Drug: The Double Edged Knife (Part six)

Mohamed H. Dahir - Chairman Pharmaceutical Association of Somaliland

The Dangers of Indomethacin

Every drug has the potential for doing some harm. Most times it is minimal, but sometimes it can be quite serious. Let us take a peek behind the cloak of secrecy and find out what doctors should be telling us. We are going to look at some commonly prescribed drugs and their potential for mucking up our bodies. A good example to begin with is Indomethacin. This medication is prescribed in enormous quantities in order to relieve pain and inflammation associated with rheumatoid arthritis.

While it is true that most people will not experience all adverse reaction, a great many individuals do find some discomfort unavoidable. According to major pharmacological textbooks, "On usual therapeutic doses, approximately 35 to 50% of patients experience unwanted (adverse) symptoms and about 20% must discontinue its use." The most frequent Central Nervous System effect is severe frontal headache occurring in 25 to 50% of patients who take the drug chronically. If you take indomethacin, did your doctor warn you to stop taking it immediately if a headache persists? Did he emphasize that it must be taken with food or immediately after meals in order to diminish the terrible stomach upset so often encountered? Did he suggest that the first day you begin taking Indomethacin you should start with half a pill, or at most one, and then slowly increase that dose each successive day until you reach the recommended level? Did your doctor recommend occasional blood tests to make sure you do not develop anemia? Did he stress that you should not drive a car while on indomethacin because mental alertness and motor coordination may not be up to par? And did he tell you to try and get off the drug completely as soon as the immediate flare-up of your arthritis is under control? If he did not communicate many or most of the above warnings and side effects, then he is not following the prescribing guidelines.

The Dangers of Antibiotics

Well, how about antibiotics? Doctors are prescribing antimicrobial agents in ever-increasing number. The potential for abuse and over-prescribing is one of the real tragedies of antibiotic therapy. For one thing, any doctor who prescribes an antibiotic (especially penicillin) for a cold or sore throat is out of his mind. Before any antibiotic is administered, the physician should determine by laboratory testing whether the infection is viral or bacterial in origin. If it is a virus, no antibiotic will make your cold or sore throat better. If a bacterium is responsible, it is extremely important for the doctor to know which specific bug is causing the trouble so that he can treat it with the right drug. Using a broad-spectrum antibiotic is a cop-out. It is the lazy way to do medicine, since it allows the doctor to cut out the time necessary to do a proper laboratory work-up and diagnosis. Of course there are times when this shotgun approach is necessary - for example, during a medical emergency before the laboratory results are in or if nothing else will work.

Antimicrobial resistance

According to an editorial article in issue No 28 & 29 (2000) of Essential Drugs Monitor published by the World Health Organization. Twenty years ago physicians in industrialized countries believed that infectious diseases were a scourge of the past. With industrialization came improved sanitation, housing and nutrition, as well as the revolutionary development of disease fighting antimicrobials. Populations living in those nations were not only enjoying an unprecedented decrease in mortality and morbidity but a corresponding increase in life expectancy. In the developing world - where poverty and ongoing civil disturbance offset often modest health gains - people could nevertheless look forward to a time when an increased quality of life might one day lead to a relatively disease free future. The tools were there. Confident in the available pharmacopoeia, the major drug manufacturers turned away from intensive antimicrobial research and concentrated on seeking cures for heart diseases and other chronic conditions. Since the 1980s significant breakthroughs have been largely confined to the development of antiviral agents targeting the ever-widening HIV epidemic.

But tragically, and even before developing countries were able to fully benefit from medical advances, we face a major risk that diseases considered vanquished in industrialized countries, will once again become killers stalking society, bringing an ever present threat of sudden death and disability. The risk that threatens to turn back the clock to a darker age in industrialized countries and to block health progress in the developing world is antimicrobial resistance.

To be continued next week

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