The training of doctors and patients is the key to rational use. Doctors should understand their role in protecting antibiotics and use them wisely. Patients should understand that antibiotics are not required in most trivial infections and do not require them from doctors and pharmacists.

Every year in November, a very relevant health topic is in the foreground, namely antibiotic resistance (AMR). During this month, a special week for antibiotic awareness (from 13-19 November) is being observed, raising global awareness of antibiotics. In particular, the harm to human health from over-use (AMR) is increasing worldwide.

In a rapidly antibiotic-dependent society, an increasing number of patients are heavily dependent on antibiotics, even for a minor viral infection such as cold or cough, in which they have no effect. Simple home remedies such as hot soup or coriander water or gargling and bed rest are often not your choice. Even doctors have been found guilty of prescribing antibiotics for such minor ailments, either due to ignorance or personal gain of pharmaceutical companies providing these drugs.

Granted, the benefits of antibiotics in fighting bacterial infections are impressive. However, they must be prescribed with caution and the appropriate treatment protocols must be monitored regularly by the prescribing physician.

DR ENOKA COREA, former President of the Sri Lanka College of Microbiology and a lecturer in microbiology at the University of Colombo, explains how and when antibiotics should be taken and explains easy-to-follow guidelines that should be followed when taking them.

Excerpts from an interview with the Sunday Observer …

F. Microbiologists will gather this week (November 13-19) to raise awareness of the world's antibiotic. Tell us what our antibiotics are and why do we need to make them more aware of them worldwide?

ON. Antibiotics are medicines that we take against bacterial infections. With the advent of the antibiotic era in the 1950s, severe infections such as bacterial meningitis, pneumococcal pneumonia or tuberculosis became accessible for treatment. However, these benefits have been lost as more and more bacteria have developed resistance to antibiotics. This means infections with these resistant bacteria are difficult to treat, leading to further complications or even death.

Q. What do antibiotics do to protect human health?

ON. Antibiotics can reduce disease and death from bacterial infections through rational and careful use.

Q. Do antibiotics fight viruses or bacterial diseases or both?

ON. Antibiotics only work against bacteria. They are not necessary for viral infections because they have no effect.

Q. Are there different types of antibiotics? I understand that there are four types.

ON. There are more than four groups of antibiotics such as penicillins, cephalosporins, tetracyclines, macrolides etc. They have different chemical structures and act on different parts of the bacterium.

F. Antibiotic resistance is an emerging health problem. Just as antibiotics fight an infection, overuse can also harm people. Your comments?

ON. The unnecessary use of antibiotics, for example in viral infections, exerts selective pressure on resistant bacteria to proliferate and spread, thereby increasing the problem of antibiotic resistance. The unnecessary use of antibiotics also causes harm to the person taking the drug as it can cause side effects (like diarrhea) and even toxic effects due to the drug. Antibiotics can also interact with other medications the person takes and render them ineffective, or the combination can be toxic.

Q. How do you rate treatment protocols to prevent antibiotic resistance?

ON. There are guidelines as to which types of infections require antibiotic treatment, which antibiotics are required in each case and what dosage and duration requires treatment with antibiotics. Doctors should follow these guidelines when prescribing antibiotics.

Q. What about pregnant women? Do you recommend antibiotics? If so, at what time of pregnancy and for what type of infections?

ON. Some antibiotics can cross the placenta and damage the baby. Therefore, these antibiotics are contraindicated in pregnancy. However, there are other antibiotic groups that can be safely used in pregnancy when the pregnant woman gets a bacterial infection such as a urinary tract infection.

F. Certain patients have the habit of repeating the same drugs over and over again by taking the same recipe they were given earlier rather than visiting their doctor to renew it. Can this practice endanger your health? As?

ON. The antibiotics recommended for infection may not be effective in another infection. For example, antibiotics administered to treat a urinary infection may not be effective for pneumonia. Therefore, using the same recipe for another infection is not correct. Most pharmacies do not give medicines to an old prescription, especially antibiotics.

Q. Some patients do not stop their prescribed antibiotic treatments and stop midway when they feel comfortable. Can too low a dose of prescribed antibiotics harm them?

ON. It is recommended to complete the entire course of antibiotic treatment as prescribed so that the bacteria are completely removed from the body. If you stop the antibiotics too early, before the bacteria are eradicated, resistant strains can take control and the infection can recur. This repetition is more difficult to treat and may require stronger and more expensive antibiotics.

Q. Children? Do you prescribe antibiotics for infants, toddlers and children under 5 years old?

ON. Most antibiotics can be used safely in children. The dosages, however, must be adjusted according to the weight of the child. There are antibiotics that can damage the growing bones and teeth, and these are contraindicated in childhood.

Q. Can antibiotic-resistant bacteria cause infections in children?

ON. If antibiotics are inappropriately used in any community, bacteria in this community will gradually become resistant to these antibiotics. When these antibiotic-resistant bacteria spread in the environment and between humans, they can cause infections in both children and adults.

Q. What are the long-term consequences of irrational use of antibiotics for human health?

ON. Long-term irrational use of antibiotics leads to an increased spread of antibiotic-resistant bacteria in the community. They replace the other bacteria and become the predominant strains. Therefore, most infections in the community are caused by these resistant bacteria. Such infections are difficult or impossible to treat and result in higher mortality due to infection.

Q: What gaps do you see in the current system of prescribing antibiotics? Explain in detail.

ON. When a patient visits a doctor, he / she expects to prescribe medication, even if it is something trivial, such as a cold or cough. Therefore, doctors feel compelled to prescribe antibiotics, even if they know that it is not useful. We need to educate the public that many infections, especially viral infections, get better on their own within a few days and that medicines are not needed and can actually be harmful.

Also, physicians should spend more time explaining the disease to the patient, so that the patient is sure that no medication is needed.

Q. Do you think there should be more prescriptions for antibiotic prescriptions, or are they enough, but need more teeth to implement them?

ON. The regulations clearly state that antibiotics should only be given to a current prescription and should not be available as "over-the-counter". Although it was fairly easy to get antibiotics without a prescription some time ago, the implementation of prescriptions by pharmacies is now much stricter. This is a big improvement.

F. The Infectious Diseases Society of America has advocated the rapid approval of antibiotics for a limited population of patients to treat serious or life-threatening infections with few treatments or without adequate existing treatment. Your comments?

ON. Such novel treatments are very expensive and completely out of reach for our patients. It is far better to conserve resources and to use antibiotics carefully so that we can retain their effectiveness.

Q. How important are you to education about antibiotics, why are they used and how should they help the community?

ON. The training of doctors and patients is the key to rational use. Doctors should understand their role in protecting antibiotics and use them wisely. Patients should understand that antibiotics are not required in most trivial infections and do not require them from doctors and pharmacists.

Q. Your message to the public?

ON. Antibiotics are not effective against viral infections such as colds or flu. Antibiotics are a valuable resource and must be conserved and used wisely. Taking antibiotics when they are not needed causes bacteria to become resistant. As a result, there is a risk of untreatable infections for children and future generations. Never take antibiotics without a prescription. Try to prevent bacterial infections by following good hygiene practices, such as: For example, regular hand washing, eating hygienically prepared foods, and drinking cooked chilled water.


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