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.