Dr. Birat Khanal

Medical Officer, B & C Hospital, Jhapa, Nepal.

 Introduction

Antibiotics, also called antibacterials, are a type of drug used in the treatment and prevention of bacterial infections. They may either kill or inhibit the growth of bacteria. Sometimes the term antibiotic (which means “opposing life”) is used to refer to any substance used against microbes, synonymous with antimicrobial. Some sources distinguish between antibacterial and antibiotic; antibacterials are used in soaps and disinfectants, while antibiotics are used as medicine.

Prescribing Antibiotics

Presently antibiotic medicines are prescribed as a part of counter medications mainly in developing societies. Doing so is malpractice than a false practice. This practice has caused great concern to society in general and the health sector in particular. We are rather delayed for realizing the harm of misusing of antibiotics. There are serious harms of antibiotic medicine one such is resistance.

Resistance

Various researches and reports reveal that there is an increase in resistance against the use of antibiotics. The patients as well seem reluctant to use antibiotic medicines. However for the quick relief and recovery antibiotics are prescribed frequently, sometimes not considering long term effects upon the health. The questions may be raised that why does it take long time to recover from various kinds of illness in hospitals without its use? Those questions would strike upon the mind of common people and the doctors as well.

Reasons behind Misuse

Why antibiotics are commonly used or misused? Who is the culprit behind it? The answer may lie deep down within. Antibiotics may not be so bad for all the times. But improper use such as either more or less of doses, patient’s failure in using doses for the prescribed period and given times may obviously affect to the patient.  Time and again patients use less than prescribed doses because of ignorance of the effect and inability to pay for all the prescribed doses. On the other hand pharmaceuticals and pharmacies as business entities often price them high, and beyond affordability of poor patients. Hence, the poor patients use less than prescribed doses. The worse in a scenario is the number of pharmacies or uncertified drug sellers would sell antibiotics without prescription of certified medical professionals. Usually, they sell it at the verbal request of the patient. The big hazard lies over there. This indicates that fault lies in both sides of the coin.

Apparent Difficulties

The sale of antibiotics without prescription has created difficulties to the hospital doctors as well. Patients who were either under dosed or received half or part of the course usually develop resistance against various bugs. These patients suffer because bugs alter the mechanism of action of the antibiotics and develop resistance towards them. These bugs develop immunity against the antibiotic and the treatment becomes harmless towards them. Generally speaking, patients usually develop resistance towards the common oral antibiotics. However, research reports indicate that resistance towards antibiotics with higher efficacy and even intravenous antibiotics may appear. This makes the treatment difficult in hospitals. Recovering from it becomes a daunting task and treatment becomes costly.

Various investigation measures such as CRP, Cultures, thorough blood counts and many more should be followed to isolate these resistant bugs. Because finding the right bug causing illness is essential in order to make the right choice of antibiotic to kill them. The killing of these bugs under a treatment regime may take longer period for inpatient treatment. Indeed the process is both lengthy and costly.

Pharmacy staffs prescribing medicines know the consequence of misusing antibiotics, including its   resistance and hazards. Despite it many of them do not hesitate to prescribe antibiotics. The motives behind this are not crystal clear though it could be of limited knowledge on the impact of the use of antibiotics and interest of sell, as they sell in the higher cost.  On the other hand the fault lies in the patients and their relatives as well, who prefer medicine prescribed by the pharmacies and not the drugs prescribed by doctors. My interaction with the OPD and Emergency ward patients indicates that they buy antibiotics from pharmacies in order to avoid long waiting queues to see a doctor in the hospital.

The working people today have hardly any spare time to keep in waiting in hospital queues for regular checkups. Buying antibiotics form pharmacies makes them good alternative to save time. The antibiotics prescribed by pharmacies with higher efficacy give quick relief at the starting point. Once they feel better or relieved patient usually stop consuming the given antibiotics before the end of course. Use of antibiotics lesser than its required course is the major reason behind resistance. Later on when they try the same antibiotics it shows no improvement. Antibiotics by now have no more effect on the bugs which have developed resistance against it. After this people visit to hospitals in fear of not recovering. At this stage doctors have to undergo for extensive investigations before prescribing any antibiotics. The proper diagnosis is a precondition for prescribing antibiotics.  Judging for the right type and right amount of antibiotics is critical for any doctor at this stage of treatment. In order to eliminate bugs from human body proper antibiotics should be prescribed for given duration.

Conclusion

In order to mitigate the problem strategic increase in public awareness about the benefit and harm of using antibiotics is vital.  Awareness rising via mass media, advocacy, campaigning, organized political and other assemblies and orientation to the school and college students could be a useful tools to this end. This could be of great help for the generations to come. Indeed the task is daunting so requires good efforts on right time to end the malpractice.

Irrational use of antibiotics invites undesirable consequences for patients, their family, society, doctors and the future generation as well. The increased level of resistance may lead to an epidemic. Proper steps should be taken by the responsible agencies to control this malpractice, without further delays. The strict application of law is required in order to punish those involved in this malpractices.

In the recent times antibiotics is the main stay of treatment against major illness. Resistance of bugs towards it cannot be underestimated. Larger extent of antibiotic resistance today may suffer the future generations. So, it is better to act now than to regret later.