Single Dose of Collistin and Dramatic Improvement in Klebsiella Sensitivity Pattern

A 57 year old woman with diabetes and uncontrolled blood sugars had an MDR urinary tract infection and was sensitive only to colistin and tigecycline (figure 1-3). Her weight is around 60 KG. Her eGFR was 42 mL/min/1.73 m2.

Based on the Urine C/S report, one shot of colistin 9 million units was given and as the patient couldn't afford any further therapy and just after one shot of colistin subjectively she was much better, so collistin was stopped.

In this case the patient had a short window of opportunity to benefit from just a single shot of colistin which was serendipity as at that point of time we didn't know that she wouldn't be able to afford the subsequent doses. Once she said that her symptoms had reduced dramatically with that one shot of colistin we felt that this was our window of opportunity as we needed to check out what was happening to the MDR klebsiella inside her and repeat urine culture sensitivity now showing that a klebsiella dramatically changed its sensitivity pattern after one single dose (figure 4).

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55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here) This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for

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drugs to avoid or use in terms of their pregnancy category

The optimal AEDs therapy of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different antiseizure drugs and no antiepileptic drug has proven safe in pregnancy in terms of teratogenesis. Data on the comparative efficacy of various antiseizure drugs for controlling seizures during pregnancy are also quite limited, and there are no randomized trials in this setting. Treatment must be individualized for all patients. Women with epilepsy are classified as high risk during pregnancy and as there are no clear data indicating that any drug is without risk in pregnancy therefore, the antiseizure drug regimen should be optimized six months prior to planned conception. Choice of antiepileptic drugs in women of childbearing age and pregnant women with epilepsy: 1. T he antiseizure drug that stops seizures in a given patient is the one that should be used with an exception of valproate. 2.

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