Only sporadic reports of failure of post-exposure prophylaxis for rabies exist in the published literature. We are reporting such a case in a 3-year-old boy. The child had Category III dog bite on his right thigh. He presented with progressive ascending paralysis, finally developing quadriplegia and respiratory paralysis. Typical hydrophobia and aerophobia were absent. He received four doses of antirabies cell culture vaccine. He did not receive antirabies immunoglobulin. The boy succumbed on the 23 rd day of the dog bite. Diagnosis of rabies was confirmed in the laboratory by demonstration of Negri bodies, direct fluorescent antibody test and reverse transcriptase-polymerase chain reaction either on impression smear of brain or a piece of brain taken during autopsy.

IntroductionHypertension is a chronic illness associated with high morbidity & mortality. A large number of antihypertensive drugs alone or in various combinations are available and physicians need to choose the most appropriate drug for a particular patient. The standard treatment guidelines and drug utilization studies at regular intervals help physicians to prescribe drugs rationally. The present study was conducted to analyze the prescription patterns of antihypertensive drugs and adherence to JNC VII guidelines in a North Indian tertiary care hospital. Methods Drug utilization data of 500 hypertensive patients, attending medicine Out Patient Department of Punjab Institute of Medical Sciences Hospital from October 2010 to March 2011 was collected from 24 hour hospital pharmacy. Following groups of anti hypertensive drugs were analyzed; Angiotensin converting enzyme inhibitors (ACE inhibitors), Angiotensin Receptor Blockers (ARBs), Beta Blockers, Calcium Channel Blockers (CCBs), Diuretics, Alpha Adrenergic Blockers and Central Sympatholytics. Patients suffering from essential hypertension with or without other co-morbid conditions were included in the study. Frequency and proportion of prescribing different groups of anti hypertensive drugs as monotherapy or combination therapy and prescription of fixed drug combinations (FDCs) was analyzed. ResultsThe most frequently prescribed antihypertensive drugs were diuretics followed by ARBs, Beta Blockers, CCB's and ACE inhibitors. 42.6% received monotherapy and 57.4% received combination therapy. 41.6% patients received fixed drug combinations. The prescription pattern was found to be in accordance with JNC VII guidelines.

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