|
FEEDBACK
Pnenmonia article : Few queries
Read with interest Dr Parang’s
article on pneumonia. There are two queries however
which I thought I must bring to notice and interact.
As we all know and the author has
also very rightfully mentioned that the pneumococcal
penicillin resistance is low in our country, then why
the low dose Amoxicillin has failed to evoke desired
response to move colleagues away from this drug?
And second, as we know the
pneumococcal resistance is not related to Beta-lactam,
it is related to decreased affinity of PBP, then in an
event of failure to respond in 48 hours why should
Coamoxiclav be the drug of choice?
- Dr
Sanwar Agrwal, Raipur
Author’s reply:
I thank Dr Sanwar Agrawal for his
interest in my article.
Answer 1: I do not believe that
Amoxycillin has been tried and found wanting in the
treatment of pneumonia rather it has been left untried.
Personally, I have used IV amoxycillin for the past
several years in the indoor treatment of pneumonia, and
oral amoxicillin for outpatient pneumonia. If adequate
doses are prescribed, and the child is able to take the
drug, results are good in the majority of cases.
Colleagues have moved away because of high-pressure
promotion of "newer, stronger, better" drugs.
Amoxycillin being an inexpensive drug is not promoted as
aggressively.
Answer 2: When the pneumonia does
not respond to amoxicillin, we should think of some
other organism. Resistant pneumococci are not an issue
in India at present. The Coamoxiclav is meant to cover
the other common bacterial causes, H. influenzae and
Moraxella, both of which produce beta-lactamases.
-Dr Parang Mehta, Surat.
IAP Drug
Formulary : Combination of Ibuprofen-Paracetamol
Thank you for the review of the IAP
Drug Formulary and the response by the editor-in-chief.
This is with reference to the policy on using the
combination of paracetamol and ibuprofen. Although the
combination is marketed, there is no definite evidence
of the safety of the combination. When both are very
common drugs used in various scenarios it is always
better to be cautious when using the combination. Blood
dyscrasias, hepatotoxicity, renal toxicity and gastric
irritation are the more obvious possibilities due to the
synergism in adverse events. This topic maybe previewed
by the IAP faculty and respective chapter members,
before including the dosage in the formulary, which
automatically recommends the usage to the primary care
pediatricians and GPs.
-Dr D. Sudhakar,
sdkar57@yahoo.co.in
Editor’s reply:
I agree with Dr Sudhakar and hence
the update did not have the combination as a separate
entity as suggested (in fact all combination drugs
except co-amoxiclav have been avoided). The two drugs -
paracetamol and ibuprofen - do not act synergistically -
paracetamol appears to inhibit COX-3 activity within the
brain while ibuprofen and other NSAID’s inhibit
peripheral COX. This means that there really isn’t any
advantage to the combination. It definitely adds to the
cost with the combination nearly 20-30% costlier than
the two drugs given separately and 3 times the cost of
paracetamol alone and 2 times costlier than ibuprofen
alone. It is clear then, the pharmaceutical companies in
India are dishing out their NSAIDs by at a high price by
popularizing the combination drug ie., even if these
drugs were to be administered together, it would be
cheaper to give them as individual tablets than as the
combined pills! I have not come across too many
references to studies demonstrating increased toxicity
except for one in rats showing potentiation of gastric
toxicity of ibuprofen by paracetamol.
-Dr Jeeson C. Unni,
Editor-in-Chief, IAP Pediatric Drug Formularly, 2004
Congratulations!!
My dear Vipin,
Kindly accept my hearty
congratulations on the excellent, erudite and educative
contents of the latest issue of Pediascene with
updated information so useful for day-to-day practice. I
have always been an admirer of your young talent,
mastery of English, treasure of quotes, wisdom of
original ideas with a capacity for critical analysis,
constructive suggestions for IAP and above all concern
about National Child Survival and Development Programs.
Keep it up!
-Dr A. Parthasarthy, Chennai.
Dear Vipin
Your write up in ‘Pediascene’ has
reminded me of the responsibility I am aspiring to take.
I request you to remind me anytime if you think I am
deviating from the path.
-Dr Naveen Thacker, President-Elect,
IAP, 2006.
Dear Vipin,
Received your Bulletin. It was very
nice. The best part of you is that you are very sincere
to your senior colleagues whom you appreciate and who
have done a little bit for you. You have truly the genes
of THANKFULNESS, which I appreciate a lot.
-Dr Subhash Agarwal, New Delhi
Dear Dr Vashishtha,
I am happy to receive your ‘Pediascene’,
which not only truly shows the current pediatric scene
as the name indicates but reflects the IAP scenario
also. The presentation is excellent! I would like to
congratulate you and wish all the very best for your
efforts.
-Dr V. Ram Narsimha Reddy, Hanamkonda,
Warangal-506001 (AP).
Respected Dr. Vashishtha,
I received the latest issue of "Pediascene"
a few days back. It is, like always, a gem. A busy
practitioner always needs recent updates and "take home
messages" for his day-to day needs. And Pediascene is
the just perfect cocktail that he looks for!
Thank you so much for publishing the review of IAP Drug
Formulary. It was a great idea to publish reply by
Editor- in Chief alongside. It is nice to know that all
the concerns raised have been considered seriously and
he has promised to resolve all these in next edition.
-Dr. Puneet Kumar, New Delhi.
Dear Dr.Vashishtha,
Received the latest issue of
Pediascene. As soon as I opened the envelope, the eyes
got stuck up to see the sober yet grand look of the
bulletin. This is such a well-knit issue that I could
not resist the temptation of going through the all of it
in one go. You have made it so interesting with many new
features that we can say that this bulletin is taking
the shape of a very good magazine with appropriate
literary touch in the hands of a very good editor.
- Dr. Sanjiv Kumar, Aligarh.
^
TOP
^
|
