Antibiotic abuse is fatal : More Lankans now at risk - study

By Carol Aloysius

It is an undisputed fact that antibiotics help save lives. Family doctors and specialists usually prescribe them as an effective treatment to those common bacterial infections that attack our bodies. While the outcomes in most cases are successful, the tendency for a growing number of patients to self medicate themselves with an overload of drugs, in the hope of a quicker recovery of some infection, without consulting their doctor, has led to Antimicrobial Resistance (AMR.,) now an increasing health concern globally, and in Sri Lanka.

Health personnel have warned that inappropriate or misuse of antibiotics, e.g., using them for minor viral infections, such as, a common cold or diarrhoea, could have negative outcomes,and could lead to Antibiotic Resistance which can put the patient’s life at risk and even have fatal results. The Sunday Observer spoke to Consultant Physician and Emeritus Professor of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Prof Gita Fernando, for more insights into this emerging health issue.

Excerpts…

Q: There has been a growing concern over antibiotic resistance globally and in Sri Lanka. How big is this problem in 1) the world 2) in Sri Lanka?

A. Antimicrobial Resistance (AMR) is a serious threat to public health globally. In Sri Lanka too research carried out shows such increase in resistance in hospital and community settings. Development of AMR hinders effective treatment of a variety of infections caused by microorganisms such as bacteria, viruses, parasites and fungi.

Q: Many people are still unaware of the meaning of antibiotic resistance. How would you describe it in layman’s language?

A. AMR is resistance of a microorganism to an antimicrobial drug which was originally effective for treatment of infections caused by such microorganism. When organisms develop resistance they are able to withstand attack by antimicrobial drugs such as antibiotics. Antibiotic resistance refers specifically to resistance to antibiotics that occurs in common bacteria causing infection-e.g.

Resistance to infections caused by other microbes as well, including parasites (e.g. malaria), viruses (e.g. HIV), fungi (e.g. Candida, a yeast)

Q: Why are bacteria becoming resistant to antibiotics today? Is it a recent phenomenon or something that has developed over the years?

A. Bacteria develop resistance due to many reasons including: inappropriate or misuse of antibiotics by health care personnel; inappropriate use which includes irrational prescribing of antibiotics by some doctors, inappropriate dispensing practices of pharmacists, misuse of antibiotics by patients and the general public, such as self medication.

AMR has developed over the years; resistance to various diseases.

Tuberculosis, malaria, HIV infection are examples of resistance developing to microbes causing chronic diseases; Multi drug resistant tuberculosis (MDR- TB) is a long standing problem observed globally as well as in Sri Lanka.

Resistance to antibiotics given for common acute bacterial infections including urine infections, pneumonia occurs in all parts of the world.

Q: Who are most at risk, age wise, gender wise and population wise?

A. AMR can occur in men, women and children of any age. The elderly and those having immune deficiency are more vulnerable to development of resistance. Mortality is high if such persons develop acute infections such as blood stream infections (septicaemia). Death may even occur.

Q: Do you see this more in urban communities or in rural populations? Why?

A. It is seen in both urban and rural populations. It may be more in urban populations as antibiotic use may be higher in urban settings. Community based research studies have indicated this. In Sri Lanka, there are only a few community based studies and more such studies need to be carried out to ascertain and quantify this problem. Hospital based laboratory research done by Consultant Microbiologists in different parts of the country has shown increasing patterns of resistance to common bacteria.

Q: What are the causes? Overuse of drugs?

A. Inappropriate or misuse of antibiotics: giving/using antibiotics when not needed e.g. for viral infections such as, a common cold, diarrhoea; using incorrect dosage regimens, using drugs for inappropriate duration such as patients stopping drugs when symptoms improve without taking full course prescribed by doctor; self medication by patients/public.

Q: Can pre-existing diseases like diabetes etc and the use of different drugs for such diseases also lead to adverse reactions from antibiotics?

A. In diabetes, resistance to infection may be lowered. Hence, if such patient develops bacterial infection, antibiotics must be started early to prevent the worsening of infection. Interactions to antibiotics due to use of other drugs can occur in any individual, not only in diabetics or chronic disease.

Q: Do genes play a role in the degree of risk factors?

A. AMR can occur due to resistant genes in bacteria which can be transmitted from person to person.

Q: What are the early symptoms of antibiotic resistance? How do you detect them?

A. AMR should be suspected if symptoms of an infection does not improve despite receiving appropriate course of antibiotics. This should be confirmed by relevant investigations such as blood tests, X rays, e.g: in pneumonia chest X ray would show non improvement of infective changes in the lungs.

Q: Is antibiotic resistance a problem of concern only in a hospital setting?

A. AMR occurs in both hospital and community settings.

Q: What is the role of antibiotics in controlling upper and lower respiratory tract infections including community acquired pneuomonia?

A. Antibiotics are indicated in lower respiratory tract infections such as community acquired pneumonia, but not in upper respiratory tract infections (URT) as URT infections are mostly caused by viruses.

Q: What is the solution to this problem?

A. AMR can be prevented by concerted action by all stakeholders, including health professionals such as doctors, pharmacists, nurses, policy makers and the public. Our recommendations include: prescribers should use antibiotics only when needed; pharmacists should not prescribe antibiotics as they are ‘prescription only drugs’, only certified health personnel should prescribe; patients/ public should use full course of antibiotics, avoid self medication, do not share antibiotics with others or use leftover drugs. Nurses and policy makers must also enhance infection prevention and control in hospitals, and promote hand washing to prevent transmission of bacterial infection. Health professionals should provide information to the pubic regarding the impact of AMR, its prevention, role of the public in preventing AMR; policy makers should promote regulatory control to prevent AMR

Q:What about antibiotic allergies? Can one die of antibiotic allergies?

A. Yes, severe allergy or anaphylaxis following antibiotic use can be fatal. So the patient needs to be rushed for treatment to the nearest hospital.

Q: What is the usual treatment procedure for an antibiotic overdose?

A. Consult a doctor for advice.

Q: Many children suffering from fever are now being overdosed by parents with paracetamol and antibiotics when they don’t need them.

At present dengue is on the rise and many parents overdose their children with paracetamol and antibiotics even when they have a slight fever or cold, hoping they will recover quickly. What are the adverse health results that this could have on the young patient?

A. Let me first emphasize this point: Antibiotics are NOT recommended for dengue fever. On the other hand, overdose of paracetamol will cause harmful health results in patients suffering from dengue or other viral fevers. Only the dosage regimen recommended should be given.

Q: Your message on the golden rules of antibiotic use to parents and the public in general.

A. Antibiotics are not indicated for viral infections and if misused will lead to antibiotic resistance. Avoid self medication. Wash hands regularly to prevent transmission of resistant bacteria.