Way too many SA doctors still prescribing antibiotics

According to colds and flu pharmaceutical firm, Pharma Dynamics, South African doctors are still prescribing 50% more antibiotics to patients than they should, especially when it comes to common ailments like sore throats, bronchitis, sinus and ear infections, which dangerously heightens the risk of antibiotic resistant infections.

Not only are doctors continuing to write prescriptions for antibiotics, but they are also doing so more frequently than they did in the late 90s, when fears around antibiotic resistance first surfaced.

Last year, the Lancet (one of the world’s leading medical journals) published a peer-reviewed research paper on global antibiotic use, which points to an alarming 36% increase in worldwide antibiotic consumption between 2000 and 2010. The paper also shamed the BRICS nations for being the main culprits behind the surge in antibiotic use.

Given that the latest international studies show that antibiotics have little or no effect on the overwhelming majority of common respiratory infections, and that antibiotic resistance poses a major threat to populations around the globe, why then are so many doctors intent on prescribing antibiotics?

Mariska van Aswegen, spokesperson of Pharma Dynamics says the answer partly lies in making an accurate diagnoses. Because it is difficult to distinguish between viral and bacterial infections, without doing a proper blood test, healthcare practitioners often err on the side of caution and prescribe antibiotics.

“Often patients put GPs under enormous pressure to prescribe antibiotics, even for minor ailments which can be treated effectively with other forms of medication, but it is important that family doctors explain to patients why antibiotics should be prescribed responsibly and that taking antibiotics when you have a virus may do more harm than good.”

She says taking antibiotics increases your risk of getting an antibiotic-resistant infection later and that doctors should do all that is needed to help curb antimicrobial resistance.

Should healthcare departments around the world fail to tackle drug-resistant infections – caused by the overuse and misuse of antibiotics – it will lead to at least 10 million additional deaths a year, according to the latest scientific review on antimicrobial resistance, which was commissioned by health authorities from around the globe.

Since the inception of various antibiotic stewardship programmes in 2011, the amount of antibiotics prescribed by South African doctors in the private sector has dropped significantly pointing to a shift in the right direction. Currently, the management of antibiotic consumption for the public sector is on the cards as part of the National Department of Health’s response to global resistance.

According to van Aswegen antibiotic use should be cut down by at least half and inappropriate prescribing should be stopped. “The increasing prescription of antibiotics is leading directly to a rise in the number of potentially life-threatening infections that are difficult to treat.

“The highest rates of resistance in the country are seen in places where the largest amounts of antibiotics are prescribed, such as hospitals. It is however more common in tertiary and private hospitals than secondary and district hospitals.

“Other adverse effects associated with antibiotic use include renal impairment, hearing loss, yeast infections and antibiotic-resistant bacteria, such as Clostridium difficile,” warns van Aswegen.

It is unclear how many South Africans are infected with antimicrobial-resistant bacteria, but according to the most recent World Health Organisation (WHO) report on antimicrobial-resistance and antibiotic resistance, about 23 000 people in the United States and 25 000 Europeans die annually of drug-resistant bacteria. Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 92 countries and in at least ten countries, including SA, there have been reported cases of untreatable gonorrhoea – a potentially fatal sexually transmitted disease (STD).

National efforts to moderate antibiotic prescriptions include the South African Antibiotic Stewardship Programme (SAASP), whose main aim is to promote the responsible prescribing of antibiotics in both public and private sectors in South Africa. There are also a variety of blended learning programmes which involves a combination of online and seminar-based courses, accredited by FIDSSA. SAASP has created a specialised app which provide doctors with a checklist of illnesses to treat and those not to treat with antibiotic; what type of antibiotic and dose should be prescribed and over what interval.

“Individuals and communities also play a vital role in limiting the spread of antibiotic resistant infections,” says van Aswegen. To the public, she offers the following advice:

  1. Using antibiotics appropriately is the best for your health, your family’s health and the health of those around you
  2. At your next doctor’s visit, ask your healthcare practitioner about what you can do to stop antibiotic resistance and what steps you can take to feel better and get relief from your symptoms without using antibiotics
  3. Should your doctor prescribe antibiotics, take the medication exactly as your doctor instructed you to. If taken improperly, antibiotics are more likely to cause harm
  4. Inquire about vaccines recommended for you and your family to prevent infections that may require an antibiotic
  5. Don’t ever take an antibiotic for a viral infection such as a cold, flu, most sore throats (except Strep throat), most coughs, sinus or ear infections
  6. Never put pressure on your doctor to prescribe an antibiotic
  7. Never skip doses or stop taking an antibiotic early, even if you feel better, unless you experience major side effects. In the case of the latter, be sure to inform your doctor immediately
  8. Never save antibiotics for the next time you get sick or take antibiotics prescribed for someone else

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