The education of doctors and patients is the key to rational use. Doctors should understand their role in conserving antibiotics and using them wisely. Patients should understand that antibiotics are not required in most trivial infections and do not ask doctors and pharmacists.
In a rapidly-dependent antibiotic society, an increasing number of patients have relied heavily on antibiotics for even a minor viral infection such as a cold or cough on which they have no effect. Simple home remedies like hot soup or coriander water or gargling and bed rest are often not their chosen choice. Doctors have also been found guilty of prescribing antibiotics for such minor ailments due to ignorance or some personal gains from pharmaceutical companies supplying these drugs.
Of course, the benefits of antibiotics in fighting bacterial infections are impressive. However, they should be prescribed with caution and appropriate treatment protocols should be followed with regular follow-up by the prescriber.
The 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 explains how to follow the guidelines to be taken into consideration when taking them .
Excerpt from an interview with the Sunday Observer …
D. Microbiologists will meet to observe antibiotic awareness in the world this week (November 13 to 19). For the benefit of our readers, tell us what antibiotics are and why do we need to raise awareness about them globally?
A. Antibiotics are drugs that we take to fight bacterial infection. With the advent of antibiotics in the years 50 serious infections such as bacterial meningitis, pneumococcal pneumonia or tuberculosis have proved to be susceptible to treatment. However, these gains have been lost as more and more bacteria have developed antibiotic resistance. This means that infections from these resistant bacteria are difficult to treat resulting in more complications or even death.
Q. What do antibiotics do to protect human health?
A. Antibiotics, if used rationally and carefully, are able to reduce the disease and death due to bacterial infections.
Q. Do antibiotics fight viruses or diseases related to bacteria or both?
A. Antibiotics are effective only against bacteria. They are not necessary in viral infections as they will have no effect.
Q. Are there different types of antibiotics? I understand that 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 sites of the bacterium.
D. Antibiotic resistance is an emerging health problem. Just as antibiotics fight infections, overuse can also harm a person. Your comments?
A. The unnecessary use of antibiotics, as in viral infections, exerts a selective pressure on resistant bacteria to multiply and spread, exacerbating the problem of antibiotic resistance. The unnecessary use of antibiotics will also cause harm to the person taking the drug as there may be side effects (such as diarrhea) and even toxic effects due to the drug. Antibiotics can also interact with other drugs that 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 types of infections require antibiotic treatment, which antibiotics are required in each case and the dosage and duration of antibiotic treatment. Doctors should follow these guidelines when they prescribe antibiotics.
D. And pregnant women? Do you recommend antibiotics for them? If so, what time of pregnancy and what kind of infections?
A. Some antibiotics can cross the placenta and have harmful effects on the baby. Therefore, these antibiotics are contraindicated during pregnancy. However, there are other groups of antibiotics that can be used safely in pregnancy if the pregnant woman has a bacterial infection as a urinary infection.
D. Some patients have the habit of repeating the same drugs over and over again using the same prescription given before instead of visiting their doctor to get them renewed. Can this practice endanger their health? Such as?
A. The antibiotics recommended for an infection may not be effective in another infection. For example, antibiotics administered to treat a urinary 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 on antibiotics.
D. Some patients also do not complete the prescribed cycle of antibiotics and stop halfway when they feel well. Can a lower dose of antibiotics be prescribed to damage them?
A. It is recommended that an entire antibiotic cycle be 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, the resistant strains can start to take over and the infection may reoccur. This recurrence will be more difficult to treat and may require stronger and more expensive antibiotics.
Q. Children? Do you take antibiotics for babies, small children and children under 5?
A. Most antibiotics can be used safely in children. However, the doses should be adjusted according to the weight of the child. There are some antibiotics that can damage growing bones and teeth and these are contraindicated during childhood.
Q. Can antibiotic-resistant bacteria also cause infections in children?
A. If antibiotics are used inappropriately in any community, the bacteria in that community will gradually become resistant to these antibiotics. When these antibiotic-resistant bacteria spread in the environment and among people, they can cause infections in both children and adults.
Q. What are the long-term consequences of the use of irrational antibiotics for human health?
A. The use of long-term irrational antibiotics 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 increased mortality due to infections.
Q. What are the gaps you see in the current antibiotic prescription system? Explain in detail.
A. When a patient visits a doctor, he expects the doctor to prescribe some kind of medication, even for something as insignificant as a cold or a viral cough. Therefore, doctors feel compelled to prescribe antibiotics even when they know it will not be helpful. We need to educate the public about the fact that many infections, especially viral infections, will improve by themselves in a few days and that the drugs are not necessary and could be harmful.
Doctors should also spend more time explaining their illness to patients so that the patient is reassured that the drugs are not required.
Q. Do you think there should be more regulations on prescribing antibiotics or the existing ones are 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 was once quite easy to get antibiotics without a prescription some time ago, pharmacies are much more reluctant to implement the regulations now. This is a great improvement.
Q.The Infectious Diseases Society of America has campaigned for rapid biotic approval for a limited population of patients for the treatment of serious or life-threatening infections with few treatments or no appropriate treatment. Your comments?
A. These new treatments will be very expensive and completely out of reach of our patients. It is much better to conserve the resources we have and to use antibiotics with care so that we can maintain their effectiveness.
Q. Which priorities do you give to the role of antibiotic education, why are they used and how should they be used to help the community in general?
A. The education of doctors and patients is the key to rational use. Doctors should understand their role in conserving antibiotics and using them wisely. Patients must understand that antibiotics are not required in most trivial infections and do not require them from doctors and pharmacists.
D. Your message to the public?
A. Antibiotics are not effective against viral infections such as colds or flu. Antibiotics are a valuable resource and must be stored and used carefully and wisely. Taking antibiotics when they are not necessary leads the bacteria to become resistant to them. This puts your children and future generations at risk for untreatable infections. Never take antibiotics without a prescription. Try to prevent bacterial infections by following good hygiene practices such as washing your hands regularly, eating food prepared hygienically and drinking chilled boiled water.