The directorate general of family planning has instructed its medical
officers to give antibiotics soon after completion of permanent and
long-acting birth control procedures, though experts find the method
'illogical' and not based on 'evidence'.
Authorities concerned told that they took the decision after a technical committee's recommendation. The committee's advice came following reports of infections after receiving permanent birth control methods.
"It was a mistake to advise antibiotic after implant (a long-acting birth control method)," said Dr AKM Mahbubur Rahman, the line director of Clinical Contraception Services Delivery Programme, who signed the memorandum -- possesses a copy.
A investigation found the family planning authorities have no evidence about infections after simple procedures of vasectomy (for men) and tubectomy (women).
Field staff from different places confirmed that they did not submit any reports of infection among users of permanent methods – vasectomy and tubectomy -- to the directorate.
It is also learnt that the line director issued the letter even before a committee's meeting to decide on the antibiotic for each dose.
The memorandum instructed medical officers under the family planning directorate to give 14 pieces of Ciprofloxacin tablet twice a day for seven days. It also instructed them to give the tablets after surgical procedure.
Line director Mahbubur Rahman said it aims to prevent infection: "We took the decision following a national technical committee's recommendation."
'INCORRECT DOSAGE'
But pharmacologist Dr Md Sayedur Rahman of Bangabandhu Sheikh Mujib Medical University said the doses mentioned in the letter is "not correct".
"For preventive use, it's a single dose each day for a maximum 48 hours," he said. In case of infection after procedures, the staff should look into the instruments they used during those minor procedures, he said.
"There is no chance of infection if you properly sterilise the instruments, gauge and bandages," Dr Sayedur Rahman said. In minor surgeries, he added, a single dose of antibiotic is recommended just before the surgery.
He also criticised the choice of Ciprofloxacin since it is resistant to almost half the bacteria. "Do they have any assessment whether the antibiotic Ciprofloxacin will work?" he asked.
PROBLEMS IN DIRECTORATE
It is still unclear why the family planning directorate took the decision on immediate antibiotics, but an official (name withheld on request) told that it involves a huge contract for drugs. The directorate, the anonymous official said, has targets of ensuring over 0.4 million permanent methods in a year as part of its population control programme.
Line director Dr Rahman confirmed that they would buy Ciprofloxacin this year. But "I cannot say its cost right now," he said. "We will buy it along with other drugs."
Diverging with pharmacologist Dr Sayedur Rahman, he said, "Different antibiotics should be administered in different doses as preventive measure."
Not willing to produce any evidence of infections, he contended: "We have a shortage of doctors for family planning services. Nearly 800 posts are lying vacant. So we cannot do all procedures in clinics -- sometimes we set up camps where a doctor has to carry out 50 or 60 cases.
"In such situations, quality can be compromised (and) it increases the risk of infection."
He claimed that antibiotic was also used before 2000 when a director instructed not to use over 15 percent cases. "But after the instruction we saw a decline in permanent method receivers. Probably people did not come in fear of post-procedure infection."
According to the director, the decision to administer antibiotics was taken "after the technical committee's recommendation".
NO 'ILLOGICAL USE', PLEASE
Technical committee member Prof Md Ismail Khan, also head of Dhaka Medical College's pharmacology department, said he is opposed to any "illogical" use of antibiotics.
"I have recommended that antibiotics could only be used if there are proper evidence of infection," he said. "Sometimes we can use antibiotics to cut post-surgery infections cost."
Khan, however, did not want to comment when asked whether any evidence of infection has been placed in their technical committee meeting. "Ask the directorate for evidence," he said. "I am a technical person (and) I can only talk about technical aspect of drugs."
He reiterated that it is "illogical" to use antibiotics if aseptic measures can be taken before those procedures.
Prof Khan confirmed that they did not take any decision about which drug will be used in which form.
Another technical committee member (name withheld to protect identity since he is with the family planning directorate) said their field staff have never reported about infections from those who underwent permanent birth control methods.
He said a small committee had been formed to decide the antibiotic to be used, and its dosage. "But they issued the instruction before our meeting," he said.
He said Ciprofloxacin would not have been the choice if they could meet.
In reply, the line director maintained, "We have fixed the dose after discussing it with clinicians later."
He said, "We made the correction after an inadvertent mistake –giving the antibiotic after implant."
According to doctors, in implant a small, flexible tube is inserted under the skin in the inner upper arm. A simple procedure, it has little chance of infection.
In vasectomy, a permanent contraception method for men, a small cut it made in the skin of the scrotum, usually under local anaesthetic. Vas deferens that carries sperm to the penis are cut and tied or sealed with heat.
In female sterilisation, a small cut is made in the lower abdomen under local or a light general anaesthetic. The fallopian tubes are then cut and tied, or sealed or blocked, usually with clips.
Authorities concerned told that they took the decision after a technical committee's recommendation. The committee's advice came following reports of infections after receiving permanent birth control methods.
"It was a mistake to advise antibiotic after implant (a long-acting birth control method)," said Dr AKM Mahbubur Rahman, the line director of Clinical Contraception Services Delivery Programme, who signed the memorandum -- possesses a copy.
A investigation found the family planning authorities have no evidence about infections after simple procedures of vasectomy (for men) and tubectomy (women).
Field staff from different places confirmed that they did not submit any reports of infection among users of permanent methods – vasectomy and tubectomy -- to the directorate.
It is also learnt that the line director issued the letter even before a committee's meeting to decide on the antibiotic for each dose.
The memorandum instructed medical officers under the family planning directorate to give 14 pieces of Ciprofloxacin tablet twice a day for seven days. It also instructed them to give the tablets after surgical procedure.
Line director Mahbubur Rahman said it aims to prevent infection: "We took the decision following a national technical committee's recommendation."
'INCORRECT DOSAGE'
But pharmacologist Dr Md Sayedur Rahman of Bangabandhu Sheikh Mujib Medical University said the doses mentioned in the letter is "not correct".
"For preventive use, it's a single dose each day for a maximum 48 hours," he said. In case of infection after procedures, the staff should look into the instruments they used during those minor procedures, he said.
"There is no chance of infection if you properly sterilise the instruments, gauge and bandages," Dr Sayedur Rahman said. In minor surgeries, he added, a single dose of antibiotic is recommended just before the surgery.
He also criticised the choice of Ciprofloxacin since it is resistant to almost half the bacteria. "Do they have any assessment whether the antibiotic Ciprofloxacin will work?" he asked.
PROBLEMS IN DIRECTORATE
It is still unclear why the family planning directorate took the decision on immediate antibiotics, but an official (name withheld on request) told that it involves a huge contract for drugs. The directorate, the anonymous official said, has targets of ensuring over 0.4 million permanent methods in a year as part of its population control programme.
Line director Dr Rahman confirmed that they would buy Ciprofloxacin this year. But "I cannot say its cost right now," he said. "We will buy it along with other drugs."
Diverging with pharmacologist Dr Sayedur Rahman, he said, "Different antibiotics should be administered in different doses as preventive measure."
Not willing to produce any evidence of infections, he contended: "We have a shortage of doctors for family planning services. Nearly 800 posts are lying vacant. So we cannot do all procedures in clinics -- sometimes we set up camps where a doctor has to carry out 50 or 60 cases.
"In such situations, quality can be compromised (and) it increases the risk of infection."
He claimed that antibiotic was also used before 2000 when a director instructed not to use over 15 percent cases. "But after the instruction we saw a decline in permanent method receivers. Probably people did not come in fear of post-procedure infection."
According to the director, the decision to administer antibiotics was taken "after the technical committee's recommendation".
NO 'ILLOGICAL USE', PLEASE
Technical committee member Prof Md Ismail Khan, also head of Dhaka Medical College's pharmacology department, said he is opposed to any "illogical" use of antibiotics.
"I have recommended that antibiotics could only be used if there are proper evidence of infection," he said. "Sometimes we can use antibiotics to cut post-surgery infections cost."
Khan, however, did not want to comment when asked whether any evidence of infection has been placed in their technical committee meeting. "Ask the directorate for evidence," he said. "I am a technical person (and) I can only talk about technical aspect of drugs."
He reiterated that it is "illogical" to use antibiotics if aseptic measures can be taken before those procedures.
Prof Khan confirmed that they did not take any decision about which drug will be used in which form.
Another technical committee member (name withheld to protect identity since he is with the family planning directorate) said their field staff have never reported about infections from those who underwent permanent birth control methods.
He said a small committee had been formed to decide the antibiotic to be used, and its dosage. "But they issued the instruction before our meeting," he said.
He said Ciprofloxacin would not have been the choice if they could meet.
In reply, the line director maintained, "We have fixed the dose after discussing it with clinicians later."
He said, "We made the correction after an inadvertent mistake –giving the antibiotic after implant."
According to doctors, in implant a small, flexible tube is inserted under the skin in the inner upper arm. A simple procedure, it has little chance of infection.
In vasectomy, a permanent contraception method for men, a small cut it made in the skin of the scrotum, usually under local anaesthetic. Vas deferens that carries sperm to the penis are cut and tied or sealed with heat.
In female sterilisation, a small cut is made in the lower abdomen under local or a light general anaesthetic. The fallopian tubes are then cut and tied, or sealed or blocked, usually with clips.
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