Journal of Pharmacy And Bioallied Sciences

: 2013  |  Volume : 5  |  Issue : 3  |  Page : 243-

A medico-legal case of irresponsiveness to antibiotic therapy: A point that should not be forgotten

Viroj Wiwanitkit 
 Wiwanitkit House, Bangkhae, Bangkok, Thailand

Correspondence Address:
Viroj Wiwanitkit
Wiwanitkit House, Bangkhae, Bangkok

How to cite this article:
Wiwanitkit V. A medico-legal case of irresponsiveness to antibiotic therapy: A point that should not be forgotten.J Pharm Bioall Sci 2013;5:243-243

How to cite this URL:
Wiwanitkit V. A medico-legal case of irresponsiveness to antibiotic therapy: A point that should not be forgotten. J Pharm Bioall Sci [serial online] 2013 [cited 2020 Aug 8 ];5:243-243
Available from:

Full Text


The unresponsiveness to an appropriate medical treatment is an important concern in medical practice. There are many possible causes including, drug resistance, poor patient compliance, and poor quality of the drug (expiration, not pass quality control process, etc.). Apart from the mentioned common causes, there are also other causes to be addressed. Here, the author would like to present an experience on a case with the problem on unresponsiveness to standard antibiotic therapy. The indexed case was a 64-year-old female patient with the acute pyelonephritis and prescribed for the standard intravenous Cef-3 therapy. However, after 2 consecutive drug administrations, there is no improvement. The case was consulted for finding of the possible explanation. Of interest, after history taking, an interesting detail was derived. The patient described for the shape of the used drug ampule for her intravenous infusion and the detail seems not to be the shape of Cef-3. Further root cause investigation, shows that the in charge pharmacist get the order of the correct Cef-3 request in prescription form, but intend to give the vitamin B complex for injection. For sure, the disguised order was made and passed to the nurse in charge at drug administration room and the nurse in charge got that disguised order. This case was further managed as a possible corruption case and under legal management. Indeed, there are many possible unexpected causes of failure of drug treatment. Corruption can be seen in the underdeveloped country.[1] The present medico-legal case can be the good case study to warn all physicians to concern on the problem that can occur in any steps on the way from drug prescription to administration to the patient. Based on this case, these recommendations are made:

There must be the repeatedly re-checking for the medical prescription. The final confirmation between nurse who perform drug administrator and physician in charge must be carried out in all cases. The drug delivery system should be in the closed loop. The drug should be sent directly from the pharmacist to the nurse in-charge. The final reconfirmation with the physician in charge must be carried out. There must be the routine auditing of the whole pathway. This is useful to detect the error as well as intentional corruption.


1Nsimba SE. Problems associated with substandard and counterfeit drugs in developing countries: A review article on global implications of counterfeit drugs in the era of antiretroviral (ARVs) drugs in a free market economy. East Afr J Public Health 2008;5:205-10.