A REPORT ON HIRING ACTIVITY IN INDIA- AUGUST'2011

THE HIRING SENTIMENT:  

A look at the Naukri job speaks index for the past few month’s shows that hiring activity has been more or less steady over a period of time. However, a yearly comparison indicates that the index has stabilized at an elevated level when compared to last year.  Thus, when we compare recruitment levels of Aug-11 with the previous month, the index moved up marginally from 1055 in Jul-11 to 1087 in Aug-11. This indicates that the global recessionary fears are yet to affect the Indian recruitment market. 

“Hiring activity especially for multinational companies, are planned about two quarters in advance” said Hitesh Oberoi, Managing Director and CEO, Info Edge India. He further added “While it is possible that the slowdown in economic activity may lead to some firms lowering down there hiring pace, the reflection of the same on the overall hiring sentiment may be visible around mid October.”

The above table indicates that both IT- Software and ITES sectors saw maximum movement in the hiring front in Aug-11 when compared to the previous month. This has led to movement in hiring activity in all the key IT hubs of the country. Thus, Chennai, Hyderabad and Bangalore saw their indices moving up by 13%, 11% and 7% respectively in Aug-11 over Jul-11.

THE MACROSCOPE

SECTORAL ANALYSIS

An in-depth analysis of the sectoral job index shows that Banking, Telecom and Pharma sectors maintained steady hiring levels in Aug-11 when compared to Jul-11. Among the key industry sectors, hiring activity has been upbeat for both ITES and IT sectors where the index moved up by 19 % and 8% respectively in Aug-11 over Jul-11.  On the other hand, Auto, Construction, Oil and Gas and Capital Goods saw their indices dip within the range of 2% and 5% during the same time period. 

Barring ITES and Construction sectors which saw negative yearly growths of 16% and 5% respectively, all other sectors saw positive year on year growth figures.

FUNCTIONAL AREA ANALYSIS

A month on month analysis of key functional areas shows that the demand for professionals in Accounts, Banking and Sales moved up by 7%, 6% and 3% respectively in Aug-11 over Jul-11.  Mirroring the monthly hiring trends of the IT- Software and ITES sector, Software and BPO professionals saw their hiring activity move up by 7% and 15% respectively in Aug-11 over Jul-11. The demand for Project Management and HR professionals dipped by 5% and 6% respectively when compared with last month. 

CITY BASED HIRING SCENARIO

All the top cities in the country saw movement in their hiring activity in August.  Chennai and Hyderabad saw their indices move up by 13% and 11% respectively in Aug-11 when compared to the previous month. While, Mumbai maintained steady hiring levels, Kolkata, Delhi and Bangalore saw their indices move up by 7% respectively in Aug-11 over Jul-11. Tier 1 cities beyond metros are also doing well, thus showing an increase in their total job pool.

A year on year comparison of the index for the top eight cities of the country shows double digit percentage growths in Aug-11 when compared to Aug-10. Kolkata and Bangalore recorded yearly growths of 29% and 21% respectively in Aug-11 over Aug-10.

WORK-EX BASED SCENARIO

Hiring activity for both 0-3 years and 4-7 years experience brackets moved up by 4% respectively during the month. In Aug-11, steady hiring levels were witnessed among the 8-12 years and above 16 years experience levels.

METHODOLOGY:

The Naukri Job Speak index from Feb’10 includes both online jobs as wells as jobs acquired from existing clients by our tele-calling team. Although the tele-calling data is a relatively small component of the entire job postings on Naukri, addition of the same to the index gives a more holistic picture of the Indian job market. Therefore, the Job index which was till now based on the July 2008, has been realigned to take care of the effect of the Jobs added by the tele-sales team. 

On the basis of job listings added to the site every month, the data shows an increase or decrease in the index. To calculate the index, job listings added to the site in July 2008 have been taken as 1000. The subsequent months have been indexed with data of July 2008. The monthly report shows hiring trends across industry sectors, geography and functional areas. There might be high volatility for certain fringe cases like smaller cities, niche industries etc. owing to a small base, but more than 34000 clients using Naukri.com leads to high reliability of the data. 

Naukri Job Speak not only talks about sectors or cities but also about the total job movement on site. The total jobs on site are defined as:

Total Jobs: Jobs Added + Jobs Refreshed

Where a refreshed job is any job that was posted earlier, however has been refreshed during the month and therefore indicates that the position is still open. 

Disclaimer

The data is only representative of the listings on Naukri.com. Our analytics team has used statistical techniques to derive insights which might be useful for our users/stake holders/ audiences. There may be a statistical margin of error

ANNEXURE

Industry Sectors

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Functional Area:

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                                                                                                                                                 REFERENCE: NAUKRI.COM' 14.11.2011  

A Review on Piperacillin - Tazobactam in Febrile Neutropenia

About Author: 

Uday Venkat Mateti^1*, Srikala Patha²

 
1. Department of Pharmacy Practice  & Pharm.D, St Peter’s Institute of Pharmaceutical Sciences, Rohini Hospital, Kakatiya University, Warangal, India
2. Department of Pharmacy Practice, Bharat Institute of Technology (Pharmacy), KIMS Hospital, JNTU, Hyderabad, India.

Abstract:
The mortality rate of febrile neutropenia (FN) has diminished steadily but remains significant. Overall mortality rates are 5% in patients with solid tumors (1% in low-risk patients) and as high as 11% in some hematological malignancies. Piperacillin/Tazobactam is a β-lactam/β-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive, Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin/Tazobactam is effective and well tolerated in patients with febrile neutropenia.  Guidelines for the Management of Febrile Neutropenia in Oncology Patients and the 2010 National Comprehensive Cancer Network (NCCN) Prevention and treatment  for febrile neutropenia recommends as initial treatment in patients with FN who are at high risk of serious infections. In comparative clinical trials against various other antibacterial regimens. Piperacillin/Tazobactam has shown higher clinical success rates, particularly in the treatment of patients with febrile neutropenia. Piperacillin/Tazobactam has shown clinical as well as the economic advantages over other antibacterial regimens in the treatment of febrile episodes in patients with neutropenia. It is likely to reduce overall treatment costs of moderate to severe febrile neutropenia by increasing initial treatment success thereby reducing the length of hospital stay and the use of additional antibacterials. Present data regarding clinical efficacy, safety and costs would support the use of Piperacillin/Tazobactam as an empirical first-line option in moderate to severe febrile episodes in patients with neutropenia.

Introduction:
Though there have been major advances in prevention and treatment of febrile neutropenia (FN) febrile neutropenia still remains one of the most feared complications of cancer chemotherapy. It is a major cause of morbidity, healthcare resource use, and results in delays and dose reductions in chemotherapy which compromise efficacy. The mortality rate of febrile neutropenia (FN) has diminished steadily but remains significant. Overall mortality rates are 5% in patients with solid tumors (1% in low-risk patients) and as high as 11% in some hematological malignancies.1 As such, febrile neutropenia (FN) requires prompt treatment with Piperacillin -Tazobactam since it may be associated with life-threatening infections. Piperacillin/Tazobactam is a β-lactam/β-lactamase inhibitor combination with a broad spectrum of antibacterial activity against most Gram-positive, Gram-negative aerobic bacteria and anaerobic bacteria. Piperacillin / Tazobactam is effective and well tolerated in patients with febrile neutropenia.  Guidelines for the Management of Febrile Neutropenia in Oncology Patients and the 2010 National Comprehensive Cancer Network (NCCN) Prevention and treatment  for febrile neutropenia recommends as initial treatment in patients with FN who are at high risk of serious infections. In comparative clinical trials against various other antibacterial regimens, Piperacillin/Tazobactam has shown higher clinical success rates, particularly in the treatment of patients with febrile neutropenia. The studies which are supported to the Piperacillin/Tazobactam in the management of Febrile Neutropenia are explained in the table 1.^2,3,4,5

Table 1: The studies which are supported to the Piperacillin / Tazobactam in the management of Febrile Neutropenia

Authors/ Guidelines	Study Title	Outcomes of the studies
NCCN guidelines 2010 for febrile neutropenia	Empirical antibiotic therapy for febrile neutropenia	According to this Guidelines  Piperacillin/Tazobactam is the initial Empirical therapy in the Management of Febrile Neutropenia
Takashi Saito et. al, 2011	Historical Cohort Study of the Efficacy and Safety of Piperacillin/Tazobactam versus Fourth-Generation Cephalosporins for Empirical Treatment of Febrile Neutropenia in Patients with Hematological Malignancies	In the present study, the overall efficacy rate was 57.0% in the Fourth-Generation Cephalosporins group and 59.2% in the Piperacillin/Tazobactam group. No adverse drug reaction requiring discontinuation or switching of the study treatments was noted in any of the patients.
Guidelines for the Management of Febrile Neutropenia in Oncology Patients, 2011	Summary of Guidelines for the Immediate Management of Suspected or Confirmed Febrile Neutropenia in Oncology Patients	According to this Guidelines Piperacillin/Tazobactam is the initial treatment in the Management of Febrile Neutropenia with the dose of 4.5gIV TDS for 14 days. Piperacillin/Tazobactam dose should be reduced in renal impairment
E. J. Bow et. al., 2006	A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies	Out of 528 subjects (265 received Piperacillin-Tazobactam and 263 received Cefepime), success rates were 57.7% and 48.3%, respectively (P = .04) at the 72-h time point, 39.6% and 31.6% (P = .06) at end of treatment, and 26.8% and 20.5% (P = .11) at the test-of-cure visit. The analyses demonstrated noninferiority for Piperacillin-Tazobactam at all time points (P ?.0001). This trial, taken together with other large clinical trials, firmly establishes the safety and efficacy of Piperacillin-Tazobactam monotherapy for the empirical treatment of the febrile neutropenic patients with cancer
Young et. al., 2002	Piperacillin/Tazobactam in Moderate to Severe Bacterial Infections	Piperacillin/Tazobactam has shown clinical and economic advantages over standard antibacterial regimens in the treatment febrile episodes in patients with neutropenia. Present data regarding clinical efficacy, bacterial resistance and costs would support the use of Piperacillin/Tazobactam as an empirical first-line option in moderate to severe bacterial infections.

Advantages of Piperacillin-Tazobactam:
Cephalosporins resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies has increased significantly, particularly in the ICU, in the past decade. The main mechanism accountable for is the emergence of extended-spectrum beta-lactamases (ESBLs). These plasmid-mediated beta-lactamases confer resistance to majority of the broad-spectrum beta-lactam antibiotics like third- and fourth-generation cephalosporins. Piperacillin/Tazobactam is currently considered as the drug of choice for these pathogens. Prevention and control measures are important because of the multiresistant nature of these pathogens. Such traditional infection control measures as contact precautions are recommended.  This type of antimicrobial resistance appears to be particularly influenced by antibiotic use. Antibiotic control measures may also be a very important intervention in controlling the spread of ESBLs.⁶

Cost analysis of Piperacillin/Tazobactam has been variable, in part, because of differences in specific costs included. The US cost analysis shows that Piperacillin/Tazobactam has lower total medical costs than other antibiotics. Intravenous antibiotics: acquisition costs per febrile neutropenia episode are summarized in the table 2.⁷

Table 2: Intravenous antibiotics: acquisition costs per febrile neutropenia episode:

Drug name	Dosage/day(mg)	Cost per vial/unit	Cost/day	Total cost/day	Days/episode	Total cost/episode
IV ceftazidime	2g q8hr; 6g/d	$17.90 for 2g	$53.7	$53.7	8.5	$456.45
IV Imipenem- Cilastatin	1-2g/d ; 2g/d	$12 for 0.5g	$48.00	$48.00	8.5	$408.00
IV Piperacillin-Tazobactam	4.5g q8hr; 13.5g/d	$15.79 for 4.5g	$47.37	$47.37	8.5	$402.64**
IV Amikacin + Piperacillin-Tazobactam	15-22.5mg/kg daily = 1406mg/d 4.5g every 6h = 18g/d	$10.14 for 500mg $15.79 for 4.5g	$28.52 $63.16	$91.68	8.5	$779.28
IV Amikacin + Ceftazidime	15-22.5mg/kg daily = 1.406g/d 3-6g/d; assume 4.5g/d	$10.14 for 0.5g $17.90 for 2g	$28.52 v40.28	$68.79	8.5	$584.72

Conclusion:
Piperacillin/Tazobactam has shown clinical as well as the economic advantages over other antibacterial regimens in the treatment of febrile episodes in patients with neutropenia. It is likely to reduce overall treatment costs of moderate to severe febrile neutropenia by increasing initial treatment success thereby reducing the length of hospital stay and the use of additional antibacterials. Present data regarding clinical efficacy, safety and costs would support the use of Piperacillin/Tazobactam as an empirical first-line option in moderate to severe febrile episodes in patients with neutropenia.

References:
1. Marti F, Cullen MH, Roila F. Management of febrile neutropenia: ESMO Clinical Recommendations. Annals of Oncology 2009; 20(4) : p. iv166-iv169.
2. Takashi S, Tatsuo I, Junya K, Miki N, Shunji T, Yutaka I, et.al,. Historical Cohort Study of the Efficacy and Safety of Piperacillin/Tazobactam versus Fourth-Generation Cephalosporins for Empirical Treatment of Febrile Neutropenia in Patients with Hematological Malignancies.      International Journal of Clinical Medicine 2011; 2 (1): p. 18-22.
3. Michael G, Maria T. NCCN guidelines for febrile neutropenia. Clinical oncology news: 2010. P. 115-122.
4. Guidelines for the Management of Febrile Neutropenia in Oncology Patients, 2011. URL: nuhnet/diagnostics_clinical_support/antibiotics [Last updated on 21 June 2011].
5. Bow EJ, Rotstein C, Noskin GA, Laverdiere M, Schwarer AP, Segal BH, Seymour JF, Szer J, Sanche S. A Randomized, Open-Label, Multicenter Comparative Study of the Efficacy and Safety of Piperacillin-Tazobactam and Cefepime for the Empirical Treatment of Febrile Neutropenic Episodes in Patients with Hematologic Malignancies. Clin Infect Dis. 2006 Aug 15;43(4):447-59.
6. Chong Y, Yakushiji H, Ito Y, Kamimura T. Cefepime-resistant Gram-negative bacteremia in febrile neutropenic patients with hematological malignancies. Int J Infect Dis. 2010 Sep;14 Suppl 3:e171-5.
7. Dominguez AG, Pérez M, SantosL, Sanz A,  Rubio C. Cost-Effectiveness of Piperacillin-Tazobactam Versus Ceftazidime in Patients with Febrile Neutropenia. Value in Health 1998; 1(1): P.68.