BOSIRE: Do you really need that antibiotic?

When a patient is sick, a lot of tests are carried out. Some tests are done to pinpoint a diagnosis; others evaluate the severity of the disease; others guide doctors on the best treatment options; while others evaluate response treatment.

One Tuesday morning during a major ward round in the teaching hospital, we (postgraduate medical students) were presented with a patient who had been in the ward for five days. She was 26 weeks pregnant and had a urinary tract infection.

Urinary tract infections (UTIs) are quite common in pregnancy, as the pregnancy hormones make the mother susceptible to infections.

Moreover, the growing uterus distorts the urinary system, leading to incomplete emptying of the bladder when passing urine, which further raises risk. Therefore, UTIs are a common reason for admitting pregnant women in hospital before childbirth, and hence are not news.

What was news in this case, the doctor stated at the end of his presentation, was that a urine test had revealed that the bacteria responsible for the mayhem was not responding to any of the antibiotics in the arsenal.

The test, which takes at least 72 hours to give results, involves painstakingly isolating the offending bacteria from the patient’s urine, growing it on a special plate with various antibiotics, and establishing which ones are capable of killing the bacteria and which ones do not.

We were perplexed by the doctor’s statement. We wondered, “How do you tell a patient that you know what is ailing her, but you do not have a cure?” And for something as simple as a urinary tract infection!

All the antibiotics we were pumping into her were a waste of time. How did we end up here?

We are consuming too many antibiotics from our food, as farmers give their livestock antibiotics in small doses, without prescription, to boost production. These antibiotics end up in our system when we eat meat and other animal products. When bacteria are exposed to small amounts of antibiotics, whose dose is inadequate to wipe them out, they develop resistance to that antibiotic.

When you do fall sick, and need that antibiotic to treat the same bacteria that has developed a thick skin, the drug, even in correct doses, fails to have an effect.

And then there are patients who use antibiotics indiscriminately even when they are not warranted. The patients who have flu, a viral disease, but refuse to leave the doctor’s consulting room without an antibiotic prescription.

This is often the case with parents; so much so that a running joke among doctors on social media is: “A fever is not a sign of ceftriaxone (a potent injectable antibiotic) deficiency!”

WE ARE ALL GUILTY

There are also patients who do not follow their antibiotic prescription to the letter. Once symptoms subside, they don’t complete the dose. They pose a danger, not only to themselves but also to the entire public.

They frustrate care providers to the point of taking drastic measures to ensure compliance. This is how the Ministry of Health ended up having two patients with tuberculosis imprisoned for refusing to complete treatment.

We must abide by prudent prescription practices if we do not want to wake up in the next 20 years and find ourselves having converted bacterial infections into terminal illnesses.

We are all guilty. Doctors who do not abide by good prescription practices, pharmacists who sell antibiotics without a prescription, patients who treat themselves by demanding unnecessary antibiotic prescriptions or buying these drugs over the counter from unscrupulous pharmacies, and farmers who pump their livestock with unnecessary antibiotics to increase yields.

What we fail to understand is that antibiotic resistance does not affect only those abusing these important drugs. It affects all of us directly.

The bacteria causing pneumonia in one patient is the same one causing meningitis in another, and the same one causing a urinary tract infection in the yet another.

Once the patient with pneumonia is improperly treated and antibiotic resistance develops, the resistant bacteria moves into the next victim and causes chaos in a different body system with equal vengeance.

It is also worth noting that once an antibiotic enters the body, it is not only going to treat the affected system. It travels all over the body and kills off all other bacteria present and responsive to it.

Antibiotic came with Alexander Fleming in 1928, with his discovery of penicillin. If he were to wake up today, he will be extremely proud of the advances that have stemmed out of his discovery.

However, he would probably have a stroke at the thought that such a major discovery that has had such a dramatic impact on humankind, is about to be declared obsolete in less than a century.

The acceleration towards gross antibiotic resistance needs to be brought to a screeching halt.
We must all understand that antibiotics are not sweets to be dished out like dessert with every meal. We must reverse the trend or perish!