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antibiotic abuse

Rise of Resistance: The Misuse of Antibiotics

The misuse of antibiotics has grave consequences, not just to the individual but it contributes to a global health crisis. The World Health Organisation (WHO) has listed antibiotic resistance as one of the top ten threats to global health in 2019. Antibiotic resistance can happen in any part of the world. The right use of antibiotics is a social responsibility but the lack of knowledge commonly results in the misuse of antibiotics in Singapore. This contributes to the alarming problem of antibiotic resistance globally.

The friendly bacteria and the harmful virus

Bacteria can be found everywhere – in the air, soil and water, on plants and in animals. Most bacteria are harmless. In fact, less than 1 percent of bacteria cause disease in people. Some actually help by digesting food and strengthening the immune system. Some infections bacteria can cause include pneumonia, tuberculosis and urinary tract infections. The use of antibiotics when prescribed by a physician is the appropriate treatment for infections caused by bacteria.

Unlike bacteria, most viruses cause diseases. However, antibiotics are not effective against viruses; they do not attack viruses in the body at all.  Some infections viruses can cause include the common cold, flu and chickenpox. Most viral infections tend to resolve on their own within 3-10 days without any treatment, so any treatment generally is aimed at providing relief from symptoms like headache, fever and cough.

The Rise of Resistance

When bacteria are exposed to antibiotics, some will die and some will survive. This is normal and expected. The bacteria that survive develop a way of protecting itself against the antibiotic and can multiply and pass on its resistant properties to other bacteria – as if passing along a cheat sheet to help each other survive.  Antibiotic resistance is a normal and expected result of antibiotic use, however it is the way that antibiotics are used that affects the rate and the extent resistance occurs.

The two ways we accelerate the problem of antibiotic resistance:

#1 Taking antibiotics when it is not needed

Antibiotics do not cure infections like common colds and sore throats. They also do not help to heal your common cold and sore throat faster. A survey by the National University of Singapore in 2016[1] found that a third of patients who visit their general practitioners (GPs) expect to be prescribed antibiotics when they have a common cold or sore throat. If antibiotics were not prescribed, half of these patients would ask for antibiotics or visit another GP.

Antibiotics do not help to heal your common cold and sore throat faster.

#2 Taking antibiotics incorrectly when it is needed

It is tempting to stop taking an antibiotic as soon as you feel better. But the full treatment is necessary to eradicate the disease-causing bacteria completely. Failure to take an antibiotic as prescribed can result in the need to resume treatment later and may promote the spread of antibiotic-resistant properties among harmful bacteria.

Some antibiotics require multiple dosing in a day while others only require a once daily dosing. This is because different antibiotics have a different “strategy” in killing different bacteria. It is important not to skip a dose for convenience sake as this can affect the effectiveness of the antibiotic and result in the rise of resistant bacteria. Always speak to your physician or pharmacist if you have concerns adhering to an antibiotic therapy.

Some chronic medications, supplements, traditional health products and even food like milk, grapefruit can reduce the effectiveness of certain antibiotics and needs to be avoided or spaced apart when taking together. Always inform your physician or pharmacist of other concurrent medications and supplements you are on for your health issues and adhere to the advice from your physician or pharmacist.

Antibiotics are a precious, limited resource

It has been more than 70 years since the first antibiotic, Penicillin was discovered. However, there has not been any new antibiotic class that has been developed for the past 30 years. Like a game of leapfrog – antibiotics and resistant bacteria, and then another antibiotic and then resistance again – the game is ending. Bacteria develop resistance so quickly and antibiotics are commonly used only for short periods, this makes antibiotics less profitable than other medications. In July last year, Novartis, one of the world’s largest pharmaceutical companies, announced the end of its antibacterial and antiviral research, joining other companies like AstraZeneca, Sanofi and Allergan.

Evolution always wins. Bacteria reproduce a new generation every 20 minutes while it takes us more than 10 years to discover a drug, undergo research and clinical trials before registering it for use. Every time we use an antibiotic, we give the bacteria billions of chances to crack the codes of defenses we have created. There has never yet been an antibiotic they could not defeat. Some antibiotics are no longer able to be used to treat infections due to widespread resistance.  

However, the risks of antibiotic uses are outweighed by their benefits in the treatment of many bacterial infections. Antibiotics can be lifesaving medications. We all have a responsibility to use antibiotics appropriately to preserve the effectiveness of current antibiotics and to protect others from antibiotic-resistant infections.

No time to waste

Everyone has a part to play in preventing an era where antibiotics are no longer effective and infections and minor injuries can once again be fatal. Here are 5 ways you can do to help:

  1. Avoid pressurizing your doctor for antibiotics.
  2. Take your antibiotics according to your doctor’s instructions.  Always take doses as prescribed and complete the course even if you feel better.
  3. Do not share antibiotics or obtain antibiotics online or from overseas. When you are sick, always speak to your doctor about your need for antibiotics.
  4. Reduce the risk of getting bacterial infection by practicing good hand hygiene and good food safety practices. Every infection prevented is an antibiotic treatment avoided.
  5. Ensure that you and your children receive recommended vaccinations. Some recommended vaccines protect against bacterial infections such as pneumococcal disease. Always speak to your doctor for the most appropriate vaccinations for you.

Far from being a cure-all for ailments, antibiotics should be treated with care and respect as a precious and limited resource threatened by the global rise in antibiotic resistance.  Our time with antibiotics is running out, let us start now.

References:

  1. NUS News ( 30th November, 2016) Misconceptions about antibiotics. Retrieved from http://news.nus.edu.sg/highlights/misconceptions-about-antibiotics
  2. World Health Organisation. Advocacy Material. Retrieved from https://www.who.int/campaigns/world-antibiotic-awareness-week/world-antibiotic-awareness-week-2018/advocacy-material
  3. World Health Organisation. World Antibiotics Awareness Week. Retrieved from https://www.who.int/campaigns/world-antibiotic-awareness-week/2017/infographics/en/

About the Author:
This article is written by Vanessa Ong. Vanessa is a registered pharmacist with the Singapore Pharmacy Council. She spent several years in the inpatient setting in a local hospital. She enjoyed her time spent in the wards working with a dedicated healthcare team passionate about better patient outcomes. She strongly believes that evidence-based health information can be made simple so that the public can find joy in taking ownership of their health and live life to the fullest.

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