PHM-Exch> Fixed dose combination medicines (FDCs) (3)

[Claudio Schuftan]

From: Vandana Prasad <chaukhat at yahoo.com>


I very much sympathise with Dr Serventi's feelings - and I wholly agree
that pediatric practice is very irrational today; many kids get unecessary
medication, but also,  many don't get medicines they require. However, I
think some moderation might be required and 'never' is a bit harsh from you
too.
There are situations, for example, where a child might require more than
two drugs - very commonly here, an antipyretic, a bronchodilator and an
oral steroid three days course / antibiotic / nasal drops.  Not all
bronchospasms are related to a viral URI and if I have a sick child with a
high fever with wheeze and rapid breathing in a rural setting without lab
facilities, I will treat her as pneumonia with bronchospasm. All I am
saying - never say never.

Multiple morbidities are also fairly common - an untreated skin infection
is picked up in many patients who have come for something else altogether.

I did pediatrics in the UK after becoming a doctor in India, but have
worked with very poor kids in India for about 20 yrs - I was initially
appalled at the amounts of antibiotics people were getting here, but I also
realise more antibiotic use is needed in some situations as compared to
others.
But on the whole - I agree with you and feel as frustrated. as pointed out
by you - standard treatment protocols are a good way of sorting this out,
but there are huge vested interests at play.
As an aside - I visited Tanzania last year and fell in love with that
country.
Don't feel alone!
warm regards
vandana prasad - a community pediatrician in India
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