Heavy use of antibiotics is blamed for stronger pneumonia strains

Over-prescription and self medication are increasing resistance to treatment against pneumococcal diseases in the UAE.

ABU DHABI // Easy access to antibiotics is being cited as an important cause behind the rising resistance of pneumonia cases to treatment.

The increased tenacity of what experts call "the forgotten killer" is attributed to self-medication and the over-prescription of antibiotics such as penicillin and amoxicillin.

"Many clinics and medical centres are using antibiotics freely and this has increased resistance over the years," said Dr Anwar Sallam, a consultant paediatric pulmonologist and deputy chief medical officer at Mafraq Hospital. "Almost anyone who walks into these centres can almost always walk out with antibiotics."

Dr Sallam was speaking ahead of World Pneumonia Day, which is today.

Dr Ghada Yahya, senior regional officer of communicable diseases at the Health Authority-Abu Dhabi (HAAD), said that only invasive forms of pneumococcal infection have been officially reported since last year, but the authority has put in a formal request to make sure that all incidents and forms of the infection are directly reported.

"A number of studies have shown the massive impact of over-prescribing antibiotics to patients," she said. "And HAAD is developing strict regulations to combat this."

Last month, HAAD said it has begun work on the first antibiotic resistance surveillance system.

HAAD's antibiotic resistance surveillance system aims to protect the populace from developing immunity to the drugs. The system is supposed to be fully functional by 2012.

Pneumonia mostly affects children under 5 and adults over 65. Figures from the World Health Organization show that 5 per cent of deaths among children under age 5 in the UAE are caused by pneumonia.

A study by Sheikh Khalifa Medical City (SKMC) and Mafraq Hospital published in July showed that the incidence of pneumococcal disease among the country's children was far higher than in the West before the introduction in the UAE four years ago of a vaccine against seven strains of the bacteria that can lead to pneumonia.

The rate in Abu Dhabi alone stood at 185 cases per 100,000 children, compared with 72 per 100,000 in the US and 42 per 100,000 in Great Britain.

Dr Mohamed Al Howidi, a paediatric consultant at Mafraq Hospital, said a new study is under way to measure progress since the vaccine was introduced.

"Preliminary research shows that the number has dropped drastically," he said.

However antibiotic resistance continues to be a significant problem.

"The use of antibiotics without good reason definitely has an impact," he said. "You find physicians prescribing medication right and left. And while we have put regulations in place, it is still out of control."

Most pneumonia cases are viral and do not respond to antibiotics, Dr Sallam said, adding that bacterial infections tend to increase as the winter season kicks in. The most common type of viral infection that can result in pneumonia is influenza. Docotrs recommend that the influenza vaccine be given to children each year until they are 12.

"If there is no undue deficiency in the individual's immune system, the body can fight it off naturally," he said. "However, a viral infection can develop into a bacterial infection if the immune system is not strong enough to combat the virus."

If the illness is only at a viral stage, patients should not be using antibiotics, Dr Sallam said. Other methods could be used to boost the immune system.

"The individual may need supplemental oxygen or IV fluids," he said. "But no specific antiviral medication would be administered to the patient."

At that point it is the doctor's responsibility to monitor the case. If it progresses into a bacterial infection, then antibiotics are prescribed accordingly.

Legally, antibiotics should be available only with a doctor's prescription. However, many patients self-medicate from pharmacists who are willing to break the law.

A study carried out last year by Haad found 68 per cent of 510 antibiotic sales in Abu Dhabi pharmacies were done without prescriptions.

An infectious disease usually starts with the colonisation of the pneumococcal bacteria in the respiratory tract, said Dr Nawal Al Kaabi, a consultant in paediatric infectious diseases at SKMC. The same bacteria can cause meningitis and sepsis, but nearly half of all cases result in pneumonia.

In advanced stages of the illness, fluid can collect in the respiratory tract, requiring a surgical procedure to drain the lungs. Antibiotic resistance coupled with highly prevalent risk factors among the UAE population, such as diabetes and heart disease, increase the chance of adults developing the disease, Dr Al Kaabi said.