Polypharmacy - A Question of Ethics or Pure Ignorance

I have come across quite a number of patients coming to my clinic seeking for treatment for the same condition after having attended other private clinics. I have chosen a couple of paediatric cases. Both children, one is a three year-old toddler and another is one and half-year old. They both suffered from intractable diarrhoea and vomiting. The older one had been suffering for more than ten days and the latter for more than a week. They both looked listless and irritable. They had not been feeding well and appeared dry and thin. The little one's bottom was raw due to prolonged purging.

According to both mothers they had been to clinics and were prescribed medications which they kept giving to their children and yet the diarrhoea never seemed to ease let alone cease.

The mother (AR) of the older child was desperate and without being prompted had proceeded to take out from her bag all the medications prescribed by the clinic and altogether with consultation, she said she forked out RM75.00. I noticed that the woman was not really educated and yet had the sense of bringing all the medications which had failed to "cure" her child, to show them to me. I was impressed as not many would bring along their "failed" or ineffective medications and yet expect the next doctor to "cure" them.

The second mother (CP) did not bring the prescribed drugs but I made her go home to get them for me to see. I always tell this kind of patients that since I don't know what drugs have been given to them earlier, I might prescribe the same ineffective drugs and they would still not get better.

What I found was interesting. For simple diarrhoea, an array of drugs: an anti-diarrhoeal preparation, anti-vomiting, anti-fever,vitamin and anti-colic were prescribed between the two kids.

Five different types of drugs prescribed
for childhood diarrhoea (Mother AR)

Three different types of drugs to treat
diarrhoea in a child  (Mother CP)

All the kids needed was an oral rehydration therapy using a pre-packed oral rehydration salts. These should be given to them as directed till the diarrhoea stops  and other soft diet like porridge and milk can be continued.

In this case, the purging should not be prevented by giving an anti-diarrhoeal preparation as the body is throwing out "something" which is not safe for absorption by the body. Use of many drugs for this simple diarrhoea which 85% of the time is due to virus, would only prolong the diarrhoea and discomfort as happened in these two cases.

For most childhood diarrhoea only
oral rehydration salt (ORS) solution is needed

Why are these drugs prescribed? It seems to me either the practitioner is treating the symptoms such as vomiting rather than the root cause of the condition or for pure monetary considerations: the more drugs are prescribed, the more profit is generated (and likely the more side-effects). Either way, the patients suffer. It is an undesirable outcome.

For both children, I just advised their mothers to stop those drugs and offer them oral rehydration salt (ORS) and told them to return in 48 hours if the diarrhoea had not subsided. True enough they both recovered on that treatment alone and at the cost of RM7 (without consultation fee)

I have seen adults also being prescribed an anti-diarrhoeal preparation when all they need is only a replacement fluid therapy till their diarrhoea usually due to gastritis or food poisoning stops. Most diarrhoea except for bloody ones are supposed to be treated this way. Over treatment with several drugs will only worsen or prolong the gastrointestinal condition.

Polypharmacy is unethical and ignorance is unacceptable.