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USE OF ANTIBIOTICS IN PRIVATE PRACTICE
OP KAPOOR
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
I am surprised to see the number of prescriptions of 3rd generation Cephalosporidin and Quinolone preparations being prescribed by general practitioners so frequently.
In my practice, I prescribe these drugs in patients of typhoid only and that too in affording patients. Otherwise, I still prescribe Chloramphenicol. The rare side effect of the granulocyte count going down occasionally, can be looked after by granulocyte stimulating factor, which is now available in the market.
Coming to chest infections - I hardly see any patients with chest problems who have infections (except kochs or fungus) as the "cause" of the complaints. Most of the times, it is virus or allergy which clears up with passage of time or steroids and the doctors attribute it to the effect of antibiotics.
Bronchiectasis and COPD patients are becoming rare. These are the only patients who will need antibiotics and the best antibiotics for these patients (recognised internationally and by all Standard Textbooks) are Ampicillin or Amoxycillin (with or without Clavulanic acid) or Cotrimoxazole which are the cheapest drugs available as compared to the above antibiotics. Even the mode of administration is only twice a day.
Yes, I do prescribe Macrolides like Azithromycin or Roxithromycin for tonsillitis or streptococcal sore throat. The problem is to diagnose the latter. More the symptoms of associated nasal discharge and sneezing, more are the chances that it is a viral sore throat. But I must admit that if I am not confident or if there is history of patient bringing out yellowish post nasal discharge, I give them a course of these drugs.
The next occasion when I prescribe antibiotics is urinary tract infection mainly the lower urinary tract infection in women. Again, I find that the practitioners are prescribing antibiotics the moment they hear the complaint of burning urine. Most of these patients have urethral syndrome which does not call for any antibiotics. A routine urine examination in most of these patients shows a few pus cells which is quite a normal finding in women and the doctors attribute this to urine infection. It will be better to make the patient spend money on the investigation of urine culture and colony count and then prescribe Norfloxacin or other antibiotics.
Though, I do prescribe this antibiotic in patients who are not ready to get the test of urine culture done when indicated or in patients with a straight forward infection with urine showing presence of albumin and plenty of pus cells, I would avoid using antibiotics freely or loosely in urethral syndrome. When these patients do not respond they go on changing their doctors who go on changing the antibiotics. Any relief is attributed to a particular antibiotic.
Nowadays I hardly see cases of venereal diseases where I have to prescribe antibiotics. Of course, non-gonococcal urethritis calls for a course of a single dose of Azithromycin 1000 mg to get rid of Chlamydia and a course of Metronidazole and Acyclovir.
For patients having rheumatic heart disease, I do prescribe penicillin tablets in adults and injections below age of 15-20 years which have to be continued for 10-20 years.
A straight forward abscess or a Carbuncle (as in a diabetic patient) of course calls for use of antibiotics as in a patient having cellulitis.
Of course there are dozens of conditions where the antibiotics have to be used in hospital practice. These include pyogenic meningitis, tetanus, infective endocarditis and most of the surgical, orthopaedic and gynaec patients. But this discussion holds true only for the private practitioners.
Finally the GPs must remember that if they go on using the above mentioned costly antibiotics just to please the medical pharmaceutical industry, it will be their funeral. Resistance will develop in the community and those antibiotics in future will not work, when you do prescribe them in "indicated" illnesses.
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