By Mohamed Haji: @Mwhaji.
An elderly relative was taken ill a while ago. She broke her shoulder after a fall and was in a lot of pain. She was recuperating at home after her shoulder was traditionally mended by a well regarded traditional doctor but while she was recovering well she was still in excruciating pain and was on painkillers. She always tells me about her pain and resultant insomnia and she was on paracetamol which was giving her little relief.
On one of her days when we were about to finish our telephone conversation she said something that interested me; she said her pain was considerably better because she has taken ‘’capsules’’. On close examination I found this infamous ‘’capsule’’ to be Flucloxacilline she bought from one of the local pharmacies. I asked how much she is taking and how she feels when she takes it. She said she feels nothing but relief and sleeps relatively well when she takes a piece or two. This patient was presumably ‘cured’ by a placebo effect and antibiotics are certainly not painkillers.
This elderly lady is at risk on many fronts; the antibiotics she is taking as a painkiller could present some side effects which could prove fatal. It could also lead to the killing of the good bacteria in the intestine and the growth of bad bacteria such as Clostridium further reducing her already compromised natural immunity.
Some antibiotics may cause infections in some women, may result in diarrhea, belly cramps and fever which sapping her energy further weakening this elderly patient. The elderly lady and those who provided her the medication are certainly oblivious of all these unintended consequences. Compounding all these is the heightened risk of antibiotic resistance.
Antibiotics are medicines designed to treat bacterial infections such as tuberculosis, pneumonia and septicaemia. They include the commonly known tetracycline, ampicillin, amoxicillin and various others that are designed to fight specific bacteria-type by either killing the bacteria or paralysing its potency hence stopping it from reproducing. Infections usually come in the form of fever and as the body’s immune response may be overwhelmed, clinicians may on rare occasions prescribe antibiotics.
Less than 100 years after the discovery of penicillin, the efficacy of antibiotics as a magic wand could come to an end due to a hazardous and rapidly emerging danger. Bacteria are quickly becoming resistant to most antibiotics.
There is a scary proliferation of resistant bacteria that has emerged over the decades such as Multi-Drug Resistant Tuberculosis (MDRT), Multi-Resistant Staphylococcus Aurous (MRSA) and dozen others. The treatment of sexually transmitted infections (STI) such as penicillinase-producing Neisseria gonorrhea is becoming a challenge. This prevalent STI has developed resistance to penicillin and the broad spectrum ampicillin and its growing resistance to the affordable and widely available tetracycline is worrying. This picture is widespread.
Contributing factors to the growing trend of resistant bacteria include rampant misuse of antibiotics. I remember when I was growing up, tetracycline and other antibiotics locally called ‘capsules’ were sold over the counter by off licenses and other shops often to ‘treat’ sore throat or common cold. It was usually sold not in doses but in pieces and consumed like painkillers, often shared between friends and family members just as you would expect people to share paracetamol (Panadol) although sharing of any medication should be discouraged.
The community was not oblivious to this danger and all sorts of comedies were created around the prolific use of antibiotics but then again it did not deter the misuse of these very important drugs. I vividly remember comedians mocking communities’ misuse of ‘capsules’ by parodying that antibiotics were weighed in kilos for people with headache and common cold. We did not know and many people do not still know that common cold is a viral infection and antibiotics do not treat viral infections. This was subtle but clever way of educating the society against the dangers of antibiotic misuse but unfortunately all was lost in the comedy.
A people interested in the superfluous tidbits of life often find difficult to read between the lines and hence the antibiotic debate was lost in translation. People had no access to qualified clinicians but the drugs were available in the high-street shops and kiosks and hence self-medication and over the counter selling of these prescription-only medicines was widespread. This in my opinion is the beginning of the anti-bacterial resistance menace that is spreading like a wild fire.
Other factors driving the anti-biotic resistance apocalypse is said to be the uncontrolled and often unregulated use of the drugs. Pharmacies are also selling antibiotics over the counter, often for simple ailments such as a routine headache. People who visit hospitals expect their physicians to prescribe antibiotics in the form of tablets or as injections. Most patients pressure doctors and clinical officers to prescribe antibiotics without which they believe their conditions will not improve. Some doctors had to resort to injecting unsuspecting patients with water just to make them leave the clinic.
The statistics are grim; 90% of doctors have felt under pressure to prescribe antibiotics, 70% of clinicians prescribe antibiotics when they are unsure of whether they are treating a viral or bacterial infection. 49% of practitioners prescribe antibiotics once a week or more without knowing whether they are medically necessary or not and 44% of doctors have prescribed antibiotics to get a patient leave the hospital or surgery. While many of the health professionals succumb to the patients’ demand others decline on points of personal and medical principle. However, the clinicians who decline to prescribe antibiotics still have to contend with high street pharmacies who sell the drugs with neither a doctor’s consultation nor prescription. Those operating private clinics often find themselves in a cul-de-sac as they want patients to come back to their clinics and those not prescribed antibiotics often get dissuaded hence loss of business.
The wanton disregard of protocol by these pharmaceutical shops will add to the growing menace of anti-microbial resistance. Another worrying trend is the use of antibiotics in livestock. In the US they are used more in livestock than in humans partly as growth promoters. The chicken and meat we eat in junk food restaurants is usually injected with antibiotics. This gives bacteria another opportunity to learn and develop its resistance mechanism. Every time we take an antibiotic, a bacterium adapts and develops a new resistance method.
According to Lord Jim O’Neill, Chair Review on Antimicrobial Resistance and the Commercial Secretary to the UK treasury, antibiotic resistance will cost the world trillion dollars and 10 million lives every year in the near future.
More worrying, there are no new antibiotics been developed to replace those rendered useless by bacterial resistance. The last set of new antibiotics has been discovered more than 30 years ago. One of the biggest drug companies in the world spent a billion dollars on antibiotic research but has not produced a single new drug. It takes about 10-15 years and about a billion dollars to make a new drug. Big Pharmaceutical companies are increasingly getting cautious of this cost given the high rate of drug failure often at their last stage of development.
As bacteria grow exponentially, every time we take an antibiotic it presents a new opportunity for a new resistant strain to emerge that renders the antibiotic almost useless. This raises a scary scenario where patients with bacterial infections may not experience any relieve in symptoms or the treatment of diseases such Tuberculosis, pneumonia and blood infections become more challenging. Alexander Flemings who discovered the ‘wonder drug’ penicillin has identified Staphylococci that were resistant to penicillin just after his discovery and predicted misuse of antibiotics will lead to clinical failure in the future. That dreaded future is now with us.
While a coordinated global response is required to what is an urgent health challenge, our counties ought to take the front-line in introducing mitigating measures to stop the spreading of resistant bacteria. Health authorities in the country and those in the counties should promote education and information on the dangers of the emerging bacteria that is increasingly getting adept at manipulating antibiotics.
We must urgently address and take steps to fight against the misuse of these important medicines. Proper guidelines and strict regulations should be put in place. Educating the society on antibiotic prescriptions and their narrow and particular efficacy is a priority. A formal process for doctors and clinical officers on antibiotics’ prescription protocol is urgent and could be enforced by an oversight body given the rapid spread of resistant bacteria and rampant misuse of antibiotics. Mass information on the uses of antibiotics and active discouragement of their misuse must be prioritized. It’s vital to inform the public on the dangers of misusing antibiotics or self-medicating. Substantial penalties for rogue pharmacies selling antibiotics without prescriptions should be instituted and regulation on the sell and prescription of the drugs strengthened.
Haji is a social commentator and Nepjournal columnist. Follow him on twitter @Mwhaji.