Bishnu Poudel

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Published On: March 17, 2019 12:05 PM NPT By: Bishnu Poudel

Antibiotics don’t work for everything

Antibiotics don’t work for everything

 

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Having flu, cold, tonsillitis or any common upper respiratory difficulties and reaching out to a pharmacy. The chance is higher that one is prescribed with azithromycin (A macrolide antibiotics) or similar other antibiotics. Some patients self prescribe antibiotics for immediate recovery. However the bitter truth is, antibiotics cannot cure viral illnesses which includes sore throats (pharyngitis), coughs, colds and runny noses (rhinitis), sinus infections, respiratory tract infections (sinusitis, bronchitis), the flu (influenza virus) and many more. Viral illness does not necessarily require special medication as the patient’s own immune system flush out the virus within a certain time. One can only take medications for symptomatic treatment such as ibuprofen or acetaminophen to relieve fever and body aches.

For example, if the tonsillitis is caused by a bacterial infection, the doctor will prescribe antibiotics. Antibiotics will not be prescribed for a normal viral case of tonsillitis. However, people take azithromycin in every case of tonsillitis either suggested by the medical shop or self-prescribed.

Taking antibiotics without doctor’s prescription or self-administrating antibiotics unnecessarily for treatment of normal viral illness is a good example for increment in antibiotic resistance.

Antibiotic resistance is a phenomenon whereby bacteria are able to withstand the effects of an antibiotic and get adapted to the particular effect. Over-exposure to a particular antibiotic allows the bacteria to build its defenses against the chemical. In the worst-case scenario, there may be no antibiotics left that can cure the infection hence the situation can be life-threatening.

Alexander Fleming’s penicillin (The first broad-spectrum antibiotics) discovery in 1928 cultivated a new era of medicine in the world that could fight bacterial infection. During the 1940s, penicillin was finally commercialized as a drug worldwide. In recent years, several microbial infectious diseases are no longer responding to commonly used antibiotics. Recent research on antimicrobial resistance in Nepal states “Well-known antibiotics such as Ampicillin, metronidazole, amoxicillin, cotrimoxazole, chloramphenicol, ciprofloxacin, nalidixic acid, gentamicin, and ceftazidime are currently ineffective to several microbial diseases because their resistance pattern has been elevated in recent years”.

 According to a journal by American College of Obstetrics and Gynecologists, Neisseria gonorrhea (Bacteria that cause sexually transmitted diseases, gonorrhea) has developed resistance to the sulfonamides, the tetracycline, and penicillin. Ceftriaxone and oral azithromycin is only recommended ‘last-resort’ dual therapy for the treatment of gonorrhea. No obvious drug is left to use against gonorrhea if these antibiotics fail.

In the context of Nepal, inadequate research, insufficient surveillance system, lack of appropriate policy and poor publications regarding the use of antibiotics and its resistance pattern has hindering to understand the exact scenario. Few research and published literature are not abundant. 

According to WHO, the leading causes of premature mortality from infectious diseases in Nepal include lower respiratory infections, diarrheal diseases, and tuberculosis, while bloodstream infections, urinary tract infections and sexually transmitted infections caused by resistant organisms are on the rise. Commonly used antibiotics used against these infections no longer work.

Addition to deadly health risks, antibiotics resistance also puts a heavy financial burden on patients and their families. Increased resistance against certain types of bacteria prolongs the illness, cost of additional tests, treatment, hospitalization, along with a risk of dying from the infection.

The US Centers for Disease Control and Prevention (CDC) considers antibiotic resistance one of their top concerns. A report from Public Health England predicts “By 2050 antimicrobial resistance will cost up to $100 trillion and kill approx 10 million people around the world each year”

Not only humans, livestock and poultry are also becoming immune to certain drugs because of the extensive abuse of antibiotics by farmers who self-administer the drugs. The US Food and Drug Administration (FDA) has proposed a ban on certain antibiotics at sub-therapeutic levels in animal feed understanding of the potential for compromising the health of humans.

Although Nepal now has a law against antibiotic additives in feed, the ban is not effective because of the open border with India. Numerous studies in Nepal have detected the residue of antibiotics (Ampicillin, tetracycline, and Penicillin) in poultry and its connections with the human food chain.

Consuming antibiotics kill the useful bacteria residing in our digestive system (Gastrointestinal system) which helps in digestion of the food. Killing the useful bacteria and strengthening the harmful bacteria is what we promote with overuse and irrational use of antibiotics. Medicating children with antibiotics unnecessarily is far sensitive and dangerous Time has come to those general populations to understand the consequences and change the trend.  If urgent steps are not taken in time antibiotic resistance can turn into a pandemic which could devastate a country like Nepal which already has weak health infrastructure.

A massive global public awareness campaign is a must to raise the voice against antibiotics misuse. Unnecessary use of antimicrobials in agriculture and their dissemination into the environment has to be reduced. Increasing coverage of vaccines can be an alternative to reduce antibiotic use. “Antibiotics only with prescription” policy has to be enforced. Pharma companies should take the lead to aware the people through mass and media. Adequate counseling should be provided while dispensing the antibiotics to the patients by the pharmacies. All the directions should be followed and a full course of antibiotics should be taken as recommended by the physician. It’s now time for collective actions.

(Poudel is a Public health professional)

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