ANTIBIOTICS: A WORD OF CAUTION

A WORD OF CAUTION ON THE USE OF ANTIBIOTICS
INTRODUCTION
Antibiotics are medicines that are used to cure infections. The term antibiotics was first used in 1942 by Walksman to describe substances that were produced by small or microscopic organisms, which destroy or prevent the growth of other microorganisms in high dilution. Before their discovery, serious infections by bacteria or other organisms led invariably to death.
Sir Alexander Fleming, a Scottish physician discovered the first antibiotics-penicillin in 1928. Since that discovery, many other antibiotics have been discovered and their numbers are now very large . With modern technology, many of these medicines are now generated from synthetic processes and not of micro-organism in origin again and are now better known as antimicrobials. For the purpose of this write up, I shall use the term “ antibiotic for anti-microbial. Some antibiotics we are familiar with include: Ampicillin, Ampiclox, Chlorophenicol, Gentamicin, Rocephin, Peflacin, Tetracycline, Septrin, Streptomycin, Erythromycin, Indocid, etc.
We are all familiar with different antibiotics and how useful they are when we suffer from infections. The introduction of antibiotics after the first world war changed the course of medicine and it remains one of the giant strides in medical practice. Diseases that were initially fatal are now conquered by the use of these “magic bullets”.
In the past 50 years, people both in developed and developing world have accepted antibiotics as their right to obtain a prescription at the first sign of trivial infection or treat themselves with a handful of cheap antibiotics.
We cannot conceive a return to the pre-antibiotic days, yet the unbridled use of these agents in man and animals is inexorably propelling us in that direction.
Misuse of Antibiotics:
Data from World Health Organization (WHO) shows that 20% of antibiotics use are in the hospitals while 80% are in the community. Antibiotics prescribing is rising in primary care. Most patients that visit hospitals will not feel that they have been treated unless they have been given antibiotics by their doctors. Some patients, who feel disappointed by their doctors, simply stroll to the nearest pharmacy to pick antibiotics for themselves. The areas of misuse of antibiotics are many. Some examples will suffice.


(a). In upper respiratory tract infection like cough, catarrh and sore throat.
It has been known for many years that antibiotics modify the course of most sore throat only slightly if at all. Nevertheless, antibiotics are often prescribed despite accumulating evidence from clinical trials that they are of no benefit.
The widespread use of antibiotics has resulted in the increasing recognition of the damage it does to the normal respiratory environment. Many works by the doctors have shown that the use of antibiotics for common cough, catarrh and sore throat results in more serious infections of the lower respiratory tract like pneumonia.
Because patients expect antibiotics, they are usually given antibiotics, by the doctors. The pressure is on the doctor to do something for the patients.
(b) In the gut and alimentary system e.g. Diarrhea. In children, most diarrhea are caused by viruses, which do not respond to antibiotics. Even in adults, viral infections cause diarrhea. The indiscriminate use of antibiotics, to treat diarrhea causes more problems for the patient. The antibiotics may actually prolong the diarrhea by causing damage to the cell of the gut.
(c) Skin infections.
Infections on the skin, which are not spreading, do not require antibiotics. The use of antibiotics may cause problems in other parts of the body. Applying certain antibiotics to the skin may sensitize the individual to the antibiotics and thus cause hypersensitivity reaction to the antibiotics when used to treat more serious infections.
(d) Urinary Tract Infection
Patients usually start themselves on antibiotics at the slightest sign of urinary tract infection even without seeing doctors. Some patients take antibiotic capsule before engaging in risky sexual behavior. This double the risk of masking the signs and symptoms of infections and also generate resistant strains of bacteria. This is one reason for the rampant cases of infertility.
(e) Poor Compliance in the Use of Antibiotics
Even though patients demand for and are given antibiotics, by their doctors, it is known that many patients, do not take their medicine as prescribed. Six hourly medicines may be taken twice a day. There are cases of patients who take the entire daily dose at once to avoid the inconvenience of proper dosing.
Patients are also prone to discontinuing their medicine at the slightest sign of improvement in symptoms. Medicines that should be taken for 1 week may be taken for only 2 or 3 days. The effect of this is to generate resistant bacteria, which will not respond to these antibiotics.
Without doubt, antibiotics prescribing and use in human must prudent. The misuse or abuse of antibiotics remains a major threat to public health. Both patients and doctors must reduce their expectation.
The pressures on both patients and doctors are easily understood.: An anxious parent, a sick child, and a doctor faced with diagnostic uncertainty. The solutions are not straightforward. Patients must be educated that most infections do not require antibiotics, that they may actually be harmful to them and their families ( through their effect on beneficial bacteria in the body) and to the society at large (through encouraging resistance).
All this requires considerable effort and time, not easily achieved in a five minutes consultations. We must remember that when we use antibiotics freely, we create resistance i.e the bacteria are no more killed by the antibiotics because they become used to them. Infections become more dangerous.
The WHO is today embarking on worldwide campaign on rational use of antibiotics. As patients, let us not go to the clinic expecting to get an antibiotic for every sickness. As for doctors, they should think and be sure that an antibiotic is actually necessary before they prescribe them. A word is enough for the wise.