As the world observes World Antibiotics Awareness Week, Omeshnie Naidoo looks at the good, the bad and the ugly side of this medical marvel.
Good and bad bacteria. Antibiotics swipe both ways. That’s the crucial point. The same medicines that can rid the body of potentially life threatening illnesses, like TB, syphilis or meningitis, can – whether prescribed willy-nilly by practitioners or demanded by patients, taken unnecessarily or not taken as prescribed – destroy the body’s own natural bacteria.
In a culture where a slight niggling feeling is promptly followed by a trip to the doctor and a course of antibiotics it is worth stepping back, looking at what antibiotics are, how they affect the body and when we should and shouldn’t take them.
Basically, antibiotics are used to treat infections caused by bacteria, which are tiny organisms that can sometimes cause illness in humans and animals.
Before bacteria can multiply and make us ill, our body’s own immune system usually destroys them.
We have special white blood cells that attack harmful bacteria. Even if symptoms do occur, our immune system can usually cope and fight off the infection.
There are occasions, however, when our bodies need some help – from antibiotics.
The first antibiotic was penicillin.
According to the website medicalnewstoday.com, penicillin-related antibiotics such as ampicillin, amoxicillin and benzylpenicillin are the most widely used. There are several different types of modern antibiotic as well but they all work in one of two ways.
They either kill the bacteria (are bactericidal) or stop the bacteria from multiplying (are bacteriostatic).
Antibiotics are not effective against viruses.
If you have an infection, it is important to know whether it is caused by bacteria or a virus.
Most upper respiratory tract infections, such as the common cold and sore throats are generally caused by viruses – antibiotics do not work against these viruses.
If antibiotics are overused or used incorrectly there is a chance the bacteria will become resistant. What this means is the antibiotic becomes less effective against that type of bacterium.
KwaZulu-Natal-based clinical microbiologist Dr Shameema Khan says resistance is common here and around the world.
She is actively involved in creating awareness on antibiotic resistance, infection control and trying to develop antibiotic stewardship programmes in the private hospital sector.
This is a multidisciplinary team approach to prescribe antibiotics appropriately so the patient gets cured of the bacterial illness adequately, while minimising drug toxicity and the development of antibiotic resistance.
Ampath laboratory also continuously monitors and identifies antibiotics that are failing to work on certain bacteria locally.
“We can see the effects of abuse of antibiotics, to the extent you might find someone requiring admission to hospital to be put on a drip for something as simple as a urinary tract infection. In this case, no oral antibiotic will cure the infection.
“If we locally and globally are not careful, we will land up back at the pre-antibiotic stage.
“It is important to recognise that new drug development is decreasing while antibiotic resistance is increasing,” she said.
Pharmacist Sudesh Lalman says while it may be that antibiotics are over prescribed it is also true that patients expect them.
He adds that the dosage and time intervals prescribed are also important factors to avoid resistance.
“In practice, I have found patients always have left-over antibiotics, and this should not be the case. It seems to be human nature to stop antibiotics when you feel better. But, this has serious implications on mutation and resistance of the causative organism.
Recently experts have endorsed high dose, short-term treatment (eg: high dose for three days), instead of a conventional dose for five days. This ensures the patient finishes the course, but the higher dose regimen has a higher side effect profile.”
The length of treatment is a controversial issue for some bacterial infections, says Khan.
However, both agree that it is best to follow the doctors orders.
“If you take antibiotics when you do not need them, they may not work when you do, which is why it is important not to pester your doctor for them as so many people do,” Khan says.
Each time you take antibiotics, you are more likely to have some bacteria that the medicine does not kill. Over time, these bacteria change (mutate) and become harder to kill. The antibiotics that used to kill them no longer work. These bacteria are called antibiotic-resistant bacteria.
These tougher bacteria can cause longer and more serious infections. To treat them you may need different, stronger antibiotics that inevitably cost more. A stronger antibiotic may have more side effects than the first medicine.
Khan says antibiotic-resistant bacteria can also spread to family members, children and colleagues. Then your community will have the risk of getting an infection that is more difficult to cure and costs more to treat. Some antibiotics that doctors prescribed in the past to treat common infections no longer work.
Khan says Ampath antibiotic guidelines are available for practitioners.
However, the consensus among doctors appears to be that individual practitioners make case-by-case clinical decisions.
Durban paediatrician Dr Japie Roos says South African doctors and the public have become more aware of the adverse effects of inappropriate or incorrect antibiotic use.
“In general, viruses should be managed like viruses while bacteria should be treated with appropriate antibiotics in the correct doses for the correct periods of time.
He says several factors play a role when deciding on medication and antibiotic prescription.
“Age, illness, exposure, other concomitant diseases, immune status and the severity of the disease all play a role.
“With any illness, it is always a risk-benefit ratio.
“The correct medication can be life saving while inappropriate use can expose the patient to the possible adverse effects, like chemical exposure, allergies, gastro intestinal side effects and fungal overgrowth or the emergence of resistance to medication.”
Roos says medication should always be used appropriately, but special care should be given to those who have underlying illnesses that may affect medication metabolism, such as the young and the aged.
“Antibiotics as preventative medication (prophylactic antibiotics) has very specific indications and is usually reserved for patients who have underlying illnesses in an organ system or an immune system illness. In those cases, it is completely appropriate.”
As the middleman, Lalman says the relationship between doctor and patient is paramount.
Doctors need to be sterner, and patients need to accept that antibiotics are not always an appropriate prescription. Medical associations can put in place more rigorous training and drug-dispensing protocols.
We all know the side-effects of antibiotics, from feeling more ill to experiencing diarrhoea or landing up with a fungal infection of the mouth, digestive tract or vagina.
There are, of course, more rare side-effects such as kidney stones, abnormal blood clotting and even deafness.
Some patients, especially elderly ones, may experience inflamed bowels (a type of colitis) which can lead to severe diarrhoea. Clindamycin, an antibiotic used for the most serious infections, commonly has this side effect.
However, although much less common, penicillins, cephalosporins and erythromycin might do too.
Some patients may develop an allergic reaction to antibiotics – especially penicillins. Side effects might include a rash, swelling of the tongue and face, and difficulty breathing.
Reactions to antibiotics can be serious and sometimes fatal – they are called anaphylactic reactions.
Use antibiotics with extreme caution and ensure you inform your doctor/pharmacist if you have reduced liver or kidney function, you are pregnant or are breastfeeding.
If you are taking an antibiotic do not take other medicines or herbal remedies without telling your doctor first. Over the counter, non-prescription medicines might also clash with your antibiotic.
Antibiotics may also undermine the effectiveness of oral contraceptives. – Side-effects edited from www.medicalnewstoday.com
WEIGH YOUR OPTIONS
Always ask your doctor if antibiotics are the best treatment. Explain that you do not want antibiotics unless you need them.
Avoid pressuring your doctor into prescribing antibiotics when they won’t help you feel better or cure your illness. Ask your doctor what else you can do to feel better.
Do not use antibiotics that were prescribed for a different illness or for someone else. You may delay correct treatment and become sicker.
Take the antibiotic as prescribed.