Editor’s Note: In view of Antibiotics Awareness Week, which is November 13-19, 2017, guest columnist Iruka N Okeke, of the Faculty of Pharmacy in the University of Ibadan, unpacks the importance of antibiotics and the need to be cognizant of the steps we all can take to reduce antibiotic resistance, to ensure that these life-saving medicines remain active in the next generation.
On the surface, it is strange to observe ‘Antibiotic Awareness’ week as almost everyone on the globe is aware of antibiotics. Just like the hyper-recognizable Mickey Mouse, who debuted in 1928, the same year that penicillin was discovered, antibiotics are very well known. Mickey Mouse’s impact though is dwarfed by that of antibiotics, which are responsible for the phenomenal progress humans have made with controlling infectious disease, performing the most invasive and intricate surgeries in which most patients survive and even using what would have been ‘poisonous’ chemotherapeutics to battle cancer.
Antibiotics are powerful medicines that fight certain infections and can save lives when used properly. They either stop bacteria from reproducing or destroy them. Antibiotics have been used to stamp out what would have been economically devastating disease outbreaks on farms, contributed to drastic declines in terrible diseases like syphilis, yaws and trachoma and made it possible for us to understand how living things work. Take away all of this, and there would be little left to medicine and health care as we know it today. These advances have been remarkable, but all could be lost in a grim tomorrow because of a growing resistance to antibiotics.
One of the many activities happening in Abuja for Antibiotics Awareness Week was a walk organised by the NCDC. Photo credit: Nigeria Health Watch
Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic. This occurs when bacteria change in a way that reduces the effectiveness of drugs, chemicals, or other agents designed to cure or prevent infections. The bacteria survive and continue to multiply, causing more harm. Antibiotic resistance can cause illnesses that were once easily treatable with antibiotics to become dangerous infections. It can spread to family members, schoolmates, and co-workers, and may threaten your community. Antibiotic-resistant bacteria are often more difficult to kill and more expensive to treat. In some cases, the antibiotic-resistant infections can lead to serious disability or even death. It has been called one of the world’s most pressing public health problems.
Although some people think a person becomes resistant to specific drugs, it is the bacteria, not the person, that become resistant to the drugs.
One of the most alarming facts about antibiotic resistance is that it is biologically inevitable. All living things, bacteria included, change their genomes spontaneously, without warning. Most times the results of these changes are undetectable or deleterious but sometimes they can cause something that we will notice: like previously susceptible bacterial strains being able to evade a powerful antibiotic. As un-empowering as this chance switch to resistance is, it rarely leads to real consequences unless human beings muddy the water. In short, the antibiotic resistance epidemic we have now is not a clinical inevitability but a consequence of human choices and actions. Every time you use an antibiotic, you give a genetically altered resistant bacterium a chance to thrive and outcompete sensitive bacteria that would normally have subdued it. This may be worth it if you are dying of a bacterial infection and there is no other route to your recovery. But if there is nothing of the sort wrong with you, then taking that antibiotic is a careless mistake at best, or the beginning of another chapter in the tragedy of antibiotic resistance.
GIF Courtesy: WHO
The key to avoiding an antibiotic resistance catastrophe is conserving these cheap but powerful drugs for only the instances when we have no alternative and to reducing the burden from infectious disease so that those ‘no alternative’ moments become fewer and fewer. In Nigeria and other countries like ours, where infections are shockingly common, dealing with roadblocks to safe water supply, vaccine access, food safety and sanitation are key to improving the quality and expectancy of life, as well as for conserving antibiotics. Also, health professionals need better tools to help them pinpoint true bacterial infections and more reliable drug supplies to treat them rapidly and effectively the first time.
What can the ordinary citizen do to make sure that antibiotics will be available for our next generation?
- Take care of yourself and your family to avoid infections. Just keeping clean, eating right and getting the right vaccinations can go a long way to ensuring your overall wellness with the added benefit of containing resistance
- Discourage inappropriate use of antibiotics in health and agricultural settings
- If you are ill, Think Twice, Seek Advice. (And if you are a health professional, educate and equip yourself to give the best advice possible).
- When you are offered a diagnostic test, have it done so that your caregiver can use its results to better inform your therapy. Overall, even when tests appear expensive, the cost of using them is far lower than the accumulated costs from resistance.
- If your health profession says that your signs, symptoms and test results show that an antibiotic won’t help, don’t insist on getting them or procure these drugs from an unauthorized source. If you have a viral infection or a non-infectious condition, no matter how ill you feel, antibiotics won’t help.
- Take the Quiz
- And now that you have the right brief, 13 – 19 November 2017 is World Antibiotic Awareness Week: Find an event near you #AntibioticAwarnessWeek and tell someone else about antibiotic resistance and the growing threat from bacteria and other microbes. Let them know that if we do the right thing, catastrophe could be averted.
Image Courtesy: WHO
To learn more about activities happening around the world for Antibiotics Awareness Week, click on the infographic above.
Antibiotic Awareness is everyone’s concern; Yours and Mine.
The greatest misusers of antibiotics are health workers. The traditional culture of using the simplest, cheapest and narrowest spectrum antibiotic effective for a diagnosed infection seems to have been all but forgotten. This discipline reserves the most expensive, often more toxic drug for the last (third) line of defence against infection. It also stresses a carefully thought out preliminary choice while awaiting the results of culture and sensitivity tests from laboratories. There is need to provide such laboratory services widely in our country. Pharmacists need to remember that antibiotics are not for over-the-counter purchase.
Although there is a small but essential place for prophylactic antibiotic therapy, it is being inappropriately used in the lazy adoption of antiseptic instead of the greater efforts needed for aseptic methods. Then the idea is to use the most modern, greater spectra drugs in the mistaken attitude that they are “not taking any chances.” Young people do not need them as prophylaxis in virus infections unless their immunity is compromised, say in AIDS.
Many health workers are yet to realise that antibiotics by themselves cannot close faecal fistulae, or heal a chronic ulcer. The tragedy is the young consultant who should be the nidus for teaching the proper use of antibiotics is deeply steeped in the malpractice in many places.
We need many CPD workshops which stress the proper use of antibiotics and re-introduce the discipline of antibiotic prescription. Increased culture facilities and grasp of the principles of prescription may hopefully lead to reinforced confidence in avoiding panic prophylactic prescriptions, disappearance of antiseptic mindset and adoption a more comprehensive approach to aseptic medical practice.
We cannot as a Nation afford to loose our antibiotics developed through rigorous and costly research to poorly regulated usage that give rise to antibiotics resistance. The pains and loss are too costly for any nation particularly for such public health infectious diseases as HIV / AIDS and TB. It is really worrisome that cases of drug resistant TB are on the rise in our country presently. Everyone particularly government, healthcare professionals, patients and civil society organizations should be involved in the fight against Antibiotics Resistance because it affects everyone.