Abstract

PROJECT TOPIC: PRESCRIBING PATTERN AND EVALUATION OF RIPASA SCORE IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Agatha Mol Eldhoes*, Amrutha Antony P. Irene Jose and Aji Varghese

ABSTRACT

Appendicitis is an inflammation of appendix.[2] It is treated conservatively or surgically. In both cases different types of antimicrobials agents are used. So, antimicrobial agents play a main stay in its management.[1] Aim & objective: The main aim of the study was to assess prescribing pattern of drugs in appendicitis and to evaluate the efficiency of RIPASA Score in the diagnosis of acute appendicitis. Method: A Prospective observational study was carried out in surgical and general medicine department of a 450 bedded tertiary care hospital for a period of 6 months. 100 patients admitted to surgery and general medicine department with complaints of abdominal pain were included in the study. Patients admitted to other departments and who were not willing to participate in this study were excluded. Demographic details and other relevant data will be collected from medical records and patients are grouped according to the RIPASA scoring system. All the data was entered into self-designed data entry form. The collected data will be analysed using simple graphical method and significance was found out by chi-square and P value. Result: The result of the study suggests that male patients of age 11-20 years had maximum incidence of appendicitis. In this study population, strategies of treatment were either conservative or operative. Conservative management was done in 71% patients. Compared to open appendectomy, laparoscopic appendectomy (79.31%) was higher as it has lower infection rate, shorter hospital stay, recovery time and less pain. The Ultrasonography (63%) report showed that majority of the patients had acute appendicitis and based on intra-operative findings 79.31% had inflamed appendicitis. RIPASA scoring system is fast, simple and more sensitive tool in the diagnosis of acute appendicitis and selection of management. There was significant association between the type of management and RIPASA score.[9] WHO prescribing indicator play a significant role in helping the health care system to understand, interpret and to improve the prescribing pattern of medications.[11] In this study wefound that average number of drugs per prescription was 6.24 which indicatespolypharmacy. Conclusion: The treatment of appendicitis should start with intra venous fluids and antimicrobials.[1] We found that Cephalosporins were the most frequently prescribed antimicrobial agents. This study suggests that RIPASA score is an efficient score in the diagnosis and selection of proper management of appendicitis,[16] along with the supportive tools like CT and USG for confirming the management[11] and recommends that the conservative management can be done in patients with score 5-7 and above 7 by surgical management. There are no clear-cut guidelines for the optimal use of antimicrobial agents in appendicitis, so guidelines should be formulated and displayed in the surgical department to promote the rational drug use.[7] The use of antibiotics and generic prescribing should be initiated and the use of injections should be regulated as it deviated from WHO standards. The involvement of clinical pharmacist is preferred to evolve treatment strategies to promote patient care.

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