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Need for local Guidelines on
H Pylori Eradication Therapy

This is with reference to your column “OFF THE RECORD” treatment of H Pylori: Need for local guidelines  published in April 1-15, 2017 issue of Pulse Internatnional.You have rightly stated that treatments with anti microbials depends upon the local sensitivity/resistance of microbes to antimicrobials. Of course it varies from country to country and in the same country from place to place. In my recent article “Anti-bacterial Resistance” Pulse March 15-31, I have discussed this subject in detail. Every medical institution should have guide lines, anti-biotic policy based on the prevalence of pattern of sensitivity/resistance to the anti-bacterial drugs and also cost- effectiveness. This requires collaborative study of clinical department/units- microbiology departments along with clinical pharmacology/clinical Therapeutic units playing the key roles.

I may narrate my professional incidence. One of my students who had earlier obtained his MRCP from the UK, got a clinical assistants job after a couple of years. On the first day of his clinical session he prescribed clarithromycin to a patient. He got a call from the clinical pharmacist enquiring if there was a special reason for prescribing clarithromycin. The doctor replied- none. The clinical pharmacist informed the doctor that he was changing it to erythromycin- the first line macrolide. He further told this doctor to study the guidelines and antibiotic policy of the hospital and follow these. The pharmacist sent him the papers for Implementation

It should be a routine practice at least in the major hospitals, clinics, etc. There should also be National guidelines/policy statement issued by the central professional bodies in collaboration with microbiology/clinical pharmacology/clinical therapeutics organization based on evidence- based scientific studies. The treatment schedules may keep on changing based on these studies. Of course all needed antimicrobials should be available. Unfortunately many anti- microbials like Penicillin V, Benzathine Penicillin, Cloxacillin/Dicloxacillin/Flucoxacillin, Furadantin, Trimethoprim etc. are not available in Pakistan because Pakistan is not implementing WHO’s “List of Essential Drugs“ programme in spite of National and International commitments. Medical profession should devote their efforts in this direction not on empty rhetoric’s.

Prof. Emeritus Lt Gen Mahmud Ahmad Akhtar
Former Surgeon General AMC
Rawalpindi. Pakistan.


An Appreciation

I received three beautiful books. Have started reading with “Though Provokers”, and enjoy reading it. I wish our medical profession had more people like you! Your thoughts, vision are an asset for medical profession, if only we can learn to value them. Once again, many thanks for the beautiful and expensive gifts of books.

Nazli Hossain
Professor & Chairperson
Department of Obstetrics & Gynecology|
Dow University of Health Sciences
Karachi, Pakistan.

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