Short term training on tropical and infectious disease 9th edition

2. Antibiotics have been described as two edge sword. Justify rational use of antibiotics by
yourself in your current work station. Enlist challenges and practical solution you had derived
at your station.

Antibiotics saves life when used appropriately, when antibiotics are overused, they can
lead to bacterial resistance and may have unanticipated side effects. Despite of that, use of
antibiotics can save life threatening conditions such as typhoid, pneumonia, sepsis, infectious
diarrhea etc. They either stop bacteria from reproducing or destroy them. Before bacteria can
multiply and cause symptoms, the immune system can typically kill them. White blood cells
(WBCs) attack harmful bacteria and, even if symptoms do occur, the immune system can
usually cope and fight off the infection. There are occasions, however, when the number of
harmful bacteria is excessive, and the immune system cannot fight them all. Antibiotics are
useful in this scenario. In certain conditions, such as in case of leptospirosis exposure, post-
exposure prophylaxis antibiotics: Doxycycline is given, which save us from getting fulminant
disease.

In our work station, hundreds of patient comes with different respiratory conditions;
they are coughing without covering their face, despite of precaution, I got upper respiratory
tract infections for several times and needed an antibiotic to get cured for me and my patients.
There are certain an antibiotic which is very useful has cured several infectious diseases of my
patients. So, it helped to cure several diseases and stopped from spreading in the community
and hospital.

There is huge variety of antibiotics as medical science now has to search for new ways
to use them in order to combat some of the new resistant strains of various bacteria. They still
have enormously wide application.

Most people in the community, where I work has misconception about antibiotics, they
think that taking higher dose and broad-spectrum antibiotics, disease can be cured faster. Many
doctors and medical professional practicing that theory, to make the patient happy temporarily.
Even some of 3rd generations antibiotics has become over the counter drug, which made our
patient resistant for variety of strains and types of bacteria. I have encountered, sometimes it’s
very difficult to treat a simple wound, because for that particular patient, low dose of
antibiotics are not effective anymore.

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 One of my patient told “I had my teeth cleaned recently, and the dentist prescribed
clindamycin to combat a possible infection. I took it for 10 days as prescribed and have had a
stomachache and diarrhea every day for two weeks. I went to a pharmacy and asked for a
medicine, he gave Loperamide stopped the diarrhea for a little while, but it came back.”

A patient told “My son was given clindamycin by a medical professional for an ingrown
fingernail that had become infected. Within a day, he got allergic rashes all over the body
associated with itchiness after 2nd dose. We gave him diphenhydramine and told to discontinue
the clindamycin.

Thus, for my work station and my professional practice, we usually prescribe antibiotics,
start with low dose, with penicillin and other antibiotics accordance with disease and causative
agent, if needed. Generally, we do not prescribe the antibiotics for minor wounds; where
simple betadine, care of wounds will work and simple cough and colds for less than few days. If
I will know the disease characteristics is not bacterial, either clinically or by laboratories, I do
not prescribe antibiotics. I do explain about disease characteristics, advantages and side effects
of certain antibiotics, allergic sensitivity with previous use, if the benefits outweigh then only
prescribed. For higher generations of antibiotics, we always do “skin test” before injecting
antibiotics. We are always aware about the dose and doses of antibiotics we give.

3. State importance of prevalence in clinical decision making.

The physicians should be aware about the prevalence of a condition in the population
they work with and tailor diagnostic strategies with this information.

As we know, medicine is not an exact science. Decision making in health care involves
consideration of a complex set of diagnostic, therapeutic and prognostic uncertainties. Medical
therapies have side effects, surgical interventions may lead to complications, and diagnostic
tests can produce false positive or false negative results, due to different factors involved.
Furthermore, patient values and service costs must be considered. Decisions in clinical and
health policy require careful weighing of risks and benefits and are commonly a trade-off of
competing objectives: maximizing quality of life vs maximizing life expectancy vs minimizing the
resources required.

Thus, knowing the prevalence of the disease takes a systematic and rational approach to
clinical decision making. It provides an essential resource for trainees and researchers involved
in clinical decision modeling, evidence-based medicine, clinical epidemiology, comparative
effectiveness, public health, health economics, and health technology assessment. The

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prevalence of a certain disease indirectly reveals the causative agent, risk factors, burden and
outcome in certain community.

For instance, if the prevalence of dengue is high in the area a doctor is practicing,
he/she is more inclined to order a dengue rapid test for atypical symptoms such as fever that
lasted for a few days, even in the absence of other characteristic symptoms and in case of
absence dengue diagnostic test in that settings, the doctor can manage effectively with the help
of clinical symptoms and prevalence of dengue in that community.

Rationale of Not Answering

1. State five examples of application of evidence based medicine by you preferably

on the field of infectious diseases.

Although, I knew the answer of the question and had encountered, evidence based
medicine practice and it can be interesting to answer, I can answer other two more logically
based on my clinical experience and research background.

4. We read epidemiology, clinical sign and symptoms (asymptomatic, symptomatic in

form of mild, moderate and severe), investigations, treatment, prognosis (natural course of
diseases with particular characterization) about any particular diseases in our classical
medical text book. Among these five highlighted content identify the most important factor
that could be applicable for the diagnosis of particular disease in your community.

Answer of above question can be found easily in any community medicine or public
health related book, not so much to think about it. It’s a straight question, have to choose most
important one and describe it.