Some of the recent cases received

"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 *******

1.     Seeing this prescription i have a big doubt about the concept of "Universal  Health Coverage"
2.     Is this the quality of medical service at ground level?(In context of developing countries).
3.        SAY  NO  TO DRUG RELATED HARM!!!
4.     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 

Thank you for your time in reading these cases