Andy’s typhoid infection had remained persistent for three years despite continuous antibiotic intake. He had always gone for widal test each time he felt the symptoms which were fever, headache, abdominal discomfort, bitter mouth and sometimes back pain, and the results are always positive for typhoid fever. Up until now, Andy has taken a total of 40 antibiotics injections from hospitals, plus self medications with countless packs of amoxicillin, chloramphenicol, co-trimoxazole and ciprotab yet, it appears the infection has grown resistant and persistent. Right now there are indications that the infection has also affected his liver.
Andy’s predicament is not uncommon to many with diverse bacterial infections that have remained resistance to treatment, ranging from sexually transmitted infections such as staphylococcus aureus, gonorrhea, pneumonia down to the common malaria fever.
Report by experts indicate that virtually all antibiotics in the West African sub region are becoming less effective as a result of growing resistance by disease causing organisms to them.
Renowned scientist and key member of the global Consensus Group on Resistance and Prescribing in Respiratoy Tract Infection (RTI), Prof. Javier Garau, during an international workshop on antibiotics held in Abuja had attributed these drug resistances to excessive prescription and over use of antibiotics.
Prof. Garau, also an Associate Professor of Medicine at the University of Barcelonia, stated that ‘antibiotic resistance had increased to an all-time high level worldwide just as prescription had also increased at an all-time high level’.
According to him, prescribing antibiotics for infections not caused by bacteria do not have clinical benefit, rather, he said, the practice promotes resistance, causing unnecessary adverse reactions.
Speaking on the six principles for the appropriate prescribing of antibiotics developed in 2002 by the Concensus – an independent world body formed to identify principles underlying prescribing and guideline formulation in view of increasing bacterial resistance – Prof. Garau said the objective of the principles was to optimize therapy to reduce morbidity, therapeutic failure and cost, and prevent resistance emergence.
He disclosed that the principles specifically targeted respiratory tract infections (RTI) because 80 percent of antibiotics were often prescribed for RTIs.
“Reducing inappropriate antibiotic prescribing through the principles will require education of physicians and patients towards a change in behaviour, an understanding of the impact on resistance, time and resources - money,” he further said.
According to him, the six principles required for appropriate prescribing and effective “locally-compliant” guidelines require that antibiotics be used to: Treat bacterial infection only, Optimize diagnosis and severity assessment, Maximize bacterial eradication, Recognize (local) resistance prevalence, Utilize pharmacodynamics for effective agents and dosage, Integrate local resistance, efficacy and cost-effectiveness.
Prof. Garaus stated that experience in some countries such as Sweden, Finland, Iceland among others, have shown that adherence to appropriate use of antibiotics according to the principles would reduce considerably the problem of resistance.
Also a medical microbiologist at the National Hospital, Abuja, Dr. Kenneth Iregbu In a paper titled “Nigeria: antibiotic resistance, practice and clinical issues in RTI therapy,” said antibiotic policies would enhance a rational use of antibiotics in the country, control spread of resistant strains, check wastages and the burden of unwanted effects.
He blamed the growing incidence of an18tibiotic resistance on lack of education on the part of doctors on the appropriate use of antibiotics and unrestrained access of the people to the drugs.
“Most drugs in Nigeria are available over the counter without doctor’s prescription leading to antibiotic abuse. There is also the problem of fake drugs due to the lucrative nature of pharmaceutical drug sales,” he further said.
The microbiologist also identified antibiotic misuse as a major factor responsible for resistance in the country. For instance, he cited a survey at the Lagos University Teaching Hospital, LUTH, which showed that over 70 percent of patients took antibiotics before seeing the doctor. The study, he said, also revealed that in private clinics, cost was the determinant factor in the choice of antibiotics instead of “local susceptibility pattern of pathogens to antibiotics.” The study, he said, thus revealed that doctors; especially in private clinics, do not often consider microbiological parameters when prescribing.
“Doctors in teaching hospitals carry out microbiological investigations of respiratory tract infections more often than those in the private practice” he observed.
“Most doctors treat with antibiotics before asking for laboratory investigation. They only ask for investigation when the patient is not responding to treatment. Such misuse of antibiotics leads to difficult laboratory diagnosis. Now there’s difficulty in the isolation of Strep pneumonia and H. Influenzae the key pathogens in pneumonia and meningitis.
“Strep pneumoniae accounted for 38.2 percent amd H. influenzae 30.9 percent of the 246 bacterial isolates in a study on frequency of organsims from CSF between 1970 and 1973. Today, recovery of these organisms has become ‘elusive’ in our laboratories in Lagos axis of Nigeria.”
Dr Iregbu told the delegates that antibiotics are not useful in viral infections like common cold, pharyngitis and acute bronchitis. According to him, they are only indicated in secondary infections of some common allergic conditions like rhinitis and bronchial asthma.
“To avoid development of antibiotic resistance, there must be a judicious and effective use of available antibiotics in the treatment of respiratory infections.
This can be realised if there’s education of the masses on the dangers of taking antibiotic without doctors’ prescription, and optimised diagnosis of bacterial infection by use of cost effective diagnostic tests by doctors and adherence to antibiotic policy.”
According to him, there should also be adequate study on the local antibiotic resistance pattern backed by education on the health care system. Also, he said, the control of antibiotics should be enhanced with good prescribing habits with knowledge of local resistance patterns by selecting appropriate antibiotics that eliminate pathogens.
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