Re: Safe drugs for children

[Guest guest]

Hi Deepali,

Yours is a nice contribution. keep up the good work.

Cough syrups : These are absolutely irrational and have no

justification. Those hospitals which have cough syrups on their

purchase list show their slip!

Tonics: This is another irrational category. Advice about feeding,

balanced diet can work wonders rather than the tonics. Similiarly

nutritional supplements unless specifically required, should not be

prescribed.

Analgesics: It is sickening to find that the highest medical

organisation which promotes Dettol soap and Aquaguard water filter

was behind the unstinted support to nimesulide in India.

Sedatives: In ancient times, in the areas of Gujarat and Rajasthan

in India where poppy was grown, all health problems of a child were

tried to be solved by home remedy of feeding the child with extract

of capsule of poppy. I do not know if it is still practiced. It is

criminal to make the child sleep under effect of sedative

medicines / drugs, just becuase the child is restless/crying/in

problem. No pediatric formulation should be allowed to be

manufactured if it contains a sedative. Similiarly all

antihistaminics, mixtures, syrups containing PPA should be banned

forthwith.

Correct me if I am wrong.

Vijay

>

>

> Hello Smita and Netrumians,

>

>

>

> First of all congratulations for getting opportunity to moderate

once

> again.

>

> A sick child is the source of great anxiety to both doctors and

carers,

> can be a huge diagnostic challenge.

>

> Indian markets are flooded with. thousands of formulations of

vitamins,

> tonics and multi-drug combinations that are unique to the Indian

market

> are manufactured and marketed here. A visit to the pediatrician

has come

> to necessarily mean a prescription comprising of a shot gun

combination

> of antibiotics – one and more, an anti pyretic or frequently an

> unnecessary combination of two, a multivitamin tonic and a

combination

> cough syrup. Intravenous rehydration and parenteral medication are

used

> far more frequently than rationally warranted. Widespread

experience

> clearly shows that the vast majority of doctors' prescriptions for

> children are quite irrational.

>

> Analyzing some of the commonest prescribed groups of drugsà

>

> Tonics And Cough Syrupsà

>

> According to Health Action International " More than four out of

> every five vitamin preparations cannot be recommended; nearly

three out

> of every five is indicated for unproven indications; more than two

out

> of every five contain non-essential or ineffective ingredients;

more

> than one out of every two is irrationally formulated; and nearly

one out

> of every two contains excessive dosage. "

>

> Over 80 per cent of cough and cold remedies on the market are

> irrational, most with ineffective and some with dangerous

ingredients.

>

> Vaccinesà

>

> There is growing trend towards prescribing optional vaccines and

> vaccines like

>

> anti pneumococcal vaccine and influenza vaccine are being used

routinely

> by some, if not many doctors though this has no current

justification

> Vaccinations have become the major source of bread and butter of

the

> pediatrician.

>

> Analgesicsà

>

> The medical community's response to drugs like nimuselide, a drug

> aggressively promoted in India for bringing down fever in

children, is

> also an eye opener. The justice is still out in India as to its

safety

> in children, with many professional organisations declaring it

safe and

> others claiming to have seen children die as a result of liver

failure

> from its use. so why to take risk when there are excellent time

tested

> safe analgesia is available for children. other countries, issued a

> precautionary advice on the marketing of the drug following some

serious

> complications of the liver, especially in children. Owing to the

death

> of a patient due to liver failure and following reports of other

adverse

> drug reaction, banned in many countries It is interesting to note

that.

> Bangladesh was the last country to ban the drug. However,

paediatricians

> in India continue blissfully to prescribe the drug and drug

companies

> continue to prevail upon them and make it lucrative for the

practice to

> continue.

>

> Sedativesà

>

> Prescribing any kind of sedative just because to diminish crying in

> infants in highly objectionable. Many pediatrician giving H1

> antihistaminic hydroxyzine only to calm children, which should not

be

> done owing to its other hazardous side effects.

>

>

>

> Regards,

>

> Dr Deepali

>

> GMC

>

> Nagpur

>

[Guest guest]

Hello Deepali,

You have posted good information. Definitely these products are

irrational. In this regard regulatory authority should play keen

vigilant and strict role so as to minimise marketing of such products.

Pharma industries know that medicines for cough and cold are confirmed

ways of making profit as coryza/rhinitis attack is with frequency of

3-5/yr/child grossly. It is duty on our part to restrict the use until

these irrational medicines are out of market.

What all measures can be taken to safeguard our child from such

medicines?

> >

> >

> > Hello Smita and Netrumians,

> >

> >

> >

> > First of all congratulations for getting opportunity to moderate

> once

> > again.

> >

> > A sick child is the source of great anxiety to both doctors and

> carers,

> > can be a huge diagnostic challenge.

> >

> > Indian markets are flooded with. thousands of formulations of

> vitamins,

> > tonics and multi-drug combinations that are unique to the Indian

> market

> > are manufactured and marketed here. A visit to the pediatrician

> has come

> > to necessarily mean a prescription comprising of a shot gun

> combination

> > of antibiotics – one and more, an anti pyretic or frequently an

> > unnecessary combination of two, a multivitamin tonic and a

> combination

> > cough syrup. Intravenous rehydration and parenteral medication are

> used

> > far more frequently than rationally warranted. Widespread

> experience

> > clearly shows that the vast majority of doctors' prescriptions for

> > children are quite irrational.

> >

> > Analyzing some of the commonest prescribed groups of drugsà

> >

> > Tonics And Cough Syrupsà

> >

> > According to Health Action International " More than four out of

> > every five vitamin preparations cannot be recommended; nearly

> three out

> > of every five is indicated for unproven indications; more than two

> out

> > of every five contain non-essential or ineffective ingredients;

> more

> > than one out of every two is irrationally formulated; and nearly

> one out

> > of every two contains excessive dosage. "

> >

> > Over 80 per cent of cough and cold remedies on the market are

> > irrational, most with ineffective and some with dangerous

> ingredients.

> >

> > Vaccinesà

> >

> > There is growing trend towards prescribing optional vaccines and

> > vaccines like

> >

> > anti pneumococcal vaccine and influenza vaccine are being used

> routinely

> > by some, if not many doctors though this has no current

> justification

> > Vaccinations have become the major source of bread and butter of

> the

> > pediatrician.

> >

> > Analgesicsà

> >

> > The medical community's response to drugs like nimuselide, a drug

> > aggressively promoted in India for bringing down fever in

> children, is

> > also an eye opener. The justice is still out in India as to its

> safety

> > in children, with many professional organisations declaring it

> safe and

> > others claiming to have seen children die as a result of liver

> failure

> > from its use. so why to take risk when there are excellent time

> tested

> > safe analgesia is available for children. other countries, issued a

> > precautionary advice on the marketing of the drug following some

> serious

> > complications of the liver, especially in children. Owing to the

> death

> > of a patient due to liver failure and following reports of other

> adverse

> > drug reaction, banned in many countries It is interesting to note

> that.

> > Bangladesh was the last country to ban the drug. However,

> paediatricians

> > in India continue blissfully to prescribe the drug and drug

> companies

> > continue to prevail upon them and make it lucrative for the

> practice to

> > continue.

> >

> > Sedativesà

> >

> > Prescribing any kind of sedative just because to diminish crying in

> > infants in highly objectionable. Many pediatrician giving H1

> > antihistaminic hydroxyzine only to calm children, which should not

> be

> > done owing to its other hazardous side effects.

> >

> >

> >

> > Regards,

> >

> > Dr Deepali

> >

> > GMC

> >

> > Nagpur

> >

>

[Guest guest]

Hi Dr Vijay and Dr Deepali,

Yes, poppy extracts are commonly given to kids to

sedate them.

Even Janam gutti and gripe water mixtures are commonly

given. The Ayurved practitioners commonly write them.

I am not awre of their scientific validity.

Could any one throw a light on them?

Anupama.

--- Vijay <drvijaythawani@...> wrote:

> Hi Deepali,

>

> Yours is a nice contribution. keep up the good work.

>

>

> Cough syrups : These are absolutely irrational and

> have no

> justification. Those hospitals which have cough

> syrups on their

> purchase list show their slip!

>

> Tonics: This is another irrational category. Advice

> about feeding,

> balanced diet can work wonders rather than the

> tonics. Similiarly

> nutritional supplements unless specifically

> required, should not be

> prescribed.

>

> Analgesics: It is sickening to find that the highest

> medical

> organisation which promotes Dettol soap and

> Aquaguard water filter

> was behind the unstinted support to nimesulide in

> India.

>

> Sedatives: In ancient times, in the areas of Gujarat

> and Rajasthan

> in India where poppy was grown, all health problems

> of a child were

> tried to be solved by home remedy of feeding the

> child with extract

> of capsule of poppy. I do not know if it is still

> practiced. It is

> criminal to make the child sleep under effect of

> sedative

> medicines / drugs, just becuase the child is

> restless/crying/in

> problem. No pediatric formulation should be allowed

> to be

> manufactured if it contains a sedative. Similiarly

> all

> antihistaminics, mixtures, syrups containing PPA

> should be banned

> forthwith.

>

> Correct me if I am wrong.

> Vijay

>

> >

> >

> > Hello Smita and Netrumians,

> >

> >

> >

> > First of all congratulations for getting

> opportunity to moderate

> once

> > again.

> >

> > A sick child is the source of great anxiety to

> both doctors and

> carers,

> > can be a huge diagnostic challenge.

> >

> > Indian markets are flooded with. thousands of

> formulations of

> vitamins,

> > tonics and multi-drug combinations that are unique

> to the Indian

> market

> > are manufactured and marketed here. A visit to the

> pediatrician

> has come

> > to necessarily mean a prescription comprising of a

> shot gun

> combination

> > of antibiotics & #8211; one and more, an anti

pyretic or

> frequently an

> > unnecessary combination of two, a multivitamin

> tonic and a

> combination

> > cough syrup. Intravenous rehydration and

> parenteral medication are

> used

> > far more frequently than rationally warranted.

> Widespread

> experience

> > clearly shows that the vast majority of doctors'

> prescriptions for

> > children are quite irrational.

> >

> > Analyzing some of the commonest prescribed groups

> of drugsà

> >

> > Tonics And Cough Syrupsà

> >

> > According to Health Action International " More

> than four out of

> > every five vitamin preparations cannot be

> recommended; nearly

> three out

> > of every five is indicated for unproven

> indications; more than two

> out

> > of every five contain non-essential or ineffective

> ingredients;

> more

> > than one out of every two is irrationally

> formulated; and nearly

> one out

> > of every two contains excessive dosage. "

> >

> > Over 80 per cent of cough and cold remedies on the

> market are

> > irrational, most with ineffective and some with

> dangerous

> ingredients.

> >

> > Vaccinesà

> >

> > There is growing trend towards prescribing

> optional vaccines and

> > vaccines like

> >

> > anti pneumococcal vaccine and influenza vaccine

> are being used

> routinely

> > by some, if not many doctors though this has no

> current

> justification

> > Vaccinations have become the major source of

> bread and butter of

> the

> > pediatrician.

> >

> > Analgesicsà

> >

> > The medical community's response to drugs like

> nimuselide, a drug

> > aggressively promoted in India for bringing down

> fever in

> children, is

> > also an eye opener. The justice is still out in

> India as to its

> safety

> > in children, with many professional organisations

> declaring it

> safe and

> > others claiming to have seen children die as a

> result of liver

> failure

> > from its use. so why to take risk when there are

> excellent time

> tested

> > safe analgesia is available for children. other

> countries, issued a

> > precautionary advice on the marketing of the drug

> following some

> serious

> > complications of the liver, especially in

> children. Owing to the

> death

> > of a patient due to liver failure and following

> reports of other

> adverse

> > drug reaction, banned in many countries It is

> interesting to note

> that.

> > Bangladesh was the last country to ban the drug.

> However,

> paediatricians

> > in India continue blissfully to prescribe the drug

> and drug

> companies

> > continue to prevail upon them and make it

> lucrative for the

> practice to

> > continue.

> >

> > Sedativesà

> >

> > Prescribing any kind of sedative just because to

> diminish crying in

> > infants in highly objectionable. Many pediatrician

> giving H1

> > antihistaminic hydroxyzine only to calm children,

> which should not

> be

> > done owing to its other hazardous side effects.

> >

> >

> >

> > Regards,

> >

> > Dr Deepali

> >

> > GMC

> >

> > Nagpur

>

=== message truncated ===

Chat on a cool, new interface. No download required. Go to

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[Guest guest]

Hello Dr Anupama,

Always the discussion gets newer ideas, questions from you; makeing

it live, nice part on your side.

Use of poppy seeds extract to sedate child was used to be done by

the parents who had to earn their bread-butter on daily wages, had

to live away from homes for whole day. Whatever, the use is unsafe

and criminal only.

About gripe-water, no standard references mention about its

indication. It is hydro-alcoholic preparation. It is strictly

recommended that paediatric medications should be free of alcohol

content. In that case this use is unethical as well as unsafe.

Janam-gutti is some kind of home-made feed for infant. Now a days

may be marketed as brand product. Also other ayurvedic, home-made

medicines (dadika nuska/ aajibaich batava)are tried simultaneously

with allopathy. Combined effects whether safe or not are not proven.

Corrections and details about its safety might be given by our

senior guide members.

Regards,

Dr Smita

GMC Nagpur.

> > >

> > >

> > > Hello Smita and Netrumians,

> > >

> > >

> > >

> > > First of all congratulations for getting

> > opportunity to moderate

> > once

> > > again.

> > >

> > > A sick child is the source of great anxiety to

> > both doctors and

> > carers,

> > > can be a huge diagnostic challenge.

> > >

> > > Indian markets are flooded with. thousands of

> > formulations of

> > vitamins,

> > > tonics and multi-drug combinations that are unique

> > to the Indian

> > market

> > > are manufactured and marketed here. A visit to the

> > pediatrician

> > has come

> > > to necessarily mean a prescription comprising of a

> > shot gun

> > combination

> > > of antibiotics & #8211; one and more, an anti

> pyretic or

> > frequently an

> > > unnecessary combination of two, a multivitamin

> > tonic and a

> > combination

> > > cough syrup. Intravenous rehydration and

> > parenteral medication are

> > used

> > > far more frequently than rationally warranted.

> > Widespread

> > experience

> > > clearly shows that the vast majority of doctors'

> > prescriptions for

> > > children are quite irrational.

> > >

> > > Analyzing some of the commonest prescribed groups

> > of drugsà

> > >

> > > Tonics And Cough Syrupsà

> > >

> > > According to Health Action International " More

> > than four out of

> > > every five vitamin preparations cannot be

> > recommended; nearly

> > three out

> > > of every five is indicated for unproven

> > indications; more than two

> > out

> > > of every five contain non-essential or ineffective

> > ingredients;

> > more

> > > than one out of every two is irrationally

> > formulated; and nearly

> > one out

> > > of every two contains excessive dosage. "

> > >

> > > Over 80 per cent of cough and cold remedies on the

> > market are

> > > irrational, most with ineffective and some with

> > dangerous

> > ingredients.

> > >

> > > Vaccinesà

> > >

> > > There is growing trend towards prescribing

> > optional vaccines and

> > > vaccines like

> > >

> > > anti pneumococcal vaccine and influenza vaccine

> > are being used

> > routinely

> > > by some, if not many doctors though this has no

> > current

> > justification

> > > Vaccinations have become the major source of

> > bread and butter of

> > the

> > > pediatrician.

> > >

> > > Analgesicsà

> > >

> > > The medical community's response to drugs like

> > nimuselide, a drug

> > > aggressively promoted in India for bringing down

> > fever in

> > children, is

> > > also an eye opener. The justice is still out in

> > India as to its

> > safety

> > > in children, with many professional organisations

> > declaring it

> > safe and

> > > others claiming to have seen children die as a

> > result of liver

> > failure

> > > from its use. so why to take risk when there are

> > excellent time

> > tested

> > > safe analgesia is available for children. other

> > countries, issued a

> > > precautionary advice on the marketing of the drug

> > following some

> > serious

> > > complications of the liver, especially in

> > children. Owing to the

> > death

> > > of a patient due to liver failure and following

> > reports of other

> > adverse

> > > drug reaction, banned in many countries It is

> > interesting to note

> > that.

> > > Bangladesh was the last country to ban the drug.

> > However,

> > paediatricians

> > > in India continue blissfully to prescribe the drug

> > and drug

> > companies

> > > continue to prevail upon them and make it

> > lucrative for the

> > practice to

> > > continue.

> > >

> > > Sedativesà

> > >

> > > Prescribing any kind of sedative just because to

> > diminish crying in

> > > infants in highly objectionable. Many pediatrician

> > giving H1

> > > antihistaminic hydroxyzine only to calm children,

> > which should not

> > be

> > > done owing to its other hazardous side effects.

> > >

> > >

> > >

> > > Regards,

> > >

> > > Dr Deepali

> > >

> > > GMC

> > >

> > > Nagpur

> >

> === message truncated ===

>

>

>

> Chat on a cool, new interface. No download required. Go to

http://in.messenger./webmessengerpromo.php

>

[Guest guest]

Hello,

While Dr Anupama has raised doubt about janam-gutti, it will be good to have a look over drawbacks in current paediatric management.

1. Wrong dosage causes short-term toxicity or treatment failure.

2. Non-availability of appropriate paediatric formulations forces manipulated administration of medicines with lack of information regarding bio-availability, efficacy and toxicity.

3. Non-availability of formulations of strengths suitable for administration to neonates, infants and young children leads to administration errors (intravenous drips running fast, errors in dosage calculation and dilution), especially in circumstances that require urgent action (as in emergency units, premature units and paediatric and neonatal intensive care units).

4. Adolescents may ingest medicines with suicidal intent or may experience health problems from illicit drug abuse.

5. Medicines can interact with traditional and herbal medicines.

6. Medicines may have long-term safety problems.

7. Resource-poor countries, co-morbidity or malnutrition may exacerbate the toxicity. Dehydration is frequently associated with ibuprofen-induced renal failure and malnutrition with paracetamol hepatotoxicity.

8. Cultural differences can lead to misunderstanding of medicine instructions.

9. A simple process of reconstitution of nonsterile oral powder can be a risk for stability or even safety.

Further additional points are invited along with conditions which are restricting management from gaining safe status.

How to overcome these hurdles?

Regards,

Dr Smita,

GMC, Nagpur.> > >> > > > > > Hello Smita and Netrumians,> > > > > > > > > > > > First of all congratulations for getting> > opportunity to moderate > > once> > > again.> > > > > > A sick child is the source of great anxiety to> > both doctors and > > carers,> > > can be a huge diagnostic challenge.> > > > > > Indian markets are flooded with. thousands of> > formulations of > > vitamins,> > > tonics and multi-drug combinations that are unique> > to the Indian > > market> > > are manufactured and marketed here. A visit to the> > pediatrician > > has come> > > to necessarily mean a prescription comprising of a> > shot gun > > combination> > > of antibiotics & #8211; one and more, an anti> pyretic or> > frequently an> > > unnecessary combination of two, a multivitamin> > tonic and a > > combination> > > cough syrup. Intravenous rehydration and> > parenteral medication are > > used> > > far more frequently than rationally warranted.> > Widespread > > experience> > > clearly shows that the vast majority of doctors'> > prescriptions for> > > children are quite irrational.> > > > > > Analyzing some of the commonest prescribed groups> > of drugsà> > > > > > Tonics And Cough Syrupsà> > > > > > According to Health Action International "More> > than four out of> > > every five vitamin preparations cannot be> > recommended; nearly > > three out> > > of every five is indicated for unproven> > indications; more than two > > out> > > of every five contain non-essential or ineffective> > ingredients; > > more> > > than one out of every two is irrationally> > formulated; and nearly > > one out> > > of every two contains excessive dosage."> > > > > > Over 80 per cent of cough and cold remedies on the> > market are> > > irrational, most with ineffective and some with> > dangerous > > ingredients.> > > > > > Vaccinesà> > > > > > There is growing trend towards prescribing> > optional vaccines and> > > vaccines like> > > > > > anti pneumococcal vaccine and influenza vaccine> > are being used > > routinely> > > by some, if not many doctors though this has no> > current > > justification> > > Vaccinations have become the major source of > > bread and butter of > > the> > > pediatrician.> > > > > > Analgesicsà> > > > > > The medical community's response to drugs like> > nimuselide, a drug> > > aggressively promoted in India for bringing down> > fever in > > children, is> > > also an eye opener. The justice is still out in> > India as to its > > safety> > > in children, with many professional organisations> > declaring it > > safe and> > > others claiming to have seen children die as a> > result of liver > > failure> > > from its use. so why to take risk when there are> > excellent time > > tested> > > safe analgesia is available for children. other> > countries, issued a> > > precautionary advice on the marketing of the drug> > following some > > serious> > > complications of the liver, especially in> > children. Owing to the > > death> > > of a patient due to liver failure and following> > reports of other > > adverse> > > drug reaction, banned in many countries It is> > interesting to note > > that.> > > Bangladesh was the last country to ban the drug.> > However, > > paediatricians> > > in India continue blissfully to prescribe the drug> > and drug > > companies> > > continue to prevail upon them and make it> > lucrative for the > > practice to> > > continue.> > > > > > Sedativesà> > > > > > Prescribing any kind of sedative just because to> > diminish crying in> > > infants in highly objectionable. Many pediatrician> > giving H1> > > antihistaminic hydroxyzine only to calm children,> > which should not > > be> > > done owing to its other hazardous side effects.> > > > > > > > > > > > Regards,> > > > > > Dr Deepali> > > > > > GMC> > > > > > Nagpur> > > === message truncated ===> > > > Chat on a cool, new interface. No download required. Go to http://in.messenger./webmessengerpromo.php>

[Guest guest]

Hello Smita and Netrumians, Four major difficulties stand out which make the study of medicines in children more challenging than in adults. 1) First, the comparative rarity of many diseases in children, leading to recruitment difficulties for pivotal trials. 2) The inhomogeneity of children defined in this convenient collective term. 3) Real (or perceived) ethical problems in conducting placebo controlled, or even positive-controlled trials in children. 4) Finally, problems of definition of end points for

establishing efficacy and safety. Here is an article describing problems in deciding dosages and suggesting various approaches to handle them. Kindly see the attachment.. Regards, Deepali Smita <smt_mali@...> wrote: Hello, While Dr Anupama has raised doubt about janam-gutti, it will be good to have a look over drawbacks in current paediatric management. 1. Wrong dosage causes short-term toxicity or treatment failure. 2. Non-availability of appropriate paediatric formulations forces manipulated administration of medicines with lack of information regarding bio-availability, efficacy and toxicity. 3. Non-availability of formulations of strengths suitable for administration to neonates, infants and young children leads to administration errors (intravenous drips running fast, errors in dosage calculation and dilution), especially in circumstances that require urgent action (as in emergency units, premature

units and paediatric and neonatal intensive care units). 4. Adolescents may ingest medicines with suicidal intent or may experience health problems from illicit drug abuse. 5. Medicines can interact with traditional and herbal medicines. 6.

Medicines may have long-term safety problems. 7. Resource-poor countries, co-morbidity or malnutrition may exacerbate the toxicity. Dehydration is frequently associated with ibuprofen-induced renal failure and malnutrition with paracetamol hepatotoxicity. 8. Cultural differences can lead to misunderstanding of medicine instructions. 9. A simple process of reconstitution of nonsterile oral powder can be a risk for stability or even safety. Further additional points are invited along with conditions which are restricting management from gaining safe status. How to overcome these hurdles?

Regards, Dr Smita, GMC, Nagpur.> > >> > > > > > Hello Smita and Netrumians,> > > > > > > > > > > > First of all congratulations for getting> > opportunity to moderate > > once> > > again.> > > > > > A sick child is the source of great anxiety to> > both doctors and > > carers,> > > can be a huge diagnostic challenge.> > > > > > Indian markets are flooded with. thousands of> > formulations of > > vitamins,> > > tonics and multi-drug combinations that are unique> > to the Indian > > market> > > are manufactured and marketed here. A visit to the> >

pediatrician > > has come> > > to necessarily mean a prescription comprising of a> > shot gun > > combination> > > of antibiotics & #8211; one and more, an anti> pyretic or> > frequently an> > > unnecessary combination of two, a multivitamin> > tonic and a > > combination> > > cough syrup. Intravenous rehydration and> > parenteral medication are > > used> > > far more frequently than rationally warranted.> > Widespread > > experience> > > clearly shows that the vast majority of doctors'> > prescriptions for> > > children are quite irrational.> > > > > > Analyzing some of the commonest prescribed groups> > of drugsà> > > > > > Tonics And Cough Syrupsà> > > > > > According to

Health Action International "More> > than four out of> > > every five vitamin preparations cannot be> > recommended; nearly > > three out> > > of every five is indicated for unproven> > indications; more than two > > out> > > of every five contain non-essential or ineffective> > ingredients; > > more> > > than one out of every two is irrationally> > formulated; and nearly > > one out> > > of every two contains excessive dosage."> > > > > > Over 80 per cent of cough and cold remedies on the> > market are> > > irrational, most with ineffective and some with> > dangerous > > ingredients.> > > > > > Vaccinesà> > > > > > There is growing trend towards prescribing> > optional vaccines and>

> > vaccines like> > > > > > anti pneumococcal vaccine and influenza vaccine> > are being used > > routinely> > > by some, if not many doctors though this has no> > current > > justification> > > Vaccinations have become the major source of > > bread and butter of > > the> > > pediatrician.> > > > > > Analgesicsà> > > > > > The medical community's response to drugs like> > nimuselide, a drug> > > aggressively promoted in India for bringing down> > fever in > > children, is> > > also an eye opener. The justice is still out in> > India as to its > > safety> > > in children, with many professional organisations> > declaring it > > safe and> > > others claiming to have seen

children die as a> > result of liver > > failure> > > from its use. so why to take risk when there are> > excellent time > > tested> > > safe analgesia is available for children. other> > countries, issued a> > > precautionary advice on the marketing of the drug> > following some > > serious> > > complications of the liver, especially in> > children. Owing to the > > death> > > of a patient due to liver failure and following> > reports of other > > adverse> > > drug reaction, banned in many countries It is> > interesting to note > > that.> > > Bangladesh was the last country to ban the drug.> > However, > > paediatricians> > > in India continue blissfully to prescribe the drug> > and drug > >

companies> > > continue to prevail upon them and make it> > lucrative for the > > practice to> > > continue.> > > > > > Sedativesà> > > > > > Prescribing any kind of sedative just because to> > diminish crying in> > > infants in highly objectionable. Many pediatrician> > giving H1> > > antihistaminic hydroxyzine only to calm children,> > which should not > > be> > > done owing to its other hazardous side effects.> > > > > > > > > > > > Regards,> > > > > > Dr Deepali> > > > > > GMC> > > > > > Nagpur> > > === message truncated ===> > > > Chat on a cool, new interface. No download required. Go to

http://in.messenger./webmessengerpromo.php>

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[Guest guest]

Hi

All are irrational as nothing is evidence based but all is folklore

based.

I remember having received gripe water when I was a kid. It had a

typical osour and taste. That time came it was in glass bottle, the

label of which had a picture of a young boy.

Vijay

> > >

> > >

> > > Hello Smita and Netrumians,

> > >

> > >

> > >

> > > First of all congratulations for getting

> > opportunity to moderate

> > once

> > > again.

> > >

> > > A sick child is the source of great anxiety to

> > both doctors and

> > carers,

> > > can be a huge diagnostic challenge.

> > >

> > > Indian markets are flooded with. thousands of

> > formulations of

> > vitamins,

> > > tonics and multi-drug combinations that are unique

> > to the Indian

> > market

> > > are manufactured and marketed here. A visit to the

> > pediatrician

> > has come

> > > to necessarily mean a prescription comprising of a

> > shot gun

> > combination

> > > of antibiotics & #8211; one and more, an anti

> pyretic or

> > frequently an

> > > unnecessary combination of two, a multivitamin

> > tonic and a

> > combination

> > > cough syrup. Intravenous rehydration and

> > parenteral medication are

> > used

> > > far more frequently than rationally warranted.

> > Widespread

> > experience

> > > clearly shows that the vast majority of doctors'

> > prescriptions for

> > > children are quite irrational.

> > >

> > > Analyzing some of the commonest prescribed groups

> > of drugsà

> > >

> > > Tonics And Cough Syrupsà

> > >

> > > According to Health Action International " More

> > than four out of

> > > every five vitamin preparations cannot be

> > recommended; nearly

> > three out

> > > of every five is indicated for unproven

> > indications; more than two

> > out

> > > of every five contain non-essential or ineffective

> > ingredients;

> > more

> > > than one out of every two is irrationally

> > formulated; and nearly

> > one out

> > > of every two contains excessive dosage. "

> > >

> > > Over 80 per cent of cough and cold remedies on the

> > market are

> > > irrational, most with ineffective and some with

> > dangerous

> > ingredients.

> > >

> > > Vaccinesà

> > >

> > > There is growing trend towards prescribing

> > optional vaccines and

> > > vaccines like

> > >

> > > anti pneumococcal vaccine and influenza vaccine

> > are being used

> > routinely

> > > by some, if not many doctors though this has no

> > current

> > justification

> > > Vaccinations have become the major source of

> > bread and butter of

> > the

> > > pediatrician.

> > >

> > > Analgesicsà

> > >

> > > The medical community's response to drugs like

> > nimuselide, a drug

> > > aggressively promoted in India for bringing down

> > fever in

> > children, is

> > > also an eye opener. The justice is still out in

> > India as to its

> > safety

> > > in children, with many professional organisations

> > declaring it

> > safe and

> > > others claiming to have seen children die as a

> > result of liver

> > failure

> > > from its use. so why to take risk when there are

> > excellent time

> > tested

> > > safe analgesia is available for children. other

> > countries, issued a

> > > precautionary advice on the marketing of the drug

> > following some

> > serious

> > > complications of the liver, especially in

> > children. Owing to the

> > death

> > > of a patient due to liver failure and following

> > reports of other

> > adverse

> > > drug reaction, banned in many countries It is

> > interesting to note

> > that.

> > > Bangladesh was the last country to ban the drug.

> > However,

> > paediatricians

> > > in India continue blissfully to prescribe the drug

> > and drug

> > companies

> > > continue to prevail upon them and make it

> > lucrative for the

> > practice to

> > > continue.

> > >

> > > Sedativesà

> > >

> > > Prescribing any kind of sedative just because to

> > diminish crying in

> > > infants in highly objectionable. Many pediatrician

> > giving H1

> > > antihistaminic hydroxyzine only to calm children,

> > which should not

> > be

> > > done owing to its other hazardous side effects.

> > >

> > >

> > >

> > > Regards,

> > >

> > > Dr Deepali

> > >

> > > GMC

> > >

> > > Nagpur

> >

> === message truncated ===

>

>

>

> Chat on a cool, new interface. No download required. Go to

http://in.messenger./webmessengerpromo.php

>

[Guest guest]

Hello Dr Mangesh, You have given a nice article from JPGM by DR Bavdekar and Dr Gogtay.The article underlines the issue of off-label use of medicines in paediatric age group very efficaciously. I will like to give one flow chart from WHO report which gives the step-wise assessment of off-label use of medicines. Please find the attachment. Regards, Dr Smita, GMC, Nagpur.mangesh bankar <drmangesh_bankar@...> wrote: Hi all, see the

attachment please. Dr. Mangesh Bankar Lecturer,GMC, Nagpur 5, 50, 500, 5000 - Store N number of mails in your inbox. Click here.

5, 50, 500, 5000 - Store N number of mails in your inbox. Click here.