Unnecessary, poorly prescribed and over prescribed remedies. On social networks, Toubib, a doctor in a pediatric emergency service, warns: most of the drugs given to children to deal with seasonal viruses “are useless.”
“Prescribing in pediatrics in winter is usually problematic. To say nothing,” he alarms on Twitter, reviewing a long pharmacopoeia well known to parents, but which he judges to be ineffective, even risky, at best.
“Excessive” prescriptions
Asked by BFMTV.com, Brigitte Virey, president of the National Union of French Pediatricians (SNPF), acknowledges that prescriptions are still too long. But she says many unnecessary medications have already been eliminated, such as long-prescribed thinners for bronchitis.
In general, however, drug prescriptions have increased by 4% in ten years, says the Inserm (National Institute of Health and Medical Research). And in France, 97% of children under the age of 6 are exposed to drugs each year – “excessive” and “inappropriate”, point to two recent studies.
For example, young people in France are five times more likely to be prescribed antibiotics than in the Netherlands, a “most often inappropriate” prescription. As for corticosteroids, they are 108 times more likely to receive them than in Denmark. This prescription is also “often set inappropriately for common ENT conditions,” Inserm further notes.
Prescriptions all the more problematic as they are not without risk.
“The pediatric population, and especially younger children, are especially vulnerable to short- and long-term adverse effects due to their immaturity,” write insert.
blind antibiotics
Warnings shared by Toubib, also author of emergencies or non-emergencies – pediatric survival handbookwhich warns in parallel about the development of resistance of certain bacteria to antibiotics.
“It’s a real public health problem,” worries BFMTV.com. In 2015, antibiotic resistance killed 5,543 people with infections caused by resistant bacteria, according to a study published in the lancet and broadcast by the Ministry of Health.
Under the slogan “antibiotics are not automatic”, their prescription, however, has decreased – less than 12% in a decade – but it is still too much: France is still the fourth European country that consumes the most, warns a new report by Public Health France, revealed by the parisian this Wednesday. Toubib believes that they are still often used “blindly”, as a “reflex” to respond “to all the ills of children”.
Because according to him, three quarters of winter infections are viral and therefore do not require antibiotics. This is confirmed by Andreas Werner, president of the French Association of Ambulatory Pediatrics (Afpa).
“White blood cells produce antibodies that attack viruses, the body heals itself very simply and without chemistry thanks to the immune system,” he told BFMTV.com.
The High Authority for Health also remember that nasopharyngitis -even with colored nasal discharge- or angina pectoris in a child under 3 years of age should not be treated with antibiotics. Only a positive rapid diagnostic test, which allows verifying the bacterial origin of the angina, can be the subject of such a prescription (in children older than 3 years).
Andreas Werner, from Afpa, invites doctors and paediatricians to equip themselves more widely with these tests, distributed free of charge to those who request them. “It’s impossible to determine the source of angina just by inspecting the throat, whether there are white spots or not,” he says. “It’s not a diagnosis.”
Haro in cough syrups
But beyond the regularly mentioned case of antibiotics, Toubib denounces a long-standing ineffective pharmacopoeia. Therefore, the doctor considers that cough syrups should not be prescribed to children under 3 years of age; some countries advise against them until the age of 6.
“Cough is a physiological and often reflex phenomenon, let’s stop trying to suppress it,” he wrote. “Especially because very often it’s irritating and therefore dry and apart from moistening the upper airways, nothing will change.”
Useless, some of these syrups are also dangerous: they make the child sleepy, preventing the expectoration reflex. Some can also cause rare side effects, such as seizures. This doctor thus recalls that a child who coughs for two or three weeks, “is not serious as long as the clinical examination is normal.”
“Les parents vont avoir l’impression que l’enfant est malade pendant plus d’un mois alors qu’en réalité, il enchaîne les viruses, comme all les enfants en hiver. A second virus succède à premier. Et c’est normal.”
Toubib also denounces the use of drugs against sore throats. According to him, drinking hot or cold is enough. He even believes that a simple piece of candy is “much more effective.” “Because it is by producing saliva and swallowing it that we will have a better analgesic effect.” As for the common cold, saline is enough: “The rest is overmedication.”
Another winter disease: gastroenteritis. Invites parents not to resort to antiemetic medications. Once the stomach is empty, he explains, consuming sugary drinks in small amounts and in fractions is enough to combat nausea (the acetone level increases in case of vomiting, causing hypoglycemia which in turn causes nausea).
The “reflex” of prescribing
How to explain this overmedication? Brigitte Virey, from the SNPF, evokes “parental pressure” to leave the practice with a prescription. Therefore, it would be “easier” and “more comfortable” to prescribe medications, including antibiotics, even for a viral infection, especially when the doctor does not know the family.
“If we only prescribe acetaminophen and recommend flushing the nose, parents get the impression that we’re not doing much to treat their child,” he says.
If Toubib also recognizes the pressure from families, he evokes a “shared” responsibility in this pediatric overmedication. “There is a reflection of French doctors to prescribe, it is in the culture of medicine,” she explains. Short of taking the time to learn new recommendations, these doctors do not deviate from their practice. “And we prescribe even if it’s useless.”
But for him, the “vicious circle” of overmedication works “at all scales.” The parents would be convinced that the child needs medication. If not, it is the relatives who are surprised that he does not have a prescription. “So we got into the habit from childhood of swallowing medicine to cure ourselves,” says Toubib.
On the doctor’s part, by dint of listening to this request, the doctor ends up modifying his practice and over-prescribing to the next patient, who may not have necessarily asked for it. In the end, the latter also gets used to leaving the office with a prescription.
“Parents as well as practitioners can’t stand the idea of doing nothing, it creates a feeling of powerlessness,” Toubib says. “The feeling of healing becomes more important than the actual healing.”
This doctor thus calls for better health education for professionals and the general public and finally recalls that “consulting a doctor is having an opinion, an experience”. Not just give medicine.
Source: BFM TV
