Education of doctors and patients is the key to rational use. Doctors should understand their role to conserve antibiotics and use them wisely. Patients should understand antibiotics are not required in the majority of trivial infections and not demand them from doctors and pharmacists.
Come November each year, the spotlight falls on a very pertinent health related issue- namely Antibiotic Resistance ( AMR). During this month a special Antibiotics Awareness Week ( starting November 13-19) is observed where increased global awareness of antibiotics- especially, their harm to human health caused by over usage leading to ( AMR) is raised worldwide.In a rapidly antibiotics dependent society an increasing number of patients have come to rely heavily on antibiotics for even a minor viral infection like a cold or cough on which they have no effect. Simple home remedies like a hot soup or coriander water or gargle and bed rest, is often not their chosen option. Even medical practitioners have been found guilty of prescribing antibiotics for such minor ailments either due to ignorance or some personal gains from pharmaceutical companies providing these drugs.
Admittedly, the benefits of antibiotics in fighting bacterial infections are impressive. But, they need to be prescribed with caution and proper treatment protocols must be followed with regular follow up by the physician prescribing them.
Former President of the Sri Lanka College of Microbiologists and Senior Lecturer of Microbiology, University of Colombo, DR ENOKA COREA tells us how antibiotics should be taken and when, and spells out easy to follow guidelines that should be considered when taking them.
Excerpts from an interview with the Sunday Observer…
Q. Microbiologists will come together to observe World Antibiotics Awareness this week ( November 13 to 19.) For our readers’ benefit tell us what antibiotics are and why we need to raise more awareness about them globally?
A. Antibiotics are medicines we take to fight bacterial infection. With the advent of the antibiotic era in the 1950s serious infections such as, bacterial meningitis, pneumococcal pneumonia or tuberculosis became amenable to treatment. However, these gains have been lost as more and more bacteria have developed resistance to antibiotics. This means, infections with these resistant bacteria are difficult to treat resulting in more complications or even death.
Q. What do antibiotics do to safeguard human health?
A. Antibiotics, when used rationally and carefully, are able to reduce illness and death due to bacterial infections.
Q. Do antibiotics fight viruses or bacteria related diseases or both?
A. Antibiotics are only effective against bacteria. They are not necessary in viral infections as they will not have any effect.
Q.Are there different types of antibiotics? I understand there are four types.
A. There are more than four groups of antibiotics such as, penicillins, cephalosporins, tetracyclines, macrolides, etc. They have different chemical structures and act on different site of the bacterium.
Q. Antibiotic resistance is an emerging health issue. Just as much as antibiotics fight infection, overuse can also harm a person. Your comments?
A. Unnecessary use of antibiotics, such as in viral infections, exerts selective pressure on resistant bacteria to multiply and spread, exacerbating the problem of antibiotic resistance. Unnecessary use of antibiotics will also cause harm to the person taking the drug as there may be side effects (such as diarrhoea) and even toxic effects due to the drug. Antibiotics may also interact with other medications the person is taking and make them ineffective or the combination may be toxic.
Q. How do you evaluate treatment protocols to prevent antibiotic resistance?
A. There are published guidelines on which type of infections required antibiotic treatment, which antibiotics are required in each instance and the dosage and duration of antibiotic treatment. Doctors should follow these guidelines when they prescribe antibiotics.
Q. What about pregnant women? Do you recommend antibiotics for them? If so at what time of pregnancy and for what kind of infections?
A. Some antibiotics can cross the placenta and have harmful effects on the baby. Therefore, these antibiotics are contraindicated in pregnancy. However, there are other groups of antibiotics that can be used safely in pregnancy if the pregnant woman gets a bacterial infection such as, a urine infection.
Q. Certain patients have a habit of repeating the same drugs over and over again by using the same prescription given them earlier instead of visiting their physician to get it renewed. Can this practice endanger their health? How?
A. The antibiotics recommended for one infection may not be effective in another infection. For example, antibiotics given to treat a urine infection may not be effective for a lung infection. Therefore, it is not correct to use the same prescription for another infection. Most pharmacies will not dispense drugs on an old prescription, especially, antibiotics.
Q. Some patients also don’t complete their prescribed course of antibiotics, and stop halfway when they feel well. Can an under dose of prescribed antibiotics harm them?
A. It is recommended that a whole antibiotic course is completed as prescribed so that the bacteria are completely eliminated from the body. If you stop the antibiotics too early, before the bacteria are eradicated, resistant strains can start to take over and the infection may recur. This recurrence will be more difficult to treat and may need stronger and more expensive antibiotics.
Q. Children? Do you prescribe antibiotics for infants, toddlers and children under 5 years?
A. Most antibiotics can be used safely in children. However, the doses must be adjusted depending on the weight of the child. There are some antibiotics that can damage the growing bones and teeth and these are contraindicated in childhood.
Q. Can antibiotic resistant bacteria cause infection in children too?
A. If antibiotics are inappropriately used in any community, bacteria in that community will gradually become resistant to these antibiotics When these antibiotic resistant bacteria spread in the environment and between people, they can cause infections in both children and adults.
Q. What are the long term consequences of irrational antibiotic usage to human health?
A. Long term irrational antibiotic use will result in an increase in the spread of antibiotic resistant bacteria in the community. They will replace the other bacteria and become the predominant strains. Therefore, most infections in the community will be caused by these resistant bacteria. Such infections will become difficult or impossible to treat and will result in higher mortality due to infections.
Q. What are the gaps you see in the current system of prescribing antibiotics? Explain in detail.
A. When a patient visits a doctor he/she expects the doctor to prescribe some kind of medication, even for something trivial like a viral cold or cough. Therefore, doctors feel compelled to prescribe antibiotics even when they know it will not be useful. We need to educate the public that many infections, especially, viral infections will get better on their own within a few days and that drugs are not required and may, indeed, be harmful.
Doctors, too, should spend more time explaining to patients about their illness so that the patient is reassured that drugs are not required.
Q. Do you think there should be more regulations on antibiotic prescription or are those existing sufficient but need more teeth to implement them?
A. The regulations clearly state that antibiotics should be dispensed only on a current prescription and should not be available ‘over-the-counter’. Although it used to be quite easy to obtain antibiotics without a prescription some time ago, pharmacies are much stricter about implementing the regulations now. This is a great improvement.
Q.The Infectious Diseases Society of America has been campaigning for rapid anti biotic approval for a limited patient population to treat serious or life threatening infections with few treatments or no adequate existing treatment. Your comments?
A. Such novel treatments will be very expensive and completely out of reach of our patients. It is far better to conserve the resources we have and use antibiotics carefully so that we can retain their effectiveness.
Q. What priority do you give to the role of education on antibiotics , why they are used and how they should be used to help the community at large?
A. Education of doctors and patients is the key to rational use. Doctors should understand their role to conserve antibiotics and use them wisely. Patients should understand that antibiotics are not required in the majority of trivial infections and not demand them from doctors and pharmacists.
Q. Your message to the public?
A. Antibiotics are not effective against viral infections like colds or the flu. Antibiotics are a precious resource and need to be conserved and used carefully and wisely. Taking antibiotics when they are not needed results in bacteria becoming resistant to them. This puts your children and future generations at risk of untreatable infections. Never take antibiotics without a prescription. Try to prevent bacterial infections by following good hygienic practices such as washing hands regularly, eating food that is hygienically prepared and drinking boiled cooled water.