Taufiq, Malika

Zuberi, Rukhsana Wamiq

eCommons@AKU

eCommons@AKUDepartment for Educational Development Medical College, PakistanJanuary 2011Overuse of antibiotics In children for upperrespiratory infections (URIs): A DilemmaMalika TaufiqAga Khan UniversityRukhsana Wamiq ZuberiAga Khan University, rukhsana.zuberi@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_dedPart of the Medical Education Commons, Pediatrics Commons, Pharmacology Commons,Respiratory Tract Diseases Commons, and the Toxicology CommonsRecommended CitationTaufiq, M., Zuberi, R. W. (2011). Overuse of antibiotics In children for upper respiratory infections (URIs): A Dilemma. Journal of theCollege of Physicians and Surgeons Pakistan, 21(1), 59-60.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_ded/14Journal of the College of Physicians and Surgeons Pakistan  2011, Vol. 21 (1): 59-60 59Sir,Forensic odontology is a specialized field of dentistryrelated to legal issues.1 This branch has been utilized formany years for the identification of victims and suspectsin mass disaster, abuse and organized crimes.2 It isalmost impossible to segregate this branch from otherdental specialities. The widely accepted classification offorensic odontology is based on the major fields ofactivity i.e. civil, criminal and research which wasproposed by Avon.3 There is no working classificationfor forensic odontology based on its relation withother dental specialities in the literature. A workingclassification for forensic odontology is proposed hereby.It embraces all dental specialities (Table I). Thisclassification will be useful for postgraduate students ofdentistry to do research by amalgamating their parentspeciality with forensic odontology. REFERENCES1. Shamim T, Ipe Varughese V, Shameena PM, Sudha S. Forensicodontology: a new perspective. Medicolegal Update 2006; 6:1-4.2. Shamim T. Forensic odontology. J Coll Physicians Surg Pak 2010; 20:1-2.3. Avon SL. Forensic odontology: the roles and responsibilities ofthe dentist. J Can Dent Assoc 2004; 70:453-8.DR. THORAKKAL SHAMIMDENTAL ASSISTANT SURGEONGOVERNMENT TALUK HEAD QUARTERS HOSPITALNILAMBUR-679329, INDIACorrespondence:Dr. Thorakkal ShamimShangrila, Parappanangadi-676303Malappuram District, Kerala, IndiaE-MAIL: A New Working ClassificationProposed For Forensic OdontologyLETTERS TO THE EDITORTable I: Working classification proposed for forensic odontologybased on its relation with other dental specialities.Dental specialities         Relationship with forensic odontologyOral pathology and 1. Age estimation using ground sections (histological  microbiology method)a. Gustafson's techniqueb. Incremental lines of Retziusc. Perikymatad. Prenatal and postnatal line formatione. Racemization of collagen in dentinf. Cemental incremental linesg. Translucency of dentin2. Identificationa. Developmental disturbances of teethb. Regressive alterations of teethc. Tumours and cysts of oral cavityd. DNA profiling from teethOral medicine and 1. Age estimation using radiographic methodradiology a. Secondary dentin formationb. Changes in the orientation of mental foramenand inferior alveolar canalc. Eruption and formation of mandibular third molard. Trabecular pattern in jawse. Pulp/tooth area ratio of teethf. Pattern of lamina dura2. Identificationa. Maintenance of dental recordsb. Dental chartingc. Comparative dental identificationd. CheiloscopyOral and maxillofacial 1. Identification surgery a. Maxillomandibular and dentoalveolar fracturesb. Surgical repairs and implants2. LeFort I osteotomy procedure in  autopsy Paedodontics 1. Age estimationa. Eruption sequenceb. Schour and Massler chartc. Demirjian's method using dental maturation chartd. Nolla's calcification stages2. Child abusePeriodontics 1. Age estimation   a. Periodontosis(gum recession)b. Root transparency and root length2. Identificationa. Gingival morphology and pathologyb. Thickness and widening of periodontal ligamentConservative dentistry 1. Identificationand endodontics a. Restorationsb. Endodontic treatment2. Identification using radiographic method (Periapicalradiograph)a. Root canal treated restorationsb. Radiolucent and radio opaque restorative materials3. Effect of heat on restorative materialsProsthodontics 1. Impression techniquesa. Bite mark analysisb. Palatal rugoscopy.2. Identificationa. Dentures and prosthesesb. Denture markingc. Bite mark analysis d. Palatal rugoscopy.e. Impressions and casts3. Sex determinationa. Palatal dimensionsOrthodontics 1. Age estimationa. Cephalometrics b. Orthopantomograph (OPG) X-ray and hand-wrist X-ray to determine pubertal state2. Identificationa. Tooth rotation and malpositionb. Orthodontic appliancesc. Orthodontic reconstruction3. Sexual dimorphisma. Mandibular canine index and mandibular first molar index4. Race identificationa. Cephalic index 5. Craniofacial superimpositionCommunity dentistry 1. Identificationa. Endemic fluorosisb. Socioeconomic groupingi. Dental cariesii. Periodontal diseaseiii. Oral canceriv. Restorative materialsc. Mass disasters2. Dental fraud and malpractice3. Elderly abuseSir,Numerous studies have documented unnecessaryantibiotic use for common illnesses including upperrespiratory infections (URIs).1 A survey of prescriptionsin public sector of Attock district of Pakistan showed that62% of prescriptions had an antibiotic and URIs was   acommon indication for antibiotic prescription.2 Similarsurvey of prescription from an Indian district showedunnecessary drug use in 47% of cases and commondiagnosis with irrational prescription were cough, coldand URIs.3 Widespread overuse of antibiotics forcommon viral illnesses will not only raise antibioticresistance but will also increase workload and cost oftreatment. Common cold commonly afflicts children particularly inday care setting with 3-8 episodes in a year.4 Most arecaused by viruses. Mucopurulent rhinitis is a sequel ofcommon cold and normally does not require antibioticexcept when symptoms persist for long.4 National surveyfrom USA in 1990s showed primary care physician'sprescription rate of 40-60% for uncomplicated URIs.1But now due to widespread effort, frequency of antibioticprescriptions had significantly reduced.1 Data fromnational survey in Pakistan regarding prescribingpattern among general practitioner (GPs) and pedia-tricians is lacking.In this context, a cross-sectional survey was conductedusing a self-administered questionnaire to determinethe prescribing practices of GPs in Mirpurkhas. Itshowed that 52% of GPs prescribed antibiotics forsymptoms of common cold and 68% prescribed forsymptoms of viral sore throat. Various studies have shown that physical findings likepathologically altered tonsils or yellow colored sputumare positively associated with antibiotic prescription.5Similarly 60% of GPs in the study even prescribedantibiotics inappropriately for discolored nasal dischargeof variable duration. Despite working in a resourcelimited setting, most GPs obtained investigations butonly 25% ordered a throat swab and none of themchose to wait for the results before prescribing anti-biotics. Unnecessarily investigating viral illnesses willincrease the cost of treating URIs which requires simplemeasures only. Penicillin was commonly prescribed for URIs followed byfirst-generation Cephalosporin and Macrolide for 5-7days. Prescribing broad spectrum antibiotics for commonviral illnesses will further aggravate the situation. MostGPs prescribed antibiotics in case of diagnostic un-certainty or for prevention of secondary bacterialinfection. It is alarming to know that most GPs were awareof growing antibiotic resistance. Still they consideredantibiotic as a safe option. There were wide gaps in the knowledge identifiedamong GPs in Mirpurkhas. As the survey indirectlymeasured GPs prescribing behavior, it may not reflecttheir true practice. More studies based on directlyobserved practice are required at a national level tounderstand the approach to URIs, and factorsassociated with it. REFERENCES1. Mainous AG, Hueston WJ, Davis MP, Pearson WS. Trends inantimicrobial prescribing for bronchitis and upper respiratoryinfections among adults and children. Am J Public Health 2003;93:1910-4.2. Siddiqi S, Hamid S, Rafique G, Chaudhry SA, Ali N, Shahab S,et al. Prescription practices of public and private health careproviders in Attock District of Pakistan. Int J Health Plan Manag2002; 17:23-40.3. Phadke AR. The quality of prescribing in an Indian district.Natl Med J India 1996; 9:60-5.4. Rosenstein N, Phillips WR, Gerber MA, Marcy CM, Schwartz B,Dowell SF. The common cold principles of judicious use ofantimicrobial agent. Pediatrics 1998; 101:181-4.5. Fischer T, Fischer S, Kochen MM, Hummers-Pradier E.Influence of patient symptoms and physical findings on generalpractitioners' treatment of respiratory tract infections: a directobservation study. BMC Fam Pract 2005, 6:6DR. MALIKA TAUFIQ AND PROF. DR. RUKHSANA W. ZUBERICorrespondence:Dr. Malika TaufiqSenior Instructor, Department of Family MedicineThe Aga Khan University TanzaniaE-MAIL: malika.taufiq@aku.edu60 Journal of the College of Physicians and Surgeons Pakistan  2011, Vol. 21 (1): 59-60Letters to the editorOveruse Of Antibiotics In ChildrenFor Upper Respiratory Infections(URIs): A Dilemmal l l l lOl l l l l

Overuse of antibiotics In children for upper respiratory infections (URIs): A Dilemma

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Overuse of antibiotics In children for upper respiratory infections (URIs): A Dilemma

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