A new mother in Kathmandu took her two-month-old baby to hospital to treat an infection. The doctor diagnosed upper respiratory infection (URI) and prescribed half a dozen medications, including the cough syrup Dextromethorphan.
Dextromethorphan is not recommended for children under four by the US Food and Drug Administration (FDA) since 2008 after studies showed it to be ineffective for colds and causes damage to the central nervous system.
In Saptari, a 14-month-old boy with chronic cough was taken to a private clinic multiple times. In each visit, the doctor there prescribed Dextromethorphan and Beclomethasone, a corticosteroid.
The child’s skin became swollen and sore, and he was brought to Om Hospital in Kathmandu. Doctors concluded that his nervous system was affected by overdose of Dextromethorphan, and referred the baby to AIIMS Hospital in New Delhi. The baby died during treatment.
A paper titled Adverse Events Associated with Pediatric Exposure to Dextromethorphan published in the medical journal Clinical Toxicology had already concluded that the cough syrup should only be given to children above four, and only for the most serious cases.
Sixty percent of the 1,716 children under four in this study who were prescribed Dextromethorphan were found to have side effects ranging from vomiting, breathing problems, and effects on the nervous system. Other studies have noted that the drug can cause the respiratory system of children to slow down severely, leading to suffocation.
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A four-year-old boy in Bhaktapur suffering from cough and constipation was taken to a nearby private hospital. The doctor diagnosed common cold and prescribed six types of medicines including a nasal drug with the generic name Oxymetazoline, commonly used to treat nasal polyps.
Oxymetazoline has also been prohibited for use in children under six by the FDA and other regulatory bodies. Doctors at the Bhaktapur hospital have been found to be prescribing this medicine to children to treat colds. Overuse of oxymetazoline can eventually cause inflammation of the nasal cavity, affecting breathing.
As more and more Nepalis, especially children and the elderly, suffer from respiratory infections due to increasing air pollution, the misuse and overuse of drugs by an over-commercialised medical and pharmaceutical sector is also increasing.
Doctors have also been found to be prescribing Montelukast, usually given only to patients with complications like asthma and rhinitis, to treat the common cold, sore throat, rashes or arthritis in children.
FDA studies have shown that Montelukast in children and adolescents can cause behavioural and psychological side effects, including suicidal ideation. The drug has a black box warning, the FDA’s strictest alert to warn the public about its side effects, to be used only in cases where its benefit outweighs its harm.
The Global Initiative for Asthma (GINA) guidelines also mention that parents must be made fully aware of the possible side effects of Montelukast before it is prescribed to children with asthma.
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Medical Sector on Steroids
Doctors in Nepal also over-prescribe steroids, usually recommended to treat cancer, arthritis, vasculitis, asthma, muscular dystrophy, and arrhythmia, for children suffering colds and coughs. Steroids suppress the body's immune system, which is why doctors might prescribe them to address short-term health problems. The random prescription of such powerful medication can have long-term effects on health.
At a clinic in Jhapa, doctors prescribed a one-year-old with a common cold, the steroid Prednisolone. When the cold persisted, the boy’s parents eventually began to buy the medicine over the counter whenever their son got sick. This went on for three and a half years until the child was unable to walk.
When he was brought to a hospital in Kathmandu, doctors discovered that he had cataracts in both eyes as well as myopathy, a rare condition that causes the muscles of the legs to deteriorate. The child had to undergo cataract surgery, usually performed on elderly patients over 60. But there was no treatment for his myopathy.
A study published in the British Medical Journal found that the prescription of steroids in children causes complications including obesity, diabetes, increased blood pressure, cataracts, weakened bones and muscles, as well as excessive body hair growth.
Immunology and paediatric rheumatologist Dharmagat Bhattarai has seen many patients with disabilities and other lifelong health complications caused by the prescription of steroids to treat common colds.
“Steroids should be used according to guidelines only in cases of serious diseases, to prevent amputations and in lifesaving situations,” says Bhattarai. “It cannot be used for general health problems.”
