The probe into the deaths of three children in Rajasthan after suspected consumption of medicines has drawn attention to troubling practices that doctors have also noted elsewhere in the country — children receiving drugs not meant for them.
The probe conducted by the state government found that two children fell ill after receiving a medicine called dextromethorphan, which is not recommended for paediatric use, prompting the suspension of a doctor and a pharmacist and a fresh advisory against the use of dextromethorphan in kids.
The Centre will soon issue guidelines for parents, pharmacists and doctors on the rational use of cough syrups, a health official told a high-level Union health ministry meeting on Sunday amid investigations into the child deaths in Rajasthan and Madhya Pradesh.
“Cough medications have minimal proven benefits in children, but carry significant risks,” director-general of health services Sunita Sharma said at the meeting attended by state drug regulators and health officials from across the country. Sharma also underlined the need for checking medications and concentrations of drugs to avoid any overdose.
Central and state health authorities are investigating the deaths of nine children in Madhya Pradesh and three in Rajasthan after suspected consumption of cough syrups since early September.
Tests have revealed a toxic substance called diethylene glycol in a sample of a cough syrup consumed by children in Madhya Pradesh, prompting inspections of manufacturing facilities of all 19 drugs consumed collectively by the Madhya Pradesh children just before their deaths.
Rajasthan health officials had on Saturday said that the three children who died had not consumed dextromethorphan, but three children became ill after consuming a formulation containing this drug.
One child became ill after taking the medicine originally prescribed to the father of the children. Two other children who had been brought to a primary health centre for treatment were given a formulation containing dextromethorphan.
The state has suspended a doctor and a pharmacist at the primary health centre.
Rajiv Bahl, the director-general of the Indian Council of Medical Research, told the meeting on Sunday that children should not be prescribed cough syrups or any combination of drugs to prevent side effects.
Medical experts say the adverse effects noted in the three children who received dextromethorphan underscored the long-standing problem of irrational prescription practices as well as dispensation of medicines by pharmacists or by parents without consulting doctors.
“These incidents highlight the need for audits of prescriptions and the strict enforcement of rules prohibiting the sale of certain medicines without prescriptions,” said Ishwar Gilada, an infectious diseases expert in Mumbai.
Concerns about the quality of drugs and adverse effects from irrational prescriptions also have the potential to erode public trust in free healthcare services available in government clinics, said Narendra Gupta, a physician with Jan Swasthya Abhiyan, a non-government public health advocacy group.
Indian guidelines advise against prescribing formulations containing dextromethorphan to children under four years due to risks, including central nervous system depression and sedation.
Doctors at the Postgraduate Institute of Medical Sciences, Rohtak, had in November reported a case of a six-year-old girl who was brought into the emergency ward after consumption of a cough syrup that contained dextromethorphan and chlorpheniramine.