I wish to bring your attention to another common problem noted in prescriptions for respiratory tract infections in children- use of corticosteroids. A cross-sectional study was carried out in the Eastern Indian state of Jharkhand (Bokaro Steel City). The study sample was based on all prescriptions for cough and cold received by ten medical shops during the period of study. Treating physicians included Pediatricians and non-Pediatricians. Ninety one prescriptions of children with cough and cold were identified during the period of study.

Prescriptions that included antibiotics along with corticosteroids were included for analysis. Prescriptions with bronchodilators were excluded, as steroids use may be appropriate in bronchial asthma. Cortico-steroids were prescribed to 22 (24%) children without any appropriate reason. Other commonly used drugs were antihistaminics (87%) and cough syrups (100%) (Unpublished observations). Inappropriate use of steroids for treating pneumonia was found in an earlier study by Kumar(2) by 31 out of 113 (28%) private practitioners.

These studies indicate that physicians for treating respiratory tract infections frequently use inappropriate medications including antibiotics and corticosteroids. This could result in an increase in the incidence of antibiotic resistance and steroid-related side effects respectively, besides an increase in the treatment cost. Possible reasons for this could include lack of adequate knowledge among treating physicians, better satisfaction of parents, and pressure from drug companies. These issues need to be evaluated further.

Sudhir Kumar,
Department of Neurology,
Christian Medical College Hospital,
Vellore 632 004, Tamil Nadu,
India.

1. da Cunha AJLA, Amaral J, Silva MAF. Inappropriate antibiotic prescription to children with acute respiratory infection in Brazil. Indian Pediatr 2003; 40: 7-12.

2. Kumar D. Recognition and management of ARI–A KAP study on private medical practitioners. Indian J Pediatr 1997; 237-242.