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UPDATE - 3  

RANDOM  TIPS

Let us now, for a moment take a break from the earlier theme of vaccines and take a walk down an uncharted sea !! – please allow me the poetic license.
 

I am penning down some tips which are coming to my mind and you may not find any particular sequence.If you, on the other hand gain something from these, I shall feel rewarded.

By the way , if you are interested in general reading, I may strongly recommend a book by Erich Segal – ‘ Doctors’ . It is a treat reading the book just as it a treatise on the psyche of Doctors.  

•  Antibiotics : when , why, how long….. ?

This is a question that is debated over and over again in almost all our scientific meetings and conferences.

At the end of the day – we are as puzzled as the speaker/ specialist is !

To be honest, antibiotics are more far more often used than they are needed.

The reasons are difficult to identify – but there are some peculiar compulsions that often make the Pediatrician write out an antibiotic ( I MAY BE APPEARING TO BE DEFENDING MY BRETHEREN)  

• It is not always possible to order investigations in every case of “minor” problems ( say , a couple of days’ fever) and the poor Pediatrician bases his judgment on purely clinical grounds.  
   

• Quite often, the poor Pediatrician is under parental pressure “ I can not see my child so miserable – please give something that works fast. Now , here, human being as the Doctor is , does at times succumb to this pressure and write out an antibiotic when he could have chosen to simply wait and watch. PLEASE DO NOT PUT A PISTOL TO YOUR DOCTOR’S TEMPLES.  
   

• If you Doctor – shop : you are very likely to have a change of the antibiotic. Please stick to the Pediatrician who vibes with you and then follow him unless you get a gut feel that this time there is something really wrong in his approach.  
   

• Please do give the antibiotic for the proper length of time and do not make the mistake of stopping it mid-way since you feel the child is now appearing to be okay. You know well about drug resistance – the reason why we insist on proper duration of antibiotic is to prevent this drug resistance.
  
   

• Strong Medicine :

It is rather common for some parents to feel that a particular Pediatrician prescribes “strong medicine”.

Yes, we all have our own levels of experience and  also a good amount of “gut feeling” when it comes to prescribing. What the text book says does not always work out the same way in real life situations and the Doctor does need to innovate. During this process there are Pediatricians who tend to write rather long prescriptions while others may be an example of brevity.

Who is right , who is wrong – very hard to comment.

I shall just give a small sketch that might help clear some clouds:

• Pediatricians are generally sensitive to the fact that administering a dose to a child is usually rather difficult and they tend to keep their prescriptions brief. All the same, there might be a particular situation ( e.g. pneumonia ) that may need a longer list of drugs. Please do allow your Pediatrician this freedom.  
   

•  “ Strong Medicine “ is quite often associated with the price of the medicine. With the advent of newer medicines , medication is getting more target oriented and the newer drugs are generally costly. A case in point could be Childhood Asthma where an ORAL steroid would cost hardly anything , give good relief but may not be the best thing to be done. Instead, an Inhaled drug would work tremendously better, cost tremendously more and may APPEAR TREMENDOUSLY STRONG MEDICINE TO YOU !  
   

• There is thus NO strong medicine – NO light medicine – it is medicine that is appropriate for the particular situation !  
  
   

•  My child does not eat well…….some appetite stimulant, please !

Oh no , not again.

This is a complaint made by every second mother.

I recall an interesting anecdote : a child with head injury with bleeding all over his scalp rushes into my Chamber.I am busy examining the child, getting a CT scan of the brain organized – the mother somehow happens to have the presence of mind to sneak in the question – by the way, he does not eat well !

Till date, medicine does not have any rational and safe appetite stimulant.There is one product that is commonly prescribed ( usually under parental duress ) – Cyproheptadine. This does increase appetite but usually causes excessive sleepiness and the textbooks do NOT recommend it for use as an appetite stimulant.

You may , at best , try any brand of B Complex syrup – it is harmless , may boost appetite , will keep you busy.

• And then , something for increasing height as well ?

There is no medicine that can increase the height of your child.

Yes, your Pediatrician shall ascertain there is nothing medically wrong with the child that is keeping his height below the expected.

If there is no medical disease – there is no medicine needed – there is no ‘ height tonic’.

• Acurrent controversy over Nimesulide as medicine for fever:

The quest for better anti – fever ( antipyretic medicines ) has been going on since the discovery of Paracetamol ( the oldest one ).

Aspirin was perhaps even older but got dropped off due to its tendency to cause gastritis and an association with a fatal liver failure in some select cases.

Then came Ibuprofen and the Pharmaceutical Industry gloated with pride over it just as we found a mini revolution. Enthused by the sale curve , they mixed Ibuprofen and Paracetamol. Then came Mesenteric Acid ( did not gain much popularity ) .

The Pharmaceutical Industry, just as any other industry, has its bottom line very clear. Of course, they are bound by strict scrutiny and drugs have to pass several trials till they hit the road. The United States’ Food & Drug Administration ( US – FDA ) is perceived to be the strongest regulatory body. This is the final hurdle to be crossed by any drug.

Interestingly , the US anyway is the watchdog for the whole World !

Why I have sketched this background has a reason. It gives us a glimpse of the ever changing prescribing affiliations and patterns of Doctors.

Nimesulide was introduced with a BANG.

There is still a fair amount of dust around the drug and it may be best to stay put till we have more  research and Global consensus. Till such time, I guess plain, old Paracetamol is our best friend.

There shall be more coming from us soon – till then good luck and happy parenting.

Dr Jindal and team Healthybaccha.com