Expert: unnecessary antibiotics increase recurrent infection

Dr Jacob Otile

Dr JACOB OTILE, an activist for better health and better health systems, has warned that surplus prescription of antibiotics is increasing recurrent infection and drug resistance among patients, writes Geofrey Serugo.

Antibiotics are drugs used to treat germs. The common prescribed antibiotics include penicillin (amoxicillin, ampicillin), cephalosporin (cefixime, ceftriaxone), fluoroquinolones (ciprofloxacin/cipro, levofloxacin), metronidazole and sundry.

According to Otile, antibiotics are becoming increasingly ineffective as drug resistance spreads globally, leading to more difficult-to-treat infections and death.

“If people or patients do not change the way antibiotics are used now, the new antibiotics that are being developed will suffer the same fate as the current ones and become ineffective,” he warns.

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness and death.

About 700,000 people die every year due to diseases caused by drug-resistant microorganisms. Of these, at least 230,000 deaths are caused by multi-drug-resistant tuberculosis.

According to Otile, recurrent infection and drug resistance have been encouraged by either under-trained healthcare workers having access to big molecules or irresponsible health workers. Recurrent infections are infections that are too great in number, severe, or too long-lasting.

He also alluded to recurrent infection and drug resistance to the absence of medical insurance and unaffordable health services, which gives a leeway for patients to opt for self-medication, a mode which leads to life-threatening effects and death.

An estimated 38 per cent of Uganda’s healthcare expenditures are paid by individuals through out-of-pocket costs, followed by development partners (41 per cent), the government (16 per cent), and others (five per cent). Uganda’s current health insurance options are an employer or community-based schemes and are estimated to cover less than two per cent of the population. Health insurers only contribute around one per cent to health spending in Uganda.

“Currently, a number of patients, especially ladies, have recurrent infections which are unresponsive to antibiotics. The recurrent infection includes yeast infections (vulvo vaginal candidiasis) from other germs that take advantage of the opportunity of normal flora (lactobacilli in the vagina) being destroyed,” he said “Patients, especially ladies, have recurrent infections which are unresponsive to antibiotics and because either initially they are wrongly diagnosed, most commonly being told they have Urinary Tract Infection (UTI) and in actual sense, they have a yeast infection with a discharge so they end up being given antibacterial drugs or buy themselves antibacterial and use them as
they please and end up with drug resistance to the common drugs.”

He said other germs such as clostridium difficile take advantage of the reduced normal flora in patients’ intestines and damage the large intestines and hence causing antibiotic-associated colitis such as abdominal cramps, bloody diarrhoea, fever, and vomiting.

“We should advocate against self-medication due to its contribution to drug resistance. That vice is caused by patient’s knowledge of the drug, peer advice, previous disease experience, and long distance and waiting time at the health facilities.” Dr Otile said almost all the drugs
that the commonly used can no longer treat infections caused by germs like E. coli. The drugs include ceftriaxon, cefuroxime, tetracycline, ciproflfloxacin, septrin, amoxicillin/ clavulanic acid, gentamicin.

Without effective tools for the prevention and adequate treatment of drug-resistant infections and improved access to existing and new quality-assured antimicrobials, the number of people for whom treatment is failing or who die of infections will increase.

Medical procedures such as surgery, including caesarean sections or hip replacements, cancer chemotherapy and organ transplantation will become riskier.

Source: The Observer

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