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DISEASE PATTERN IN INDIA

First and Second Line of Drugs in Private Practice
OP Kapoor
We first heard of 1st or 2nd line of drugs in case of tuberculosis, where 2nd line of drugs were used only if the patient had resistant (MDR) tuberculosis or if the patient was allergic to the 1st line of drugs.
But now, even H-pyloridis infection is being treated by the 1st or 2nd line of drugs. Initially, we were under the impression that the infection responds to a combination of Clarithromycin and Doxycycline with Omeprazole and Metronidazole (triple course). But, lately it has been observed that a few patients have become resistant. Such patients need 2nd line of drugs with quadruple treatment, e.g. PPI or H2 antagonsits added to Bismuth based triple regime, plus high doses of Metronidazole.
Similarly, the words ‘1st line’ and ‘2nd line’ are now used in case of typhoid, where the 1st line of drugs were Chloramphenicol, Amoxycillin or Cotrimoxazole and the 2nd line of drugs are Quinolones or Cephalosporidines. But, it is interesting to note that if a typhoid patient does not respond to very high doses of Quinolones in injectable form (specially if the MIC report is very high), often he may now respond to the 1st line of drugs (specially Chloramphenicol).
Thus, like the above example of a reverse trend, the terminology of ‘1st line’ and ‘2nd line’ of drugs has lost its initial significance.

(Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008)

Book Review
‘ Introduction to Clinical Neurology’ Anil Desai and Satish Khadilkar

Published by National Book Depot, Mumbai, is a compact book covering important areas of practical Neurology written by clinicians with experience. It focuses on topics of day to day importance for general practitioners and medical students. There are many tables helping the reader to have a rapid reference to the differential diagnosis of clinical situations.
Priced very reasonably, it is a welcome desk book for medical students and general practitioners.

Dr OP Kapoor



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