The overuse of antibiotics continues to have severe health consequences for South Africa and around the world. We cannot discount that antibiotics are important drugs.
It would be difficult to overstate the benefit penicillin and other antibiotics have played in treating bacterial infections, preventing the spread of disease and minimising serious complications of disease. But there is also a problem with antibiotic medications. Drugs that used to be standard treatments for bacterial infections are now less effective.
When an antibiotic drug no longer has an effect on a certain strain of bacteria, those bacteria are said to be antibiotic resistant. The overuse and misuse of antibiotics are key factors contributing to antibiotic resistance. The public, doctors and hospitals all play a role in minimising the development of antibiotic resistance.
There are likely several factors contributing to overuse. When penicillin and other antibiotics were first introduced, they were perceived as wonder drugs because they worked quickly and with few side-effects. They seemed like an answer to all common illnesses. In spite of a growing awareness of antibiotic resistance, overuse still occurs:
- Doctors may prescribe antibiotics before receiving test results that identify the actual cause of infection.
- People who want quick relief from symptoms, regardless of the cause of illness, may pressure doctors for a prescriptions.
- People may take antibiotics purchased abroad or via the internet for self-diagnosed illnesses.
- People may take antibiotics that are leftovers from a previous prescription.
- Problems with not following instructions.
The appropriate use of antibiotics can help preserve the effectiveness of current antibiotics, extend their life span and protect the public from antibiotic-resistant infections. Many hospitals and medical associations have implemented new diagnostic and treatment guidelines to ensure effective treatments for bacterial infections. As a patient you can also play a role. You can help reduce the development of antibiotic resistance by taking the following steps:
Use antibiotics only as prescribed by your doctor.
Take the appropriate daily dosage and complete the entire course of treatment.
If you have an antibiotic prescription, ask your doctor what you should do if you forget to take a dose.
If, for some reason, you have leftover antibiotics, throw them away. Never take leftover antibiotics for a later illness. They may not be the correct antibiotic and would not be a full course of treatment.
Never take antibiotics prescribed for another person.
Don’t pressure your doctor to give you an antibiotic prescription. Ask your doctor for advice on how to treat symptoms.
Practise good hygiene. Wash your hands regularly with soap, especially after using the toilet, before eating, before preparing food and after handling meat. Wash fruits and vegetables thoroughly, and keep kitchen surfaces clean.
Make sure you or your children receive recommended vaccinations. Some recommended vaccines protect against bacterial infections, such as diphtheria and whooping cough (pertussis).
If you think you may have penicillin allergy, talk to your doctor about getting an allergy skin test. Research has shown that penicillin or other antibiotic allergies may be overreported. Ruling out an antibiotic allergy can help your doctor prescribe the most appropriate antibiotic when it’s needed.
Antibiotics do not fight infections caused by viruses such as colds, flu, most sore throats, bronchitis, and many sinus and ear infections. Instead, symptom relief might be the best treatment option for viral infections. ɳ
Get smart about when antibiotics are needed – to fight bacterial infections. When you use antibiotics appropriately, you do the best for your health, your family’s health, and the health of those around you.
What causes antibiotic resistance?
A bacterium is resistant to a drug when it has changed in some way that either protects it from the action of the drug or neutralises the drug. Any bacterium that survives an antibiotic treatment can then multiply and pass on its resistant properties. Also, some bacteria can transfer their drug-resistant properties to other bacteria – as if passing along a cheat sheet to help each other survive. The fact that bacteria develop resistance to a drug is normal and expected. However, the way that drugs are used affects how quickly and to what extent drug resistance occurs. Failure to take an antibiotic as prescribed can contribute to antibiotic resistance. The instructions for an antibiotic tell you how many pills to take and how often you should take them. The prescription is filled so that you have the exact number of drugs you need to complete the course of treatment. It is tempting to stop taking an antibiotic as soon as you feel better. But the full treatment is necessary to kill the disease-causing bacteria.
Consequences of antibiotic resistance
The increasing number of drug-resistant infections results in: ɳ More-serious illness or disability. ɳ More deaths from previously treatable illnesses. ɳ Prolonged recovery. ɳ More-frequent or longer hospitalisation. ɳ More doctor visits. ɳ Less effective or more-invasive treatments. ɳ More-expensive treatments.
Overuse of antibiotics
The overuse of antibiotics, especially taking antibiotics even when they’re not the appropriate treatment, promotes antibiotic resistance. Antibiotics treat bacterial infections but not viral infections. For example, an antibiotic is appropriate treatment for an infected throat, when it is caused by the bacterium Streptococcus pyogenes. But it’s not, the right treatment for most sore throats, which are caused by viruses. If you take an antibiotic when you actually have a viral infection, the antibiotic is still attacking bacteria in your body, bacteria that are either beneficial or at least not causing disease. This misdirected treatment can then promote antibiotic-resistant properties in harmless bacteria.
Common viral infections that do not benefit from antibiotic treatment include:
Cold ɳ Flu (influenza) ɳ Bronchitis ɳ Most coughs ɳ Most sore throats ɳ Some ear infections ɳ Some sinus infections ɳ Stomach flu The commonest side-effects of antibiotics overuse
1. Antibiotics increase fatal diarrhoea cases in children
Because the majority of common colds are viral, using antibiotics to treat them does nothing to stop the infection and can create unwanted side-effects. Recent studies have shown that children given antibiotics for routine upper respiratory infections are more susceptible to aggressive antibiotic-resistant strains of the bacteria commonly known as Clostridium, which cause fatal diarrhoea. This bacteria is responsible for 250 000 infections in hospitalised patients and 14 000 deaths every year among children and adults.
2. Antibiotics can upset sensitive gut flora
Your intestines contain about 100 trillion bacteria of various strains. While some can be deadly, there’s a natural balance in the gut that can be thrown out of whack by antibiotics. These helpful bacteria, known as gut flora, support immunity and proper digestion. Aggressive antibiotics, while helpful if you have a serious infection, can wipe out many good gut bacteria while leaving those immune to antibiotics to flourish. Many people, especially children, are vulnerable to unwelcome side-effects of unnecessary antibiotics, including lasting changes to their gut flora.
3. Antibiotics help teach good bacteria to go bad
Bacteria have evolved defences against antibiotics through the process of horizontal gene transfer. Essentially, bacteria don’t need to reproduce to pass along their genetic protection from antibiotics. They can simply pass along these genes to fellow bacteria like students passing notes in a classroom. One study found that bacteria passing through the colon can transfer their resistance genes to other forms of bacteria.
4. Antibiotics are increasing cases of untreatable gonorrhoea
Untreatable gonorrhoea not only causes pain but also has been linked to pelvic inflammatory disease, ectopic pregnancy, tubal infertility, and neonatal eye infections, among other conditions. The commonest strain, Neisseria gonorrhoeae, has developed resistance to the antibiotics typically used to treat these infections.
5. Antibiotics drive up drug and hospital costs
The further antibiotic resistance spreads, the more common antibiotics – including generics – must not be used. This means that ridding patients of infection requires longer, more expensive forms of therapy. Our public health system currently loses millions due to premature deaths and longer hospital stays, related to antibiotic-resistant infections.
Just because your healthcare professional doesn’t give you an antibiotic doesn’t mean you aren’t sick. Talk with your doctor about the best treatment for your or your child’s illness. To feel better when you have a viral infection:
- Ask your healthcare professional about over-the-counter treatment to reduce symptoms.
- Drink more fluids.
- Get plenty of rest.
- Use a cool-mist vaporiser or saline nasal spray to relieve congestion.
- Soothe your throat with crushed ice, sore throat spray, or lozenges. (Do not give lozenges to young children.)
- If you are diagnosed with the flu, there are flu antiviral drugs that can be used to treat it. They are prescription drugs.
- Viruses or bacteria – what’s got you sick? Viral illnesses cannot be treated with antibiotics. When an antibiotic is not prescribed, ask your healthcare professional for tips on how to relieve symptoms and feel better. If you have a cold, runny nose, bronchitis, chest cold, flu, sore throat (except strep) or fluid in the middle ear, it is most likely caused by a virus and does not require an antibiotic. If you have whooping cough or strep throat, it is most likely caused by bacteria and needs antibiotics.