WHAT IS AN ANTIBIOTIC AND WHY I CANNOT START ONE ON MY OWN

What is an Antibiotic?

ANTIBIOTIC

ANTI - Against
BIOS - Life
ANTIBIOTIC = Against Life

In its most common use, an Antibiotic is a medicine that destroys or slows down the multiplication or growth of a Bacteria.

How do Antibiotics work?

Antibiotics work by either destroying the cell wall of the bacteria, or interfering with it's growth/ multiplication or by preventing protein formation.

Based on their action Antibiotics are either Bactericidal (Kill Bacteria) or Bacteriostatic (Slow down the multiplication of the bacteria so that the body's own defense mechanism can then kill the bacteria).

Though Sir Alexander Fleming is credited with having created the first Antibiotic- Penicillin - in 1928, as a class of drugs they were available before this also.
in 1909, a highly toxic drug called ' Salvarsan' was used to treat Syphilis.
The Sulphonamides were discovered in the 1920s and Prontosil was used to treat infections caused by Streptococcus and Staphylococcus.
From 1940 onwards, for the next 20 years or so, more Antibiotic classes were made available.
At the current moment however, very few new Antibiotics are under development.
How did we reach this stage?
After having understood that Antibiotics fight against dangerous Bacterial Infections and help us to survive them, it must be acknowledged that they have been among the most abused group of drugs in Pharmaceutical industry.

Apart from Humans even the Livestock industry rampantly misuses antibiotics - in fact animals consume more antibiotics than humans - largely in chicken and pig farms.
In his Nobel prize acceptance speech Sir Alexander Fleming predicted the onset of Antimicrobial resistance. 

Antibiotic Resistance

• The WHO lists Antibiotic resistance as a global health issue.
• Every use of an antibiotic kills some responsive bacteria, but many resistant ones grow and flourish
• Overuse of antibiotics causes overall increase in antibiotic resistant infections.
• This resistance makes it more difficult to treat simple infections with first line drugs.
• Decreasing inappropriate antibiotic use is a critical requirement for reducing antibiotic resistance.
• In the presence of Resistance, more expensive and dangerous drugs are required, fatality rates are also higher.
• India is the leading nation globally in Antimicrobial Resistance.
• Some of the most lethal and drug resistant bugs are found in India.

Bacterial resistance happens by many factors, one of which is mutation - the Bacteria changes its form so that the antibiotic does not work - this Bacteria then multiplies producing a strain of resistant Bacteria.

Some Facts

1. A simple course of an Antibiotic to a child gets rid of good bacteria from the gut - these may take up to 6 months to be replenished. We are increasingly concerned about that.
2. Most upper respiratory tract infections are viral in origin - an antibiotic is not required
3.  Once started an Antibiotic must be taken in the correct dosage and for the proper duration - do not stop because you are feeling better on the second day.
4. There are very few newer antibiotic molecules in the pipeline - we have to depend on what we have.
5. Undigested antibiotics are passed on in the stools - we do not know the effect these have on the environment.
6. Antibiotic usage can sometimes cause life threatening side effects, including Anaphylactic reaction.

Why you should not start one on your own

1. You do not have the qualification to know the nature of your problem, nor have you been examined or tested.
2. You do not know which is the best antibiotic - if at all it is required.
3.Relying on a previous prescription regarding a similar illness is no guarantee that you need an antibiotic in this instance.
4. Antibiotics can have serious side effects - including life threatening ones
5. You are not aware of the proper dosage or duration.
6. You and your family are more likely to end up with antibiotic resistance in the future - requiring a higher, more expensive, and maybe more toxic antibiotic in the future.
7. You may be wasting hard earned money on purchasing medicine you do not need.
8. The GOOD (Gut) Bacteria - Antibiotics make no distinction between the bacteria that is causing the infection and the Gut bacteria- whose role we are learning to appreciate more and more. In a recent study some gut bacteria were found to keep depression away - imagine Depression as a side effect of improper antibiotic prescribing?

In most developed countries in the world oral antibiotics are not OTC (over the counter) medicines - the pharmacy will not dispense without a doctor's prescription. We are hoping that Government regulations will come in to prevent over the counter sale of antibiotics in our country to prevent their rampant misuse which will help to mitigate the high level of Antibiotic Resistance in our country.
Just one last fact to consider - ANTIBIOTIC RESISTANCE IS A COMMUNITY PROBLEM- IT AFFECTS ALL OF US.

Dr (Major) Rajesh Bhardwaj
MS DNB

DOES MY CHILD NEED A FLU VACCINE - I ASKED GOOGLE

Being an ENT Specialist with a considerable Paediatric practice, I am frequently asked by parents whether their child needs the annual Flu Vaccine. They often tell me "according to the Internet she/he should get it". Following this line of reasoning, I decided to abandon my textbooks for a change and ‘Google’ it. 

This is what I learnt:

The top results that came up after typing in "Should my child get a Flu Vaccine?" are as follows:

Caring For Children:

All children over 6 months old should get a flu shot each year. That would mean a child from 6 months to 18 years of age.

Mayo Clinic: 

In most cases, yes. The Centers for Disease Control and Prevention (CDC) recommends a yearly flu (influenza) vaccine for all children 6 months and older - ideally given as soon as the vaccine is available each year.

KidsHealth:

The Centers for Disease Control and Prevention (CDC) recommends a flu vaccine for everyone 6 months of age and older. But it is especially important for those who are at greater risk of developing health problems from the flu, including: all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)

So, as per the most credible information that I have gathered from Google, any child above the age of 6 months should get an annual flu vaccine. But it may be necessary for children between 6 months and 4 years.

Now I enter - 'Flu Vaccine for children India' so that I can get a local context. These are the top results:

The Indian Express; EXPRESSPARENTING. The write-up talks about certain Indian statistics and then takes a quote from the Country Head of Sanofi Pasteur, one of the largest vaccine manufacturers. Most of the views are those expressed by this gentleman. So now we are taking health advice from someone who has a strong business interest in how many vaccines are sold.

The Hindu; Science. Talking about the advantages of the Quadrivalent Influenza Vaccine, the article quotes:

If you want to reduce the influenza burden in adults, then we must target children as they act as reservoirs. (Dr. Su-Peing Ng, Sanofi Pasteur, Head of Global Medical Affairs).

Once again, we have Industry persons advising us about the need for vaccines. The article goes on to state:

The Correspondent visited Sanofi Pasteur’s vaccine manufacturing unit at Val de Reuil, near Paris, at the invitation of Sanofi Pasteur.

Babycenter.in: 

It is recommended that your child gets the influenza (H1N1) vaccine, even though it is an optional vaccine in our country. Since the H1N1 pandemic (popularly called swine flu) in 2009, medical experts have advised that the flu vaccine be given to every child between six months and three years of age.

So now, half an hour into my search, I am informed that any child above 6 months of age, to any child up to 4 years, or up to 3 years, should receive the annual flu shot. Confused, I decide to search more authentic sources, hoping for more reliable guidelines.

So I enter ‘WHO’ hoping to get an unbiased scientific view. Though WHO itself received a lot of flak for the declaration of the 'False Swine Flu Pandemic', where Drug Companies made billions of dollars in selling vaccines against a mild disease.

This is what WHO has to say about the Flu Shot:

WHO recommends annual vaccination for children aged between 6 months to 5 years.

For another unbiased opinion I decided to see what the largest Government Healthcare organization in the world, the NHS, was recommending for the current year:

In the autumn/winter of 2019/20, the vaccine will be available free on the NHS for eligible children, including:

Children aged 2 and 3 on 31 August 2019. That is, children born between 1 September 2015 and 31 August 2017

All primary school children (5 to 11 years old)

Children aged 2 to 17 with long-term health conditions

I decide to make my search more Indian; looking for a specific Indian context I search for 'Indian Academy of Paediatrics'. There is a very comprehensive document: Immunization Schedule for Children, published by the IAP, which gets updated periodically:

The latest available influenza vaccine can be administered after 6 months of age, 2-4 weeks prior to the influenza season: two doses at the interval of one month in the first year, and one dose annually before the influenza season up to 5 years of age.

The vaccine is safe. It is generally now accepted that even children with egg allergies can be given the vaccine. The nasal spray is not yet easily available in India.

After having gone through these various recommendations, it seems that the most acceptable vaccination schedule would be to give the latest flu vaccine every autumn (October) to a child between 6 months and 5 years of age.

Now we come to a tricky section: children between 6 and 18 years of age. There are two considerations here:

- Easy affordability  

- What harm can it do?

To get an expert opinion on these concepts I asked a senior and renowned Paediatrician,

Dr HPS Sachdev. He is on the panel of the IAPs Immunization Schedule and an authority on the subject. He says that parents find the vaccine is not easily affordable. In which case, only high-risk children should be vaccinated, such as those who are immune compromised, on steroids, have Type 1 diabetes or with a chronic lung disease etc.

On the other hand, when money is not a consideration, parents ask “where is the harm if I want to vaccinate my child who is 8 years old, just to make sure he does not fall ill with influenza?” Dr Sachdev answers this by saying that they can go ahead, the vaccine is safe, but it does carry a slight morbidity risk, related to mild flu-like symptoms.

There is a general consensus that no flu shot is required for healthy individuals between 6 and 65 years of age.

To conclude, I would like to caution that knowledge from Google should be judiciously used. Google is an unbridled monster of knowledge; it must be tamed in order for it to give you the results you seek.

In this instance, as we see, two of the more cerebral newspapers of the country gave opinions regarding flu shots. These opinions are purely industry-sponsored. This is unavoidable - it is up to you to make sense of it.

WHAT MY FATHER TAUGHT ME

To be brought up by a loving and supportive father is one of the joys of life. you  never know how the things that your father does for you when you are a child will impact you when you grow older. my brother and I were very lucky to have a father who thought the Sun rose out of the eyes of his sons!

In the association  I had with him, there were certain aspects of him that were so inspiring and true that i thought that I should put them down.

1. LOVE YOUR CHILDREN, SUPPORT THEM AND PRAISE THEM

My brother and I were brought up in the 60s and 70s when it was common place for fathers to physically strike their children and overall strike terror in their hearts. In my association with my father I do not remember a time when he struck me physically. He loved his sons to distraction and found it easy to support them in whatever they did. Whenever i fell short of money, help was easily forthcoming from him- "'It's all for you guys - whatever I have is yours." In need of a Motorcycle after I had passed out of Medical College, he bought a Yezdi motor cycle for me and had it delivered to Dehra-Dun - the place where I was posted!

In fact the day before he died he was with me in Delhi and had gone to visit a senior official in the Ministry of Foreign affairs - Mr Katoch. In the middle of the day I get a call from Mr Katoch telling me that my father is sitting with him and he felt he had to talk to the person my father was speaking so highly of. I told Mr Katoch - Sir he is just being humble - we all love and respect our father so much because of the person that he is. That was just about the last time my father and I spoke with each other. He left for Surat the same day and we lost him the next day.

There were times I would tell him - why do praise us so much in front of others? It is embarrassing!

He always had a stock reply - Because you guys deserve it. 

2. DON'T GRAB ANYONE'S RIGHT AND DON'T GIVE ANY OF YOUR OWN

It sounds more appropriate when expressed in Hindi - Kisi ka hak chheenna nahin, Apna hak dena nahin! It was never more evident when there were attempts to encroach upon our property by our neighbour cousins - he stuck to his ground, even to the extent of going to the Court for establishing our rightful claim to our areas. I think this came easily to him because he was a lawyer and a Judge in the Army.

3. KEEP YOUR PAPERWORK METICULOUS - PUT EVERYTHING DOWN IN WRITING

We have a joint property, and it is easy to have disputes in such a situation. We could win all our rightful claims to our sections of the property because he had meticulously put everything down in writing and it was all stamped and registered. I am still trying to reach that  level of documentation sophistication!

4. IT IS NEVER TOO LATE TO PICK UP A NEW SKILL SET

After his full stint in the Army my father decided to settle down in Surat,since my brother would be setting roots there and I was being shunted from place to place, being in the Army myself.

As soon he reached Surat, he embarked on a tortuous course to learn the language! He succeeded partially but was confounded by the numbering! I remember him walking around the house with the 'Gujarati Primer' in his hands, muttering kem chho and tamaro abhhar! But he gave up at '

Ognees Wees' (nineteen twenty in Gujarati)!

He picked up employment with two companies one after the other, but felt exploited. Nor was he happy with the corruption that prevailed even in the private sector - regular workers subcontracting to outsiders for 'overtime' and then sharing the spoils! And then this Judge from the Army decided to go into business for himself and set up a Security Agency! Calling it ''Vigil Securities" he set up a business venture from scratch and raised it to become one of the most trusted names in the Security Business in Surat! And now, many years after his demise, thanks to his foresight and my brother's tenacity the Company continues to be one of leading players in the city!

After his demise I went to close down his desktop system and was most astonished to see that he was taking tutorials in typing lessons - so that he could improve his Computer Skills!

5. WORK HARD 

I think these are things you pick up subliminally. Whenever I look back upon my father I can only see him as doing something useful with his time. Though he loved listening to the news, he never watched it on TV - he had a trusted transistor that he would keep with him, and in the early morning hours he would tune in to BBC news for his updates.

6. EXERCISE REGULARLY

Having been brought up in Jalandhar in pre partition Punjab, his preferred languages were Urdu and Punjabi. He spoke and wrote English very well. So the tree was '' Drakhat" and the morning paper was ''Akhbaar" and his morning exercise, which he never shunned was ''Barjish!" - no such things as ''work out'' or  any other phrase for it!

7. PERSONAL BRAVERY

We owned a property in Surat which was wanted by some land grabbers. One day, while my father was at home, some 10-12 goons landed up at home to grab the land. My father went into the house, brought out his licensed Pistol and waved it in the face of all the men – “The first guy who comes in will be shot!” The goons scooted.

He was more than 70 years old at that time.

To have been brought by such an inspirational father was a stroke of luck for my brother and I and we will always be grateful to God for having granted us this privilege.

WHY I NEED TO STOP THINKING LIKE A SMALL BUSINESS OWNER

I am the owner of a small boutique Ear, Nose & Throat Centre in Delhi, being an ENT specialist.

When the young audiologist in my Centre enters his room in the morning and switches on his AC at 18 degrees, while I suffer in silence under a fan rotating at speed 2, my vision is diverted immediately to the whirring Electronic Meter and the huge bill that will land on my table a few days later. While he nonchalantly plays with the infinite distractions on his phone my day has begun on a sour note.

I am reluctant to hire bright people because they cost so much! There is always a need to grow your business- so while my local Kirana store owner struggles to cope with the fickle loyalty of his customer base, and hauls his son out of college to manage the store for him when he is admitted for a serious lung infection, chains like Big Bazaar and  LocalBaniya hire smart talent and grow big at his expense.

I hate taking loans! My father was in the Army (as was I), and we grew up in a regular Indian middle class family. The Army allowed you to live in genteel poverty – though your needs were taken care of in style, you never had enough loose cash to play around with. Loans were anathema since you had limited capability to pay back. I remember two occasions to make my point. When my Maruti car booking materialized (in the year 1990 while I was a Major in the Army), my cash flows did not permit me to take a loan since I could not have afforded the EMIs. So I happily traded my booking for a premium (many thousands at that time) and bought a Sony music system with it – I still use that system! In 1992 my Army Welfare Housing Organization (AWHO) house was allotted in Bangalore – again, since the cost of the dwelling unit was about 28 lacs, I could not have afforded the EMIs needed to pay back my loan. I finally surrendered the booking at a loss! When I read a biography of Richard Branson, I was struck by one word used frequently in the book – “leverage”. It seems all that he did was exaggerate the value of his businesses to get more loans! A few days ago he was listed as among the top 20 richest persons in the UK with a family wealth of 4.1 billion pounds! When I went to pay my respects by signing in the register placed for the late Col Nair at the Leela Kempinski at Chankyapuri I was reminded that the debt burden of the company at that time was Rs 5,125 Crores! The Anil Ambani group companies have an accumulated debt of Rs 1 Lakh crores! As do most of the richest persons in the country. Is there a lesson for small business owners here? Are we too shy, too scared to leverage our businesses and grow with borrowed capital?

This is what my CA normally tells me sometime in December - “Sir, we are generating too much profit this year! We will end up paying too much tax!”  So what do I do? Stop working? Create less profit? No, I withdraw large sums of cash periodically to create what my CA calls ‘’cash in hand’’! And now I look for shysters to raise fake bills against the ‘cash in hand’ so that my tax burden is reduced.  It is not the CAs job to tell you how to use your ‘’too much profit’’ to grow your business – it is yours. When you go to the banker looking for a loan, one look at your balance sheet and the savvy banker can see through your game in seconds.  And now that I have generated that cash, what do I do with it? Buy a property/ buy gold?  So what have I done?  I have effectively buried the profit from my business that I could otherwise have used to grow bigger and better.

It is currently felt that a Doctor, especially a surgeon, is as good as the technology that she can learn to master. The use of technology is rapidly changing the way we look at and treat diseases.  This behooves the surgeon to do two things – attend surgical workshops and conferences as well as buy books pertaining to that field and secondly, invest in the buying of that equipment – both come at a huge personal cost. The day a surgeon stops doing that she has effectively declared her retirement.  Similarly, a small business owner needs to constantly train and retrain herself to understand how the world around her is changing and to make use of that change. Satya Nadella, CEO Microsoft says ‘’ I buy more books that I can read, I sign up for more online courses than I can finish…” You might like to say that since he has become CEO Microsoft it is easy for him to buy all those books and attend the online courses, but I’d like to believe it was because he did all this that he could become CEO of Microsoft. If you are in any knowledge based enterprise, you have to invest in training yourself.

Currently all of us reside in two places. One is the physical world we can smell and touch. The other is the virtual world out there, becoming bigger, smarter and stronger every day. My refusal to engage with the virtual world is inexplicable. Just as we use architects and interior designers to design and beautify our shops and offices we need software programmers and web designers to create our virtual world. I attend social functions, sometimes travelling long distances just to show my presence at a friend’s daughter’s wedding and crawl back through the nightmarish traffic to reach home late at night. Social media lets me create a vibrant social presence from the comfort of my home. If I can employ a marketing person to take care of my small enterprise, it makes that much sense for me to employ a digital marketing person as well. The reach of the internet is obviously huge, the audience is much bigger!

So what’s my message?  Ok, here’s what I think

• THINK REVENUE NOT COST

• Grow your business, spend money , but wisely
• Once you are big enough, hire someone to bring down your costs and pay him a small percentage of the costs reduced

• HIRE PERSONS SMARTER THAN YOU

• And listen to them!

•  LEVERAGE YOUR ASSETS, USE BORROWED CAPITAL TO GROW
• Remember your revenue has to just beat the EMI
• 
  
• SAY NO TO CASH!
• It is a nuisance and a headache you can do without

• INVEST IN YOURSELF – TRAIN YOURSELF ALL THE TIME; READ, READ, READ
• Attend courses, learn online
• 
  
•  USE THE INTERNET WISELY
•     Don't be shy of the net - use it to help you.

I can only become big if I think big!

All the best!

Dr (Major) Rajesh Bhardwaj

Director, MedFirst ENT Centre.