E-DRUG: The Threats of Bacterial Resistances
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My main cause for writing this piece is to request e-drug members to share their experiences and any success stories used to ward-off bacterial resistance in their respective countries that would help to justify the seriousness of the problem and suggest a pragmatic solution to countries that are extensively endangered with the threat. I am providing the following background information in order for e-drug members to appreciate my cause.
Until the early 1900s, people were suffering and dying from trivial and curable ailments. Thanks to those scientists who had devoted their resources to invent antibiotics that saved the life many. Today, we are in the post-antibiotics era where majority of those killer ailments that were considered to be unimaginably curable and/or preventable are within a human control and manipulation.
Therefore, it is clear that antibiotics save life; are great weapons to fight different bacterial infectionsand so are one of the most commonly prescribed medications to treat infections both simple and life-intimidating ones. However, in order to obtain such benefits they must be prescribed, dispensed, and used cautiously and smartly. Otherwise, it is a usual phenomenon for some bacteria to become resistant to antibiotics which adds a challenge to the medical practice. When resistance emerges, antibiotics become disarmed and rendered ineffective which gives the bacteria the opportunity to reclaim its power and strength to cause infection by winning the fighting.
Dear e-drug members, antibiotic resistance emerges with multifaceted and interrelated impacts on the public health. It brings cost to both the patient and the country and compounds the treatment complexities and challenges because doctors are pressed to look for a medication that is unsafe and at the same time, may not be cost effective. Bacterial resistance to antibiotics also denies and/or narrows treatment options, spreadsresistant strains that have no known alternate treatment, and raise a global problem concern.
Though, I realize the paramount importance of a comprehensive research work in order to substantiate my statements, I have the general belief that the extent and depth of bacterial resistance to be of a serious threat in the developing world and to be more specific, in countries liked Ethiopia. Why? Based on my practical observation and experience, I have identified the following facts as major attributing factors:
- Overprescribing of antibiotics by doctors: doctors in developing countries lack diagnostic facilities and testing laboratories within their health care settings or for that matter, within a reasonably reachable geographic distance. This creates a stumbling block that drives doctors to prescribe antibiotics under conditions of uncertainties. As a rule of thumb, they are commonly seen prescribing combination antibiotics to avoid the risk of patients' death due to missed examination and diagnosis. They heavily rely on the philosophy that if one antibiotic misses the target the other will hit it. And it is not uncommon to see doctors prescribing antibiotics for trivial infections such as common colds and coughs because it is sometimes hard and confusing to reach a conclusion based on signs and symptoms and physical examinations as to whether the infection is caused by a virus or bacterium or both.
- Lack of clearly defined prescribing privileges.The doctor-patient ratio is way far from the accepted standard. As a result, all health care professional (Health Assistants, Nurses, Medical Doctors, Specialists) have, more or less, the same privilege to prescribe antibiotics regardless of their seniority, specialty, and level of qualification and whether they are working in the lower or upper tiers of the health care system.
- Dispensing without prescription: in Ethiopia it is not only possible to obtain antibiotics without prescription but also is easy to get the quantity requested, frequently at sub-optimal doses. It is most common to observe antibiotics being dispensed without prescription from pharmacies, drug stores, and rural drug vendors that are operational retail outlets in the country. So, this is an obvious potential source of inappropriate antibiotic use which ultimately leads to the emergence of resistance.
- Inappropriate use by Patients: there are documented facts that have evidenced a wide misuse of antibiotics by the general public. I myself together with my colleagues undertook two research works that addressed the perception and patterns of community medication use by visiting a house to house. What we generally observed were serious problems, some related to the level of education and consciousness; others related to cultural, religious and traditional beliefs; some related to inadequate counseling and information; and while others were related to low socioeconomic conditions. Shortly put, the research works have signaled that there is a lot to be done to change the community's perception and drug use patterns and the situation is complex that demands concerted efforts from every stake holders.
- Failure to respect professional responsibilities and ethical standards. I recognize the fact that many of the health care professionals including the pharmacists are providing services to the public by respecting their professional responsibilities and ethical standards. However, it would be reasonable to reflect the reality that there are some health care professionals who are not valuing their profession. For example, while providing education and counseling to the public remain to be the main domains of pharmacists' responsibilities, it is unfortunate to see some greedy individuals whose main goal is making money while risking others lives.
I came across the information that different countries are taking different measuresto improve the situation and prevent the emergence of resistance consequent to inappropriate use through concerted regulatory actions because they are alarmed by the impacts of the situation. For example, the U.S.A is addressing the issue using an Interagency Task Force: the US Centers for Disease Control and Prevention, the National Institutes of Health(NIH) and the Food and Drug Administration(FDA). This reflects a political willingness from the government side and as a result, there is a directive that provides a guidance to prescribers as to how, who, what, and when is appropriate to prescribe an antibiotic. What I observed in the U.S.A is that obtaining a prescription for antibiotics is not easy unless otherwise it is evidenced and supported by diagnostic and lab tests.
I was also impressed by the initiatives of the Alliance for the Prudent Use of Antibiotics (APUA) which is playing a leading role in this area with a mission 'to strengthen society's defenses against infectious disease by promoting appropriate antimicrobial access and use and controlling antimicrobial resistance on a worldwide basis by conducting antimicrobial resistance research, education, capacity building and advocacy at the global and grassroots levels'.
Apparently, it is not easy to replicate the US system to developing countries because they are lacking resources to develop such a program and establish diagnostic facilities and lab tests. Unlike the American doctors, the doctors in developing countries are not in a position to identify the strains and prescribe a specific antibiotic. Instead, they tend to solely rely on physical examination and a combination of antibiotics therapy. I think it is essential to undertake a Cost-Benefit Analysis in countries like Ethiopia to determine the costs and impacts of the two sides of matter: establishing approachable diagnostic facilities and lab tests versus the impacts of bacterial resistance.
So now, what I would like to ask members of the e-drug is to share their experiences regarding the issue of antibiotic resistance; how other developing countries are dealing with and handling the problem; and any success stories that would help replicate to countries like Ethiopia.
Thank you so much
Gidey Amare
Ethiopian and RPh US Based.
gideyam@yahoo.com