Thursday, 12 April 2007

Cotrimoxazole: Basic health workers to institute oral anti-biotic treatment

Syed Akbar
Hyderabad, April 12: Basic health workers have now been empowered to institute oral anti-biotic treatment with cotrimoxazole, a drug known for its side-effects, for treatment of neonatal and childhood infections, particularly sepsis and pneumonia.
The Central government last week issued orders to health secretaries of all States and Union Territories empowering health workers to give cotrimoxazole to infants and children. This in effect means, ordinary health workers with simple training will decide on the medicine and its dosage. Doctors, however, feel that the Central government's order will put the life of neonates and children under five years of age to a greater risk.
The Centre's orders come in the wake of spurt in cases of neonatal sepsis and childhood pneumonia in different parts of the country. Doctors criticise the government saying that it has been pushing the drug since it was easily available, though the side-effects are often severe. The drug institution task has been given to health workers under Integrated Management of Neonatal and Childhood Illnesses.
"We can't risk the health of a neonate by allowing health workers to give cotrimoxazole. It's not a broad spectrum antibiotic," argued Dr J Narsing Rao, assistant professor of paediatrics, Deccan College of Medical Sciences.
He pointed out that neonatal sepsis could be due to various reasons and Cotrimoxazole address only a few of these. "It is not appropriate to administer the medicine without proper study of the individual case. Moreover it should not be given routinely by health workers. It has serious side effects like rashes. Usually we never prescribe this drug for neonates, for whom there are other safer drugs," Dr Narsing Rao observed.
Cotrimoxazole or septrin is a mixture of two drugs, trimethoprim and sulphamethoxazole. It prevents reproduction of harmful bacteria in the body. The drug is excreted through the kidneys and hence doctors should be judicious in prescribing it to those with damage to kidneys. The side-effects include rash, fever, nausea, low white blood cells and liver inflammation.
Child specialist Dr Manorama Prakash said health workers were ill-equipped to administer the drug. "One has to see the condition and nature of the patient before administering the drug. Health workers, how well trained they are, cannot decide on the dosage or course. It will lead to misuse of the drug throwing the lives of children to risk," she added.
But the government wants to push the medicine to curb childhood pneumonia which has higher mortality rate than AIDS. About 19 per cent of deaths in children below five years of age is because of pneumonia.

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