PHM-Exch> World Health Day: antibiotic resistance (2)

[Claudio Schuftan]

From: massimo serventi <ser20 at hotmail.it>


I think that the views of those who daily prescribe drugs should be heard.
This is mine.

------------------------------
 World Health Day 2011: Antimicrobial resistance This year's World Health
Day will be focused on antimicrobial resistance. [*1]

As a pediatrician I do daily prescription of drugs. I've been doing so from
years, in different settings, poor, rich, urban, rural, African, Asian.

I usually try to adhere to the (good) guidelines and principles of IMCI.
[*2]

I must also write that 'too many antibiotics' (and drugs altogether) are
often prescribed to children by other professionals. For several reasons,
one being the lack of confidence in dealing with a sick child (so an
antibiotic will cover any possible infection), another being the 'need' of
satisfying the mother who wants a medicine for the illness of her child. A
medicine... and not a 'simple' ORS for diarrhoea or cleaning of his nose for
cough. Private providers are obviously more 'affected' by the second reason.


I usually ask my local colleagues to follow a rule:
Do not exceed 25% of antibiotic prescription in your daily pediatric
practice. In other words: no more than 1 child out of 4 should go home with
an antibiotic.

In case there is a reliable laboratory that can check for white cells count,
malaria parasites ,urine and stool, the percent of 'allowed' antibiotics
should go down to 10%.

This being valid for any setting, under any circumstance and any period of
the year. One favorable condition is the possiblity for the mothers to come
back for the follow up.

I ask my colleagues whether they agree with my behaviour.

Massimo (Serventi), Pediatric Centre of EMERGENCY, Italy.
Bangui
CAR


PS. I do think that WHO/IMCI should propose some practical indications on
how to be 'on track' concerning prescriptions in the clinic.
The percent of children who can receive antibiotics is just one. Another
indication is the average number of medicines per child. My behaviour is: 2
medicines per child, rarely 3 , never 4.
A general rule should also be that a dispensing clinic should never be
associated with the delivering of drugs or laboratory tests. In other words:
I do prescribe, but then the drugs and lab test should be obtained in a
different setting then my clinic. The reason is clear: to avoid the conflict
of interest. Private dispensaries( and not only them) 'survive' on
overprescription and the follow-up selling of drugs and lab tests.


1. World Health Day is 7 April 2011:
http://www.who.int/world-health-day/2011/en/
2. IMCI = Integrated Management of Childhood Illness
Thanks, Neil PW]
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