E-drug: Essential diagnostics programme (cont'd)
-------------------------------------------------------------------------
Dear Dr. Thomas van der Heijden, dear E-druggers,
The issue presented by Dr Thomas van der Heijden, Need for an
essential diagnostics program, is a topic well worth attention.
Not only the step of essential drug prescribing, but rather the whole
chain of events need to be considered. Sensitivity and precision in
diagnostics and decision-making, is therefore clearly very important.
Indeed, it is clear to everyone that rational use of (essential) drugs is
quite impossible to achieve, without a reasonable sensitivity and
precision in the first, diagnostic step!
Results from studies within the frame of our current work with rational
use of drugs, illustrate the need to discuss this issue of "essential
diagnostics". Children with "pneumonia" written in their diagnostic &
treatment records, and who ware prescribed beta-lactam antibiotics,
seldom did show significantly elevated CRP levels. Among
approximately 100 antibiotic treated children, only few cases
presented with elevated CRP levels. The majority of these were only
marginally elevated (15-25 mg/l), and only very few did show levels
as high as would be expected in patients with a serious bacterial
respiratory tract infection with Pneumococci or Haemophilus
influenzae.
The reason for this low-level CRP among ARI patients can however be
due to many factors. These factors need to be identified and analyzed
here before CRP is used as a routine diagnostic tool. One reason for
our findings may of course be a low precision in the routine
ARI-diagnostics, but there are also other possible reasons. A program
such as an essential diagnostic program is therefore needed to help
assess to what extent diagnostic procedures used routinely in many
(western) countries can or can not be implemented and used with
analogous results-interpretation, in rural healthcare, in tropical
countries.
With respect to our recent findings, one may speculate about the
possibility that our respiratory tract infections here to a higher degree
may due to viruses, or due to other pathogens causing only
moderately elevated CRP; such as Chlamydia or Mycoplasma.
Therefore the CRP may or may not be a suitable routine diagnostic
tool here.
This is only one question among many, illustrating that this issue need
to be seriously debated; Essential diagnostics is a needed fundament,
in order to ensure rational use of essential drugs.
An essential diagnostics programme is thus a logical and very good
idea. This need appear very clear from my everyday perspective, as
adviser for rational and safe use of drugs in Viet Nam. I therefore wish
to express my warmest support to the idea which was presented on
E-drug, by Dr. Thomas van der Heijden.
I also wish to express a strong interest in a working contact with the
very relevant program mentioned by Thomas van der Heijden,
regarding research on essential diagnostic procedures.
Yours truly,
Sam Tornquist, dr med.,Ph.D. Msc pharm.
Adviser for rational and safe use of drugs
Ministry of Health of Vietnam
138 B Giang Vo street, Hanoi, Vietnam.
E-mail: s_tornquist@hotmail.com
--
Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to: `owner-e-drug@usa.healthnet.org'.