The judicious use of antibiotics
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《美国医学杂志》
A-D-7, Devi Marg, Bani Park, Jaipur-302016, India
This refers to an excellent article by Gaur and English entitled 'The Judicious Use of Antibiotics - An Investment towards Optimized Health Care'.[1] In the last sentence the authors had stated: "While the goal is far from being reached, a reader who makes it to the end of the review article is encouraged to pause for a moment, reflect on his practice and decide what he as an individual can do to address this problem." I got three xerox copies and presented to my doctor friends.
The authors had stated: "Numerous studies have shown widespread unnecessary use of antimicrobials in patients with viral upper respiratory tract infections". A runny nose, patient's general look and a peep in the throat should suffice in most of cases to distinguish upper respiratory infection of viral origin from bacterial origin.
Under certain circumstances a 'non-rational' antimicrobial therapy may be justified. I work in Maharaja Agrasen Hospital, Jaipur, where poor patients are offered 75% concession on consultation fee for the consultants. In suspected cases of urinary tract infections, I ask for routine microscopic examination of urine. We get the report in about half an hour's time, if indicated, I ask for culture and sensitivity report. But, in case of poor patients I start antibiotic on empirical basis, without asking for culture and sensitivity report, and instruct the parents to get urine examined again after three days. The second urine report tells whether antibiotic started on guess was appropriate or not. If report suggests treatment failure then I suggest urine culture and sensitivity examination, by explaining and discussing the problem. I avoid the initial urine culture examination because there are every chances that poor family may not be left with any money to buy the drugs after the costlier investigations. Although it is strictly not a textbook management of UTI, but it works in such situations so is a practical solution.
References
1. Gaur AH, English B.K. The Judicious Use of Antibiotics - An Investment towards Optimized Health Care. Indian J Pediatr 2006; 73 (4): 343-350.(Paul Yash)
This refers to an excellent article by Gaur and English entitled 'The Judicious Use of Antibiotics - An Investment towards Optimized Health Care'.[1] In the last sentence the authors had stated: "While the goal is far from being reached, a reader who makes it to the end of the review article is encouraged to pause for a moment, reflect on his practice and decide what he as an individual can do to address this problem." I got three xerox copies and presented to my doctor friends.
The authors had stated: "Numerous studies have shown widespread unnecessary use of antimicrobials in patients with viral upper respiratory tract infections". A runny nose, patient's general look and a peep in the throat should suffice in most of cases to distinguish upper respiratory infection of viral origin from bacterial origin.
Under certain circumstances a 'non-rational' antimicrobial therapy may be justified. I work in Maharaja Agrasen Hospital, Jaipur, where poor patients are offered 75% concession on consultation fee for the consultants. In suspected cases of urinary tract infections, I ask for routine microscopic examination of urine. We get the report in about half an hour's time, if indicated, I ask for culture and sensitivity report. But, in case of poor patients I start antibiotic on empirical basis, without asking for culture and sensitivity report, and instruct the parents to get urine examined again after three days. The second urine report tells whether antibiotic started on guess was appropriate or not. If report suggests treatment failure then I suggest urine culture and sensitivity examination, by explaining and discussing the problem. I avoid the initial urine culture examination because there are every chances that poor family may not be left with any money to buy the drugs after the costlier investigations. Although it is strictly not a textbook management of UTI, but it works in such situations so is a practical solution.
References
1. Gaur AH, English B.K. The Judicious Use of Antibiotics - An Investment towards Optimized Health Care. Indian J Pediatr 2006; 73 (4): 343-350.(Paul Yash)