APPROPRIATE  USE  OF  DRUGS

DR. M ABBAS SUBHANI
 MBBS DCH

Remember all illnesses do not require treatment with drugs. Use them only if they are genuinely required {recovery is less likely with out them (drugs)}.

• USE ORAL AND TASTY DRUGS AS FAR AS POSSIBLE
•  CALCULATE THE DOSE ACCORDING TO THE WEIGHT   This is much more accurate than the calculation according to the age. One may forget the exact doses of the drugs. Keeping a laminated sheet (for the doses of various drugs) on the table and in the emergency bag will solve this problem. Where weighing machine is not available e.g. attending patient in emergency at home one dose may be given empirically, but readjust the dose later on, based on weight
• SPECIFY THE SIZE OF THE SPOON TO BE USED OR FRACTION OF TABLET
•  USE SHORT ACTING DRUGS FOR QUICK RESPONSE AND LONG ACTING DRUGS FOR STABLE PATIENTS WITH RECURRENT/ PERSISTENT PROBLEMS e.g. ASTHMA
•  DO NOT MIX DRUGS      (SPECIALLY IF THEY ARE TO BE GIVEN AT DIFFERENT TIMINGS e.g.cotrimoxazole 12 hourly and paracetamol 6 hourly .
•  INSTRUCT  TO SHAKE THE BOTTLE THOROUGHLY BEFORE GIVING DRUG
•  CONSIDER THE COST EFFECTIVITY RATIO BUT DO NOT ADVISE CHEAP DRUGS WHICH ARE NOT RELIABLY EFFECTIVE
•  ADVISE THE FREQUENCY OF USE IN HOURS (4, 6, 8 OR 12 HOURLY).  ADVISING THE FREQUENCY OF USE IN NUMBER OF DOSES PER DAY e.g. 2, 3, 4 TIMES A DAY  DOES NOT MAINTAIN THE UNIFORM DISTRIBUTION OF DRUG)

COMPLIANCE IS BETTER WITH 8-12-24 HOURLY DRUGS NOT WITH 4-6 HOUR FREQUENCY

 KEEP A CHECK ON THE PHARMACIST'S ADVICE TO THE PATIENTS
Call back the patients again after they have taken the drug from clinic pharmacy or out side

CHECK THE PRESCRIBED DRUGS HAVE BEEN GIVEN AND NOT REPLACED OR SUBSTITUTED, ADVICE ABOUT THE DOSE AND FREQUENCY IS NOT MODIFIED

 DO NOT FORGET TO MENTION THE POSSIBLE SIDE EFFECTS----But mention in a manner that does not generate undue fear about the drug

          DO NOT ADVISE DRUGS WHICH ARE NOT RECOMMENDED

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NOT RECOMMENDED FOR CHILDREN

Some of the commonly used drugs in adults are not recommended to be used in children before a particular age.  This is in addition to their contraindication, which are almost similar in adults and children.

Following are the common drugs not recommended for children.

ANALGESICS/ANTIPYRETICS ----- Aspirin (risk of Reye's syndrome : a form of Hepatic encephalopathy  it may be fatal)

ANTIBIOTICS AND CHEMOTHERAPEUTIC AGENTS -----  Chloremphenicol and Co-Trimoxazole (for neonates)
Quinolones e.g. Ciprofloxacin (risk of cartilage damage below 12 years of age)
Tetracycline and doxycycline (below 8 years ? risk of deposition and discoloration in bones and teeth)
Ethambutol (below 6 years ? risk of vision impairment and detection at this age is not easy)
Metronidazole (below 2 years ? experimental evidence)
Mefloquine (young children)

ANTIHISTAMINES --- Astemazole (below 6 years) and Terfinadine (below 3 years)

COUGH REMIDIES
Cough sedatives should not be used in young children until and unless cough is disturbing feeding, sleep, and routines of the child or causing exhaustion or vomiting.  Even in these children preparations containing narcotics are not advised.
Cough expectorants are not recommended below the age of 6 years.

MISCELLANEOUS
Preparations sold as appetizers, tonics, carminative mixtures, Gripe Water, oil massages and teething preparations have no proven efficacy and their use should better be avoided. Occasionally some of the above mentioned preparations (harmless only) may be advised/ used as ? Placebos?.

BRONCHODILATORS --- Contrary to the popular belief amongst the physicians both Aminophylline and Salbutamol are not that much toxic (as believed ) and there is no extra risk for children.  Some physicians consider the metered dose inhalers are costly, harmful and difficult to use.This is not true
In young infants fix the inhaler inside the cheek and push the drug.  It would be absorbed rapidly through oral mucosa.  Spacers also enhance the ease of use of inhalers in children

Self-medication: Needs to be discouraged as selection, dose, frequency of administration and duration of treatment may not be appropriate. In addition to economic burden it is harmful to health. Education in this regard is highly rewarding.

Repeat prescriptions: Physicians should also turn down the request for prescriptions or their repetition without examining the patients.