DO NOT DO HARM

It is a fact that Azer-baijani paediatricians sometimes incorrectly prescribe antibiotics for children even for a cold, although paediatricians throughout the world advise parents to limit their use. Most doctors know that they should not prescribe antibiotics if they are ineffective and so it is very important to carry out a campaign to parents on this matter. But who will conduct it if local paediatricians think that almost all children's diseases can be cured by antibiotics?

The importance of this problem was underlined by the scientific conference, "Modern aspects of antibiotic use in paediatric practice" which was held in Baku by the pharmaceutical company Pasha-K. The question of antibiotic use in paediatric practice is quite a delicate one, because this group of medicines is regarded as most virulent, and incorrect prescription for children often causes undesirable side effects. Thus, in treating children, paediatricians everywhere try to replace antibiotics with pharmaceutical medicines with similar effects, but which do not belong to this group. 

The event hosted by Pasha-K was intended to draw doctors' attention to medicines which have a mild effect on children. One of these medicines is IKSIM. In the USA and Europe, it is known as SUPRAKS, and in the CIS and Russia as IKSIM. It is made by the Indian company LUPIN and is certified by the USFDA.

The conference was attended by paediatricians from the whole country. Ukraine's chief immunologist, the head of the department of children's infectious diseases at the Ukraine National Medical Academy and doctor of medicine, Professor Lyudmila Chernysheva, shared her experience in using antibiotics in paediatrics. She had been invited to Baku to participate in the conference. 

No to antibiotics

In conversation with a correspondent of R+, Chernysheva said that, currently, the whole world is fighting the incorrect prescription of antibiotics to children.

"Parents and paediatricians are advised to restrict the use of antibiotics to cure flu; however, doctors still prescribe them, trying to please their customers. A patient visiting a doctor is worried and hoping to recover; the doctor simply prescribes antibiotics and the patient is simply delighted! This is the crux of the problem," she said.

But such a situation does not bode well. The excessive use of antibiotics has led to the evolution of micro-organisms, and they have now developed immunity against many standard medicines. Anyone who has ever used antibiotics risks getting steady infections.

According to world experience, 40 per cent of antibiotics prescribed in 1995 were used to cure viral infections, which runs counter to one of the basic rules of medicine - antibiotics kill bacteria. These medicines are ineffective against viruses, including those that cause flu. There are no medicines against most of the viruses, while infection wanes in the course of time. Despite this, many people who clearly have a viral infection expect to be given and even demand antibiotics, and doctors give in because it is easier than arguing with the patient.

Antibiotics are also incorrectly used to cure otitis media because, in 50 per cent of all cases, they are caused by viruses and these medicines are useless. Treatment should aim at alleviating the symptoms while the body struggles and time cures.

"When children get a cold, they may have a small amount of liquid in their middle ear, and in this situation, antibiotics are ineffective. Doctors must establish whether this infection is of bacterial origin and whether it is susceptible to antibiotics. Antibiotics should be immediately prescribed to children who have pus in their middle ear or if their eardrum has reddened or protruded," Chernysheva said.

Antibiotics are no remedy

In Azerbaijan, the use of antibiotics in paediatric practice is at a level of 98 per cent. Antibiotics are prescribed to children on the same mass scale in China. In France this level is 24 per cent and in the USA - 25 per cent, according to the prominent Azerbaijani physician, doctor of medicine and professor of the department of children's diseases at Azerbaijani Medical University, Surxay Musayev.

According to Musayev, in Azerbaijan even reserve antibiotics, which may have a negative impact even on an adult's health, are prescribed to children. Meanwhile, antibiotics that may cause dysbacteriosis, or reduce immunity, should not always be prescribed to cure respiratory infections, infections of viral origin, infections of the upper respiratory tract or rotavirus infections. Overly aggressive tactics are used - reserve antibiotics are used from the first days of a child's life.

"We must understand why we prescribe antibiotics to children. If they are not necessary, even the simplest ones will not be effective. We have to admit that our biggest problem nowadays is antibiotic poisoning. What sort of experiments are we carrying out on our children? It is even worse when antibiotics are used not on prescription, but by parents themselves. And this happens on advice from neighbours, relatives and other well-wishers. This happens very often here and it has ruinous consequences," Musayev said.

The expert believes that doctors should pay more attention to medicines, other than antibiotics, which have a mild anti-bacterial effect. In previous editions of R+, we touched on the problem of the growing infant mortality rate in Azerbaijan, quoting the State Statistics Service. The Ukrainian paediatrician Chernysheva thinks that one of the main causes of this trend is the incorrect prescription of antibiotics to children. Every year about 10 million children in the world die before their 5th birthday. About 6 million of these children die of curable diseases, although their lives could be saved if they had access to safe, effective and inexpensive medicines. Pneumonia alone kills 2 million children below the age of five every year, while HIV kills 330,000 children below 15. "These diseases can be overcome, but many children receive no treatment because there are either no medicines suitable for their age or such medicines are inaccessible or too expensive - they can be three times more expensive than medicines designed for adults," Chernysheva says.

She said that one of the indicators of a country's development is infant mortality. It is quite high in Ukraine as well. This is explained by the same factors as in other CIS countries, for example, by the nature of demographic policy. For Ukraine this is problem number one, as it is a country with restricted financial resources. But despite this, the latest achievement in this sphere is the fact that a vaccine against the haemophilic bacillus (which causes pneumonia, sepsis and meningitis) has been introduced. There is no such infection in the United States, while the rest of the world has only 20 years of experience of fighting it.

"It is necessary to expand the range of vaccines against infections, i.e. to pay more attention to immunoprophylaxis. Today our vaccination regime is approaching that of the West. For example, vaccination against 15 infections was carried out in the USA in 2007 and in Ukraine against nine. A law has been adopted "On the protection of the population from infectious diseases". Propaganda against vaccination was often promoted in the USSR. They thought that it caused a lot of side effects. As a result, an epidemic of diphtheria broke out in 1990-91, killing thousands of children and adults. Unfortunately, Ukraine has one of the highest numbers of HIV cases. It spread as the number of intravenous drug addicts increased. Now we have managed to stop the rise in infant mortality, thanks to our efforts to boost perinatal diagnostics. Perinatal centres have been set up and provided with the necessary equipment, mainly by international organizations. Statistics should also change due to the changing criteria of viviparity. Whereas previously premature babies weighing 1,000 grams were nursed, now even babies weighing 500 grams are nursed as well," Professor Chernysheva said.

According to the president of Pasha-K, Xaladdin Quliyev, the role of the exchange of experience in improving results is important to the medical public.

In mid-December last year, the World Health Organization announced a new programme of scientific research which should stimulate the efforts of the world community to secure better access to children's medicines. The programme applies to the research and production of medicines, including antibiotics, asthma medicines and pain killers which should better meet children's needs. The aim is to expand clinical research involving children who are not treated well in society. The WHO calls for the development of combined medicines against HIV/AIDS, tuberculosis and malaria, as well as therapeutic measures to protect children against some tropical diseases that are regarded as extinct.

"In both rich and poor countries, there is a great difference between the availability of medicines suitable for children and the demand for them," WHO Director-General Margaret Chan has said. "Children's health should become a priority in the fight for fair access to scientific achievements in the health sphere."

In early 2008, the WHO plans to open an Internet portal on clinical experiments on children. The organization has released the first international list of medicines regarded as safe for children. The list includes 206 medicines. "But a lot still has to be done. There are priority medicines that are not adapted for children or are unavailable when there is a need for them," said Hans Hogerseil, the director of the WHO department for policy and standards in the sphere of medicine.

The WHO will continue working with the governments of various countries in order to make changes to legal issues and requirements in respect of children's medicines. At the same time, the Azerbaijani medical public should pay attention to this important issue.