Low density lipoproteins carrying cholesterol – (LDL cholesterol); this is often referred to as ‘bad cholesterol’ as it is mainly involved in forming a cholesterol rich fatty deposit in blood vessel wall

High density lipoproteins carrying cholesterol – (HDL cholesterol); this is often referred to as ‘good cholesterol’ as it may actually prevent fat deposition in blood vessels

Why is high cholesterol bad?

High cholesterol in blood can get deposited in blood vessel walls that supply blood to the major organs such as heart or brain resulting in poor blood circulation to these organs. At a site where cholesterol is deposited in a blood vessel, a blood clot can form which can give rise to a heart attack or a stroke. Such disease are known to be a main cause of hospital deaths in 91´«Ã½.

Who should have blood cholesterol tested?

It is advisable for all persons aged 40 years or more, those of any age with a strong family history of early heart disease or stroke, and persons of any age with a family history of a hereditary lipid (cholesterol) disorder to have blood cholesterol tested. If you are found to have a high risk of developing heart disease or stroke, you will usually be advised to take drugs to lower your cholesterol and other lipids.

What factors affect the blood level of cholesterol?

In most people, cholesterol level reflects the amount of fat that you eat. However, different people who eat the same amount of fat can have different amounts of cholesterol. In general, if you eat less fat, your cholesterol level is likely to go down. In some, a high cholesterol level may be due to predisposing conditions. For example those having an underactive thyroid gland, persons who are obese or drink too much alcohol as well as those with rare kidney and liver disorders are likely to have raised blood cholesterol levels. In some, a very high level of cholesterol runs in the family due to an inherited genetic problem. One such problem is called Familial hypercholesterolaemia.

Do all people with a high cholesterol level need treatment?

Treatment is needed only for people at a high risk of developing a cardiovascular disease. They include:

• People at higher risk of cardiovascular disease due to presence of multiple risk factors or familial hypercholesterolaemia
• Patients with existing cardiovascular disease such as those who had a heart attack or gets angina
• Diabetes
• Those with kidney disorders

Can diet lower cholesterol level?

Changing from an unhealthy diet to a healthy diet can reduce cholesterol level. However, dietary changes alone rarely lower the cholesterol level adequately to alter the risk of cardiovascular disease from a high risk to a lower risk category.

What drugs are given to reduce cholesterol and how should they be taken?

A group of drugs called statins usually lowers blood cholesterol level. Drugs of this group include, atorvastatin, simvastatin, rosuvastatin available in several brand names. They work by blocking an enzyme (chemical) which is needed to make cholesterol in the liver. These drugs are taken once a day, ideally in the evening at about 5-6 pm. But, if you forget to take the drug at that time, take it later on at night.

Statins are usually well tolerated. Doctors will usually check your liver function after you started these drugs, as some patients can develop abnormalities of liver function. They can also cause muscle pain and if you experience any muscle or body pains, you must inform your doctor. Once treatment is started, your lipid profile will be repeated in about 2 months to check whether cholesterol level has reduced satisfactorily. If not, the dose may be increased. Rarely, additional drugs may be needed to reduce cholesterol if the level is very high. Once you achieve good control, doing regular cholesterol testing is not necessary.

Apart from drugs to reduce cholesterol, do I need any other treatment?

If you are at high risk of developing a cardiovascular disease, then following treatment may be given along with advice to tackle any lifestyle issues.

– Anti hypertensives are recommended if your blood pressure is raised
– A daily low dose of aspirin may be given depending on your age and other factors. Aspirin helps to prevent blood  clots formingon patches of cholesterol deposits inside blood vessels
– Where relevant, the following will also help:

• stopping smoking,
• eating a healthy diet with higher fruit, vegetable, fish intake and reducing fatty food and salt intake
• keeping your weight and waist to ideal levels
• taking regular physical activity such as walking
• reducing intake of alcohol if you have been drinking too much alcohol

Professor Priyadarshani Galappatthy
MBBS, MD, Dip Med Tox(Cardiff), FRCP (Lond), FCCP
Consultant Physician and Professor in Pharmacology
Faculty of Medicine
University of Colombo

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Antibiotics are used mainly for treatment of infections caused by bacteria. They act either by stopping the multiplication of bacteria or killing bacteria. Hence, an adequate dose of antibiotics should be given at appropriate intervals to achieve this purpose.

It is important to use antibiotics only if they are necessary. They should not be used for treatment of viral infections such as common cold or viral diarrhoea. These are self-limiting and will not benefit by the use of antibiotics. Selection of antibiotics is based on how effective the drug is on a particular bacterium. Thus, they should only be used when prescribed by a doctor. Inappropriate use of antibiotics leads to the problem of antimicrobial resistance (AMR). As a result some antibiotics may become ineffective when used for certain bacterial infections. AMR is a global problem.

To reduce resistance the following are recommended.

• Use antibiotics only if indicated; avoid self-medication
• Use the correct dose for the appropriate duration. Follow the doctor’s advice about the correct dosage regimen
• Do not stop antibiotics early when you feel better; take the full course recommended
• Do not keep any remaining antibiotics at home and such antibiotics should not be given to any other person
• Look at the expiry date when purchasing
• Do not use antibiotics for prevention of bacterial infection except in specific instances to be decided by your doctor

Reactions of Antibiotics

Antibiotics such as penicillins are known to cause allergic or hypersensitivity reactions. These reactions could be either mild or severe. Mild reactions include itching, urticarial rash and swelling round the eyes. If an allergic reaction develops, stop the antibiotic immediately and consult your doctor. Severe reactions may be life threatening and need immediate treatment in hospital. Such reactions comprise difficulty in breathing, low blood pressure and the patient may even collapse. Inform your doctor, if you have developed allergic reactions to penicillin or any other antibiotic earlier, so that an alternate antibiotic can be given. Ask your doctor about adverse effects and precautions.

How to use Antibiotics

Antibiotics are mainly given orally or by injection depending on the severity of the infection. For children, antibiotic suspensions are given. These are available as powder for reconstitution. Usually, pharmacists prepare the suspension. However, if the pharmacist does not prepare it, ask the pharmacist about the correct method of preparation and administration. Once reconstituted the suspension must be stored properly, ask for advice regarding storage from the pharmacist. Some antibiotics such as erythromycin and oral penicillin should be given before meals to increase absorption. Ask your doctor about administration of antibiotics in relation to meals. In pregnant women only some antibiotics are considered to be safe, whereas others may be harmful to the unborn child (fetus). Please obtain information from your doctor about the safety of antibiotics in pregnancy.

Examples of commonly used antibiotics include: amoxicillin, cloxacillin, benzylpenicillin, co-amoxiclav, erythromycin, ciprofloxacin, cefalexin, and tetracycline.

Written by Professor Gita Fernando MBBS, MRCP (UK), FRCP (Lond), FCCP
Consultant Physician and Emeritus Professor of Pharmacology
Faculty of Medical Sciences
91´«Ã½
Cited from Patient Information on Commonly Used Medicinal Drugs, Medicinal Drugs Committee, 91´«Ã½ Medical Association, 2016

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Antibiotics Guidelines from 91´«Ã½ College of Microbiologists

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