We talk to sci­en­tist Marco Haenss­gen on the dan­gers of mis­us­ing an­tibi­otics

With the threat of an­tibi­otic-re­sis­tant ‘su­per­bugs’ loom­ing large across the re­gion, South­east Asia Globe spoke with mixed-meth­ods sci­en­tist Marco Haenss­gen about his work ed­u­cat­ing ru­ral com­mu­ni­ties on the dan­gers of mis­us­ing an­tibi­otics

Southeast Asia Globe - - Healthcare Special - Paul Mil­lar

What are some of the mis­con­cep­tions about an­tibi­otic use in ru­ral parts of South­east Asia?

I would per­son­ally re­frain from talk­ing about 'mis­con­cep­tions' and would rather re­fer to 'lo­cal con­cep­tions'. There is, of course, still a lot that we do not un­der­stand, which is why there is so much so­cial re­search ac­tiv­ity in this area. But some of the things we have ob­served in our so­cial re­search... were re­lated to lan­guage. For ex­am­ple, the Thai ver­nac­u­lar ex­pres­sion of an­tibi­otics trans­lates into 'anti-in­flam­ma­tory drugs', used for a specific set of symp­toms – like a sore throat.

Where peo­ple don’t have an ac­tive no­tion of an­tibi­otics, it be­comes quite dif­fi­cult to steer them away from overuse via ed­u­ca­tional mes­sages. Some­times, warn­ing mes­sages about an­tibi­otics can in fact have ad­verse con­se­quences for these groups be­cause they could be scared off from us­ing medicine more broadly.

What are some of the dan­gers of in­cor­rectly or over­pre­scrib­ing an­tibi­otics?

Gen­er­ally it is widely ac­cepted that the over- and mis­use of an­tibi­otics con­trib­utes to the prob­lem­atic trend of an­tibi­oti­cre­sis­tant bac­te­ria. There might be many rea­sons for why too many – rather than too few – an­tibi­otics are be­ing prescribed. Some are com­monly at­trib­uted to sup­ply pres­sure from phar­ma­ceu­ti­cal com­pa­nies or that an­tibi­otics are per­ceived as magic pills, but that is cer­tainly not the whole story.

Just imag­ine a set­ting where a doc­tor has to make a choice un­der uncer­tainty – the pa­tient might have an in­fec­tious dis­ease that might be cured with an an­tibi­otic, but this is dif­fi­cult to tell with­out proper di­ag­nos­tic equip­ment. In such a case, an­tibi­otics can be the ‘safe choice’ for a doc­tor to pre­vent a po­ten­tial pa­tient death – at the ex­pense of po­ten­tially con­tribut­ing to an­tibi­otic re­sis­tance.

What are some of the steps that you and your col­leagues take to ed­u­cate these com­mu­ni­ties on the threat of an­timi­cro­bial re­sis­tance?

The [South­east Asia-based] Mahi­dol-Ox­ford Trop­i­cal Medicine Re­search Unit is very ac­tive in pub­lic en­gage­ment. Ed­u­ca­tional videos and posters have been pro­duced. We are cur­rently brain­storm­ing more – and scal­able – ac­tiv­i­ties that might reach a broader ru­ral pop­u­la­tion. But there are in­deed a lot of chal­lenges.

Ed­u­ca­tional mes­sages are dif­fi­cult to craft and need to be ap­pro­pri­ate to the lo­cal un­der­stand­ing of an­tibi­otics and ill­ness. It is also dif­fi­cult to assess whether ed­u­ca­tional mes­sages are ef­fec­tive, be­cause they do not au­to­mat­i­cally change be­hav­iour.

Part of the prob­lem­atic pat­terns that we see might not be be­cause peo­ple are ‘ig­no­rant’, but sim­ply be­cause they don’t have bet­ter healthcare choices. Some­body who is poor, de­pen­dent on work for mere sur­vival and po­ten­tially iso­lated in their com­mu­nity might find it dif­fi­cult to act on the good ad­vice that they shouldn’t take an­tibi­otics with­out first con­sult­ing a doc­tor – who might be very dif­fi­cult to reach in some ru­ral ar­eas. –

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