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Betamethasone Abuse in Infancy
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     Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India.

    Oral Betamethasone is being prescribed unnecessarily for innocuous conditions like common cold. The ignorant mothers also misuse betamethasone for their babies to make them chubby. These steroid babies develop cushings syndrome, immuno-suppression and serious infections like pneumonia and meningitis. We present two infants with Cushings syndrome due to prolonged betamethasone use.

    A four month old male infant born with a birth weight of 2.5 kg presented with chickenpox. On examination, he weighed 11 kg and had cushingoid features. His blood pressure was normal and had multiple papulo-vesicular lesions characteristic of chickenpox. The child had to be treated with oral acyclovir in view of cushingoid features. At fifteen days of life, a private practitioner had prescribed betamethasone oral drops for upper respiratory tract infection. The mother had noticed increased appetite after betamethasone use and continued the same daily.

    A three month old female infant born with a birth weight of 2.6 kg presented with high grade fever for two days associated with multifocal seizures. On examination, she weighed 11 kg (more than 95th centile) and had cushingoid features. Her blood pressure was 80/50 mm Hg. She had an irritable cry and her anterior fontanelle was bulging. CSF showed plenty of pus cells and culture grew H. influenza. The mother had procured 3 vials of oral betamethasone over the counter and had been administering it from birth as a "health tonic". The child was treated with intravenous antibiotics for 10 days and discharged with an advice to stop betamethasone.

    The children mentioned above represent only the tip of the iceberg and a large number of other steroid babies go undetected. Guidelines for dispensing over the counter steroids in developing countries are lacking(1). The irrational prescriptions of steroids as treatment for common cold both by practitioners of allopathy and alternative systems of medicine are increasing. Kshirsagar, et al. estimated that more than 30% of prescriptions by medical practitioners are irrational(2). Apart from the irrational prescriptions, the health awareness among the general public is also lacking to the extent that the rapid weight gain due to steroids, basically a side effect is mistaken for good health. As a result, multiple vials of this drug are bought everyday over the counter. In order to reduce this problem, doctors should undergo continuing medical education programs highlighting the harmful effects of steroid misuse. The government can enact stringent law for restricting over the counter dispensing of harmful drugs.

    References

    1. Hui JYH, Woo PCY, Lo SS, Chan JCS. Over the counter medication and its effects. Lancet 2002; 359: 1120.

    2. Kshirsagar MJ, Langade D, Patil S, Patki PS. Prescribing patterns among medical practi-tioners in Pune, India. Bull World Health Org 1998; 76: 271-275.(Adhisivam B.,Mahadevan S.)