Background: Antibiotics are one of the commonly prescribed drugs over the world. Overprescribing of antibiotics may result in serious bacterial resistance. The main cause of inappropriate prescription of antibiotics is the absence of guidelines and protocols for its use. The aim of this study was to evaluate the appropriate use of ceftriaxone (broad-spectrum third generation cephalosporin antibiotic) in internal medicine wards of Wad Medani teaching hospital in Sudan, as well as comparing its use with reference to the standard of Sudan treatment guidelines and reliable references like British National Formula (BNF) and Sanford guide. Methods: Prospective cross –sectional study conducted in the internal medicine department at Wad Medani Teaching hospital by reviewing the files of all in-patients admitted to medical wards, who received ceftriaxone between November and December, 2018 and the appropriateness use of ceftriaxone was evaluated depending on six criteria: indication, dose, frequency, duration of treatment, culture and sensitivity test and drug –drug interaction Results: A total of 280 admitted patient’s treatment chart containing ceftriaxone injection were analyzed. Ceftriaxone was indicated empirically in 91.1% mostly for respiratory tract infection (35%). Ceftriaxone appropriate dose was given in 59% of patients, inappropriate frequency in 68.9% and incorrect duration in 51.1%. Co-administered drugs with major interaction in 3.6% of patients. Conclusions: This study revealed high inappropriate use of ceftriaxone where it was given without implementing culture and sensitivity test in the majority of patients. This may result in treatment failure so educational programs is recommended to address the irrational use of antibiotic.

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Hypoglycemia is under-reported by many patients; but the time in hypoglycemia among patients with type 2 diabetes (T2D) using pre-mixed (biphasic) insulin is not clear. This pilot study aimed to determine the amount of time in hypoglycemia in this patient cohort. The study included people with T2D, aged 18 or over, treated with pre-mixed (biphasic) insulin for at least 6 months with their most recent HbA1c <7.5% (58 mmol/mol) recorded in medical notes in the last 12 months. Pregnant patients were excluded, as were patients on dialysis. A total of 43 participants (65.1% male) from 12 primary and secondary care sites in the UK enrolled in the 2-week single arm study using the FreeStyle Libre Pro Flash Glucose Monitoring SystemTM. Mean HbA1c was 6.9±0.8% (52.1±8.3 mmol/mol), age was 68.8±8.3 years, BMI was 35.0±9.2 kg/m2, average duration of pre-mixed insulin was 6.8±4.8 years with a mean daily dose of 53.4±40.7 units (mean±SD). The number of blood glucose tests performed per day (self-reported) was 1.9±1.1. Time in hypoglycemia <70 mg/dL (3.9 mmol/L) was 1.35±1.56 hours per day, biological hypoglycemia was experienced by 34 patients. Approximately half of the time in hypoglycemia (<70 mg/dL [3.9 mmol/L]; 0.82±1.06 hours) was during night time hours (23:00 to 06:00). Time in hyperglycemia >180 mg/dL (10.0 mmol/L) was 3.55±3.07 hours per day, which mostly occurred was during daytime hours (06:00 to 23:00) (3.15±2.83 hours per day) (mean±SD). Five anticipated sensor insertion site symptoms were experienced by four participants: erythema (n=2 [1 slight pink, 1 well-defined redness]), pain (n=1), bruising (n=1) and bleeding (n=1), all were mild in severity. This population, with HbA1c in target range, have a greater amount of hypoglycemia than the International Consensus and ADA targets of <1 hour per day, excursions occurred both during the day and at night. Further improvements on this level of glycemic control is challenging for this type of insulin therapy due to further escalation of the risk of nocturnal hypoglycemia. Disclosure I.R. Idris: None. N. Annamalai: None. T. Aung: None. I. Binnian: None. F.W. Gibb: None. M.I. Malik: None.

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