Background: Drugs used in the treatment of rheumatoid arthritis show significant toxicity and morbidity. The objective of the study was to evaluate the nature and incidence of adverse drug reaction in patients with rheumatoid arthritis on anti-rheumatic drugs and to assess the causality and severity of the documented adverse drug reactions.Methods: The prospective observational study was done for two months in rheumatology outpatient department. All patients were interviewed for basic details, treatment history and adverse drug reactions and were recorded. Causality assessment and severity assessment of the recorded adverse drug reactions were done.Results: About 283 patients attended the rheumatology out-patient department during the two months period out of which 57 patients had one or more adverse drug reaction. The incidence of adverse drug reaction observed in rheumatology out-patient department to anti rheumatic drug was 20.14%. A total of 145 adverse drug reactions were noted in 57 patients. The most common adverse drug reaction reported was epigastric pain (6.89%) followed by headache and dyslipidemia (6.25%). The most common system associated with adverse drug reaction was gastrointestinal system (29.66%) followed by central nervous system and cardiovascular system (15.86%). Reported adverse drug reactions were assessed for causality and maximum belonged to probable (66.9%). Severity assessment revealed that most of the adverse drug reactions were mild (74.48%) in nature.Conclusions: Active surveillance for adverse drug reactions to anti rheumatic drug in patients with rheumatoid arthritis will allow early detection of adverse drug reactions and timely intervention to provide maximum benefit to the patients.

BACKGROUNDChronic suppurative otitis media (CSOM) is the chronic inflammation of the middle ear. It can cause permanent perforation and is known for its' recurrence and persistent infection. Chronic Suppurative Otitis Media (CSOM) is one of the common hearing problems which can cause many complications if not treated at early stage. Injudicious use of antibiotics and increasing use of higher antibiotics has led to persistent change in microbial flora. Hence, the aim of the study is to identify the bacterial isolates causing CSOM and to study their antimicrobial susceptibility pattern. METHODSA hospital based cross sectional study was carried out in Katuri Medical College and Hospital, Guntur, for a period of 12 months from January 2017 to January 2018. A total of 230 patients of CSOM with unilateral or bilateral discharge attending the ENT department were included in the study. Bacterial isolates from ear discharge were identified using standard methods and antibiotic susceptibility testing was done and the results were interpreted. RESULTSOut of 230 samples collected from diagnosed cases of CSOM, significant pathogens were isolated in 167 samples. It was observed that females 52% (120) were found to be more affected with CSOM than males. Majority with CSOM i.e. 34% (78) belonged to 11-20 years age group followed by 27% (61) in 21-30 years age group. Right ear involvement was observed in 37% (86) of the study samples. Pure growth from the sample was observed in majority of the collected samples in this study. Majority of the isolates in this study were found to be Gram negative. In our study the predominant Gram positive species isolated was Staphylococcus aureus and predominant Gram negative species was found to be Pseudomonas aeruginosa followed by Proteus spp., Escherichia coli, Klebsiella spp., Acinetobacter and Citrobacter spp. Antibiotic sensitivity shows Pseudomonas aeruginosa 86.7% (65) with sensitivity towards Piperacillin-Tazobactam, Gentamicin, Amikacin, Imipenem, and Staph aureus showed sensitivity towards Linezolid, a first line drug followed by erythromycin, clindamycin. CONCLUSIONSProper care needs to be taken while treating and it is strongly recommended to use selected local or systemic antibiotics guided by culture and sensitivity. It is mandatory to study each case of CSOM bacteriologically to formulate local antibiotic policy for appropriate use of antibiotics. This will certainly help in achieving a safe ear and to control the organisms developing resistance to prevalent antibiotics