The good, the bad of antibiotics

Antibiotic resistance is rising to dangerously high levels in all parts of the world. Experts, in this report by Sade Oguntola, fear that this may continue to threaten the ability to treat common infectious diseases.

Diagnosed of ulcer three years ago, he spent so much money moving from one hospital to another where antibiotics and pain killers were prescribed to treat the infection without solution.

Mrs Sarah Haruna never completed any of the dosages prescribed by the doctor for the condition caused by Helicobacter pylori, a germ that was proving very difficult to treat. It took several months before the infection dramatically disappeared.

Mrs Haruna is not alone in the antibiotic resistance, (ABR), crisis. Mr Henry Adu was diagnosed with gonorrhoea four years ago. He spent so much money on treatment, moving from one hospital to another where antibiotics were prescribed to treat the infection without any solution.

These experiences are commonplace in Nigeria. The incidence of antibiotic resistance, (ABR), and the emergence of multidrug-resistance bacteria are on the increase they are considered a major public health issue currently.

In 2015, experts detailing Tuberculosis (TB) surveillance in West Africa reported in the journal, BMC medicine that almost a quarter of new TB cases were not susceptible to first line antibiotics, with Lagos and Ibadan among the highest drug resistance hotspots.

Antibiotic resistance occurs when bacteria change in response to the use of medicine. It can affect anyone, of any age, in any country. It occurs naturally, but misuse of antibiotics in humans and animals is majorly accelerating the process.

Germs that are resistant to antibiotics also can move from one environment to another (e.g. animal to human or vice versa), through direct contact (e.g. between animal and human) or indirectly (e.g. in food or water) as well as due to movement of hosts or contaminated products between locations (including between continents).

Across the globe, the Centres for Disease Control and Prevention (CDC) estimates that 700,000 now die each year from such drug-resistant microbes.

In fact, a blue-ribbon study commissioned by the UK government, indicated also that by 2050, the figure could well soar to 10 million, surpassing even worldwide deaths from cancer.

Dr Oladoyin Odubanjo, executive secretary, Nigerian Academy of Science, said that the idea that key antibiotics could be rendered useless against even minor infections is linked with many factors.

He stated: “The self treatment approach to disease, a situation whereby for everything, we buy drugs by ourselves, makes antibiotic resistance a reality in Nigeria. Many people resort to buying akapo or akape, a collection of many drugs, including painkillers and antibiotics, sold in the open market.

“The person takes it and feels better. But this is not appropriate. You have become exposed to antibiotics unnecessarily perhaps and definitely in sub doses. This is one practice that is very dangerous.”

Odunanjo, a public health physician, said prescription of antibiotics for infections like diarrhoea was also promoting antibiotic resistance.

“They just go on to take antibiotics, whereas in most cases of diarrhoea you actually do not need any antibiotics,” he declared.

Dr Odunbanjo, however, explained that dosage and length of use of antibiotics is dependent on many factors.

“There are conditions that you write for somebody to take antibiotics for five days, seven days, or even at least two weeks based on the professional knowledge of the person writing the prescription. But all of those will be missing when we self medicate,” he said.

Regrettably, Dr Taofeek Adeyemi, Tz Hospital, Idi Ape, Ibadan, said already antibiotic resistance is contributing to higher medical costs, prolonged hospital stays and increased mortality.

According to him, antibiotic resistance will continue to be a challenge in Nigeria if antibiotics continue to be sold over the counter without any prescription, do not  complete antibiotic course and individuals  refuse to imbibe the culture of regular hand washing and safer sex.

Often, people do not complete an entire course of antibiotics once they ‘feel better’. But improvement in symptoms does not necessarily mean the infection has been completely eradicated.

Meanwhile, Iruka Okeke, Professor and Head, Department of Pharmaceutical Microbiology, University of Ibadan, described antibiotics as societal drugs, whose effect when misused can extend to others in the society, thus the need to regulate its use.

“Individuals must only use antibiotics when they have an infection that can be cured by that antibiotic. Otherwise, you should not be using the antibiotic,” she declared.

Professor Okeke said that although antibiotics are cheap, safe and effective for treatment of infections, resistance is growing against all antibiotics, including newer and expensive ones, due to mutation.

She declared: “The problem is worse with the older ones. Resistance to older antibiotics like Ampicillin and tetracycline is about 90 per cent. It is as much as 30 per cent for newer antibiotics like cephalosporins that is used for severe infections.

“So, we are actually at a point where somebody will get an infection now that will would have been curable 10 years ago, but which today, there may be no cure.”

Sadly, she said that overall, everyone faces some level of risk contracting germs that had grown resistant to antibiotics, even though children, elderly people; those with other diseases; as well as the poor were more vulnerable than the others in the society.

However, Professor Okeke said individuals can protect themselves from all infections, including those that had grown resistant to antibiotics through vaccination, maintenance of good sanitation, drinking clean water and eating safe foods.

The don urged health professionals to only prescribe antibiotics after a laboratory test had indicated it is required and the type of antibiotics that will be effective to stem incidence of antibiotic resistance and the emergence of multidrug-resistance bacteria.

She stressed the need for increased public awareness on appropriate use of antibiotics, adding that stopping the abuse of antibiotics should be a joint effort by all.

Currently, experts warn that antibiotic resistance in Helicobacter pylori and tuberculosis is a factor preventing their successful eradication.

For instance, in a 2017 study in PLoS One, Helicobacter pylori strains from different parts of the country had divergent antibiotic resistance rates. A high frequency of bacterial resistance was observed for metronidazole (99.1 per cent), followed by amoxicillin (33.3 per cent), clarithromycin (14.4 per cent) and tetracycline (4.5 per cent).

Regrettably, most hospitals only have good ABR systems for only Tuberculosis. In fact, experts say that detection of resistance and monitoring ABR requires appropriate laboratory-based surveillance.

In addition, they said there is need to sustain the efficiency of diagnostic laboratories, improved surveillance, curtailing circulation of substandard/counterfeit antibiotics, as well as better regulation and education of the public, clinicians/prescribers in the appropriate use of antibiotics.

Meanwhile, new research from Canterbury University has found ingredients in a number of everyday weed killer like Round-up can cause antibiotic resistance at even low level application rates.

In a new study published in the scientific journal Microbiology, the researchers found that three of the most commonly used herbicides – glyphosate (active ingredient in Roundup), dicamba (found in Yates), and 2,4-D – caused E.coli and salmonella to become less susceptible to antibiotics.

They suggested that this could be a problem especially in pets and children who unknowingly track the herbicide into the home and indirectly into the mouth after walking through lawns and gardens that had been sprayed since there is no “safe level” of antibiotic use below which AMR does not develop.

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