16 Sep 2009

Antibiotics used too readily

You hear about MDR- and XDR-TB patients, and reports are doing the round about resistance to Tamiflu – one of the few drug we have against swine flu. But is all the talk about ‘superbugs’ just a scare-tactic, or is it really something to be afraid of?

There is a global increase in bacterial resistance to antibiotics, and we are increasingly seeing the emergence of 'super bugs', or bacteria that are resistant to all available antibacterial medications. The implications of antibiotic resistance are immense, making it more difficult to treat infections, and increasing the costs of medication, hospitalisation and rehabilitation.

Dr Elsa Badenhorst, medical advisor at Mediscor PBM, explains that antibiotic resistance is the ability of a micro-organism to resist the action of antibiotics. She says such resistance is in large part the result of the misuse and overuse of antibiotics.

In the human body, antibiotics not only attack the bacteria causing the illness, but also eliminate competing susceptible micro-organisms that usually help keep the resistant strain under control. This results in more resistant micro-organism that in turn requires a more powerful antibiotic to combat it.

Prescribed too regularly
Antibiotics have also been prescribed too readily, and some doctors have used them as antibacterial prophylaxis, for example, to prevent a possible lung infection or for a patient with a viral infection such as influenza. She says that many doctors have been prescribing medications that are too powerful, while other may also have used them for the incorrect duration of time, or in the wrong dosages.

“Antibiotics should only be used when they are really needed,” she advises. “They are effective in treating bacterial infections, but not viruses such as your everyday colds and flu, which usually run their course on their own. And they should only be used for more serious illnesses and infections.”

She says that more serious infections may include pneumonia, and wound and skin infections. Severe ear and sinus infections also need to be treated with antibiotics. The golden rule is that the infection must have a strong element of bacterial infection if it is to respond to treatment with antibiotics. This is where proper diagnosis is vital and doctors need to show due care.

Patients also to blame
Badenhorst believes that patients have also been to blame for the growing resistance to antibiotics, insisting on being treated with them at every sign of infection.

Of great concern today is that there is an increase in the number of high-risk patients that require antibiotic therapy more frequently.

These include:

Patients whose immune systems are compromised
Those undergoing operations and other invasive medical interventions
Those with implanted medical devices
Patients with chronic debilitating diseases

Newer, more powerful antibiotics have been developed, but should be reserved to treat more severe infections, because of the danger of bacteria developing resistance against these as well, leaving physicians with a limited arsenal of antibiotics to treat seriously ill patients with.

In trying to contain the problem of the new super bugs, the World Medical Association (WMA) has proposed the following measures:

Enhancing training and education to increase awareness of antimicrobial resistance in order to contain and slow its development;
Improving the appropriate clinical use of antimicrobials by doctors;
Educating patients about the appropriate use of antimicrobials;
Implementing national and global efforts to contain the development and spread of antibiotic resistance, which will require substantial cooperation among nations;
The availability of antimicrobial agents without a prescription in many developing countries is escalating resistance, and this practice must be discontinued;
The increasing prevalence of counterfeit medications is another critical and expanding risk factor;
The inappropriate use of antibiotics in veterinary medicine and livestock production in many countries needs to be controlled.

“The growing resistance of bugs to antibiotics is of great concern to medical authorities around the world,” suggests Badenhorst. “We cannot be faced with a situation where we are left without any medications to treat infections. This would be little short of disastrous. People need to be educated about this, and each one of us needs to use antibiotics responsibly and with great care.” – (September 2009)

Issued by Martina Nicholson Associates (MNA) on behalf of Mediscor PBM (Pty) Ltd