Prevention of Accidents and First Aid

Prevention of Accidents and First Aid





Children will always have accidents no matter how careful you are. They are especially likely to injure themselves when they first become mobile. You can help prevent unnecessary accidents by following the safeguards listed :



• Keep small hard objects and pieces of food away from the baby. Check all toys to be sure that nothing could be bitten or pulled off which might cause choking.



• Before the baby crawls, check your home for unguarded fires, trailing or dangling electrical cords, unsafe electrical sockets (use power outlet guards), breakable (especially glass) objects which are within reach of a crawler.



• All children's clothing should be fireproof.



• Fix guards to reachable windows and staircases.



• Keep all medicines and poisons out of reach and locked up.



• Have childproof doors on all low cupboards.



• Check water hazards. All fish ponds and pools should be absolutely inaccessible. Never leave the baby alone in or near a bath containing water.



• Guard against scalds : Turn saucepan handles in to the stove, never drink hot drinks while holding a baby, don't use a table cloth when serving hot drinks, keep your hot water temperature as low as practical. Safety taps are available for the bath.



• Project your baby from sunburn with creams and hats.

Learn and practise how to give artificial respiration and external heart compression. Every home should have instructions for these life saving resuscitation procedures and all adults and older children in the household should know what to do in an emergency.



FIRST AID



Every parent will need to give first aid to children many times. Fortunately injuries are usually minor but it is best to be prepared for all kinds of emergencies.

You'll be surprised at what you can do in an emergency and it's important to know that you've done the best you can. Remember that help is only a phone call away. Write clearly the phone numbers of nearby doctors, the ambulance, the nearest Poisons Information Centre and some reliable neighbours on an adhesive label and attach it to the phone or close to it.





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First Aid Kit 2

First Aid Kit



Every home should have a well stocked first aid kit. You can make up your own quite inexpensively. A shoe box strengthened with contact paper or a plastic two litre icecream tub makes a good container. The kit should contain :



• Sterile pads and dressings, including paraffin-soaked dressings



• Adhesive dressing of various sizes as well as one or two rolls of adhesive bandage



• Crepe and cotton bandages



• Small roll of cotton wool



• Safety pins



• Antiseptic lotion and tincture (Betadine, Savlon etc.)



• Scissors, blunt ended tweezers, sharp ended (splinter) tweezers



• Analgesic tablets and mixture (Aspirin or Paracetamol)



• Local anaesthetic cream or jelly or a small bottle of kitchen vinegar (for stings)



• Thermometer



• One metre square of cotton fabric (for sling, or pad for bleeding injuries)

Keep the kit out of children's reach but easily accessible. A similar kit should be kept in the car.





Burns and Scalds



If clothing catches fire, roll the child on the floor or in a carpet or blanket to put out the flames. Call for help. Flood the burnt or scalded area with cold water for at least five minutes. Don't remove adherent clothing. Don't apply any antiseptics or creams. Cover the burnt area with a clean handkerchief or sheet and take your child straight to your doctor.



Bites and Stings



Sandflies, mosquitoes and various other insects can bite. Wash and dry the area. Apply a cold compress if swollen. If itchy, dab with Calamine lotion, Eau de Cologne or Vinegar.





Apply a dressing to prevent scratching and infection. Seek medical advice if the victim shows any signs at all of an allergic reaction (excessive swelling, difficulty with breathing, vomiting, generalised skin rash).



Animal and human bites :



Stop bleeding, wash and dry wound, apply a dressing and take the child to the doctor or hospital without delay.



Snake, spider and dangerous insect bites :



Kill the biter, if possible, in case identification is necessary. Ring the ambulance or someone to drive you to emergency medical care. While waiting to go, bandage the bitten part (if a limb) firmly, starting 20 cm above and continuing 20 cm below the bite. Immobilise the limb with a splint. These measures help to prevent spread of venom. Watch breathing and pulse carefully. If either stops, give appropriate resuscitation.





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Firs aid 3

Bleeding



Bleeding from wounds can usually be stopped by direct, firm pressure. Use a handkerchief or towel. Add pads as they become soaked. Don't remove soaked pads. When bleeding stops or eases, apply a pressure bandage and seek medical help as soon as possible.



Fits



Quickly clear the surroundings of any injurious objects. Call for help. Loosen any tight clothing around neck and waist. Most convulsions don't last long. When the jerking movements have stopped, lay the child on a soft bed or couch, cover with a warm blanket if cold, or sponge with cool water if hot. Watch breathing. If breathing stops, begin artificial respiration until help comes.



Drowning



Drowning can occur quickly and quietly in a very small amount of water. Call for help. Drain water from lungs by hanging the baby over your knee for about 10 seconds. Then start heart and lung resuscitation and continue until help comes or you get to the hospital.



Electrocution



Turn off the current. Call for help. Start heart and lung resuscitation at once and continue until help comes. Never attempt" to pull anyone away from a live current as you risk electrocution yourself.



Choking



Call for help. Hold the child's head down and give several firm slaps between the shoulder blades. Repeat in a few seconds if necessary. Remove any obstruction in the mouth but don't put your fingers down the child's throat — you may push the obstruction further down. If he doesn't cough up whatever is obstructing breathing, stand behind the child and place your arms around his middle, hands between his navel and ribs. Grip the fist or one hand with the other and-squeeze upwards firmly three or four times. Repeat if necessary. If this fails, hold him firmly by the feet and swing him round and round. If choking continues, take the child to a doctor or hospital as quickly as possible.



Head Injuries



Head injuries must always be taken seriously. Anyone who loses consciousness, even momentarily, after a blow on the head should be checked by a doctor. If the infant remains conscious, keeps a good colour and stops crying in reasonable time, he'll probably be all right. After any head injury, watch the child carefully for the next few days. If headache, drowsiness, vomiting, eye disturbances or lack of coordination develop, seek medical help without delay.



Fractures



The only first aid required is to minimise motion of the fractured parts to lessen the excruciating pain. Splinting the fractured part does this. A splint can be anything which is stiff. Usually the most common material used is a piece of broad wood. The splint should ideally by supporting the joints before and the joint after the fracture, in addition to the fractured site. For example, in a suspected fracture of the forearm, the splint should extend beyond the wrist (i.e. the joint before) and the elbow (i.e. the joint after the fractured part). Don't try to move them. Instead put the splint parallel to the fractured part and bandage together with clothes. For practical purposes, even three handkerchiefs, one each tied around the two ends and one in the middle will suffice. During transport to the hospital, take care that the fractured part is kept as motionless as possible and not jostled too much.



And finally as a matter of abundant caution, in any case of a trauma, while handling the patient, take great care that you don't extend or flex his neck and the spine, i.e. the backbone, should not undergo any motion (flexion, extension or rotation). In other words, the patient should be lifted by at least 4 persons in the same state that he was lying on the ground, particularly avoiding any motion of the neck or backbone relative to the rest of the body. Otherwise it can lead to an injury of the spinal cord and result in paralysis.



Poisons



Try to estimate how much poison the child has consumed. Take the remains of the poison with you to hospital. It is a good idea to keep syrup of Ipecac (available at your chemist) on hand. This can reduce vomiting. However some poisons make vomiting dangerous as they can burn the gullet and throat. Do not induce vomiting for poisoning which involves petroleum products (paraffin, petrol, liquid furniture and car polish, benzene, lighter fuel, turpentine and dry cleaning fluids), strong acids (nitric, sulphuric, hydrochloric), strong alkalis (bleach, ammonia, washing soda, caustic soda) and oil. based paint or insect sprays. Pesticides such as dog and flea rinses are particularly dangerous. In these cases give the child a drink of milk or water to help dilute the poison.



If the child has swallowed pills from a container and you are unsure how many or how dangerous they may be, induce vomiting. It only takes five quinine pills to kill a 2-year-old. If you cannot get through to the Poisons Information Centre or contact a doctor, take the child to a hospital making sure you take a sample of the poison with you, if possible.



Resuscitation Methods



Expired Air Resuscitation (EAR). Shake or shout at the patient to determine whether she is consious. If unconscious, roll her onto her side and clean out any foreign material from her mouth. Move patient onto back. Tilt head backwards.

Infants' head should not be tilted backwards. To keep the airway of an unconscious infant open, the forehead should be held and the point of the chin supported.

Look for movement from the chest and abdomen. Listen and feel for movement from the mouth and nose of the patient.



If there is no sign of breathing, take a breath and place your mouth completely over the patient's open mouth. Seal the nose with your cheek or fingers. For infants, place your mouth over the mouth and nose to seal it off.

Blow five gentle breaths watching the lower chest rise. With infants give little puffs, keeping the patient's jaw upwards and forwards. Vigorous blowing can damage an infant's lungs so take great care. Listen and feel for air leaving the mouth. Breathing should be about 20 per minute (one breath every 3 seconds).





When breathing restarts, roll the patient onto her side. Should breathing become irregular again recommence artificial respiration.

Cardiopulmonary Resuscitation (CPR) : Compression should be applied to the middle of the sternum of the patient when there is no pulse. The resuscitator should carefully feel around the bottom of the ribs to where they meet at the midline. One index finger should be placed on this point, the other hand should be positioned just touching the index finger.



Place the heel of the hand on the midline of the person's sternum, with the finger pointing across the chest and exerting no pressure on the chest.

The second hand should be placed over the first and held, either by the finger holding the other or the thumb holding the wrist. The compression should be vertical and there must be no pressure exerted on the chest except through the need of the lower hand. The upper end of the sternum should be found by feeling the groove between the collar bone.

One hand should be used to compress the centre of the sternum to a depth of about 2.5 cm. For infants, two fingers should be used to compress the centre of the sternum to about 1.5 cm or to a depth assessed for the individual patient by an experienced resuscitator.



For a single resuscitator, two breaths of EAR followed by one compression should be given within 10 seconds. A minimum of six cycles should be completed each minute. For two resuscitator CPR, the victim should receive 100 uninterrupted compressions each minute, counting with 20 breaths at intervals of 5 compressions.

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Vaccines and Immunisation

Vaccines and Immunisation





Many infectious diseases, including most of the common viral infections, occur only once during a person's lifetime. The reason is that the antibodies produced in response to the disease remain afterwards, prepared to repel any future invasion as soon as the first infectious germs appeared. The duration of such immunity varies, but it can last a lifetime.



Protection against many infections can now be provided artificially by the use of vaccines derived from altered forms of the infecting organism. These vaccines stimulate the immune system in the same way as a genuine infection, and provide lasting, active immunity. Because each type of microbe stimulates the production of a specific antibody, a diffferent vaccine must be given for each disease.



Another type of immunisation, called passive immunisation, relies on giving antibodies.



Why They Are Used



Some infectious diseases cannot be treated effectively or are potentially so serious that prevention is the best treatment. Routine immunisation not only protects the individual but may gradually eradicate the disease completely, as has been achieved with smallpox.

Newborn babies receive antibodies for many diseases from their mothers, but this protection lasts only for about three months. Most children between the ages of 2 months to 15years are routinely vaccinated against common childhood infectious diseases. In addition, travellers to many under developed countries, especially those in the tropics, are often advised to be vaccinated against the diseases common in those regions.



Effective lifelong immunisation can sometimes be achieved by a single dose of the vaccine. However, in many cases, reinforcing doses, commonly called booster shots, are needed later to maintain reliable immunity.



Vaccines do not provide immediate protection against infection and it may be up to four weeks before full immunity is able to develop. When immediate protection from infectious disease is needed— for example, following exposure to infection — it may be necessary to establish passive immunity with immune globulins.



How They Work



Vaccines provoke the immune system into creating antibodies that help the body to resist specific infectious diseases. Many vaccines (known as live vaccines) are made from artificially weakened forms of the disease-causing germ.



Common Vaccinations



Most vaccinations are given during infancy and childhood as part of a routine immunisation schedule. Most are given by germs and are effective in stimulating sufficient growth of antibodies. Other vaccines rely either on inactive (or killed) disease-causing germs, or inactive derivatives of these germs, but their effect on the immune system remains the same. Effective antibodies are created, thereby establishing active immunity.



How They Affect You



The degree of protection varies among different vaccines. Some provide reliable lifelong immunity; others may not give full protection against a disease, or the effects may last for as little as six months. Influenza vaccines usually protect only against the variety of virus causing the latest outbreak of flu. New varieties appear during most years. Those people at particular risk through their work or travel can have additional immunisation in adulthood. Any vaccine may cause side-effects but they are usually mild and soon disappear. The most common reactions are a red, slightly raised, tender area at the site of injection and a slight fever or a flu-like illness lasting for one or two days.



Risks And Special Precautions



Serious reactions are rare and, for most children, the risk is far outweighed by the protection given. Children who have had fits may be advised against vaccinations for pertussis (whooping cough) or measles. Children who have any infection more severe than common cold will not be given any routine vaccination until they have recovered.





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Disease

Disease

Age at which Vaccination is given

Diphtheria



2 months, 3 months, 4 months, 3-5 years, Booster on leaving school

Tetanus



2 months, 3 months, 4 months, 3-5 years, Boosters on leaving school and every 10 years thereafter

Pertussis (whooping cough) 2 months, 3 months, 4 months

Polio



2 months, 3 months, 4 months, 3-5 years, Boosters on leaving school

Haemophilus influenzae type b (hib)



2 months, 3 months, 4 months

Rubella (German measles) 12-15 months and 3-5 years

Measles



12-15 months and 3-5 years

Mumps



12-15 months and 3-5 years







Tuberculosis (BCG) (Bacille Calmette-Guerin)

6 weeks or 10-14 years

Influenza



People of any age who are at risk of serious illness or death if they develop influenza



Hepatitis A

Single dose for people of any age who are at risk. Booster 6-12 months after initial shot. Boosters every 10 years if needed



Hepatitis B

3 inoculations at any age, with the second and third shots 1 and 6 months after the first. Booster after 5 years if needed



Pneumococcal pneumonia



Single dose for people of any age who are at risk

Meningococcal meningitis

Single dose for people of any age who are at risk



BCG (Bacille Calmette-Guerin) — Vaccine used to prevent children from Tuberculosis(TB).



OPV (Oral Polio Vaccine) — Vaccine given to children upto 5 years of age to make them immune from Polio.



DPT (Diphtheria, Whooping cough and Tetanus) — A combined vaccine that makes children immune from Diphtheria, Whooping cough and Tetanus.



MMR (Measles, Mumps and Rubella) — Vaccine used to prevent children from Measles, Mumps and Rubella.



HIB — Haemophilus influenza type b does not affect the children inoculated by this vaccine.



TT — Used to provide immunisation from Tetanus.

Live vaccines should not be given during pregnancy because they can affect the developing baby, nor should they





be given to people whose immune systems are weakened by disease or drug treatment. It is also advisable for those taking high doses of corticosteroids to delay their vaccinations until the end of drug treatment.



IMMUNE

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Immune Globulins

The risk of high fever following the DPT (combined diphtheria, pertussis, and tetanus) vaccine can be reduced by giving Paracetamol at the time of vaccination. The pertussis vaccine may in rare cases cause a mild fit, which is brief, usually associated with fever and stops without treatment. Children who have experienced such fits recover completely without neurological or developmental problems.



Immune Globulins



Antibodies, which can result from exposure to snake and insect venom as well as infectious diseases, are found in the serum of the blood (the part remaining after the red cells and clotting agents are removed). The concentrated serum of people who have survived diseases or poisonous bites is called immune globulin, and, given by injection, it creates passive immunity. Immune globulin from blood donated by a wide cross-section of donors is likely to contain antibodies to most common diseases. Specific immune globulins against rare diseases or toxins are derived from the blood of selected donors likely to have high levels of antibodies to that disease. These are called hyperimmune globulins. Some immune globulins are extracted from horse blood following repeated doses of the toxin.



Because immune globulins do not stimulate the body to produce its own antibodies, their effect is not long-lasting and diminishes progressively over three or four weeks. Continued protection requires repeated injections of immune globulins.

Adverse effects from immune globulins are uncommon. Some people are sensitive to horse globulins, and about a week after the injection they may experience a reaction known as serum sickness, with fever, a rash, joint swelling and pain.







This usually ends in a few days but should be reported to your doctor before any further immunisation.



Travel Vaccinations



These are not normally necessary for travel to Western Europe, North America, Australia, or New Zealand (although you should make sure that your tetanus and poliomyelitis boosters are up-to-date). Consult your doctor if you are visiting other destinations. Check that children travelling with you have had the full set of routine childhood vaccinations as well as any that are necessary for the areas in which you will be travelling.

If you are visiting an area where there is yellow fever, an International Certificate of Vaccination will be needed. You may also need this certificate in the future. Many countries that you might want to visit require an International Certificate of vaccination if you have already been to a country where yellow fever is present.



You are at risk of other infectious diseases in many parts of the world, and appropriate vaccinations are a wise precaution. For example, there is a zone called the "Meningitis Belt" that runs across northern India, Nepal, Bhutan, and Pakistan, and continues across Africa from the Sahara down to Kenya. Anyone intending to visit this zone should have meningococcal vaccine A and C. Visitors to Saudi Arabia at certain times of the year may also be required to have had the meningitis group A and C vaccine.



You may need extra vaccinations if you are backpacking or planning to stay for a long time. For example, hepatitis A vaccine would be sensible for anyone travelling to a developing country, but a long-stay traveller should consider having the hepatitis B vaccine and BCG(tuberculosis) as well. Anyone travelling into remote areas is recommended to have rabies vaccination.

All immunisation should be completed well before departure as the vaccinations do not give instant protection.







BCG needs 3 months, and some, for example typhoid, needs more than one dose to be effective.



Travel Immunisation



The immunisations needed before travelling depend on the part of the world you intend to visit, but some diseases can be contracted almost anywhere. Make sure that you have been immunised against tetanus and polio and have had boosters if necessary. Ask you doctor or pharmacist for the most up-to-date information on vaccination for specific areas.

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Useful Biochemic Combinations

Useful Biochemic Combinations





There are 28 combination compounds of biochemic remedies which are detailed hereunder with main symptoms for which each one should be used. These combinations are numerically numbered.



Before purchasing any biochemic combination, make sure that only products of standard homoeo companies are purchased (e.g. WSI, SBL, Ralson, Baksons, Bioforce etc.)



Biochemic Compounds



Number-1 Anaemia

Number-2 Asthma

Number-3 Colic

Number-4 Constipation

Number-5 Coryza

Number-6 Cough, Cold and Catarrh

Number-7 Diabetes

Number-8 Diarrhoea

Number-9 Dysentery

Number-10 Enlarged Tonsils

Number-11 Fever

Number-12 Headache

Number-13 Leucorrhoea

Number-14 Measles

Number-15 Menstruation Troubles

Number-16 Nervous Exhaustion

Number-17 Piles

Number-18 Pyorrhoea

Number-19 Rheumatism

Number-20 Skin Diseases

Number-21 Teething Troubles of Children

Number-2 2 Scrofula

Number-23 Toothache

Number-24 Tonic for Nerves and Brain

Number-25 Acidity, Flatulence and Indigestion

Number-26 Easy Delivery/Parturition

Number-27 Lack of Vitality

Number-28 General Tonic



Dosage for children and adults have been mentioned on each combination but in emergent situations like cholera, diarrhoea, colic, flatulence, fever etc. dosage may be repeated with greater frequency but quantity of dose will, however, remain the same. In case of any confusion or difficulty consult a Homoeopathic physician.



Biochemic Combination No. 21 (Teething Troubles)

This is the mostly used Biochemic Combination



These tablets help to build up general health of the baby and also keep him free from most of the health problems which normally occur during dentition period. It is a combination of Ferrum Phos and Calcarea Phos which in combined form, proves more effective and efficacious due to addition of Ferrum Phos. Mothers generally prefer to use Calcarea Phos but, in our view, this combination should be preferred in comparison to single use of Calcarea Phos. These tablets can be used regularly, from the anticipated time of cutting teeth until your child can be relieved from the agony of dentition problems.





AYURVEDIC TREATMENT

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Treatment by Ayurveda

Treatment by Ayurveda





Ayurveda is a well established science which is non harming to children.



Cough



If cough is dry and sputum is difficult to expel, mix 125 mg each of parched and pulverised powder of Alum and Borax and mix with honey which the child should lick (give this 3-4 times daily). It will moisten and loose the phlegm and help it to expectorate, normalise respiration and relieve cough. It is also useful in tonsillitis.

If phlegm is white, give parched Borax powder and Abhrak Bhasma 15-20 mg (mixed with honey) 3-4 times daily. Anand Bhairava Rasa (15-20 mg) may also be given for the same purpose (2-3 times daily).





Fever



Ayurveda is an ancient Indian science providing treatment by herbs and refined chemicals.

Praval Bhasma — 50-60 mg (for children aged 1-2 years) with milk will quell general fever but, when fever is due to cough, cold and dyspepsia, give 15 mg with milk. Fever due to heat can be brought down by Paracetamol (lA-l/2 Tsp) — Paed. dose — or 50-100 mg of Aspirin (soluble). If 15-25 mg of Abhrak Bhasma is given Vz-l hour before anticipated time of fever, it won't let fever surface — it will also relieve symptoms of cough. Septrin tablets of Baidyanath are also good.





Pain in Ribs



Prepare a liniment/rubbing oil by mixing Heeng (Asafoetida) and Garlic. Massage this oil over the affected rib-area 2-3 times daily. In addition give also Abhrak Bhasma (5-10 mg) with Milk or Honey. It will not only alleviate pain but also remove swelling.



Pain in the Ear



Fry 4-5 cloves of Garlic and 25-30 gms of Heeng in Mustard oil. Boil and let it cool down. Drop 2-3 drops in the painful ear. Alternatively 3-4 drops of doctor's brandy (slightly heated in winter) should be inserted into the painful ear. Even 2-3 drops of turpentine oil used as ear-drops or extracted juice of Onion and some Alum (red colour) should be mixed together to yield the relieving effect. But do not probe anything into the ear, as it (it is better to consult an ENT specialist) may cause infection and aggravate pain.



Abdominal/Stomach pain



This is also known as colic. Mix Heeng, fried Harar and table Salt with Milk or Honey or apply Amritdhara locally over navel and adjoining area. It can also be given in 2 drop doses with a lump of sugar or mixed with milk. As a supportive measure, the child should be laid on his stomach side and gently patted — it will help expel trapped wind and provide relief to the child.



Stomatitis



This condition arises due to reddening of mucus surface in the mouth when the child refuses to be fed and cries when any attempt is made to feed him. There may also be white patches on sub mucus portion. Mix parched Alum, Papparia Katha, and powder of Cardamom with Honey and apply over the infected site or else parched Suhaga, Alum powder or Katha and Kabab cheeni should be mixed with Honey or Ghee (pure) and applied locally, as indicated above.





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Pain in Eyes and Redness

Pain in Eyes and Redness



We are of the opinion that most of the children are quite sensitive to ayurvedic medicines if used as eye drops. Pure Rose water is, by far, the best effective and harmless remedy — drop 1-2 drops into each eye, 3-4 times daily and also wash the eyes with a weak lotion of Boric acid. Some people suggest use of Alum with Rose/plain water but we shall advise you to get in touch with an ayurvedic physician for proper and harmless treatment.



Diarrhoea



Try Nar Kachoor — 15-20 gms and mix it with mother's/ cow's milk and serve thrice daily — will stop green loose motions or try 125 mg Kamaraja Rasa with milk or substitute this with Praval Bhasma (125 mg) with milk and honey (equal quantity of both) and give either of the combinations 6 hourly.

If the above mentioned combinations fail to yield any relief, give 15-25 mg of Anand Bhairava or Sanjeevani by mixing with honey and mother's or cow's milk. It will stop loose motions quite quickly. Consult your ayurvedic physician about Rasa Peepari for this disorder. In any case, try to maintain sodium-water-balance in the body and give only boiled water (when it has cooled) or juice of Pomegranate (1-2 tsp thrice).



Constipation



It is considered as the chief causative of a host of other diseases. Constipation has direct effect on metabolism. Unsuitable, stale, putrid diet is held to be responsible for this problem. Mix powders of Alua Usari Revand 6 gms each, fried Heeng 2 gm and prepare a thick paste so that pills of 10-15 mg could be processed. Give one such pill to the infant with mother's milk — it will expel trapped milk and ease constipation or give powder of parched Suhaga 1 gm, Usari Revand 500 mg and serve with milk to regulate bowels or give 10-15 mg of Anand Bhairava Rasa with water or milk.







Worms



Extracted juice of fresh Onion (1 gm) + 10-15 mg of Heeng should be given with water in the morning and evening — it will expel worms. Apply locally paste of roots of Indrayan and Bakayan over the stomach, to derive desired benefit, or prepare a paste of roots of Vaya Vidang and Kabela, adding some amount of fried Heeng. Before ^giving this compound, give jaggery (Gur) first. It will also expel worms. Some people suggest taking of two half-cut pieces of ripe tomato, with a sprinkling of black pepper powder, in the morning on empty stomach.



To Restore Free Flow of Urine



This is a dangerous condition and must not be handled by a layman but by a specialist only. The medicines suggested should serve as a guideline only and not used without proper guidance and monitoring of a specialist. When no urine is passed, it is still a graver situation and calls for immediate hospitalisation. Parents who are syphilitic or had been so but had not been declared 'Negative' should be extra careful. Generally, retention of urine is attributed to some obstructive pathology like stone in the urinary tract, some urinary infection. Without going into clinical details, use of catheter is the only possible alternative or consult some surgeon but do not leave anything to chance. If urinary flow is not free and urine is expelled in drops, with much pain and tenesmus or blood/pus is also passed, it points to some sort of obstruction in the urinary passage. Scanty urine in summer or during diarrhoea or when water intake is not sufficient to meet even body's normal demands, such situations may occur.





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Formulations to Cure Marasmus

Formulations to Cure Marasmus



(1) Majeeth 60 gms, Chaleera Sugandh wala and Nagarmotha (each 22-25 gm), Haldi 25 gms, Laung, Saunth Taj, Jaiphal, Daru Haldi, sliced pieces of Ginger, Peepal-6 gms each, Kachoor 50 gms, Sandalwood powder, Lai Chandan 12 gms each, Kapur (Camphor) 3 gms— boil all the mentioned ingredients in water (in 1.25 litres), When the water content is reduced to 1 kg, mix 1/2 litre Til oil to it and boil until entire quantity of water evaporates and only oil is left behind. After this, mix in Lai Ratna jyot in the oil and remove from fire. After removing from fire put in 4-6 tablets of Camphor and when the liquid cools down, bottle the contents and secure with a cork or stopper. The prepared oil is said to remove fever, pains and aches in the body, shrivelling of skin, weakness and will make muscles arid bones healthy, tough and full of strength.



(2) Mulethi 6 gms, Ilayachi, Dalchini, Tulsi leaves (2 gms each), Banshlochan 3 gms, Kesar 2 gms, Mishri (sugar candy) equivalent to half the weight of above-mentioned ingredients — all the ingredients may be ground and reduced to paste form in juice of Tulsi leaves. Prepare pills of 125 mg each. A pill may be dissolved with mother's milk and given to the infant 3-4 times daily to get rid of infantile marasmus.



(3) Root of Patharchata 500 mg may be rubbed in mother's milk and 300 mg Black pepper powder added to it. It should be served to a child for 3 days ( one dose daily) and is said to cure marasmus.



Note : Quantities mentioned above and down below or in other cases are simply indications only and may be adjusted in consultation with an Ayurvedic physician as also frequency of dosage.



SOME OTHER GOOD AYURVEDIC PREPARATIONS FOR CHILDREN

Bal Sanjeevan Ark



Saunf, Ajwain, Vaiviranta (2 gms each), Peepal, parched Borax, Nausadar, Marorh Phali, Munakka—12 gms each, Makoy 125 mg, Indra Jau — 250 mg, Sanai Mulethi, Harar, Kachoor,









Laung, Mangore, Amaltas-60gms each. Boil all the said ingredients, ( after reducing all of them into a'powder form) in 10 kgs water. When the contents are reduced to l1/^ kgs, put in Kesar 400 mg and Mishri 400 gms and boil again. Remove from fire and let it cool, after which the contents should be bottled and corked. The resultant product, so procured, is said to make weak and marasmic children stronger, removes fever, cough, stomach and digestion related disorders, including green or yellow loose stools.



Ras Peepari



Process Kajali from purified mercury and purified sulphur (6 gms) each after which add 3 gms each of powdered Heeng (fried), Peepal, Saunth, Taj Jaiphal, Kesar (fried), Suhaga, Rock (red) salt, fried Laung, Ateesa, Ajwain, Vaivaringa, Kakkarsinghi and mix with Kajali and process pills of 125 mg each. It is said to be useful when the child is suffering from cold, fever, cough, nasal discharge, flu, milk vomiting, green and loose motions, and other stomach and digestion related disorders. One pill should be dissolved in mother's or cow's milk and given 2-3 times daily. This preparation is said to serve both as a preventive and curative medicine. It will also benefit during fever (due to cold conditions and coryza and catarrh).



Bal Roga Janam Ghutti



Take an equal quantity Zahar Mohra Salai, Hajrul yahood, Dariyai Narial, Yellow Harhar, Banshlochan, Peepal, Ilayachi, Jaiphal, Kesar, Gulab ke phool and finely pound all the ingredients. Process pills to the weight of 10-15 mg. Dissolve a pill in mother's milk and give evening and morning. It is said to be beneficial in fever, (intense) thirst, loose motions, vomiting of milk and other diseases which are specifically attributed to infancy stage. Some good Ayurvedic companies are preparing it. You can purchase from market also.

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Homoeopathic Treatment

Homoeopathic Treatment





What is Homeopathy suitable for ?



Most complaints respond well to homoeopathy. Most of the remedies are readily available over the counter from pharmacies or health shops, and are made from lactose or sucrose so they taste good to children.



What can I treat at home ?



There are many common complaints that you can treat at home using homoeopathy, including :



Colic : If your baby brings her legs up and screams a lot, try Colocynth (bitter cucumber). If she burps and possets a lot, a good remedy might be Carbo vegetabilis (vegetable charcoal). If she is furious, is not soothed by being carried and strains to fill her nappy, try Nux vomica (poison nut).



Teething : Chamomilla (chamomile) might help pain or sleeplessness from teething.



Feverish illness : If your child is pale, Aconite (monkshood) may help if given early in the illness. If she is very hot and red, Belladonna (deadly nightshade) might be better.



Gastroenteritis : As well as giving lots of fluid, you could try Arsenicum album (white arsenic) if there is both diarrhoea and vomiting. Phosphorus might be more suitable for vomiting alone, while Podophyllum (may-apple) can help diarrhoea.





Common cold : For a snuffle baby, Kali bichromicum (potassium bichromate). For a toddler with catarrh or a cold, try giving her Pulsatilla (wind anemone) tablets twice a day.



Bumps and bruises : Swelling and bruising can be relieved with Arnica cream. If there is an open cut or graze, give the Arnica in tablet form.



Night fears : Calcarea carbonic (crushed oyster shells) or Phosphorus could be worth trying.



Bed-wetting : If your child wets the bed early in the night, try Equisetum (souring rush). If she wets it later, try Lycopodium (club moss).



Colic : Distention of abdomen, use Colocynth.





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Some other good Homoeopathic remedies

Some other good Homoeopathic remedies



Chamomilla : For colic, diarrhoea, ear infection, teething problems.



Aconite : For colds, cough, dry, sudden occurence of symptoms.



Ferrum Phos : For gradual onset of fever, throbbing pain of ear, red cheeks.



Dulcamara : For cough, cold during rainy season.



Gelsemium : For colds and influenza.



Calendula : For minor cuts.



Bryonia : For cough, cold during change of weather.



Belladona : For high rise of temperature.



Calc. Phos : For delayed teething and diarrhoea.



Hep. Sulph : For abscesses.



Colocynth : Distension of abdomen. Jelly like stools.





How do I give the remedies ?



Homoeopathic remedies come either in tablets or granules. Babies can take homoeopathic tablets crushed and mixed in a little cooled, boiled water. Give half a teaspoon at a time,

and make up a fresh solution daily. A baby on solids will usually take a crushed tablet or granules off a spoon, while a toddler or child can suck the tablet whole. Initially use in 30 potency only.



How long does treatment last?



Some treatments for minor ailments may only need a single dose, although if your child has long-term problems she may need to continue treatment for months. However, with homoeopathy it is usual to stop the treatment as soon as improvement occurs — unlike conventional drugs.



When should I see the doctor ?



Always see the doctor if your child's symptoms persist, if symptoms change, or if this could be due to a serious illness. You may even consult the authors.

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Anti-fungal Drugs

Anti-fungal Drugs





We are continually exposed to fungi — in the air we breathe, the food we eat and the water we drink. Fortunately, most of them cannot live in the body and few are harmful. But some can grow in the mouth, skin, hair or nails, causing irritating or unsightly changes, and a few can cause serious and possibly fatal disease. The most common fungal infections are caused by the tinea group. These include tinea pedis (athlete's foot), tinea corporis (ringworm), tinea cruris (groin ringworm) and tinea capitis (scalp ringworm). Caused by a variety of organisms, they are spread by direct or indirect contact with infected humans or animals. Infection is encouraged by warm, moist conditions.



Problems may also result from the proliferation of a fungus that is normally present in the body; the most common example is excessive growth of Candida, a yeast that causes thrush infection of the mouth, vagina and bowel. It can also infect other organs if it spreads through the body via the blood stream. Overgrowth of Candida may occur in people taking antibiotics or oral contraceptives, pregnant women, or those with diabetes or immune system disorders such as AIDS.



Superficial fungal infections—those that attack only the outer layer of the skin and mucous membranes— are relatively common and, although irritating, do not usually present a threat to general health. Internal fungal infections — for example, of the lungs, heart or other organs— are rare but may be serious and prolonged.



Because antibiotics and other anti-bacterial drugs have no effect on fungi and yeasts, it is necessary to use a different type of drug. Drugs for fungal infections are either applied topically to treat minor infections of the skin, nails, and mucous membranes or they are given by mouth or injection to eliminate serious fungal infections of the internal organs and nails.



Choice of Anti-fungal Drug



The particular drug chosen in each case depends on the precise nature and site of the infection. The usual route of administration for each drug is also indicated.



How They Work



Most anti-fungals alter the permeablility of the fungal cell's walls. Chemicals needed for cell life leak out and the fungal cell dies.



Common Drugs



Amorolfine, Amphotericin, Benzoyl peroxide, Cotrimazole, Econazole, Fenticonazole, Fluconazole, Griseofulvin, Isoconazole, Itraconazole, lucytosine, Ketoconazole, Miconazole, Nystatin, Sulconazole, Terbinafine, Tioconazole.





ANTI MALARIAL DRUG

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Anti-malarial Drugs

Anti-malarial Drugs





Malaria is one of the main killing diseases in the tropics and is most likely to affect children and people who live in or travel to such places.

The disease is caused by protozoa whose life cycle is far from simple. The malaria parasite, which is called Plasmodium, lives in and depends on the female Anopheles mosquito during one part of its life cycle. It lives in and depends on human beings during other parts of its life cycle.

Transferred to humans in the saliva of the female mosquito as she penetrates ("bites") the skin, the malaria parasite enters the bloodstream and settles in the liver, here it multiplies asexually.



Following its stay in the liver, the parasite (or plasmodium) enters another phase of its life cycle, circulating in the bloodstream, penetrating and destroying red blood cells and reproducing again. If the plasmodia then transfers back to a female Anopheles mosquito via another "bite", they breed sexually and are again ready to start a human infection.

Following the emergence of plasmodia from the liver, the symptoms of malaria occur: episodes of high fever and profuse sweating alternate with equally agonizing episodes of shivering and chills. One of the four strains of malaria (Plasmodium falciparum) can produce a single severe attack that can be fatal unless treated. The others cause recurrent attacks, sometimes extending over many years.





A number of drugs are available for preventing malaria, the choice depending on the region in which the disease can be contracted and the resistance to the commonly used drugs. In most malarial areas, Plasmodium Falciparum is resistant to Chloroquine. In all regions, three drugs are commonly used: Quinine, Mefloquine and Malarone.



Choice of Drugs



The parts of the world in which malaria is prevalent and travel to which may make anti-malarial drug treatment advisable, can be divided into six zones. Due to drug resistance, specific anti-malarials are recommended for each zone.



Zone 1 — North Africa and the Middle East: Chloroquine, and Proguanil in areas of Chloroquine resistance.



Zone 2 — Sub Saharan Africa : Mefloquine or Chloroquine with Proguanil



Zone 3 — South Asia : Mefloquine or Chloroquine with Proguanil



Zone 4 — Southeast Asia : Mefloquine in high risk areas or Chloroquine with Proguanil; Doxycycline in Mefloquine resistant areas



Zone 5 — Oceania : Mefloquine or Doxycycline



Zone 6 — Latin America, Central America : Chloroquine or Proguanil. South America : Mefloquine in high risk areas or Chloroquine with Proguanil

As prevalent strains of malaria change very rapidly, you must always seek specific medical advice before travelling to any of these areas.





RISK AND SPECIAL PRECAUTIONS









ANTI FUNGAL DRUG

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Anti-protozoal Drugs

Anti-protozoal Drugs





Protozoa are single celled organisms that are present in soil and water. They may be transmitted to or betwen humans through contaminated food or water, sexual contact, or insect bites. There are many different types of protozoal infection, each one causing a different disease depending on the organism that is involved.



Many types of protozoa infect the bowel, causing diarrhoea and generalised symptoms of ill health. Others may infect the genital tract or skin. Some protozoa may penetrate vital organs such as the lungs, brain, and liver. Prompt diagnosis and treatment is important in order to limit the spread of the infections within the body and, in some cases, prevent it from spreading to other people. Increased attention to hygiene is another important factor in controlling the spread of the disease.



A variety of medicines is used in the treatment of these diseases. Some, such as Metronidazole and Tetracycline are also commonly used for their anti-bacterial action. Others, such as Pentamidine are rarely used except in treating specific protozoal infections.



How They Affect You



Protozoa are often difficult to eradicate from the body. Drug treatment may therefore need to be continued for several months in order to eliminate the infecting organisms

completely and thus prevent recurrence of the disease. In addition, unpleasant side effects such as nausea, diarrhoea and abdominal cramps are often unavoidable because of the limited choice of drugs and the need to maintain dosage levels that will effectively cure the disease.





TYPES OF PROTOZOL

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Risks and Special Precautions

Risks and Special Precautions



When drugs are given to prevent or cure malaria, the full course of treatment must be taken. No drug gives long term protection; a new course of treatment is needed for each journey.





Most of these drugs do not produce severe adverse effects, but Primaquine can cause the blood disorder haemolytic anaemia, particularly in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Blood tests are taken before treatment to identify susceptible individuals. Halofantrine can have an adverse effect on heart rhythm. Mefloquine is not prescribed for those who have had psychological disorders or convulsions.



Other Protective Measures



Because Plasmodium strains continually develop resistance to the available drugs, prevention using drugs is not absolutely reliable. Protection from mosquito bites is of the highest priority. Such protection includes the use of insect repellents, such as DEBT and mosquito nets impregnated with Permethrin insecticide, as well as covering any areas of exposed skin after dark.



Common Drugs



Artemether, Chloroquine, Doxycycline, Halofantrine, Mefloquine, Primaquine, Proguanil, Proguanil/Atovaquone (Malarone), Pyrimethamine/Dapsone (Malaprimj, Pyrimethamine/Sulphadoxine (Fansidar), Quinine.

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Types of Protozoal Disease

Types of Protozoal Disease



Amoebiasis (Entamoeba histolytica), or amoebic dysentery, is an infection of the bowel (and sometimes the liver and other organs) usually transmitted in contaminated food or water. Its major symptom is violent, sometimes bloody, diarrhoea. Treatment is with Diloxanide, Metronidazole or Tinidazole.



Balantidiasis (Balantidium coli) is an infection of the bowel, specifically the colon, usually transmitted through contact with infected pigs. Possible symptoms include diarrhoea and abdominal pain. Treatment is with Tetracycline, Metronidazole or Diodohydroxy quinoline.



Cryptosporidiosis (Cryptosporidium) affects the bowel (and occasionally the respiratory tract and bile ducts). It is spread through contaminated food or water or by contact with animals or other humans. Symptoms include diarrhoea and abdominal pain. There are no specific drugs to treat it, but Paromomycin, Azithromycin or Eflornithine may be effective.



Giardiasis (Giardia Lamblia] or Lambliasis, affects the bowel and is usually transmitted in contaminated food or water; but it may also be spread by some types of sexual contact. Its major symptoms are generalised ill-health, diarrhoea, flatulence and abdominal pain. Treatment is with Mepacrine, Metronidazole or Tinidazole.



Leishmaniasis (Leishmania) is a mainly tropical and subtropical disease caused by organisms spread through sandfly bites. It affects the mucous membranes of the mouth, nose and throat and may, in its severe form, invade organs such as the liver. Treatment is with Paromomycin, Sodium stibogluconate, Pentamidine or Amphotericin.



Pneumocystis Pneumonia (Pneumocystis carinil) is a potentially fatal lung infection usually affecting only those people with reduced resistance to infection, such as AIDS sufferers. Symptoms include cough, breathlessness, fever and chest pain. Treatment is with drugs such as Atovaquone, Co-trimoxazole, Pentamidine and Trimetrexate.



Toxoplasmosis (Toxoplasma gondii) is usually spread via cat faeces or by eating undercooked meat. Although usually symptomless, toxoplasmosis may cause generalised ill health, mild fever and eye inflammation. Treatment is necessary only if the eyes are involved or the patient is immuno-suppressed (such as in AIDS). It may also pass from mother to baby during pregnancy, leading to severe disease in the foetus. Treatment usually consists of Pyrimethamine with Sulfadiazine, Azithromycin, Clarithromycin or Clindamycin, or during pregnancy, Spiramycin.



Trichomoniasis (Trichomonas vaginalis) most often affects the vagina, causing irritation and an offensive discharge. In men, it may occur in the urethra. It is usually sexually transmitted. Treatment is with Metronidazole or Tinidazole.



Trypanosomiasis (Trypanosoma) or African trypano-somiasis (sleeping sickness) is spread by the tsetse fly and causes fever, swollen glands and drowsiness. South American trypanosomiasis (Chagas disease) is spread by assassin bugs and causes inflammation, enlargement of internal organs and infection of the brain. Sleeping sickness is treated with Pentamidine, Suramin, Eflornithine or Melarsoprol. Chagas disease is treated with Primaquine or Nifurtimox.

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Anti-viral Drugs

Anti-viral Drugs





Viruses are simpler and smaller organisms than bacteria and are less able to sustain themselves. These organisms can survive and multiply only by penetrating body cells. In order to reproduce, a virus requires a living cell. The invaded cell eventually dies and the new viruses are released, spreading and infecting other cells. Because viruses perform few functions independently, medicines that disrupt or halt their life cycle without harming human cells have been difficult to develop.



There are many different types of virus, and viral infections cause illnesses with various symptoms and degrees of severity. Common viral illnesses include colds, influenza and flu-like illnesses,' cold sores and childhood diseases such as chickenpox and mumps. Throat infections, pneumonia, acute bronchitis, gastroenteritis and meningitis are often, but not always, caused by a virus.



Fortunately, the body's natural defences are usually strong enough to overcome infections such as these, with drugs given to ease pain and bring down fever. However, the more serious viral diseases, such as pneumonia and meningitis, need close medical supervision. Another difficulty with viral infections is the speed with which the virus multiplies. By the time symptoms appear, the viruses are so numerous that anti-viral drugs have little effect. Anti-viral agents must be given early in the course of the infection; they may also be used as a prophylactic (preventive). Some viral infections can be prevented by vaccination.

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Why They Are Used

Why They Are Used



The main area where anti-viral drugs are helpful is in the treatment of various conditions caused by the herpes virus: cold sores, encephalitis, genital herpes, chickenpox, and shingles.

Some drugs are applied topically to treat cold sores, herpes, eye infections, and genital herpes. They can reduce the severity and duration of an outbreak but do not eliminate the infection permanently. Other anti-viral drugs are given by mouth or, under exceptional circumstances, by injection to prevent chickenpox or severe, recurrent attacks of the herpes virus infections in those who are already weakened by other conditions.

Anti-viral agents are also given to prevent influenza A, as is Amantadine, a drug for Parkinsonism that also has anti­viral properties.



The interferons are proteins produced by the body and involved in the immune response and cell function. Interferon alpha and beta have recently been shown to be effective in reducing disease activity in people infected with hepatitis B and hepatitis C. Further research into the anti-viral activity of these agents is under way, including their use in the treatment of central nervous system conditions, such as multiple sclerosis.



AIDS (acquired immune deficiency syndrome) is caused by infection with the human immuno deficiency virus (HIV), which reduces the body's resistance to infection by other viruses, bacteria and protozoa, and to some types of cancer.



How They Work



Some anti-viral drugs, such as Idoxuridine, act by altering the cell's genetic material (DNA) so that the virus cannot use it to multiply. Other drugs stop multiplication of viruses by blocking enzyme activity within the host cell. Halting multiplication prevents the virus from spreading to uninfected cells and improves symptoms rapidly. However, in herpes infections, it does not eradicate the virus from the body. Infection may therefore flare up on another occasion.



Amantadine has a different action : it stops the virus from entering cells. It is therefore most effective when given prophylactically, before the infection has spread widely.



How They Affect You



Topical anti-viral drugs usully start to act at once. Provided that the treatment is applied early enough, an outbreak of herpes can be cut short. Symptoms usually clear up within two to four days. Anti-viral ointments may cause irritation and redness. Anti-viral drugs given by mouth or injection can occasionally cause nausea and dizziness.



Risks and Special Precautions



Because some of these drugs may affect the kidneys adversely, they are prescribed with caution for people with reduced kidney function. Some anti-viral drugs can adversely affect the activity of normal body cells, particularly those in the bone marrow. Idoxuridine is, for this reason, available only for topical application.



Common Drugs



Aciclovir, Amantadine Cidofovir, Famciclovir, Foscarnet, Ganciclovir, Idoxuridine, Inosine pranobex, Interferon, Penciclovir, Tribavirin, Valaciclovir, Zanamivir.

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Anti-Tubercular Drugs

Anti-Tubercular Drugs





Tuberculosis is a contagious bacterial disease that is acquired, often in childhood, by inhaling the Tuberculosis bacilli present in the spray caused by a sneeze or cough from someone who is actively infected. It may also be acquired from infected cow's milk. The disease usually starts in a lung and takes one of two forms: either primary infection or reactivated infection.



In 90 to 95 percent of those people with a primary infection, the body's immune system suppresses the infection, but it does not kill the bacilli. They remain alive but dormant and may cause the reactivated form of tuberculosis. After the Tuberculosis bacilli are reactivated, they may spread throughout the body via the lymphatic system and the bloodstream.



The first symptoms of the primary infection may include a cough, fever, tiredness, night sweats and loss of weight. Tuberculosis is confirmed through clinical investigations, which may include a chest X-ray, isolation of the bacilli from the person's sputum and a positive reaction — localised inflammation to the Mantoux test, an injection of tuberculin (a protein extracted from tuberculosis bacilli) into the skin.



The gradual emergence in adults of the destructive and progressive form of tuberculosis is caused by the reactivated infection. It occurs in 5 to 10 per cent of those who have had previous primary infection. Another form, reinfection tuberculosis, occurs when someone with the dormant, primary form is reinfected. This type of tuberculosis is clinically identical to the reactivated form. Reactivation is more likely in those people whose immune system is suppressed, such as the elderly, those on Corticosteroids or other immuno-suppressant drugs, and those who have AIDS. Reactivation tuberculosis may be difficult to identify because the symptoms may start in any part of the body seeded with the bacilli. It is most often first seen in the upper lobes of the lung, and it is frequently diagnosed after a chest X-ray. The early symptoms may be identical to those of primary infection: a cough, tiredness, night sweats, fever, and loss of weight.



If left untreated, tuberculosis continues to destroy tissue, spreading throughout the body and eventually causing death. It was one of the most common causes of death in India and the disease is on the increase again. Vulnerable groups are people with suppressed immune systems and the homeless.



WHY THEY ARE USED

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Why They Are Used

Why They Are Used



A person diagnosed as having tuberculosis is likely to be treated with three or four anti-tubercular drugs. This helps to overcome the risk of drug-resistant strains of the bacilli emerging.



The standard drug combination for the treatment of tuberculosis consists of four drugs, usually including Rifampicin, Isoniazid, Pyrazinamide and Ethambutol. Other drugs may be substituted if the initial treatment fails or if drug sensitivity tests indicate that the bacilli are resistant to these drugs.



The standard duration of treatment for a newly diagnosed tuberculosis infection is a six month regimen as follows: Isoniazid, Rifampicin, Pyrazinamide and Ethambutol daily for two months, followed by Isoniazid and Rifampicin for four months. The duration of treatment can be extended from nine months to upto two years in older children at particular risk, such as those whose immune system has been suppressed. Ethambutol can sometimes be omitted if resistance is unlikely. Corticosteroids may be added to the treatment, if the immune system is not supressed, to reduce the amount of tissue damage; and Pyridoxine is also often prescribed to protect the nerves from damage by Isoniazid.



Both the number of drugs required and the long duration of treatment may make treatment difficult, particularly for those who are homeless. To help with this problem supervised administration of treatment is available when required, both in the community dispensary and in the hospital.

Tuberculosis infection in patients with HIV infection or AIDS is treated with the standard anti-tubercular drug regimen; but lifelong preventative treatment with Isoniazid may be necessary.





How They Work



Anti-tubercular drugs act in the same way as antibiotics, either by killing bacilli or preventing them from multiplying.



How They Affect You



Although the drugs start to combat the disease within days, the benefits of drug treatment are usually not noticeable for a few weeks. As the infection is eradicated, the body repairs the damage caused by the disease. Symptoms such as fever and coughing gradually subside and the appetite and general health improve.



Risks And Special Precautions



Anti-tubercular drugs may cause adverse effects (nausea, vomiting, and abdominal pain) and they occasionally lead to serious allergic reactions. When this happens, another drug is substituted.

Rifampicin and Isoniazid may adversely affect the nerves as well. Ethambutol can cause changes in colour vision. Dosage is carefully monitored, especially in children, the elderly and those with reduced kidney function.





Tuberculosis Prevention



A vaccine prepared from an artificially weakened strain of cattle tuberculosis bacteria can provide immunity from tuberculosis by provoking the development of natural resistance to the disease (see Vaccines and immunisation). The BCG (Bacille Calmette-Guerin) vaccine is a form of tuberculosis bacillus that provokes the body's immune response but does not cause the illness because it does not invade tissues. The vaccine is usually given to children between the ages of 10 and 14 years who are shown to have no natural immunity when given a skin test. BCG vaccination may be given to new born babies if, for example, someone in the family has tuberculosis.

The vaccine is usually injected into the upper arm. A small pustule usually, appears 6-12 weeks later, by which time the person can be considered immune.



Common Drugs



Capreomycin, Cycloserine, Ethambutol and Isoniazid, Pyrazinamide, Rifampicin, Refabutin, Streptomycin.

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Anti-Bacterial Drugs

Anti-Bacterial Drugs



This broad classification of drugs comprises agents similar to the antibiotics in function but dissimilar in origin. The original antibiotics were derived from living organisms such as moulds and fungi. Anti-bacterials were developed from chemicals. The Sulphonamides were the first drugs to be given for the treatment of bacterial infections and were the mainstay of the treatment of infection before Penicillin (the first antibiotic) became generally available. Increasing bacterial resistance and the development of more effective and less toxic antibiotics have reduced the use of Sulphonamides.



How They work



Most anti-bacterials function by preventing the growth and multiplication of bacteria. Folic acid, a chemical necessary for their growth, is produced within bacterial cells by an enzyme that acts on a chemical called para aminobenzoic acid. Sulphonamides interfere with the release of the enzyme. This prevents folic acid from being formed. The bacterium is therefore unable to function properly and dies.



How They Affect You



Anti-bacterials usually take several days to eliminate bacteria. During this time your doctor may recommend additional medication to alleviate pain and fever. Possible side effects of Sulphonamides include loss of appetite, nausea, a rash and drowsines.



Risks and Special Precautions



Like antibiotics, most anti-bacterials can cause allergic reactions in susceptible people. Possible symptoms that should always be brought to your doctor's attention include rashes and fever. If such symptoms occur, a change to another drug is likely to be necessary. Treatment with Sulphonamides carries a number of serious but rare risks. Some drugs in this group can cause crystals to form in the kidneys, a risk that can be reduced by drinking adequate amounts of fluid during prolonged treatment. Because Sulphonamides may also occasionally damage the liver, they are not usually prescribed for people with impaired liver function. There is also a slight risk of damage to bone marrow, lowering the production of white blood cells and increasing the chances of infection. Doctors therefore try to avoid prescribing Sulphonamides for prolonged periods. Liver function and blood composition are often monitored during unavoidable long term treatment.





COMMON DRUG

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Uses of Antibiotics

Uses of Antibiotics





The table at the end of this chapter shows common drugs in each class of antibiotics that are used to treat infections in different parts of the body; it is not intended for use as a guide to prescribing. For comparison, some anti-bacterial drugs are included under 'Other drugs'. Generally when a type of antibiotic is needed that cannot be given by mouth, the drug may be given by injection. Antibiotics are also included in tropical preparations for localized skin, eye, and ear infections, infective, skin preparations.





How They Work



Depending on the type of drug and the dosage, antibiotics are either bactericidal, killing organisms directly, or bacteriostatic, halting the multiplication of bacteria and enabling the body's natural defenses to overcome the remaining infections.

Penicillin and Cephalosporin’s are bactericidal, destroying bacteria by preventing them from making normal cell walls; most other antibiotics act inside the bacteria by interfering with the chemical activities essential to their life cycle.





CLASSESS OF ANTIBIOTICS

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Common Drugs

Common Drugs



Quinolones, Cinoxacin, Ciprofloxacin, Grepafloxacin, Levofloxacin, Nalidixic acid, Norfloxacin, Ofloxacin. Sulphonamides, Co-trimoxazole, Sulfadiazine, Sulfadimidine.



Drug treatment for Hansen's disease (Leprosy)



Hansen's disease, more commonly known as leprosy, is a bacterial infection caused by Mycobacterium leprae. It is rare in the United Kingdom, but relatively common in parts of Africa, Asia, and Latin America.

The disease progresses slowly, first affecting the peripheral nerves and causing loss of sensation in the hands and feet. This leads to frequent unnoticed injuries and consequent scarring, Later, the nerves of the face may also be affected.





Treatment uses three drugs together to prevent the development of resistance. Usually, Dapsone, Rifampicin and Clofazimme will be given for at least 2 years. If one of these cannot be used, then a second line drug (Ofloxacin Mmocycline or Clarithromycin) might be substituted' Complications during treatment may require use of Prednisolone, Aspirin, Chloroquine, or even Thalidomide

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Classes of Antibiotics

Penicillin’s: The first antibiotic drugs to be developed, penicillin’s are still widely used to treat many common infections. Some are not effective when they are taken by mouth and therefore have to be given by injection in the







hospital. Unfortunately, certain strains of bacteria are resistant to penicillin treatment, and other drugs may have to be substituted. Penicillin’s often cause allergic reactions.

Cephalosporins: These broad spectrum antibiotics, similar to the Penicillin’s, are often used when Penicillin treatment has proved ineffective. Some can be given by mouth, but others are only given by injection. About 10 per cent of people who are allergic to Penicillin’s are also allergic to Cephalosporin’s. Some Cephalosporin’s can occasionally damage the kidneys, particularly if used with amino glycosides. Another serious, although rare, adverse effect of a few Cephalosporins’ is that they occasionally interfere with normal blood clotting, leading to abnormally heavy bleeding, especially in the elderly.



Macrolides: Erythromycin is the most common drug in this group. It is a broad spectrum antibiotic that is often prescribed as an alternative to Penicillin’s or Cephalosporin’s. Erythromycin is also effective against certain diseases, such as Legionnaries' disease (a rare type of pneumonia), that cannot be treated with other antibiotics. The main risk with Erythromycin is that it can occasionally impair liver function.



Tetracyclines: These have a broader spectrum of activity than other classes of antibiotics. However, increasing bacterial resistance has limited their use, but they are still widely prescribed. As well as being used for the treatment of infections, Tetracyclines are also used in the long term treatment of acne, although this application is probably not related to their anti-bacterial action. A major drawback to the use of Tetracycline antibiotics in pregnant women and young children is that they are deposited in developing bones and teeth.



With the exception of Doxycycline, drugs from this group are poorly absorbed through the intestines and when given by mouth they have to be administered in high doses in order to reach effective levels in the blood. Such high doses increase the likelihood of diarrhea as a side effect. The





absorption of Tetracyclines can be further reduced by interaction with Calcium and other minerals. Drugs from this group should not therefore be taken with iron tablets or milk products. Tetracyclines deteriorate and may become poisonous with time, so leftover tablets or capsules should always be discarded.



Aminoglycosides: These potent drugs are effective against a wide range of bacteria. They are not as widely used as some other antibiotics since they have to be given by injection and have potentially serious side effects. Their use is therefore limited to hospital treatment of serious infections. They are often given with other antibiotics. Possible adverse effects include a severe skin rash and damage to the kidneys and nerves in the ear.

Lincosamides: The Lincosamide — Clindamycin — is not commonly used as it is more likely to cause serious disruption of bacterial activity in the bowel than other antibiotics. It is mainly reserved for the treatment of bone, joint, abdominal and pelvic infections that do not respond well to the safer antibiotics. Clindamycin is also used topically for acne and vaginal infections.



Quinolones: These drugs, often called anti-bacterials, are derived from chemicals rather than living organisms. Quinolones have a wide spectrum of activity. They are used in the treatment of urinary infections and are widely effective in acute diarrhoeal diseases, including that caused by salmonella, as well as in the treatment of enteric fever.

The absorption of Quinolones is reduced by antacids containing Magnesium and Aluminium. They are well tolerated but should be avoided by epileptics, as they may in rare cases cause convulsions, and by children, as studies have shown that they may cause arthritis.



How They Affect You



Antibiotics stop most common types of infection within days. Because they do not relieve symptoms directly, your doctor may advise additional medication, such as Analgesics, to relieve pain and fever until the antibiotics take effect.

It is important to complete the course of medication as prescribed by your doctor, even if all your symptoms have disappeared. Failure to do this can lead to a resurgence of the infection in an antibiotic-resistant form.



Most antibiotics used in the home do not cause adverse effects if taken in the recommended dosage. In people who do experience them, nausea and diarrhea are common. Some people may be sensitive to certain types of antibiotics, which can result in a variety of serious adverse effects.





ANTIBIOTICS RESISTANCE

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Antibiotics Resistance

The increasing use of antibiotics in the treatment of infection has led to resistance in certain types of bacteria to the effects of particular antibiotics. This resistance to the drug usually occurs when bacteria develop mechanisms of growth and reproduction that are not disrupted by the effects of the antibiotics. In other cases, bacteria produce enzymes that neutralize the antibiotics.



Antibiotic resistance may develop in a person during prolonged treatment when a drug has failed to eliminate the infection quickly. The resistant strain of bacteria is able to multiply, thereby prolonging the illness. It may also infect other people and result in the spread of resistant infection. One particularly important example is Methicillin resistant Staphylococus aureus, which resists most antibiotics but can be treated with other drugs such as Teicoplanin and Vancomycin.



Doctors try to prevent the development of resistance to antibiotics by selecting the drug most likely to eliminate the bacteria present in each individual case as quickly and as thoroughly as possible. Failure to complete a course of antibiotics that has been prescribed by your doctor increases the likelihood that the infection will recur in a resistant form.







Risks and Special Precautions



Most antibiotics used for short periods outside a hospital setting are safe for most people. The most common risk, especially with Cephalosporins and Penicillins, is a severe allergic reaction to the drug that can cause a rash and sometimes swelling of the face and throat. If this happens, you should stop the drug and seek immediate medical advice. If you have had a previous allergic reaction to an antibiotic, all other drugs in that class and related classes should be avoided. It is, therefore, important to inform your doctor if you have previously suffered an adverse reaction to treatment with an antibiotic (with the exception of minor bowel disturbances).



Another risk of antibiotic treatment, especially if it is prolonged, is that the balance among micro-organisms normally inhibiting the body may be disturbed. In particular, antibiotics may destroy the bacteria that normally limit the growth of Candida, a yeast that is often present in small amounts in the body. This can lead to overgrowth of Candida (thrush) in the mouth, vagina or bowel and an anti-fungal drug may be needed.

A rarer, but more serious result of disruption of normal bacterial activity in the body is a disorder known as Pseudo-membranous colitis, in which bacteria that are resistant to the antibiotic multiply in the bowel, causing violent, bloody diarrhoea. This potentially fatal disorder can occur with any antibiotic, but is most common with the Lincosamides.



Common Drugs



Aminoglycosides: Amikacin, Gentamicin, Neomycin, Netilmicin, Streptomycin, Tobramycin.

Cephalosporins: Cefadroxil, Cefaclor, Cefalexin, Cefamandole, Cefazolin, Cefixime, Cefodizime, Cefoxitin, Cefodoxime, Cefradine, Ceftazidime.

Lincosamides: Clindamycin.

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Anthelminthic Drugs

Anthelminthic Drugs



Anthelminthics are drugs that are used to eliminate the many types of worm (helminthes) that can enter the body and live there as parasites, producing a general weakness in some cases and serious harm in others. The body may be host to many different worms. Most species spend part of their life cycle in another animal, and the infestation is often passed on to humans in food contaminated with the eggs or larvae. In some cases, such as hookworm, larvae enter the body through the skin. Larvae or adults may attach themselves to the intestinal wall and feed on the bowel contents; others feed off the intestinal blood supply, causing anemia. Worms can also infest the bloodstream or lodge in the muscles or internal organs.

Many people have worms at some time during their life, especially during childhood. Most infestations can be effectively eliminated with anthelminthic drugs.





Why They are Used





Most worms cause only mild symptoms and usually do not pose a serious threat to general health. Anthelminthic drugs are usually necessary, however, because the body's natural defenses against infection are not effective against most worm infestations. Certain types of infestation must always be treated since they can cause serious complications. In some cases, such as threadworm infestation, doctors may recommend





Anathematic treatment for the whole family to prevent reinfection. If worms have invaded tissues and formed cysts, they may have to be removed surgically. Laxatives are given with some anthelminthics to hasten expulsion of worms from the bowel. Other drugs may be prescribed to ease symptoms or to compensate for any blood loss or nutritional deficiency.



Types of Infestation



Threadworm (Enterobiasis): The most common worm infection, especially among young children. It lives in the intestine but travels to the anus at night to lay eggs, causing itching; scratching leaves eggs on the fingers, usually under the fingernails. Sucking the fingers or eating food with unwashed hands often transfers these eggs to the mouth. Keeping the nails short and good hygiene, including washing the hands after using the toilet and before each meal, and an early morning bath to remove the eggs, are important in eradication of the infection.





DRUGS

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Drugs

Drugs : Mebendazole, Piperazine.



All members of the household should be treated simultaneously.

Common roundworm (Ascariasis) : The most common worm infection worldwide. It is transmitted to humans in contaminated raw food or in soil. The worms are large, and they infect the intestine, which can be blocked by dense clusters of them.



Drugs : Levamisole, Mebendazole, Piperazine



Tropical Threadworm (Strongyloidiasis) : Occurs in the tropics and southern Europe. The larvae from contaminated soil penetrate the skin, pass into the lungs, and are swallowed into the gut.



Drugs : Albendazole, Thiabendazole, Ivermectin







Whipworm (Trichuriasis) : Mainly occurs in tropical areas as a result of eating contaminated raw vegetables. The worms infest the intestines.



Drug : Mebendazole.



Hookworm (Uncinariasis): Mainly found in tropical areas. The worm larvae penetrate the skin and pass via the lymphatic system and bloodstream to the lungs. They then travel up the airways, are swallowed and attach themselves to the intestinal wall, where they feed off the intestinal blood supply.



Drug : Mebendazole.



Pork roundworm (Trichinosis): Transmitted in infected undercooked pork. Initially, the worms lodge in the intestines, but larvae may invade muscle to form cysts that are often resistant to drug treatment and may require surgery.



Drugs : Mebendazole, Thiabendazole.



Toxocariasis (Visceral larva migrans): Usually occurs as a result of eating soil or eating with fingers contaminated with dog or cat faeces. The eggs hatch in the intestine and may travel to the lungs, liver, kidney, brain, and eyes. Treatment is not always effective.



Drugs : Mebendazole, Thiabendazole, Diethylcarbamazine.



Creeping eruption (Cutaneous larva migrans): Mainly occurs in tropical areas and coastal areas of the southeastern US as a result of skin contact with larvae from cat and dog faeces. Infestation is usually confined to the skin.



Drugs : Thiabendazole, Ivermectin, Albendazole



Filariasis (including Onchocerciasis and Loiasis): Occurs in tropical areas only. It may affect the lymphatic system, blood, eyes, and skin. Infection by this group of worms is spread by bites of insects that are carriers of worm larvae or eggs.



Drugs : Diethylcarbamazine, Ivermectin



Flukes Sheep liver fluke (Fascioliasis): Is indigenous to the UK. Infestation usually results from eating watercress grown in contaminated water. It mainly affects the liver and biliary tract. Other flukes only found abroad may infect the lungs, intestines, or blood.



Drug : Praziquantel



Tapeworms : Including beef, pork, fish, and dwarf tapeworms. Depending on the type, it may be carried by cattle, pigs, or fish and transmitted to humans in undercooked meat. Most types affect the intestine. Larvae of the pork tapeworm may form cysts in muscle and other tissues.



Drugs : Niclosamide, Praziquantel



Hydatid disease (Echinococciasis): The eggs are trans­mitted in dog faeces, and the larvae may form cysts over many years, commonly in the liver. Surgery is the usual treatment for cysts.



Drug : Albendazole.



Bilharzia (Schistosomiasis): Occurs in polluted water in tropical areas. The larvae may be swallowed or penetrate the skin. Once inside the body, they migrate to the liver; adult worms live in the bladder.



Drug : Praziquantel.







HOW DO THEY WORKS

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How They Work

How They Work



Anthelminthic drugs act in several ways. Many of them kill or paralyse the worms, which pass out of the body in the faeces. Others, which act systemically, are used to treat infection in the tissues.



Many anthelminthics are specific for particular worms, and the doctor must identify the worm before selecting the most appropriate treatment. Most of the common intestinal infestations are easily treated, often with only one or two doses of the drug. However, tissue infections may require more prolonged treatment.





How they affect you



Once the drug has eliminated the worms, symptoms caused by infestation rapidly disappear. Taken as a single dose or a short course, anthelminthics do not usually produce side effects. However, treatment can disturb the digestive system, causing abdominal pain, nausea, and vomiting.



Common Drugs



Albendazole, Diethylcarbamazine, Ivermectin, Levamisole, Mebendazole, Niclosamide, Piperazine, Praziquantel, Thiabendazole.

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Infection and Infestation

The human body provides a suitable environment for the growth of many types of micro-organisms, including bacteria, viruses, fungi, yeasts, and protozoa. It may also become the host for animal parasites such as insects, worms, and flukes.

Micro-organisms (microbes) exist all around us and can be transmitted from person to person in many ways: direct contact, inhalation of infected air, and consumption of contaminated food or water. Not all micro-organisms cause disease; many types of bacteria exist on the skin surface or in the bowel without causing ill effects, while others cannot live either in or on the body.

Normally the immune system protects the body from infection. Invading microbes are killed before they can multiply in sufficient numbers to cause serious disease.





Types of Infecting Organism





Some bacteria are aerobic — that is, they require oxygen — and therefore are more likely to infect surface areas such as the skin or respiratory tract. Others are anaerobic and multiply in oxygen-free surroundings such as the bowel or deep puncture wounds. Bacteria can cause symptoms of disease in two principal ways : first, by releasing toxins that harm body cells; second, by provoking an inflammatory response in the infected tissues.





Viruses are smaller than bacteria and consist simply of a core of genetic material surrounded by a protein coat. A virus can multiply only in a living cell by using the host tissue's replicating material.

Protozoa are single celled parasites and are slightly bigger than bacteria. Many protozoa live in the human intestine and are harmless. However, some types cause malaria, sleeping sickness and dysentery.





Infestations



Invasion by parasites that live on the body (such as lice) or in the body (such as tape worms) are known as infestation. Since the body lacks strong natural defenses against infestation, antiparasitic treatment is necessary. Infestation is often associated with tropical climates and poor standards of hygiene.





What Can Go Wrong





Infectious diseases occur when the body is invaded by microbes. This may be caused by the body having little or no natural immunity to the invading organism, or the number of invading microbes being too great for the body's immune system to overcome. Serious infections can occur when the immune system does not function properly, as in the malnourished or the elderly, or when a disease that weakens or destroys the immune system, as occurs in AIDS (acquired immune deficiency syndrome).



Infections (such as childhood infectious diseases or those with flu-like symptoms) can cause generalized illness, or they may affect a specific part of the body (as in wound infections). Some parts are more susceptible to infection than others—respiratory tract infections are relatively common, whereas bone and muscle infections are rare.





Some symptoms are the result of damage to body tissues by the infection, or by toxins released by the microbes. In other cases, they result from the body's defense mechanisms.

Most bacterial and viral infections cause fever; and bacterial infections may also cause pus formation and inflammation in the affected area.





WHY DRUGS ARE YOUSED

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