"Case 1"
This is a recent case I received from one of the state in India. It is about a 2.9 year old female patient undergoing some treatment at Ambulatory Care/OPD setup for her cough and cold complaint. Attaching the prescription/ Drug chart for the discussion in simple language.
 |
| "Prescription/Treatment Chart" |
After
taking the above mentioned drugs the patient is complaining of vomiting of
ingested matter at once after eating, throat pain, weakness and no improvement of
condition up to 2 days. So, the patient's relative contacted me for my opinion
about the ongoing treatment .
My overall critical review about the treatment:-
a) The
prescription is incomplete and confusing due to following reasons
1. The
prescription has no description about the actual Diagnosis of the patient
condition. I.e the “Diagnosis” is missing in the treatment chart!
2. There
is no laboratory investigation report/data mentioned in the chart just physical
assessment was done i.e temperature & abdomen
3. Prescribing
of Azithromycin (200mg/5ml) 4ml/day
X 6days, I mean for which disease
condition/ Indication? as there is no defined diagnosis.
4. If
the physician prescribes azithromycin then what is the exact regimen of the treatment?
For example, according various treatment guidelines/Evidence it can be
prescribed for max. of 5 days in case of community acquired pneumonia and 12mg/kg for
Pharyngitis/Tonsillitis for 5days in pediatric patients.
5. If
it is for community acquired pneumonia then the dose should be 10mg/kg at first
day then 5mg/kg for next four days ( Total duration is 5 days and the total dose should be 15 ml).
6. In
this case first of all the Physician has not defined the diagnosis of the
patient rather, knowingly or unknowingly he is giving OVER DOSE of Azithromycin I.e 4ml/day X 6days ( According to
guideline it should not exceed 15ml total dose in five days but patient is going to take 24 ml in 6 days)
it may lead to other side effects of Azithromycin.
7. Other drugs in the prescription have their own indications such as for fever it is crocin syrup "sos" and have no issues.
b) My recommendation Till now :-
1.
Discuss
immediately about the dose of Azithromycin with your Physician (Provided
evidence with calculated dose for the patient ie 3.25ml at day one and 1.6 ml at
day 2 and same up to day 5 if physician confirms the diagnosis as “community
acquired pneumonia”, if it is Pharyngitis or tonsillitis then 3.9ml/day up to
5days . IF ANY OTHER DIAGNOSIS THEN CONSULT ME FOR THE DOSING.
2. Vomiting
is the side effect of Azithromycin. So, no need to worry and give it after meal/food( Give Ranitidine syrup at least 30 min before food, if prescribed by the
physician)
3. Observe
for any episode of diarrhoea or any sorts of bloody stool, if it is, then immediately
consult with the physician.
******* Special comment about this case *******
- Seeing this prescription i have a big doubt about the concept of "Universal Health Coverage"
- Is this the quality of medical service at ground level?(In context of developing countries).
- SAY NO TO DRUG RELATED HARM!!!
- Stop Itarogenic Diseases!
“Case 2”.
last week a 72 years old Veterinary Surgeon came
to consult with me about his chronic throat complication. After conducting
through Past medical and medication history, I came to know he was treated for
a severe throat infection by some antibiotic (cefpodoxime by an Indian
Physician in his home town during his visit to India) and the same throat
problem he faced again after 20 days, once he came back to Ethiopia. Further,
one of his well wisher (Non medical Professional in Ethiopia) suggested him with some cough
syrup and an antibiotic (As cefpodoxime is not widely available in Ethiopia)
for his throat complication, as some physician prescribed him the same and he
got relief!
My intervention: - I counseled him
about his current condition and instructed him to stop that cough syrup (He was
taking for last one month) and the antibiotic (Unknown antibiotic suggested by
his well wisher. I guess he was talking about Ciprofloxacin).
Further, I suggested him:
A.
Take 1/2 inch of
finely chopped ginger with a pinch of salt to chew after meal.
B.
Take it on TID
basis for 3 days.
C.
Drink Luke warm
water
Currently he has
no issue with throat and cough (He is a live example and currently he is doing
his regular activity without any previous issues).
*** Every time we
should not rely on allopathic medicine, some time we should go for an alternative,
which should be based on "EVIDENCE".
*** I am not a traditional healer, But, I
have little bit knowledge of active chemical constituents of a drug it may be
Allopathic drugs, Ayurvedic drugs etc.
*** The Above case has some more issues which I
didn't discussed above to make it more simple to understand (Some of the issues
I have highlighted in Clinical Point of View section for health care
professionals).
Clinical Point of view for this case:-
1. The drug prescribed by the physician in India (cefpodoxime)
is not a first line drug for the treatment of throat infection. So,
prescribing cefpodoxime is not rational for this case. (It may lead to
antibiotic resistance)
2. The patient was taking some unknown antibiotic
and cough syrup based on his well wishers recommendation which is a very
serious issue (It may lead to antibiotic resistance or life threatening
condition).
3. To start with any antibiotic, first it should
be properly diagnosed by the physician whether really it’s a throat infection
or “Common Cold” symptom?
****Special Comment for this case****
1. Stop antibiotic resistance
2. Public should know about their drugs very well to prevent drug related harms
1. Stop antibiotic resistance
2. Public should know about their drugs very well to prevent drug related harms
Thank you for your time in reading these cases
