑sectional survey, pre‑designed questionnaires were filled in convenient 
sampling by pharmacists who had attended the congress of rational drug use in Tehran, Iran.
Findings: A total of 144 pharmacists with the average age of 40.78 years old were enrolled to 
the study. Data indicated that the most priorities in irrational use of drugs from pharmacists’ 
view point were lack of appropriate cooperation and communication between physicians and 
pharmacists(39%), pharmacists’ low tariff and economic issues (34%), lack of public knowledge 
about drug usage (45%), and lack of supervisory regulations on pharmacy practice (15.8%).
Conclusion: In this study, lack of public knowledge and awareness about appropriate use 
of medicines was the most important element from pharmacists’ viewpoint in occurrence 
of irrational drug use. Dissemination of information and compiling of diverse strategies 
in education, management, regulation, and finance can be very efficient due to a strong 
relationship between drug policies and performance of regulations and supervisions as well 
as drug services.

Abstract Objective: Various non‑hormonal agents have been used for the treatment of hot flashes 
in women with menopause. Some studies have reported that gabapentin appears to be an 
effective and well‑tolerated treatment modality. The aim of this study was to evaluate whether 
the treatment with gabapentin is effective in reducing hot flash frequency and severity and 
also to compare gabapentin 100 mg/day, 300 mg/day and conjugated estrogen in this regards.
Methods: In this comparative clinical trial, 100 post‑menopausal women attending outpatient 
clinics of Isfahan University hospitals were included from April 2008 to February 2009. 
Participants randomly received gabapentin 300 mg/day, gabapentin 100 mg/day, or conjugated 
estrogen 0.625 mg/day for 12 weeks. Frequency and severity of hot flashes and adverse 
effects were compared among the three groups.
Findings: From all, 16 participants dropped out. There were no significant differences among 
the groups before intervention in terms of age, body mass index and baseline hot flash 
frequency and severity. Hot flash diaries were used to record the frequency and severity of 
hot flashes. After the treatment period, there was a significant decrease in both severity and 
frequency of hot flashes in all three groups. Post‑hoc analyses showed that the frequency and 
severity of hot flashes were significantly lower in those who received gabapentin 300 mg/day 
or estrogen 0.625 mg/day compared to those who received gabapentin 100 mg/day. There 
was not statistically significant difference between those who received gabapentin 300 mg/day 
and those who received estrogen. Very few adverse effects, mostly gastrointestinal discomfort 
were observed in both gabapentin groups (8%).
Conclusion: Gabapentin 300 mg/day could be useful to relieve hot flashes in women 
for whom hormone therapy is not suitable or when hot flashes do not respond to other 
therapies. Further researches are needed to determine the efficacy of gabapentin use for 
longer periods or at higher doses.

Abstract Objective: The purpose of this study is to analyze the antibiotic sensitivity pattern of 
microorganisms, to study the antibiotic usage pattern, and to conduct a cost‑effectiveness 
analysis (CEA) for the antibiotics prescribed in a tertiary care teaching hospital in south India.
Methods: This prospective study was carried out in the General Medicine and Pulmonology 
departments of the hospital for a period of 6 months. The study was carried out in three 
phases: A prospective analysis to check the sensitivity pattern of microorganisms to various 
antibiotics, data extraction and determining the cost of antibiotics and finally evaluation of 
the sensitivity pattern of microorganisms and the antibiotic usage. A total of 796 documented 
records were analyzed.
Findings: It was found that Escherichia coli was the major organism identified in 36.4% of 
the isolated specimens, followed by Klebsiella sp. (18.9%), Streptococcus pneumoniae (15.8%),
Staphylococcus aureus (12.4%), and Pseudomonas (9.3%). The sensitivity pattern data of the 
prospective study revealed that E.coli was highly sensitive to Amikacin (99.3%), Klebsiella to 
Amikacin (93.8%), Pseudomonas to Meropenem (97.6%), and S. pneumoniae to Ofloxacin (93.8%). 
In the prescribing pattern study, it was found that the most common disease (21.2%) was 
found to be lower respiratory tract infection in 51 patients. Cephalosporins(73%), in particular 
Ceftriaxone (63.5%) was highly prescribed, followed by fluoroquinolones(53.9%). In the CEA, 
it was revealed that Ceftriaxone was the cost‑effective antibiotic with a cost‑effectiveness 
ratio (CER) of 78.27 compared to Levofloxacin, which had a CER of 95.13.
Conclusion: Continuous surveillance of susceptibility testing is necessary for cost‑effective 
customization of empiric antibiotic therapy. Furthermore, reliable statistics on antibiotic 
resistance and policies should be made available.

Abstract Objective: Endotracheal intubation is a common procedure in neonatal care. The objective 
of this study was to determine whether the premedication with remifentanil before intubation 
has analgesic effects in newborn infants.
Methods: A total of 40 premature infants who needed endotracheal intubation for 
intubation‑surfactant‑extubation method were randomly assigned in two groups of an 
equal number at two university hospitals. The control group was given 10 µg/kg atropine 
IV infusions in 1 min and then 2 ml normal saline. In the case group, the atropine was given 
with the same method and then remifentanil was administered 2 µg/kg IV infusions in 2 min.
Findings: For remifentanil and control groups, the mean birth weight were 1761 ± 64 
and 1447 ± 63 grams (P = 0.29), and the mean gestational ages were 31.69 ± 3.5 and 
30.56 ± 2.8 weeks (P = 0.28),respectively. Using premature infant pain profile score, infants
who received remifentanil felt significantly less pain than the control group (15.1 ± 1.6 vs.
7.5 ± 1.4; P < 0.001). There were no significant differences in the duration of endotracheal
intubation procedure (20.8 ± 6 vs. 22.8 ± 7.3 s; P = 0.33), the number of attempts for 
successful intubation and oxygen desaturation between groups.
Conclusion: Premedication with remifentanil has good analgesic effects for endotracheal 
intubation in premature infants without significant derangements in mean blood pressure
and oxygen saturation.

Abstract Objective: The primary objective of this study is to examine the medication adherence 
levels (as a function of pharmaceutical care) and its contributing factors in schizophrenic 
patients receiving antipsychotic drugs.
Methods: This was a cross-sectional study administering a structured questionnaire to 
231 patients. Adherence was measured through patient self-reporting. Association between 
independent variables and adherence to antipsychotics were measured through odds ratios 
(OR) in the univariate analysis while the best predictors of adherence were determined 
through the multiple logistic regressions.
Findings: Adherence level was found to be 65.8% (95% confidence interval [CI]: 59.3-71.9%). 
The following factors were identified to be associated with adherence in the univariate 
analysis: age (OR 1.088), sex (OR 1.231), employment (OR 0.366), marital status (singles, OR 
0.022), drug adherence counseling (OR 11.641), twice a day frequency (OR 8.434), alcohol 
non-intake (OR 1.469), educational level (primary OR 1.9312, secondary OR 11.022, tertiary 
OR 4.771), occupation (public servant 6.273). In the multivariate analysis, age, three times 
a day frequency of drug intake, singles and educational levels such as primary, secondary or 
tertiary school, strongly affected adherence (P < 0.05).
Conclusion: Although patients adherence level was high (65.8%), there is a need to 
emphasize that pharmacists spend more time in counseling and educating patients, especially 
younger ones on drug adherence before any antipsychotic medications are dispensed. 
Furthermore, patients should be taught the use of adherence devices such as reminders so 
that adherence to antipsychotic medications can be optimized.

Abstract Objective: Recurrent aphthous stomatitis (RAS) is a common, painful ulcerative disorder 
of the oral cavity with unknown etiology. No documented cure exists and topical application 
of medications aims to reduce pain associated with this condition. The aim of this study was 
to evaluate the efficacy of Punica granatum (PG) extract on the clinical management of RAS.
Methods: A total of 40 patients with RAS participated in this randomized, double‑blind, and 
placebo‑controlled study. During three episodes of RAS, the efficacy of topical PG gel (10%) 
was evaluated. Patients were randomly assigned to use placebo gel or PG gel daily. The time 
of pain elimination and the time of complete healing were recorded and the pain degree was 
assessed and recorded by each patients in different time intervals including: Before using 
the oral gel (day 0), and on days 1, 3, 5, 7 after using the product. Data were analyzed using 
the repeated measures ANOVA, paired and independent t‑test.
Findings: Mean time of pain elimination showed a significant difference (P < 0.001) between 
PG group (3.4 ± 1.09) and placebo group (5.9 ± 0.6). The mean duration of complete healing 
also showed a significant difference (P < 0.001) between PG group (5.3 ± 0.81) and placebo 
group (8.6 ± 0.99). The visual analog scale score in PG group was significantly less than the 
placebo group in all time intervals (day 1 to day 7) (P < 0.001).
Conclusion: The findings of this study revealed that PG extract in the form of oral gel (10%) 
may be beneficial in reducing RAS pain and has a positive effect in reducing the overall time 
period of complete healing. It was concluded that PG is an effective herbal medicine for 
the management of RAS.

Abstract Objective: To characterise consumer adverse drug reaction (ADR) reports for 
phosphodiesterase type 5 (PDE5) inhibitors.
Methods: We included ADR reports submitted by adults to the European ADR 
database  (EudraVigialnce) from 2007 to 2011. ADRs were classified according to type,
seriousness and age and sex of consumers. The unit of analysis was one ADR.
Findings:Totally,328ADRs were reported for sildenafil and vardenafil,and only 5% of these
were serious.The largest number of reported ADRs was found for sildenafil, i.e., “lack of
efficacy” and/or “drug efficacy decreased” (n = 134) and “headache” (n = 21).
Conclusion: ADRs reported by consumers for PDE5 inhibitors were relatively low, and
only few ADRs were serious.

Abstract