1/ This is a standard prescription for viral hepatitis in an admitted patient in India
Next time you see this, fight against it
This patient suffers from coronary artery disease & has stents placed for the same and has reactivation of hepatitis B infection.
Whats wrong here?π§΅
Next time you see this, fight against it
This patient suffers from coronary artery disease & has stents placed for the same and has reactivation of hepatitis B infection.
Whats wrong here?π§΅
2/ Inj. Augmentin is an antibiotic (a powerful one too). Antibiotics are used against bacteria.
Hepatitis B is a virus
It requires anti-viral
- here there is no antiviral prescribed
Injudicious antibiotic use leads to resistance which impacts us ALL, everywhere.
Hepatitis B is a virus
It requires anti-viral
- here there is no antiviral prescribed
Injudicious antibiotic use leads to resistance which impacts us ALL, everywhere.
3/ Tab Pantocid is a proton pump inhibitor. It is a "gas medicine" used in patients with dyspepsia and peptic ulcer disease. This patient has dyspepsia, but the dose is too high - he requires only SOS (as need be dose)
4/ Tab Meftal is Mefenamic acid. Its a non-steroidal anti-inflammatory drug (NSAID). Its used for pain relief mostly.
This physician was scared of using paracetamol in hepatitis and so used a NSAID which is contraindicated in chronic liver disease, thinking its safer. Its not...
This physician was scared of using paracetamol in hepatitis and so used a NSAID which is contraindicated in chronic liver disease, thinking its safer. Its not...
...this patient neither had pain, nor significant fever (he had fever and that resolved). NSAID can cause kidney injury in patients with pre-existing liver disease
5/ Tab Udiliv - is ursodeoxycholic acid
It has no role in the management of hepatitis B virus infection and only...
5/ Tab Udiliv - is ursodeoxycholic acid
It has no role in the management of hepatitis B virus infection and only...
...role is in cholestatic liver disease (jaundice with itching)
6/ Tab Viboliv - is metadoxine - it was considered useful in patients with alcohol-related liver disease - but further research showed its useless for any liver disease - not sure why its used here
6/ Tab Viboliv - is metadoxine - it was considered useful in patients with alcohol-related liver disease - but further research showed its useless for any liver disease - not sure why its used here
7/ Cap Essential is omega-3 fatty acids - it has no role in hepatitis or in viral disease - it is useful for reducing triglycerides - not sure why it has been used here (probably bcoz there was grade 1 fatty liver on ultrasound - but that's also not an indication)
8/ Tab Clonotril is Clonazepam, a sedative/anxiolytic - probably given to alleviate the patients anxiety - but this can also be done though words of encouragement and assurance, and not prescription of sedatives directly
9/ Tab Cirrhosam is Ademetionine or SAMe derivative...
9/ Tab Cirrhosam is Ademetionine or SAMe derivative...
...it was found to be absolutely worthless in any liver disease condition especially in viral hepatitis - not sure why this feature in the prescription
10/ Tab Zincovit a multivitamin supplement - WHY? Patient is eating well, has loss of appetite only. Multivitamins do not...
10/ Tab Zincovit a multivitamin supplement - WHY? Patient is eating well, has loss of appetite only. Multivitamins do not...
...improve appetite or energy, this is a stupid myth.
11/ Cap Mucinac is N-acetyl cysteine - it is indicated in Paracetamol poisoning and not in viral hepatitis. This patient was not even receiving paracetamol, so why?
12/ Livorg sachet is L-Ornithine L-Aspartate granules..
11/ Cap Mucinac is N-acetyl cysteine - it is indicated in Paracetamol poisoning and not in viral hepatitis. This patient was not even receiving paracetamol, so why?
12/ Livorg sachet is L-Ornithine L-Aspartate granules..
..which is used in management of acute hepatic encephalopathy or brain failure due to ammonia in INTRAVENOUS/Injection form, not oral use! - absolutely unnecessary here
13/Zolfresh is Zolpidem, a sedative again (not sure why its given, I hate is personally as it causes...
13/Zolfresh is Zolpidem, a sedative again (not sure why its given, I hate is personally as it causes...
...sleep walking and disorientation and severe amnesia in some patients). Not ideal for liver disease patients.
14/ Cap Rifaxigress is Rifaximin an non-absorbable antibiotic which is given for secondary prevention of brain failure due to high ammonia - this patient doesnt have..
14/ Cap Rifaxigress is Rifaximin an non-absorbable antibiotic which is given for secondary prevention of brain failure due to high ammonia - this patient doesnt have..
..brain failure to start with and not sure why this is given.
15/ Cap Esogress is again given for "gas" trouble, and not sure why its prescribed again at discharge when patient clearly has no "gas" issues, only loss of appetite.
16/ The drug needed was Tenofovir, which is..
15/ Cap Esogress is again given for "gas" trouble, and not sure why its prescribed again at discharge when patient clearly has no "gas" issues, only loss of appetite.
16/ The drug needed was Tenofovir, which is..
..the antiviral, and is not prescribed here.
Summary lessons
β In acute viral hepatitis A and E, no antiviral required, only symptom care and nutrition
β In reactivation of hepatitis B, antivirals help clear virus early and prevent complications
β In viral hepatitis, thers NO..
Summary lessons
β In acute viral hepatitis A and E, no antiviral required, only symptom care and nutrition
β In reactivation of hepatitis B, antivirals help clear virus early and prevent complications
β In viral hepatitis, thers NO..
..ROLE of
Antibiotic
Pain killers
Ursodeoxycholic acid
Metadoxine
Omega 3
Sedatives
SAME or ademetionine
L-Ornithine L-Aspartate oral or injection
N-acetyl cysteine
Multivitamins
If modern med doctors do not practice ethically, patients will flock to pseudoscientific medicine!!
Antibiotic
Pain killers
Ursodeoxycholic acid
Metadoxine
Omega 3
Sedatives
SAME or ademetionine
L-Ornithine L-Aspartate oral or injection
N-acetyl cysteine
Multivitamins
If modern med doctors do not practice ethically, patients will flock to pseudoscientific medicine!!
This patient spent > 15K Indian rupees for 2 weeks for just the drugs when he could have been managed for 500 to 800 Indian rupees easily.
That's additional financial burden for nothing
He's on 2 medicines now for his Hepatitis B and continuing his heart disease meds.
End
That's additional financial burden for nothing
He's on 2 medicines now for his Hepatitis B and continuing his heart disease meds.
End
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