Us­ing an­tibi­otics wisely

Financial Mirror (Cyprus) - - FRONT PAGE -

To solve the prob­lem of an­timi­cro­bial re­sis­tance, the world needs not only new drugs, but also new be­hav­iour – by all seven bil­lion of us. Be­cause of the mis­use and overuse of an­tibi­otics, com­mon in­fec­tions such as pneu­mo­nia and tu­ber­cu­lo­sis are be­com­ing in­creas­ingly re­sis­tant to ex­ist­ing treat­ments; in some cases, they have be­come com­pletely im­mune.

The threat is global in scale. Ac­cord­ing to the Re­view on An­timi­cro­bial Re­sis­tance, which I chair, drug-re­sis­tant in­fec­tions kill at least 700,000 peo­ple ev­ery year. By 2050, if noth­ing is done to ad­dress the prob­lem, some ten mil­lion peo­ple a year could be dy­ing from mal­adies that were once treat­able.

De­vel­op­ing new drugs is an im­por­tant ap­proach in a co­or­di­nated re­sponse to fight an­timi­cro­bial re­sis­tance. But it will not be enough. We also need to re­duce our de­mand for an­tibi­otics and un­der­stand that they can some­times do more harm than good. Ac­cord­ing to one es­ti­mate, nearly half of all pre­scrip­tions for an­tibi­otics in the United States are in­ap­pro­pri­ate or un­needed. So the steep rise in an­tibi­otic re­sis­tance is hardly sur­pris­ing.

Im­prov­ing peo­ple’s un­der­stand­ing of the prob­lem will be cru­cial to re­vers­ing this trend.

Most peo­ple are ei­ther com­pletely obliv­i­ous to an­timi­cro­bial re­sis­tance or in­cor­rectly be­lieve that it is an in­di­vid­ual’s body that be­comes drug re­sis­tant – not the bac­te­ria it­self. A bet­ter un­der­stand­ing of when to use an­tibi­otics, and how to use them ef­fec­tively, will help peo­ple use them re­spon­si­bly.

We need cam­paigns

like

the

one

in­tro­duced

by

the Aus­tralian char­ity NPS MedicineWise, which held a com­pe­ti­tion for videos pro­mot­ing public aware­ness of an­tibi­otic use. The re­sult was a se­ries of short, witty films ex­plain­ing sim­ply and hu­mor­ously how an­tibi­otics can be mis­used.

These types of ef­forts are needed world­wide, par­tic­u­larly in the largest and most rapidly grow­ing coun­tries. The BRIC coun­tries – Brazil, Rus­sia, In­dia, and China – con­sume fewer an­tibi­otics per per­son than the US. But they are rapidly catch­ing up as the rate of an­tibi­otics con­sump­tion out­strips the pace of eco­nomic growth.

Pes­simists will claim that be­hav­iours are hard to change, es­pe­cially when do­ing so de­pends on ex­plain­ing the science of germs to un­e­d­u­cated au­di­ences. That line of think­ing brings to mind one of the most ab­hor­rent ar­gu­ments against mak­ing HIV medicines af­ford­able for pa­tients in low­er­in­come coun­tries: Peo­ple in Africa have no watches, so they will not be able to take their an­tiretro­vi­ral medicine three times a day.

The truth, as re­searchers have shown, is that Africans are per­fectly ca­pa­ble of re­li­ably ad­her­ing to an­tiretro­vi­ral ther­apy – of­ten more so than North Amer­i­cans. In­deed, in July, UNAIDS an­nounced that the goal of hav­ing 15 mil­lion peo­ple on life-sav­ing HIV treat­ment by the end 2015 was met ahead of sched­ule.

Ev­ery year on De­cem­ber 1, World Aids Day high­lights the is­sue and raises global aware­ness. We need a sim­i­lar ef­fort to ad­dress the per­ils of an­timi­cro­bial re­sis­tance. Euro­pean An­tibi­otic Aware­ness Day, on Novem­ber 18, is a good start; but we must also find new, cre­ative ways to spread the mes­sage.

Tech­no­log­i­cal in­no­va­tion brings un­prece­dented op­por­tu­ni­ties to reach peo­ple di­rectly. Roughly 95% of Chi­nese and 75% of In­di­ans use mo­bile phones regularly. In ar­eas where lit­er­acy rates are high, send­ing text mes­sages can be a rapid and ef­fec­tive way to spread a mes­sage. Re­search in Europe and the US shows that 90% of text mes­sages are read within three min­utes of be­ing re­ceived.

So­cial media are another pow­er­ful and rel­a­tively cheap tool to reach mil­lions of peo­ple. In China – home to the world’s largest In­ter­net base, with 641 mil­lion users – 80% of doc­tors use smart­phones for pro­fes­sional pur­poses, in­clud­ing by pro­vid­ing med­i­cal ad­vice via so­cial media, with some prac­ti­tion­ers at­tract­ing mil­lions of fol­low­ers. En­list­ing these med­i­cal so­cial-media su­per­stars to ed­u­cate the public on the ur­gency of an­timi­cro­bial re­sis­tance is an ex­cit­ing op­por­tu­nity.

An anti-smok­ing so­cial-media cam­paign led by the World Health Or­gan­i­sa­tion pro­vides another model that could be fol­lowed. Posts by Chi­nese celebri­ties were used to in­crease aware­ness of a law ban­ning smok­ing in in­door public spa­ces.

In some parts of the world, the best way to com­bat drug re­sis­tance will be to en­cour­age changes in be­hav­iour that re­duce the spread of in­fec­tions and min­imise the need for treat­ment. Proper hand wash­ing is a great place to start. In In­dia, a clever cam­paign called Su­perAmma used im­ages of peo­ple ex­posed to un­san­i­tary sit­u­a­tions to en­cour­age hand wash­ing. The cam­paign suc­cess­fully and sus­tain­ably in­creased reg­u­lar hand wash­ing from 1% of the groups in­volved to about 30%.

The cost of a global ef­fort to raise aware­ness of the threat of an­timi­cro­bial re­sis­tance would be minis­cule com­pared to the amount be­ing spent to de­velop new drugs and tech­nolo­gies, which in any case will take years to be­come avail­able. Coun­tries should ur­gently put in place ed­u­ca­tional cam­paigns and be­gin to change be­hav­iors. To­gether, we can break our bad an­tibi­otic habits.

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