Thursday, October 06, 2005

Rational drug use?

Last Tuesday, i accompanied my grandpa to the district hospital to follow up on his hypertension. First we went to the registration counter to take his number at 7:45 am. No 138!!! Registration started at 7:30 am.

Only at t 9:30 am, we get to meet the Dr. The young Indian Dr, after hearing my grandpa complaining about coughing white sputum and checking his throat, he prescribed amoxycillin 500mg tds for 1 week and benadryl cough syrup. My grandpa had got no fever, got no sore throat, and came back with antibiotics!!!Diagnosis??Pertussis?? I don't know (But why not erythromycin, roxithromycin or other macrolide, i thought the effectiveness of penicillin is questionable??)
Are we as a pharmacist, in the position to query the dr decision? What do you think i should tell my grandpa? Do you think the Dr at least should ask how long he has been coughing? Does it disturb his sleep, etc? The Dr. should have noticed that his medication list contains an ACEI, Coversyl which it’s well known side effect is cough.
My grandpa had this irritating cough since he started on Coversyl, but since it is tolerable, he just ignore it. ARB, another group of drug, mainly used to replace ACEI, is not available in the hospital formulary.

Total time in hospital:
Waiting to see Dr. 1 hour 45 minutes
See Dr. 5 minutes
Waited in pharmacy 1 hour 15 minutes.

I am a bit disappointed with the long waiting time in pharmacy department myself. Imagine how long we have to wait if that day is Monday. They should have an express counter just for senior citizen aged 75 and above.

My lessons:
1. Want to go government hospital, remember to take your breakfast and a bottle of water.
2. Got to bring a newspaper or something to keep me entertained, like my palm Zire 72.
3. Ask the Dr. if you are not sure what are you taking and why?
4. Finished reading your newspaper and bored waiting, try talking to the person sit beside you.

Finally, do you think my grandpa should take the antibiotics?

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1 comment:

Anonymous said...

It is quite a common sight to see patients carrying antibiotics in thier hands everytime they leaves a clinic. No matter how serious their condition is. Reason? To increase the probability of the patient recovery?

We are thought in our studies that we should be careful with the use of antibiotic.

However, the uncontrolled usage of antibiotic in Malaysian practice has become a "tradition" practice. Patients came in with cough and flame, antibiotic are prescribe without further investigation.

It will be better if the patient follow through with the regime and finish all the antibiotic.

However, based on my encounter (and knowledge of antibiotic's side effect), only a handful of patients actually know that they have to finish taking the antiobiotic course and even fewer actually have actual compliance.

I guess pharmacists know the problem. Just that, the solution is not found as yet.

Any other comment?