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I have the following things to share in response to this article
1. Over prescribing an antibiotic is commonly seen in general practice.
This is more common while managing a case of "cough & cold", and
"diarrhoea" especially in children. I have some data --
a).Inappropriate antibiotic used for "cough & cold"--65%(1)
b).Children with pneumonia not given antibiotics--19%(1)
c).Viral causes of diarrhoea (Rota Virus) – 15 to 20%(2)
d).No pathogen found in cases of diarrhoea – 20 to 30%(2)
The remaining cases of diarrhoea are mostly bacterial causes
2). Now there are two important problems encountered by general
practitioners.
a). Resource poor settings in which the general practitioners have to
work. This limits the chances of good diagnostic workup to differentiate
between bacterial and viral causes of pneumonia and diarrhoea.
b).Malnutrition which is common in children. Most of these children with
bacterial pneumonia have higher chances of progressing to respiratory
distress and septicemia if they are not treated with antibiotics.
Similarly bacterial causes of diarrhoea also need antibiotics. It is also
common that some of these children are brought late in the course of
disease.
So general practitioners may end up over / inappropriately (broad
spectrum) prescribing antibiotics. Educating the general practitioners is
not the complete solution to the problem. Access to better diagnostic
facilities and efforts to solve problem of malnutrition is of higher
importance in tackling this issue.
References
1).WHO (1999).“Health situation in south east Asia region- 1994 to 1997”.
Regional office of South East Asia Region. New Delhi
2).Fricker J.“Children in tropics”. 1993:204.
Competing interests:
None declared
Competing interests:
No competing interests
28 July 2007
Dr. Harsha Kumar H N
Epidemiologist & Assistant Professor
Dr. Sulochana M
Department of Community Medicine, Kasturba Medical College, Mangalore
Pediatric cases – Malnutrition and Resource Poor Settings take the blame
Respected Sir,
I have the following things to share in response to this article
1. Over prescribing an antibiotic is commonly seen in general practice.
This is more common while managing a case of "cough & cold", and
"diarrhoea" especially in children. I have some data --
a).Inappropriate antibiotic used for "cough & cold"--65%(1)
b).Children with pneumonia not given antibiotics--19%(1)
c).Viral causes of diarrhoea (Rota Virus) – 15 to 20%(2)
d).No pathogen found in cases of diarrhoea – 20 to 30%(2)
The remaining cases of diarrhoea are mostly bacterial causes
2). Now there are two important problems encountered by general
practitioners.
a). Resource poor settings in which the general practitioners have to
work. This limits the chances of good diagnostic workup to differentiate
between bacterial and viral causes of pneumonia and diarrhoea.
b).Malnutrition which is common in children. Most of these children with
bacterial pneumonia have higher chances of progressing to respiratory
distress and septicemia if they are not treated with antibiotics.
Similarly bacterial causes of diarrhoea also need antibiotics. It is also
common that some of these children are brought late in the course of
disease.
So general practitioners may end up over / inappropriately (broad
spectrum) prescribing antibiotics. Educating the general practitioners is
not the complete solution to the problem. Access to better diagnostic
facilities and efforts to solve problem of malnutrition is of higher
importance in tackling this issue.
References
1).WHO (1999).“Health situation in south east Asia region- 1994 to 1997”.
Regional office of South East Asia Region. New Delhi
2).Fricker J.“Children in tropics”. 1993:204.
Competing interests:
None declared
Competing interests: No competing interests