Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Original Article
2009:75:6;588-592
doi: 10.4103/0378-6323.57720
PMID: 19915239

Prescription auditing of griseofulvin in a tertiary care teaching hospital

M Hepsi Bai Kirubha
 Department of Pharmacy Practice, Sri Ramachandra College of Pharmacy, Sri Ramachandra University, Chennai, India

Correspondence Address:
M Hepsi Bai Kirubha
Department of Pharmacy Practice, Sri Ramachandra College of Pharmacy, Sri Ramachandra University, Chennai - 600116
India
How to cite this article:
Bai Kirubha M H. Prescription auditing of griseofulvin in a tertiary care teaching hospital. Indian J Dermatol Venereol Leprol 2009;75:588-592
Copyright: (C)2009 Indian Journal of Dermatology, Venereology, and Leprology

Abstract

Background: Griseofulvin has been the mainstay of treatment for dermatophytosis since many years. Since it is a penicillium antibiotic and used commonly in the outpatient department, the prescription should be audited for its safety and quality. Clinical pharmacists being an important member of the healthcare system have an immense responsibility in delivering pharmaceutical care by auditing prescriptions in order to achieve rational and cost-effective medical care thereby improving patient's Quality of Life (QOL). Aims: To study the utilization of griseofulvin by auditing prescriptions, to assess the impact of griseofulvin on the QOL of patients and to emphasize role and responsibilities of a clinical pharmacist in the treatment outcome of dermatophytosis. Methods: 120 patients prescribed with griseofulvin in the dermatology outpatient department were included in the study. On the basis of therapeutic response, improvement was graded at the end of the treatment regimen. Adverse drug reactions (ADRs) during the treatment period were recorded. Laboratory investigations were performed at baseline and at the end of treatment. Quality of Life was measured at baseline and at the end of therapy. Results: 56.7% were females and 43.3% were males. The most common diagnosis was tinea corporis (44.17%) followed by tinea cruris (14.17%) and onychomycosis (9.17%). The most common ADR due to griseofulvin was headache (5.83%). 64.20% patients had complete cure following treatment with griseofulvin. The overall QOL score improved significantly following treatment with griseofulvin (P < 0.0001). Conclusion: Griseofulvin can be used extensively for the treatment of dermatophytosis as it has no serious adverse effects and has higher cure rates. Treatment with griseofulvin significantly improves the QOL in patients with dermatophytosis.
Keywords: Dermatophytosis, Griseofulvin, Quality of life

Introduction

Dermatophytes are fungi that invade and multiply within keratinized tissues causing infection called dermatophytosis or Tinea or ringworm. Dermatophytosis contributes to a large extent in any skin clinic in India. Griseofulvin which was first discovered in 1939 was the first orally effective antifungal agent used against dermatophytes. It inhibits the fungal cell division by disruption of the mitotic spindle structure. [1],[2],[3],[4],[5],[6],[7],[8] Absorption of griseofulvin can be increased by the administration of a fatty meal or by reducing the drug particle size. [9]

The role of pharmacist has changed dramatically over the past years. Recently, the profession of pharmacy has adopted pharmaceutical care as its mission and thereby extended the responsibility of the pharmacist. Clinical pharmacists, providers of pharmaceutical care have the responsibility to identify, prevent and resolve medication-related problems. The ultimate goal is to achieve optimal outcomes that improve the patient′s Quality of Life (QOL). Pharmaceutical care provided by clinical pharmacists adds value to the care of patients. This added value includes improvement in patient outcomes, enhanced patient compliance and reduced healthcare costs. [10]

The word prescription audit focuses on ′evaluation of healthcare′. The aim of the present study is focused to study the utilization of griseofulvin by auditing prescriptions, to assess the impact of griseofulvin on the QOL of patients with dermatophytosis and to emphasize role and responsibilities of a clinical pharmacist in the treatment outcome of dermatophytosis.

Methods

The study was performed between August 2006 and March 2007 in the dermatology outpatient department of Sri Ramachandra Hospital, Chennai. Patients of both sexes, all age groups and who were prescribed with micronized griseofulvin for the treatment of dermatophytosis were included in the study. Exclusion criteria were: 1) All other skin conditions other than dermatophytosis; 2) Patients who did not visit for follow up from the second week of treatment and 3) Patients with dermatophytosis but not prescribed with griseofulvin due to clinical conditions.

Clinical assessment and diagnosis was made by dermatologists and confirmed by direct mycologic microscopic examination of skin scrapings (in potassium hydroxide). Prior to initiation of treatment and during the treatment period, patients were subjected to laboratory monitoring including complete blood count and liver function test. Before initiating the therapy, patients were educated on: 1) Compliance; 2) Regular follow up; 3) Possible adverse drug reactions (ADRs) and 4) Precautions to be taken while taking griseofulvin. Griseofulvin was prescribed for 26 weeks for fingernail onychomycosis, 52 weeks for toenail onychomycosis and 6 weeks for other tinea infections.

Patient information leaflet on griseofulvin [Table - 1] was prepared and oral counseling was given to patients for better compliance. Each patient was reviewed weekly or on alternative weeks. The ADRs were recorded as ′Yes′ or ′No′ in the ADR assessment form. Improvement was graded at the end of the treatment regimen by dermatologists as:

The patients QOL was assessed at baseline and during the final visit with the questionnaire, ′Dermatology Life Quality Index′ (DLQI) for adults and ′Children′s Dermatology Life Quality Index-cartoon′ (CDLQI) version for children. The questionnaire comprised 10 questions and applied for every patient. The questions were scored and summed up. The scoring was 0 to 30. The higher the score, the more QOL is impaired. [12] Formal permission was obtained from the authors of the questionnaire.

Statistical analysis

Data were entered into a software spreadsheet (Excel, Microsoft) and the age, gender, duration of the disease and QOL scores were summarized by mean ± SD and clinical variants of dermatophytosis, co-morbid diseases, scrapings for fungus test, ADRs and therapeutic response were summarized by percentage. Assessment of the patient′s QOL at baseline and after treatment was analysed using paired sample t-test. The data were analyzed by the Graph Pad Instat version 3.05 statistical package.

Results

Altogether 120 patients were enrolled in the study. In the study population there were 52 males (43.3%) with a mean age of 33.8 ± 16.04 years and 68 females (56.7%) with a mean age of 41.82 ± 15.32 years. It was found that dermatophytosis were more common in the age group of 11-20 for males (17 patients) and 31-50 for females (16 patients in 31-40 and 16 patients in 41-50 age group). The mean duration of the disease was 11.82 ± 4.57 months.

[Table - 2] shows the clinical variants of dermatophytosis. Approximately 95% of patients had positive result for scraping for fungus test; 27 patients (22.5%) had past history of dermatophytosis. The co-morbid conditions seen in the study population were: 11 patients (9.2%) had diabetes mellitus, 10 patients (8.3%) had hypertension and one patient (0.8%) had bronchial asthma.

Ten patients out of 120 discontinued the therapy due to severity in the clinical conditions and adverse drug reactions. One hundred and ten patients (91.66%) completed the therapy with griseofulvin. [Figure - 1] shows the ADRs of griseofulvin during the study period. Seventeen patients (14.17%) reported ADR with griseofulvin. Clinical cure rate was good on treatment with griseofulvin. Seventy seven patients (64.2%) had complete cure with griseofulvin and 40 patients (33.3%) had partial cure with the drug. Only three patients (2.5%) showed no improvement in the cure rate. Using paired sample t-test the QOL scores were analysed. The CDLQI and DLQI scores before and after treatment were analysed under six subscales. [Table - 3] and [Table - 4] show that the overall mean CDLQI score was 9.14 ± 4.94 (SD) before treatment which decreased significantly (P < 0.0001) with a mean of 1.71 ± 1.36 (SD) after treatment. The overall DLQI score was found to be increased with a mean of 7.62 ± 4.27 (SD) which decreased significantly (P < 0.0001) with a mean of 1.49 ± 1.70 (SD) after treatment. The QOL in diabetic patients was also observed before and after treatment. The mean score before treatment was found to be 6.64 ± 5.43 (SD) which decreased significantly (P < 0.0031) after treatment with a mean of 1.00 ± 1.18 (SD).

Discussion

This study on the prescription auditing of griseofulvin in a population of 120 patients showed a clear clinical improvement in patients treated with griseofulvin. This study shows several interesting epidemiologic features. In this study, dermatophytosis was more prevalent in females than in males. The most common diagnosis was tinea corporis (52.47%) followed by tinea cruris (14.16%) and onychomycosis (9.16%), which was similar to the report by Chee-leok et al.. [5] Tinea corporis was seen more commonly in females (39 patients) than in males (14 patients).

Human contact (family members and friends) such as sharing combs, hats, towels, socks, shoes and clothes and close personal contact with playmates was observed to be greater source of infection than animal contact. Lack of personal hygiene and direct animal contact were found to be the causative factors. The majority of patients who were enrolled in the study were from low socioeconomic status. Hence these patients were counseled more on hygienic measures. The prevalence of onychomycosis and tinea corporis were seen among diabetic patients. The significance of onychomycosis, tinea pedis and tinea corporis in diabetic patients should be looked into because diabetics have impaired sensation that is often associated with trauma that can initiate infection. Additionally, these patients have altered resistance to infections resulting in widespread and recurring fungal and bacterial infection. [13],[14],[15] Hence, diabetic patients should be counseled on proper footcare to prevent the fungal infection of feet. No interactions were seen with the antidiabetic drugs.

Almost all patients completed the therapy with griseofulvin except 10 patients who were prescribed with newer antifungals because of severity in the clinical condition and adverse reactions due to griseofulvin. Headache, gastrointestinal upset, photosensitivity and proteinuria were the common ADRs observed in the study population. The side effects subsided after withdrawal of griseofulvin.

The overall mean QOL score of patients improved after treatment with griseofulvin. Although the newer oral antifungal agents have largely superseded griseofulvin, it still remains the safe and cost-effective drug for the treatment of dermatophytosis. [11],[14],[16] However the disadvantages of griseofulvin are that it requires prolonged treatment thereby leading to noncompliance; contraindicated in pregnancy, hepatic impairment and porphyria and has side effects such as headache, photosensitivity and gastrointestinal disturbances. [5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20]

Conclusion

From this study, it can be concluded that griseofulvin can be used extensively for the treatment of dermatophytosis as it has no serious adverse effects and also the clinical cure rates are higher. Dermatophytosis significantly lowers the QOL of patients. Treatment with griseofulvin has a significant improvement in the QOL in these patients indicating that griseofulvin has a good treatment outcome in tinea infections. Proper education on personal hygiene to patients plays a key role in the prevention of spreading the infection to others. Clinical pharmacist key responsibility of providing proper counseling on the use of medication improves the treatment outcome of dermatophytosis.

References
1.
Wyatt EL, Sutter SH, Drake LA. Dermatological pharmacology. In: Gilman AG, Hardman JG, Limbird LE, editors. Goodman and Gilman′s The Pharmacological Basis of Therapeutics. 10 th ed. New York: McGraw Hill; 2001. p. 1811-12.
[Google Scholar]
2.
Gupta AK. Systemic antifungal agents. In: Wolverton SE, editor. Comprehensive dermatologic drug therapy. Philadelphia: Saunders; 2001. p. 73-5.
[Google Scholar]
3.
Hay RJ, Moore MK. Mycology. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook′s Textbook of Dermatology. 7 th ed. Oxford: Blackwell; 2003. p. 31.19-31.55.
[Google Scholar]
4.
Nelson MM, Martin AG, Heffernan MP. Superficial fungal infections: Dermatophytosis, Onychomycosis, Tinea nigra, Piedra. In: Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith AL, Katz SI, editors. Fitzpatrick′s Dermatology in General Medicine. 6 th ed. New York: McGraw Hill; 2003. p. 1989-2005.
[Google Scholar]
5.
Chee-leok G, Yong KT, Kamarudin BA, Mong TK, Chew SS. In vitro evaluation of griseofulvin, ketoconazole and itraconazole against various dermatophytes in Singapore. Int J of Dermatol 2004;33:733-7.
[Google Scholar]
6.
Lestringant GG, Qayed K, Blayney B. Tinea capitis in the United Arab Emirates. Int J Dermatol 1991;30:127-9.
[Google Scholar]
7.
Reisner RM, Homer RS, Newcomer VD, Sternberg TM. Onychomycosis of the feet: Treatment with griseofulvin. California Medicine 1968;93:217-23.
[Google Scholar]
8.
Fleece D, Gaughan JP, Aronoff SC. Griseofulvin versus terbinafine in the treatment of Tinea capitis: A meta-analysis of randomized clinical trials. Pediatrics 2004;114:1312-5
[Google Scholar]
9.
De Doncker P. Pharmacokinetics of orally administered antifungals in onychomycosis. Int J Dermatol 1999;38:20-27.
[Google Scholar]
10.
Gail DN. Ambulatory Patient care In: Alfonso RG. Remington: The Science and Practice of Pharmacy, 20th ed. Baltimore, MD: Lippincott Williams and Wilkins: 2000. p. 1893-94.
[Google Scholar]
11.
Sharma RP, Sharma NK, Sanjay G. Comparative study of ketoconazole and griseofulvin in dermatophytoses. Indian J Dermatol Venereol Leprol 1992;58:108-10.
[Google Scholar]
12.
Finlay AY. Quality of life indices. Indian J Dermatol Venereol Leprol 2004;70:143-8.
[Google Scholar]
13.
Gupta AK, Tu LQ. Dermatophytes: Diagnosis and treatment. J Am Acad Dermatol 2006;54:1050-5.
[Google Scholar]
14.
Daistghaib L, Azizzadeh M, Jafari P. Therapeutic options for the treatment of Tinea capitis: Griseofulvin versus fluconazole. J Dermatol Treat 2005;16:43-46.
[Google Scholar]
15.
Phoebe R, Anna H. Onychomycosis in a special patient population: focus on the diabetic. Int J Dermatol 1999;38:17-19.
[Google Scholar]
16.
Gupta AK, Lambert J. Pharmacoeconomic analysis of the new oral antifungal agents used to treat toenail onychomycosis in the USA. Int J Dermatol 1999;38:53-64.
[Google Scholar]
17.
Hasan MA, Fitzgerald SM, Saoudian M, Krishnaswamy G. Dermatology for the practicing allergist: Tinea pedis and its complications. Clin Mol Allergy 2004;2:1-11.
[Google Scholar]
18.
Cerner Multum Inc. Patient Education Leaflet-Griseofulvin. [Online]. [2006 Jun 15]. Available from: URL: http://health.yahoo.com/other-other/griseofulvin/healthwise-d00100a1.html .
[Google Scholar]
19.
Acharya KM, Mukhopadhyay A, Thakur RK, Mehta T, Bhuptani N, Patel R. Itraconazole versus griseofulvin in the treatment of tinea corporis and tinea cruris. Indian J Dermatol Venereol and Leprol 1995;61:209-11.
[Google Scholar]
20.
Wingfield, Fernandez-Obregon AC, Wignall FS, Greer DL. Treatment of tinea imbricate:a randomized clinical trial using griseofulvin, terbinafine, itraconazole and fluconazole. Br J Dermatol 2005;1:119-26.
[Google Scholar]

Fulltext Views
2,826

PDF downloads
1,919
Show Sections