Antibiotics: Facts that you should know

Antibiotics: Facts that you should know

Antibiotics are a very special class of modern medicines which are used to fight many infectious diseases caused by bacteria. Infection means the condition or state in which body or any part of body is invaded by harmful microorganisms causing serious damaging effects . The most important symptoms of the Infection is inflammation . The other common symptoms are pain, heat , redness, swelling or edema and disordered function of the tissue. It is well known to all , the infectious diseases are caused by invasion of various types of pathogenic or harmful microorganisms like bacteria, virus, fungi, parasites into the body. Antibiotics are effective only against infections that are caused by bacteria. Antibiotics are not effective at all against most viral infections . That is why it is useless to prescribe costly and dangerous antibiotics for the common viral infections such as colds , bronchitis, sore throats and watery diarrhea. Some viral infections like influenza, and HIV and AIDS can be treated with definite antiviral drugs. On the basis of the illness , sign and symptoms and laboratory tests, the physicians usually determine whether any antibiotic is at all necessary or if it is really indispensable then what antibiotic should be appropriate for a particular patient. Everybody should bear in mind that self-medication of antibiotics may be dangerous and fatal .

We use plenty of drugs in our daily life but probably we know very little about the consequences of the widely used medicines . If the doctor prescribes an antibiotic, it is the most important thing to ask him or her about the possible side effects of the drug. Antibiotics may cause very serious side effects . Some of the common side effects are allergic reactions, which are characterized by skin rash and itching or in very severe cases difficulty in breathing, nausea, vomiting , diarrhea an stomach pain . Antibiotics also kill or inhibit the growth of the normal or good bacterial flora on our skin or mucous membrane . These naturally occurring good bacteria are very essential for our body. The use of antibiotic causes the good bacteria to be replaced by the bacteria that can cause diarrhea and yeast infections . It is very important to call a doctor or seek advice from the expert when anybody experiences any side effects during antibiotic therapy.

The most notorious and dangerous problem with this type of drug use is the development of bacterial resistance to an antibiotic. According to an International Task Force studying antibiotic resistance, although antibiotics are said to have saved and improved millions of lives than any other class of medicine, their use has set in motion the biggest intervention in population genetics seen to date of this planet . The effects of that intervention are seen in the distributions of antibiotic resistance genes throughout the world's bacterial populations. This change , although not seen apparently has had a very profound effect on human health as the antibiotics themselves . One expert observed that, " resistance to antibiotics has become a global problem with a major and devastating impact on health care in both developed and developing countries".

Some bacteria are naturally resistant to certain antibiotics, but usually resistance is acquired . Bacteria can become resistant to an antibiotic that was previously effective. Resistance mostly develops after long time treatment with an antibiotic or antibiotics that kill a wide range of bacteria. Resistance is a growing problem and it is thought that some types of infectious diseases will eventually not be treatable with antibiotics. This resistance is due to over use or indiscriminate use of antibiotics especially for common viral infections.

The antibiotics should be used only when it is prescribed or advised by the physician. It is not a good practice to take any kind of medicine without consulting the doctors. It is sometimes very risky to take antibiotics given by someone else or prescribed for a previous illness. There are three basic principles to help ensure that indicated antibiotics treatment will be effective.

1. The dosage is a very important factor for antibiotic effectiveness and safety. If the dosage of the antibiotic is not correct or adequate , it will not be effective against the infection and bacteria are more likely to develop resistance.

2. Full course of antibiotic should be taken for the full amount of time prescribed by the doctor. Very often , it is observed that the patients stop taking antibiotics when they begin to feel better with a misconception that the illness has been cured. The fact is that , even after the symptoms disappear , the bacteria may still be present in small quantities and subsequently the infection may return if the antibiotic use is stopped. The discontinuance of the prescribed dose may also cause resistance.

3. Antibiotic should not be saved or reused. All of the antibiotics should be taken and none of them should be left over . In any case , if it happens , then the antibiotic should not be used to treat any other infectious diseases. Because, different types of antibiotics are used for different infections. So taking left over antibiotics may not be effective. Moreover, it may be futile if antibiotics are used after the date of expire .

The global antibiotic market was put at 15.5 billion US dollar in 1991 and estimate suggests it will reach to 22 billion dollar in 1993. By the year 2000 , the antibiotic market is expected to reach 40 billion dollar. In 1989, more than 1.1 billion US dollar was spent on only five expensive oral antibiotics. These antibiotics were ciprofloxacin , norfloxacin, amoxicillin, cefuroxime axetil and cefaclor. The US antibiotic market is worth some 6 billion US dollar a year. Since the drug industries are profit oriented, they try to uplift the sales of antibiotics. This occurs either by increasing the volume or increasing the relative proportion of expensive antibiotics, which usually are not drug of choice . It is therefore doubtful whether optimal and rational prescribing of antibiotics can be attained in this context .

Recommendations:

1. Government should develop strict antibiotic policies as part of national drug policy .

These should include:
a) A limited list of antibiotics with some kept in reserve for use against microorganism resistance to first line drugs.

b) A regularly revised set of therapeutic guidelines or standard treatment guidelines.

c) Drug use indicator studies to monitor the use of antibiotics and , where necessary , the introduction of intervention strategies to encourage the rational use of antibiotic

2. Product information should include clear warning about the problems of resistance and the need for careful diagnosis and selective use .

3. Combination products of antibiotics except cotrimoxazole or those with active ingredients such as clavulanate or sulbactum should be banned .

4. The policy makers and health authorities should introduce regular refresher courses and other independent exchanges of information on antibiotics for health workers. One of the most important information to communicate is that new antibiotics should be used cautiously and often kept in reserve for the treatment of serious infections that proved to be resistant to other antibiotic.

5. Antibiotics with potential dangers such as chloramphenicol or systemic neomycin should be placed under severe restriction .Wherever necessary, they should be withdrawn from the general market and be prescribed by specialist who are familiar with their adverse reactions.

An Advice for All :

Always consult your doctors if you have an infection. Remember , only your doctors and pharmacists can determine if you have an infection and the type of antibiotics that will be the most effective and safe for you to take.

By Dr. Muniruddin Ahmed
Professor and Chairman,
Dept. of Clinical Pharmacy and Pharmacology,
Faculty of Pharmacy, University of Dhaka