Antibiotic abuse is a bane that must be addressed
Saturday, 6 November 2010
RESEARCHERS and specialist physicians were quoted, sometime in April this year, as saying that doctors in Bangladesh are found to prescribe far too many medicines, antibiotics in particular, and this is having an adverse impact on the health of the consumers. According to an ‘Antibiotic guide’, published by BSMMU (Bangabandhu Sheikh Mujib Medical University) some years back, people are having to pay a heavy price — both in terms of money and the long-term health impact on people — for the abuse or misapplication of antibiotics. Some 40 per cent of the total amount spent on medicines nationally is on account of antibiotics, and that amounts to more than Tk 40 billion (4000 crore).
This information has been gleaned from research findings of the Clinical pharmacy and pharmacology departments of two universities in Dhaka. The British Council-funded project is probably on-going. It is said to have selected six district hospitals from the country’s six divisions and is focusing primarily on antibiotic use and abuse. The preliminary findings are that 80 per cent of patients admitted to surgery, general medicine and pediatrics were administered antibiotics although in many cases it was quite unnecessary. The reason behind this, we are told, may not always be doctors’ callousness. Often the acute state of the patients in Bangladesh may lead even the best and well informed doctors to prescribe broad spectrum antibiotics cover rather than risk infection, although the other risk — of antibiotic resistance — is by no means small. At least one physician in Dhaka’s Apollo Hospital who was treating a friend for severe lung infection admitted he was giving multiple antibiotics because there was nothing else to do !
Antibiotic resistance in fact had developed into a global crisis decades ago as more and more pathogens proved smarter than the drugs when not used properly — at the right dose and duration. According to WHO, this fault is seen even in a developed country like the US where 25 to 30 per cent of hospital patients are given antibiotics although half of them don’t need the drugs at all! In August the media quoted a research paper in the The Lancet, which claimed that a new ‘superbug’, identified in some 50 cases in UK hospitals, was found to be resistant to even the most powerful antibiotics available. It is said to have entered the UK with National Health Service (NHS) patients who went abroad to countries like India and Pakistan for treatments like cosmetic surgery, according to a BBC health reporter. This superbug, experts say, can make an enzyme called NDM-1 which can exist inside other kinds of bacteria also, including E-coli, the bug that can cause nasty poisoning of people’s alimentary systems through food and drink. Can we identify this superbug if it comes visiting Bangladesh, or has it been with us already and is making the rounds now ? The nastiest ‘loose motions’ have been sighted lately. Rest and ORT prove good enough to tackle these bouts. Perhaps we are resilient even in this regard !
But scientists do fear this NDM-1 could ultimately take over other strains of bacteria that are already resistant to many antibiotics, producing unmanageable infections that could spread rapidly across the world from person to person. Similar infections have been seen in the US, Canada, Australia and the Netherlands. The subcontinent is obviously a hotspot given the general health and sanitation situation and common culture: there is little drug control; use of antibiotics is irrational; people can buy popular antibiotics over the counter and indulge in self medication, taking small doses and discontinuing treatment when they feel better !
NDM-1 makes the bacteria resistant even to one of the most powerful groups of antibiotics — carbapenems — which are usually reserved for emergencies to combat hard-to-treat infections caused by multi-resistant bacteria. Scientists fear it might go global in no time and advise tight surveillance, rapid identification of cases and isolating them, and most important of all, getting handlers to wash hands and disinfect equipment. New drugs are needed, they say, to keep this new menace down. In the meantime, it would be wise to subject patients to compulsory drug-sensitivity tests prior to prescribing any antibiotics. However, facilities for such tests are available only in a few selected urban labs and hospitals in Bangladesh, although the Alliance for Prudent Use of Antibiotics, established as part of the path-breaking New Drug Policy of the mid 1980s, has long been calling for caution. Twenty years after that, some enlightened physicians sought to revive the move to rationalize antibiotic use with the BMMSU’s relevant ‘Guideline’. Amazingly, many doctors, even in this institution, are reportedly unaware that such a guideline exists !
The above mentioned research team also revealed that health practitioners here are guilty of ‘poly-pharmacy’ or prescribing too many medicines simultaneously regardless of the side effects and the potential for harm. Given the fact that the population is largely unlettered and socially at the lower rungs compared to the status of the prescribing doctors, the latter most often can get away with insensitivity and abuse without risk to their practice.
All kinds of drugs, essential or otherwise, do get prescribed without so much as a ‘why’ or ‘what’ from the receiving end. Accountability is non-existent. What is most alarming is that some doctors are found to be quite liberal in prescribing anti-depressants and other related psychiatric drugs even for people who have had no such disorders. The result of this abuse might be an epidemic of doctor-induced mental disease, unless saner elements in the medical establishment put a stop to it. Pro-people health activists need to take up the issue forthwith, to institute mandatory monitoring of prescription drugs.
This information has been gleaned from research findings of the Clinical pharmacy and pharmacology departments of two universities in Dhaka. The British Council-funded project is probably on-going. It is said to have selected six district hospitals from the country’s six divisions and is focusing primarily on antibiotic use and abuse. The preliminary findings are that 80 per cent of patients admitted to surgery, general medicine and pediatrics were administered antibiotics although in many cases it was quite unnecessary. The reason behind this, we are told, may not always be doctors’ callousness. Often the acute state of the patients in Bangladesh may lead even the best and well informed doctors to prescribe broad spectrum antibiotics cover rather than risk infection, although the other risk — of antibiotic resistance — is by no means small. At least one physician in Dhaka’s Apollo Hospital who was treating a friend for severe lung infection admitted he was giving multiple antibiotics because there was nothing else to do !
Antibiotic resistance in fact had developed into a global crisis decades ago as more and more pathogens proved smarter than the drugs when not used properly — at the right dose and duration. According to WHO, this fault is seen even in a developed country like the US where 25 to 30 per cent of hospital patients are given antibiotics although half of them don’t need the drugs at all! In August the media quoted a research paper in the The Lancet, which claimed that a new ‘superbug’, identified in some 50 cases in UK hospitals, was found to be resistant to even the most powerful antibiotics available. It is said to have entered the UK with National Health Service (NHS) patients who went abroad to countries like India and Pakistan for treatments like cosmetic surgery, according to a BBC health reporter. This superbug, experts say, can make an enzyme called NDM-1 which can exist inside other kinds of bacteria also, including E-coli, the bug that can cause nasty poisoning of people’s alimentary systems through food and drink. Can we identify this superbug if it comes visiting Bangladesh, or has it been with us already and is making the rounds now ? The nastiest ‘loose motions’ have been sighted lately. Rest and ORT prove good enough to tackle these bouts. Perhaps we are resilient even in this regard !
But scientists do fear this NDM-1 could ultimately take over other strains of bacteria that are already resistant to many antibiotics, producing unmanageable infections that could spread rapidly across the world from person to person. Similar infections have been seen in the US, Canada, Australia and the Netherlands. The subcontinent is obviously a hotspot given the general health and sanitation situation and common culture: there is little drug control; use of antibiotics is irrational; people can buy popular antibiotics over the counter and indulge in self medication, taking small doses and discontinuing treatment when they feel better !
NDM-1 makes the bacteria resistant even to one of the most powerful groups of antibiotics — carbapenems — which are usually reserved for emergencies to combat hard-to-treat infections caused by multi-resistant bacteria. Scientists fear it might go global in no time and advise tight surveillance, rapid identification of cases and isolating them, and most important of all, getting handlers to wash hands and disinfect equipment. New drugs are needed, they say, to keep this new menace down. In the meantime, it would be wise to subject patients to compulsory drug-sensitivity tests prior to prescribing any antibiotics. However, facilities for such tests are available only in a few selected urban labs and hospitals in Bangladesh, although the Alliance for Prudent Use of Antibiotics, established as part of the path-breaking New Drug Policy of the mid 1980s, has long been calling for caution. Twenty years after that, some enlightened physicians sought to revive the move to rationalize antibiotic use with the BMMSU’s relevant ‘Guideline’. Amazingly, many doctors, even in this institution, are reportedly unaware that such a guideline exists !
The above mentioned research team also revealed that health practitioners here are guilty of ‘poly-pharmacy’ or prescribing too many medicines simultaneously regardless of the side effects and the potential for harm. Given the fact that the population is largely unlettered and socially at the lower rungs compared to the status of the prescribing doctors, the latter most often can get away with insensitivity and abuse without risk to their practice.
All kinds of drugs, essential or otherwise, do get prescribed without so much as a ‘why’ or ‘what’ from the receiving end. Accountability is non-existent. What is most alarming is that some doctors are found to be quite liberal in prescribing anti-depressants and other related psychiatric drugs even for people who have had no such disorders. The result of this abuse might be an epidemic of doctor-induced mental disease, unless saner elements in the medical establishment put a stop to it. Pro-people health activists need to take up the issue forthwith, to institute mandatory monitoring of prescription drugs.