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Unnecessary prescription, over- the-counter buying multiply harmful impact of antibiotics



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By Ajita Rijal

Kathmandu, Dec. 29: When Shuvekshya Sharma of Samakhusi went to a nearby pharmacy with her ailing seven-year-old daughter and sought medicine for the daughter, the pharmacy provided Azithromycin, an antibiotic.
After taking a few doses of the medicine, the daughter started having stomach pain, probably a side effect of the medicine. Sharma took her kid to the hospital to see a doctor. The doctor suggested for taking rest and having plenty of fluids, saying it was curable.
Overuse and prescribing unnecessary antibiotics has led to a rise of drug-resistant bacteria, causing patients to suffer significant side effects from medications they don’t really need, according to health experts.
Health experts say about 50 per cent of the antibiotic prescriptions may be unnecessary.
Talking to The Rising Nepal, Dr Jyoti Ratna Dhakhwa, a pediatrician, said that children are more exposed to the use of antibiotics. It is because, most parents simply choose to go to the nearest pharmacy when their children get sick, thinking it’s quicker. The pharmacies then hand over them antibiotics without prescription of doctors. This is the main problem, said Dr. Dhakhwa.
“We witness a lot of misprescription of medicines, in cases of diarrhea, fever, sore throat and common cold, for the children,” said Dr. Dhakhwa.
But the fact is, 70 per cent to 80 per cent of diarrheal cases are naturally curable, said Dr. Dhakwa, adding most colds and sore throats are caused by viruses and antibiotics only work on bacterial infections.
“Every time someone has a fever, a doctor prescribes an antibiotic. This trend should be stopped.” Doctors should wait for the blood reports and lab test to determine the fever factor, added Dr. Dhakhwa.
Likewise, in adults the use of antibiotics is prevalent in the cases of respiratory tract infections.
Bishal Aryal, 34, of Budhanilkantha went to a local clinic with complaints of a sore throat. The doctor there prescribed him Amoxicillin, an antibiotic, used to treat a wide variety of bacterial infections. This scenario ostensibly is a common thing for many whenever they feel unwell and look for a quick cure. The practice of prescribing antibiotics has become a first line of treatment for many.
Lack of awareness among public
Not only doctors, but patients themselves are more in a hurry to get rid of their illness. They reach nearby pharmacies for any sort of disease. Most people, however may not realise the long-term impact on their body of this practice.
Another important thing is, the general public should join in tackling antibiotic resistance by consulting and listening to their doctor and pharmacist and only take antibiotics when necessary,” Dr. Dhakwa added.
According to Dr Bimal Kunwar, a pharmacist doctor, if the antibiotics are necessary for patients after the clinical examination, the doctor can prescribe antibiotics from a narrow spectrum. But the doctors should never take the patients as a target of trial, such as prescribing antibiotics just in cases of the viral, which is curable with plenty of fluids and rest.
Misprescription is also likely to occur when doctors are unable to diagnose whether an infection is a viral or bacterial one, based on empirical evidence, said Dr Kunwar.
Doctors will have more empirical evidences then they would reduce the chances of prescribing antibiotics that have already developed rapid resistance in patients, added Dr Kunwar.
So there is a clear and urgent need to raise awareness among all on the use of antibiotics and its effects.
The fact that most people consider antibiotics as generally harmless medicines that effectively treat cold. It simply means there is a lack of proper awareness. It is really harmful to use antibiotics without necessary prescriptions, said Dr Kunwar.
People are more likely to resort to antibiotics without a prescription when they don’t have any access to a regular doctor or clinic, or are unable to afford the cost of doctor visits or medicines, or feel easy in going over the counter and get the medicines without any hassle. This may seem

easy, but one should think about long-term health impact of antibiotics.
According to World Health Organization (WHO), antimicrobial resistance (AMR) is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.
The WHO has developed ‘Global Action Plan on Antimicrobial Resistance’ which was endorsed by the World Health Assembly in May 2015. It’s a global action plan to tackle antimicrobial resistance, including antibiotic resistance, the most urgent drug resistance trend, according to WHO website.
Researcher’s suggestions
According to BBC news from October 2019, antibiotics are essential for treating serious bacterial infections, such as sepsis, pneumonia and meningitis. But they should not be used to treat coughs, earache and sore throats, which usually clear up without drugs.
If antibiotics are taken inappropriately, harmful bacteria living inside the body can become resistant to the antibiotics, which means the medicines may not work when really needed, writes BBC.
Global health officials have repeatedly warned about the rise of bacteria and other microbes that are resistant to most available drugs, raising the threat of untreatable infectious diseases that could spread rapidly.
Various research indicate that, if antibiotics are taken inappropriately, harmful bacteria living inside the body can become resistant to the antibiotics, which mean the medicines may not work when really needed.
Dr Sakhila Ghimire, a researcher, suggests, “I recommend changing lifestyle, diet, workout and sanitation which is extremely important to live relatively a disease free life, it’s better not to get sick, and not to approach antibiotic use.”
If one falls sick with common illnesses, s/he should opt to use bestowed simple secrets, like honey, turmeric for cough, hot lemon, ginger, fruits and veggies for common cold, among other home remedies, she added.
The (mis)use of antibiotics even for simple problem like runny nose, or common cold is wrong; Doctors need to confirm bacterial infection by doing blood tests, Dr Ghimire said.
Researchers also suggest medical doctors for practicing suggestive prescription and offer simple suggestions like humidifiers and plenty of fluid, along over-the-counter remedies to try and how to use them. Doctors should also offer guidance on when patients should return if they’re not getting better.
Laws and protocols
Nepal has promulgated the Drugs Act 1978, to prohibit the misuse or abuse of medicines and allied pharmaceutical products. The act states that antibiotics can only be sold on a doctor’s prescription, but in practice, antibiotics are reportedly sold like ‘toffees’.
The government must impose strict prohibition on the sale of antibiotics without proper prescriptions, if it is serious about combating antibiotic resistance in the country.
The hospitals must have the medication prescription procedures guidelines by which the physicians would abide with, said Dr Dhakhwa. The health experts stressed on the need on uniformity in treatment procedures and medicine prescription in every health institutions.
Dr. Dhakhwa advised that the government should devise a medication guidelines or protocol- that provides clear policy on the prescription process i.e. what sort of medicines can be used under what condition and how to treat a particular disease; and this protocol needs monitoring and follow up.
The quicker and quality diagnostic tests to determine whether an infection is bacterial or viral are crucial in the fight against antibiotic resistance. Also, well-equipped and improved laboratory services are needed for the identification of disease.