Almost every visit to a pediatrician leads to the appointment of one or more drugs. As a parent, you want to believe that the medicines your child prescribed for your child are selected on the basis of a thorough analysis and are not only effective, but also safe. Unfortunately, this is not always the case. Being a certified pediatrician of sixteen years, I regret that many of the methods we offer are ineffective, while others can cause serious harm. Too often, we, doctors, deviate from the generally accepted standards of care as expediency, the result of a habit, or satisfaction of perceived parental expectations. Nowhere is this more evident than when a pediatrician prescribes a medicine that agrees with experts should never be used by primary care physicians.
A medicine that is avoided by pediatricians usually has one or more of the following symptoms: it is not safe; it is ineffective; its use has been superseded by newer, better choices; pediatricians do not have the experience necessary to prescribe the drug. Using these criteria, let's look at 7 medications that your pediatrician should never prescribe under any circumstances.
Promethazine:
Pediatricians usually use this drug to treat nausea and vomiting that often accompany intestinal viral infections. Unfortunately, it does not work very well, and it often causes drowsiness, dizziness and confusion: symptoms that we want to avoid in a child whose mental status should be monitored as an indicator of dehydration. Intravenous use of this medication was permitted in tragic events that required amputation of the limbs due to the caustic nature of the drug, and is now banned in many hospitals. Fortunately, we have much more effective drugs at our disposal with a much better safety profile; what makes you wonder why some doctors still cling to Promethazine.
Preparations for cough:
The common cold is the most common illness in childhood. It is natural to want to give some help to a child who is coughing so that she does not sleep. Unfortunately, the cough medicines that we have at our disposal have not shown efficacy in children and can lead to unacceptable side effects. Over-the-counter cough medicines almost universally include the active ingredient, dextromethorphan (DM), while prescription options may use codeine. Both of these drugs are derivatives of opiates. Respiratory depression and behavioral problems were observed in children taking these products, and in babies overdose was found to die.
In October 2007, the American Academy of Pediatrics offered the Food and Drug Administration the following warning about cough marking:
"This product has proven ineffective in treating cough and cold in children under six years old." Serious adverse reactions have been reported, including, but not limited to, death, use, misuse and abuse of this product. ” It is inexplicable that many pediatricians continue to regularly prescribe these medicines even for babies.
Dexamethasone eye drops:
This is an example of drugs that can be extremely effective, but pediatricians should not prescribe because they lack the necessary experience for safe use. Dexamethasone is a steroid that is used for its anti-inflammatory properties. These eye drops are a powerful tool for various conditions, but before using them they require careful eye examination by an ophthalmologist. If they are applied in the middle of some eye infections, dexamethasone drops can aggravate the infection and lead to irreparable eye damage. This drug is best left to specialists.
Nystatin with triamcinolone combination cream:
Sometimes the sum of the parts is less than the individual parts. Nystatin is a useful antifungal drug that is commonly used to treat diapers that have excessive yeast growth. Triamcinolone is a powerful steroid cream that is effective in treating various inflammatory skin conditions, including eczema. The problem occurs when the two drugs are combined. Doctors who want to add an anti-inflammatory effect in treating a yeast rash or are not sure whether the rash is the result of a fungal infection or because of simple inflammation, mistakenly teach parents to use this product in the diaper area. The effectiveness of all steroid creams is multiplied when applied to the skin, which is sealed with bandages, plastic wrappers or diapers. When applied under the cover of a diaper, triamcinolone can lead to ulceration of the skin, which often increases as a well-intentioned parent continues to use more and more cream in an insane but useless attempt to alleviate the aggravation of the rash. Only thin applications of much weaker steroid creams can be applied to this extremely depleted area of the body and only after careful consideration of potential risks and benefits.
Cefaclor:
Decades ago, Cefaclor was one of the only oral antibiotic drugs known as cephalosporins, which are commonly used to treat various childhood infections. However, this particular drug has a much higher frequency of allergic reactions compared to other drugs in its class, including a particularly severe complication, known as a serum reaction, as in children who develop rash, fever, swollen, painful joints and other disturbing symptoms. . Many, many bacteria have become resistant to this drug. In a large study published in 2003, out of 19 tested antibiotics, Cefaclor was the least likely to kill the most common bacteria associated with ear infections, sinus infections, and pneumonia. Academic medical centers stopped using this drug about 20 years ago, but some doctors in the community simply cannot break the habit.
Albuterol Oral Syrup:
Albuterol inhalation, both in aerosol and in the form of an inhaler, remains the most important rescue tool for treating asthma attacks. When the medication is inhaled, it moves directly to the receptors located on the walls of the respiratory tract, signaling that the muscle fibers relax, thereby reducing the narrowing of the bronchi and improving the flow of air into and out of the lungs. The inhalation route maximizes the amount of medication delivered to the intended target, and alleviates common side effects, such as trembling and accelerated heart rate, that occur when the medication enters the bloodstream. When an oral composition is used, the drug must first be absorbed from the intestinal tract into the blood circulation, whereby it then passes through the body, and only a fraction of the ingested dose ultimately finds its way to the airway receptors. This is a very inefficient delivery system that increases side effects while minimizing efficiency. Albuterol oral syrup is often not used for asthma, but as a type of ersatz cough medicine; a practice that is a relic of the past.
Antidiarrheal compounds:
Diarrhea is common in childhood, most often the result of viral gastroenteritis; what is commonly called "gastric flu." From time to time this can be the result of bacterial dysentery. The key to treating this usually self-limiting butothersome condition is to provide hydration and nutrition. The guidelines of the American Academy of Pediatrics and the Centers for Disease Control and Prevention prevent the use of antidiarrheal compounds due to their lack of effectiveness and the potential for serious side effects, including severe cramps and temporary paralysis of the intestines, which can lead to concentrations of bacteria and their toxins in dysentery. Unfortunately, many pediatricians either do not know or prefer to ignore these recommendations.
At best, the practice of pediatrics includes scientific evidence, critical thinking, best practice, and accepted standards of care, embracing humility and deep compassion; who ever know the unique constitution of each child and the cultural values of his family. Too often, we, doctors, are far from this goal, especially when we are rushed, when we don’t spend time patiently listening or studying carefully, or when we get into habits, not responding to what we think we know .
Sir William Osler, who rejected a 19th century doctor who practiced at a time when many of the treatments were ineffective and fraught with dangers, wrote: “One of the first duties of a doctor is to educate the masses not to take medicine”: a warning that keeps a clear ring of truth even in the 21st century. All medications have potential side effects, and especially in children, a reasonable philosophy is to use several medications with the most favorable safety profile for the least amount of time.
Many childhood illnesses are self-regulatory conditions that doctors must manage, providing comfort for the child and advising parents, rather than blithely giving out prescriptions for suppressing symptoms, without a conscientious attempt to determine the true nature of the underlining condition. We doctors must do better. The best parents can do this to become informed consumers of health care and have never doubted to question their doctor.
