The urgent need ‘to change the way we prescribe and use antibiotics’

Many of us take modern medicine for granted, not giving a second thought to being prescribed a pill to make us feel better. But scientists and doctors are warning that this luxury may soon be a thing of the past if we don’t start behaving more responsibly when we’re ill.

“Without urgent action we are heading for a post-antibiotic era in which common infections and minor injuries can once again kill,” the World Health Organization has warned.

The most worrying aspect of antibiotic resistance is that almost all the damage is being done by the patients themselves; those who self-diagnose and self-prescribe might render antibiotics useless before scientists have had a chance to create new ones.

People taking antibiotics when they don’t need them, taking them incorrectly, and not finishing the course are allowing bacteria to become resistant to some of the most common forms of antibiotics. There have been no major new forms developed over the last 30 years and resistance to certain ones is growing. Illnesses such as pneumonia, tuberculosis and gonorrhoea are already becoming harder to treat.

The UAE’s record for misuse of antibiotics is not a good one, and the blame is often primarily put on the pharmacists caught selling them over the counter and without a prescription.

A 2014 report printed in the British Journal of Applied Science & Technology described over-the-counter sale of prescription-only medicines in Abu Dhabi as “endemic”.

David Achanfuo Yeboah and Tracey Maree Yeboah, the authors, state: “while the health authorities assert that it is a law enforcement issue, other respondents agree that there is an inherent and underlying element of professional ethics for pharmacists.”

A survey of 131 people also revealed worrying trends: nine out of 10 said they regularly bought prescription medicines without a prescription, and only one of the 131 said a pharmacist had refused to sell them the medicine because they didn’t have a prescription.

“In my opinion, the incorrect use of antibiotics is very common, globally and here in the UAE,” says Dr Harpreet Sani, consultant and head of family medicine at Healthpoint in Abu Dhabi. “In the UAE, it is against the law to sell antibiotics without a doctor’s prescription, but pharmacies are still selling them to people over the counter. It is big business.”

Probably the most common misconception about antibiotics is that they are a catch-all medicine that work against any bugs. They don’t. They are completely ineffective against viruses, which are the main causes of the common cold, flu, sore throats and, sometimes, ear infections.

When antibiotics are required – when the infection is bacterial and not viral – it is important to be prescribed the right kind. Amoxicillin, a type of penicillin, will treat different bacteria to ciprofloxacin, a variety of the fluoroquinolone antibiotic, for example.

“There are many different types of antibiotics and some are specific for certain types of bacterial infections,” says Sani. “Without the correct diagnosis, patients can end up buying the incorrect type of antibiotics, rendering it useless. There are also risks associated with antibiotics. They can cause damage to the liver for example, kill the body’s good bacteria, and interact with other medications.”

Sani says there is still a lack of awareness about the safe use of antibiotics, and when people buy them over the counter, they haven’t received adequate information from physicians or the pharmacists on how to use them safely.

“Physicians are often under time pressure and do not spend long enough explaining how antibiotics work, how they should be taken and potential side effects,” she says.

As well as making us feel better, antibiotics can also come with some uncomfortable side effects such as diarrhoea and bloating, because they kill all bacteria, including the good ones that help keep yeast fungus under control, so some people may develop a yeast infection.

A more serious complication is clostridium difficile (C diff), which can occur when the large intestine is rid of the good bacteria, creating an environment in which C diff bacteria can spread. It causes swelling and irritation of the colon, known as colitis, and can even be fatal.

Over-the-counter probiotics can help mitigate the nasty effects of taking antibiotics.

It is also important to consider the effects an unprescribed antibiotic might have on any other medications a person is taking, or vice versa. Certain penicillin antibiotics, for example, can affect birth control pills or blood thinning drugs.

It is essential to read the instruction label of any medication to know whether it should be taken before or after food, for example, because this can affect how quickly it is absorbed into the body.

Another common issue is people stopping the course of antibiotics too early, not fully killing the bacteria and giving the remaining ones the chance to become resistance. When prescribed a course, it is essential to finish it, even if the antibiotics appear to work sooner.

The WHO says in Europe alone, drug-resistant bacteria cause about 25,000 deaths every year, and cost more than US$1.5 billion (Dh5.5bn) in healthcare expenses and losses in productivity.

“The world urgently needs to change the way we prescribe and use antibiotics,” it says. “Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat.”