What not to prescribe

This post is about the usage of drugs that is more and more being molded by the pharma industry. Not one day goes without the addition of a new brand and not a month without the addition of a new molecule. The question is should we go for the latest. This can be decided only after knowing for which disease we are talking about.
If it is the question of antibiotics, obviously an effective antibiotic with most narrow spectrum need be given. This is where our pharma friends come and ‘help’ us. They promote only drugs which are the latest and most powerful. They have visual aids which tell the indication of the drug. So you will see the visual aid showing Gatifloxacin and Gemifloxacins for URI. When a lie is told too many times, we may tend to believe it as the truth. Think about the general practioner who has finished his MBBS about 15-20 years before, he will tend to accept what is being repeated promoted as the truth. Unluckily for us there are no compulsory periodic licensing exams to keep ourselves up to date. So it is common to see the prescription pattern becoming dependent on the way the pharma wants it to go. Then we should not be surprised that Co-amoxi-clauv being used for common cold very commonly. Pathetic. Who to blame? – The pharma industry for misleading us or ourselves for not being up-to-date. I guess it is both. Finally who suffers? Of course the patient, who assumes that the doctor, knows best. In metros, when a patient goes to a big hospital and waits for an hour to meet the consultant paying big money for the appointment, they are not satisfied with a Paracetamol for the URI. The doctor writes a prescription worth at least his consultation so that the patient is satisfied. So a fission bomb is prescribed where TLC would do.
What I hate more is, doctors who are (supposedly) reputed, trend setters, using broad spectrum, powerful antibiotics which could have been taken care of a common, cheap molecule. Of course the patient gets relief nearly at the same time as the cheap, appropriate molecule would have worked compared to the all powerful, latest molecule. What it has paved way is, for community level drug resistance and rise in medical cost for the common man.
When the question of drug use is about a chronic non-infectious illness, it should be the drug which has the least side effect moderated to the patients affordability be prescribed. If you see the efficacy of various drugs in a class across the board, we will see that there are not many differences between individual drugs. So why bother about the hair-splitting differences between Losartan and Telmisartan. If the patient can afford, go for Telmisartan or any other later sartan. If he/she cannot afford go for Losartan. The same applies for other drugs like Glibenclamide Vs Glimepiride, Lisinopril Vs Ramipril…. That is the reason; all guidelines suggest the class of drug for a particular indication instead of a specific drug. While the difference in efficacy is small, the difference in cost is enormous. Ten tablets of Glibenclamide (Daonil 5mg by Aventis) costs Rs 6.60 while the same number of Glimepiride (Amaryl 2mg by Aventis) costs Rs 103. If a patient cannot afford much, we should not be writing Glimepiride just because no one is promoting Glibenclamide and because Glimepiride is the latest.
i want to conclude by saying, that we should use the drug for its indication and not for what the pharma person says. Importantly there is no alternative to keeping ourselves up to date.