Antibiotics

Antibiotics are the antimicrobial drugs which are designed to work against microorganisms either by inhibit the growth or kill the infecting organism. Antibiotics are effective against bacteria, so they are also known as antibacterial. It is important to know that antibiotics are not effective against viruses such as common cold and influenza. So before taking any antibiotic proper knowledge about antibiotics is very important. Never take any antibiotic without doctor’s prescription and never ask doctor for prescribing antibiotics, it would be harmful for your body.
Antibiotics were one of the most, if not the most, transformational discoveries in all of medicine. Infections are something that we struggled to treat for many, many years, for centuries before the advent of antibiotics, and infections were a major cause of death before the advent of antibiotics. They are really miracle drugs in cancer chemotherapy, bone marrow transplantation, stem cell transplantation, ant severe infection. But overuse and misuse of antibiotics is worldwide concern nowadays.

Antimicrobials are classified in many ways, according to chemical structure, mechanism of action, against the type of organism, spectrum of activity, type of action and antibiotics obtained from microorganisms. Antimicrobials according to the type of organisms against which primarily active are Antibacterial, Antifungal, Antiviral, Antiprotozoal, Anthelmintic.
Antibiotics have different mechanism of action. They work either by inhibiting cell wall synthesis, inhibiting protein synthesis, cause leakage from cell membranes, cause misreading of mRNA code and affect permeability, interfere with DNA synthesis or DNA function, inhibit DNA gyrase or interfering intermediary metabolism. Antibiotics may be bacteriostatic or bactericidal. Some static drugs may become cidal at higher concentration, on the other hand some cidal drugs may be only static under some circumstances.

Problems with the use of antibiotics
1.Toxicity
Local irritancy – usually at the site of administration, pain and abscess formation at i.m site or thrombophlebitis with i.v administration.
Systemic Toxicity- Almost all antibiotics may cause some type of systemic toxicity, depending upon doses. Some antibiotics Aminoglycosides can cause 8th cranial nerve and kidney toxicity, tetracyclines can affect kidney and liver, chloramphenicol can cause bone marrow depression, vancomycin can cause hearing loss and kidney damage, polymixin B and amphotericin B can cause neurological and renal toxicity. So never use any antibiotics without doctor’s prescription and advise.
2. Hypersensitivity Reactions
All antibiotics can cause unpredictable reactions from rashes to anaphylactic shock.
3. Drug resistance
Natural resistance– some microbes have always been resistance to certain antibiotics. They lack the metabolic process or the target site which is affected by a particular drug.
Acquired Resistance- It is development of resistance by organism due to the use of antibiotics over the period of time. It is the biggest problem for public health. Bacteria, like any living organism, want to survive. They are adapted that way, and any successful bacteria is the bacteria that’s most able to survive in the environment. So bacterial resistance is largely inevitable, because bacteria will always change in order to survive, this is a phenomenon that plays out in nature. Resistance may be developed by mutation or gene transfer. Resistance organisms can be either drug tolerant, drug destroying, or drug impermeable.
4. Superinfection
This is an appearance of new infection because of using antibiotics. Antibiotics may alter the normal microbial flora of our body which is natural host defence for our body. More complete the suppression of body flora, greater the chances of developing superinfection. Most common example is antibiotic induced diarrhea, because of suppression of colonic bacteria by antibiotic. Superinfections are more common when host defence is compromised.
5. Nutritional Deficiency
Prolonged use of antibiotics alter the normal intestinal flora (which plays an important role in synthesis of Vitamins B complex group and Vitamin K), may result in vitamins deficiency.
6. Masking of an infection
Short course of an antibiotic may be sufficient to treat one infection but it can also suppress another organism for a while which may become a severe infection later. For example syphilis is masked by single dose of penicillin which is enough to cure gonorrhea.

The most common and biggest problem today with antibiotic use is the resistance, The golden age of antibiotics appears to be coming to an end, its demise hastened by a combination of medical, social and economic factors. For decades, these drugs made it easy for doctors to treat infections and injuries. Now, common ailments are regaining the power to kill.

The problem goes beyond treating infections. As bacterial resistance grows, Lesho said, “we’re all at risk of losing our access” to medical miracles we’ve come to take for granted: elective surgeries, joint replacements, organ transplants, cancer chemotherapies. These treatments give bacteria an opportunity to hitch a ride on a catheter or an unwashed hand and invade an already vulnerable patient.
The struggle to sustain the effectiveness of antibiotics is a never-ending arms race. If humankind were regularly finding new anti-microbial agents and turning them into medicines, there might be less cause for worry.
Researchers haven’t identified a new class of antibiotic medication since 1987. As a result, while bacteria have continuously evolved new ways to develop resistance against antibiotics, the medicines have not gained new mechanisms to fight back.
Because of overuse and misuse of antibiotics microorganisms also found new ways to survive, they modify themselves against antibiotic and thus antibiotic does not work against microorganism. Though hospitals are following infection control policies, but everyone has to aware the fact about antibiotics. We are close to the time of end of antibiotic usage only because of resistance. We are quickly running out of therapies to treat some of these infections that previously had been eminently treatable. There are bacteria that we encounter, particularly in health-care settings, that are resistant to nearly all — or, in some cases, all — the antibiotics that we have available to us, and we are thus entering an era that people have talked about for a long time.
So I want to tell you that never use antibiotics without doctor’s prescription and never force them for prescribing antibiotics.
If doctor prescribes you antibiotics, complete the full course and in the correct way as doctor told you, and follow your doctor’s instructions.

Content source – latimes.com, medical news, The essentials of pharmacology book by K.D.Tripathi ( 6th edition)

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.

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How To Fight With Depression

In my previous blog I have discussed about the depression and its causes, here I will talk about treatment that can help a depressed person overcome depression. So if you have not read that then click here

Treatment-
The worst thing about depression is that it a real illness which can be very serious but best thing about this is that it is treatable. If your symptoms are severe enough then a make a doctor appointment and talk to doctor in detail. The choice of treatment depends on the pattern, severity, persistence of depressive symptoms and the history of the illness. As with many illnesses, early treatment is more effective and helps prevent the likelihood of serious recurrences. Depression must be treated by a physician or qualified mental health professional.

Few natural tips of treating Depression
1. If you feel you are sad and have the symptoms of depression, talk to the person you trust more, talk to your friend, or your loved one or who is in your close relation (like your parent, or your spouse, your best friend), Don’t be isolated, involve in social gathering, go for outing, meeting with your friends this will help you reminding past and nice memories.
2. Being optimistic- you know what is the cause or may not, but you have to be very positive towards your life, your job and in everything you are involved. Boost your mind by thinking positive only. Make your will power very strong.
3. Go near to the nature- Nature is such a precious gift in our life, nature will make you feel better in all ways it rejuvenate you to feel emotionally and physically. IT will boost your inner strength. Naturo-therapy is the best treatment for depression.
4. Yoga and Meditation– Yoga has uncountable benefits, it not only builds your inner strength and awareness but provides many mental and physical benefits. It focuses your attention on your body’s abilities at the present moment. Yoga is known for its ability to soothe tension and anxiety in the mind and body. But it can also have an impact on a person’s exercise capacity. So if you want to get rid from depression and anxiety you must practice Yoga every day. Everyday 30 minutes yoga is good for you.
5. Daily routine- You should fix your goal. Every day in the morning make “to do list” and try to do all those things within your time limit with full enthusiasm. You have to fix your daily routine from time you wake up to time you go bed, good sleep is important so try to sleep early and wake up early but never too late. Fix your meal time.
6. Hygiene- You should follow hygienic habits. Keep your room nice and clean, Open the windows in your room for fresh air and natural sunlight which helps to fight depressive mood. You can use some Quotations on your wall which boost up your mind. Clean your bed every day and change your bedsheet frequently, do not use dark and dull color bedsheets, use light and colorful bedsheets.
7. Eat healthy- Always eat healthy food rich in protein, fibers like green leafy vegetables and fruits. Drink plenty of water, 2-3 liters water every day to flush out the toxins. Eat healthy, think healthy and stay healthy.
8. Dance and Music- turn on any soothing light music while at home, dance on music can help you to feel better physically and emotionally.
9. Avoid caffeine after 4 pm, if you have difficulty in sleeping.
10. Never take alcohol.

Medical treatment-
If symptoms are severe then doctor may prescribe you antidepressants which are of different types and some medications may take few weeks or longer to take full effect.
Different kinds of antidepressants-
SSRI (Selective Serotonin Reuptake Inhibitors), SNRIs (Serotonin Nor-epinephrine Reuptake Inhibitors), NDRIs (Nor-epinephrine Dopamine Reuptake Inhibitors), MAO (Mono Amine Oxidase) inhibitors, Atypical antidepressants, Tricyclic antidepressants.
All these medication have some side effects and MAO inhibitors also have some food restrictions (cheese containing food, wine) because of drug interactions. So always discuss about side effects of the drugs with your doctor or pharmacist.

Doctor may choose to treat you with either combinations of two antidepressants, or one antidepressant and one mood stabilizer or antidepressants with antipsychotic drugs.

Guidelines for antidepressants-
1. All antidepressants have side effects so always discuss about the drug and its side effects with your doctor.
2. Keep patience, because sometimes drugs may take week or longer to show full effect.
3. Some foods are restricted in MAO inhibitors like cheese and wine, so never take this if you are taking the drugs.
4. If you want to take any other medicine please ask your doctor first.
5. If you become pregnant or planning to get pregnant or you are breastfeeding inform your doctor, because some antidepressants may pose risk to your unborn child or nursing baby.
6. Be careful while driving or using machinery, especially if your medicine makes you sleepy.
7. Never stop antidepressants without doctor’s advice, sudden stopping of drugs may cause sudden worsening of symptoms or withdrawal like symptoms. They should be stopped gradually and according to your doctor’s instructions.
8. If you develop any new symptom please inform your doctor.
9. During treatment or before treatment anytime if you have any thought of hurting yourself or suicidal thought, inform the doctor immediately.

Please note: Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a health care professional.

 

Depression

What is depression?
Depression is a simple word but it has deep and vast meaning, In my words Depression is a feeling generated by your state of mind, it is a sad feeling, or feeling low, not feeling good, not feeling energetic are usually used to express depression and person say I am depressed. Depression is very common problem nowadays. It is a real medical illness which comes in many forms and really needs attention.
Though it is a feeling in your mind state but it may be a real illness or disease. So you have to know what depression is. Life is full of ups and down and sometimes person may not accept all aspects of life and can feels sad or goes in to depression, which not only affect the person who is depressed but also his surroundings or family members who are very close to the person.
Usually people think, feeling sad or feeling dull is depression, but it is more than that, there are few signs and symptoms which can help you to diagnose depression.
1. Persistent sad feeling or anxious, loneliness, emptiness.
2. Loss of interest in daily activity and hobbies. Person may lose the interest in daily activities and he or she may lose the interest in his or her favorite activity or hobby also. He may lose interest in sex too.
3. Sleep disturbance – problem in falling asleep or problem in waking up or disturbed sleep.(Either sleeping too much or less)
4. Fatigue, low energy – person will always feel tired (fatigue), or dull. No motivation to work. Ability to think and speak are slowed down which may affect body movements too.
5. Guilt or feeling of hopelessness or worthlessness.
6. Poor concentration – person cannot concentrate on work, affects ability to take decisions, impacts memory, person finds hard to remember or recall things.
7. Suicidal thought or harming himself by any mean
8. Change in appetite- Though decrease in appetite is common but in some people there may be increase in appetite. So weight loss and weight gain both can be seen.
9. Other psychological disturbances like irritation, agitation, mood changes may be seen.
10. Unexplained body aches may also be seen like headache, pain in abdomen or in any body part.
For diagnosis at least five of these symptoms should be present during most of days, almost every day for at least two weeks and severely interrupting daily activities. If you have these symptoms then make a doctor appointment and talk to doctor in detail.

It is not necessary that all these signs will be present in a depressed person but only few of them may also present so counselling and asking questions related to all these symptoms are very important for diagnosing the problem. And if you are asking questions you have to take the patient under your confidence and make sure that information provided by the patient will not go outside. The most important question asking about suicidal thoughts or any thought to harm him-self or her-self.

Causes-
There may be different causes of depression from genetic, biochemical, environmental to any life event. Depression can occur in any age but more often starts by the age 16. In teenagers stress may be related to school life, studies or friends, any trauma, love relations, loss of loved one or any other. In adults causes may be related to family life, stressful situation between partners, work load in the office, competition everywhere, infidelity, not getting success at work, unsatisfactory jobs, any trauma or loss of loved one and much more. Sometimes depression is medication induced, related to medical problems and long term illness. In women depression may be due to hormonal changes during menstrual cycle, before menstruation known as pre menstruation syndrome (PMS). After delivery of baby depression is called as postpartum blues which is more common in women due to hormonal and physiological changes in body and adding another responsibility in her life of taking care of baby.

Depending on symptoms, duration and cause depression may be of different varieties-
Major Depression- Symptoms are severe enough to interrupt daily activities, and presents at least two weeks with noticeable change in previous level of functioning.
Bipolar I Disorder-Mood disorder in which patient experiences manic symptoms (elated mood) for at least one week that cause significant distress or impairment in his/her level of functioning.
Dysthymic Disorder-It is a chronic disorder characterized by depressed mood that presents most of the time during the day and present on most days for at least two years.
Cyclothymic Disorder- A chronic disorder characterized by many episodes of depressed mood and in between many episodes of hypomanic mood (Mild elated mood) for at least two years.
Seasonal Affective Disorder-It is characterized by depressive symptoms usually in winter months and in snowy places,when there is absence of sunlight, people can not go outside, all the activities are limited inside the closed home.
Post traumatic depression- After any trauma or because of loss of loved one .It is different from Grief in which usually return of normal baseline functioning within two months but in depression patient do not returns to his baseline level functioning.
Postpartum Depression- Symptoms starts within one month after giving birth to baby and may continue for long time.

Diagnosis-
Usually symptoms and physical exam can diagnose the Depression ,no lab tests are necessary but sometimes to rule out medical causes doctor may order for lab tests.

Thyroid and Pregnancy

Normally pregnancy cause changes in thyroid and its function because of pregnancy related hormones.

1. Hormonal Changes– Human chorionic gonadotropin (hCG) and Estrogen cause increase in thyroid hormones level in the blood.

hCG (produced by placenta) is similar to TSH and mildly stimulates the thyroid to produce more thyroid hormones. So high hCG levels in the first trimester may result in a slightly low TSH (called subclinical hyperthyroidism).

Increased estrogen produces higher levels of thyroid-binding globulin, a protein that transports thyroid hormone in the blood.

However, measurements of “Free” hormone (that not bound to protein, representing the active form of the hormone) usually remain normal. The thyroid is functioning normally if the TSH, Free T4 and Free T3 are all normal throughout pregnancy.

2. The size of thyroid increases slightly in healthy women during pregnancy, but not enough to be detected by a physical exam. Only with the help of very sensitive imaging techniques (ultrasound), it is possible to detect an increase in thyroid volume in some women.

3. Physiological changes during pregnancy such as increase in cardiac output, oxygen consumption and heat production may mimic mild hyperthyroidism and is the reason why hyperthyroidism remain undetectable during pregnancy. Even before conception, thyroid conditions that have lingered untreated can hinder a woman’s ability to become pregnant or can lead to miscarriage.

Therefore detecting a thyroid problem is important, for all those already diagnosed with a condition and if they are planning to become pregnant or are pregnant.

In a pregnant women thyroid hormone plays a very important role in the normal development of the baby’s brain and nervous system and her own expanded metabolic needs. For the first 10-12 weeks of pregnancy, the fetus is completely dependent on the mother for the production of thyroid hormone. By the end of 12 week, the baby’s thyroid begins to produce thyroid hormone on its own. But fetus is still dependent on mother for intake of adequate amount of iodine. The best way to ensure adequate amounts of iodine reach the unborn child is for the mother to take a normal diet with iodized salt, or prenatal vitamin with a sufficient amount of iodine. The WHO recommends iodine intake of 200 micrograms/day during pregnancy to maintain adequate thyroid hormone production.

Preconceptional counseling: Considering the hazards during pregnancy, preconceptional counseling is important. Adequate treatment should be instituted to bring down the thyroid function profile to normal. Radioactive iodine (131I) therapy should not be given to patients trying to get pregnant or female wants pregnancy within one year. If pregnancy occurs inadvertently, termination should be done. Oral pill is to be withheld because of accelerated metabolism and disturbed liver function.

Hyperthyroidism in pregnancy

Autoimmune hyperthyroidism (Graves’ disease) due to thyroid stimulating antibodies is the most common cause. Other causes are: Nodular thyroid disease, sub-acute thyroiditis, hyperemesis gravidarum and trophoblastic disease.

Diagnosis

  • History, physical examination and lab tests.
  • Measuring levels of FT4 (high), FT3 (high) and TSH (low).
  • Thyroid peroxidase antibodies (TPOAb), (Anti microsomal antibodies) and thyroid stimulating immunoglobulin should be measured.
  • Ultrasonography of the fetal thyroid gland is done when the mother is taking anti thyroid drugs.
  • Radioactive iodine uptake and scans are contraindicated during pregnancy as it will cross the placenta and damage the fetal thyroid gland permanently.

Complications Of Untreated Hyperthyroidism

Maternal Miscarriage, preterm delivery, preeclampsia, congestive heart failure, abruptio placenta, thyroid storm and infection.

Fetal/Neonatal: IUGR, prematurity, stillbirth, hyperthyroidism, hypothyroidism, increased perinatal morbidity and mortality.

Treatment –

Mild hyperthyroidism with minimal symptoms may not require any treatment with close monitoring. Severe hyperthyroidism require to treat drugs which interfere production of thyroid hormones.

Antithyroid drugs [propylthiouracil (PTU) or methimazole (MM) is the mainstay of treatment and are very effective. The goal of therapy is to keep the mother’s free T4 and free T3 levels in the high-normal range on the lowest dose of antithyroid medication.

Propylthiouracil is given at a daily dose of 300–450 mg and continued till the patient becomes euthyroid, the maintenance dose being 50 and 150 mg daily.

Carbimazole is given orally with a daily dose of 10–40 mg and maintained at this dose until the patient becomes euthyroid. Then it is progressively reduced to a maintenance of between 5 mg and 15 mg daily.

Side effects – Both the drugs may cause fetal goiter and hypothyroidism. Methimazole may be associated with aplasia cutis of the neonate and has the risk of embryopathy.

Therapy should be closely monitored during pregnancy. Fetal surveillance is maintained with serial USG, NST and BPP. The drugs are not contraindicated during breastfeeding provided the dose is kept relatively low and close monitoring of the neonatal thyroid functions is carried out. Cord blood should be taken for TSH and free T4 at the time of delivery to detect neonatal hyperthyroidism.

Thyroidectomy –surgical removal of thyroid is an option for the patients those who develop an allergic reaction to the drugs or who have pressure symptoms. It can be done safely in the second trimester with prior biochemical control.

Hypothyroidism in Pregnancy

 The Causes of hypothyroidism in pregnancy may be due to

  • Undiagnosed before pregnancy
  • Hypothyroid women who either discontinue thyroid therapy or taking inadequate doses of antithyroid drugs
  • Hyperthyroid women on excessive amounts of antithyroid drugs
  • Women with lithium or amiodarone therapy.
  • Hashimoto thyroiditis ( autoimmune disorder )is the most common cause of Primary hypothyroidism in pregnancy

Complications or risks

 Maternal – preeclampsia, anemia, myopathy, and congestive heart failure.

Neonatal – Miscarriage, stillbirth and prematurity and deficient intellectual development of the child.

Diagnosis

Physical exam, clinical symptoms and lab tests

  • TSH -Serum TSH should be repeated at an interval of 6–8 weeks as there is increased demand of thyroid hormone in the second half of pregnancy.
  • Serum thyroid peroxidase antibodies (TPO-Ab) or antimicrosomal antibodies are elevated in autoimmune thyroiditis.

Treatment –

Synthetic levothyroxine-levothyroxine requirements frequently increase during pregnancy, so If the patient is having substitution therapy in pre-pregnant state, the dose of levothyroxine need to be increased in pregnancy. Generally, therapy is started 2 to 2.4 mcg/kg/day and then maintenance doses 75 and 150 mcg of levothyroxin per day. The serum TSH should be repeated every 2 to 6 weeks. After delivery of the child, the woman may go back to her usual pre-pregnancy dose of levothyroxine.

Levothyroxine and prenatal vitamins should not be taken at the same time because iron and calcium in the prenatal multivitamins can impair the absorption of thyroid hormone from the gastrointestinal tract and therefore should be separated by at least 2-3 hrs. Levothyroxin is safe during pregnancy.