A BITTER PILL TO SWALLOW

▶ Misusing antibiotics can cause serious health problems. Panna Munyal investigates when we need to take them, when we should definitely avoid them, and how they have seeped into the food we eat

The flu, a cough or common cold, headaches: these are all ailments that cannot be treated by popping antibiotics. Just as diseases can be roughly divided as bacterial, viral and fungal, so can the drugs that help to fight them. You wouldn’t slather cough syrup, which is filled with anti-viral agents, on to a patch of ringworm, so why would you use a pill that’s only effective against bacteria to cure any of the above-mentioned conditions?

“It cannot be said enough: an antibiotic should be consumed only in the case of a bacterial infection. Taking it otherwise is really compromising yourself,” says Dr Mitesh Patel, medical director of Aetna International. “What we are seeing time and time again is years of overprescribing antibiotics, which causes real problems.”

He adds that even certain bacterial afflictions can be overcome without using these strong and long-lasting drugs. “Say a young person has a bacterial chest infection; his or her body may be able to fight it on its own. And a good doctor should be able to take that call, and prescribe the drug only if necessary.”

The reasons Patel and many others are concerned with the misuse of antibiotics are manifold. For one, the pills are unable to distinguish between bad and good bacteria, with the latter being essential to healthy digestion. “There are trillions of living, healthy bacteria in our systems, called gut microbiota. These play a significant role in our immune response and metabolic balance,” explains Dr Hanan Sheikh Ibrahim, an internist and geriatrician at Cleveland Clinic Abu Dhabi’s Medical Subspecialties Institute.

“Antibiotics that kill the bacteria making us ill can also alter the balance of healthy gut microbiota, which may increase the risk of multiplication of resistant superbugs and could pose serious health problems. In addition, an altered microbiota can cause bloating, diarrhoea and irritable bowel syndrome.”

Secondly, consuming these pills for unrelated ailments can cause antibiotic resistance, or put simply, make the bad bacteria immune to the drug. Not so simple, however, are the fatalistic downfalls of this resistance. “The spread of antibiotic-resistant bacteria is threatening the effectiveness of last-resort treatments for life-threatening infections,” states Patel. “Every year, 700,000 deaths (and counting) are attributed to antimicrobial resistance – that’s equivalent to the population of Washington being decimated annually.”

This is not to say that antibiotics are all-bad or don’t save countless lives. They are a must for several infections, including strep throat, tuberculosis, typhoid, meningitis, bacterial urinary tract infections, bacterial pneumonia and C difficile. “Antibiotics are extremely important in case of contagious bacterial infections, which could be fatal if left untreated,” says Dr Waed Jaber, an internal medicine specialist at Medcare Hospital Sharjah.

The side effects, meanwhile, can be countered to an extent with probiotics and fermented foods that contain healthy bacterial species such as lactobacilli. These include yoghurt, cheese and kimchi, which should be consumed a few hours before or after the drug. Ibrahim adds: “High-fibre foods, such as wholegrains, beans, fruits and vegetables, may help the growth of healthy bacteria in the gut. However, we prefer to start a high-fibre diet after the course of antibiotics is complete, as it might reduce absorption of the drugs,” he explains.

Another concern is that many people stop taking the pills prematurely, once they start to feel a little better, even if the recommended duration of the course is not complete. However, says Jaber, feeling better or an improvement in symptoms does not always mean that the infection has completely gone. A partially treated condition can cause a rebound as well as make the bacteria more resistant to the drug.

Also worrying is the use of antibiotics in agriculture and animal breeding, causing certain strains to enter the food chain. “Despite the growing use of antibiotics among humans, the lion’s share actually goes to farm animals. In some countries, up to 80 per cent of antibiotics may be used in agriculture, primarily to promote growth, not to treat disease,” says Patel. “And those bacteria don’t stay on the farm. Instead, they are transmitted to consumers.”

Jaber suggests some basic precautionary measures one can take to avoid illnesses that can be caused from these largely unmetabolised antibiotics. “Wash your hands before and after you handle food; and wash and cook your food thoroughly to prevent any harmful bacteria from getting into your system,” he says. “Also, refrain from eating raw or undercooked meat, poultry and eggs. Do not cross-contaminate your food by using the same utensils for raw meat or eggs, and fresh fruits and vegetables, until those utensils have been thoroughly washed. Make sure you also clean your sinks, cutting boards and countertops after handling these items, as contaminated surfaces are often to blame for cross-contamination.”

Education, then, is key when it comes to curbing the abuse, misuse and overuse of antibiotics. While medical practitioners need to be incredibly discerning about their diagnoses and prescriptions, the blame does not always lie with the doctor. “The patient is often the driver, and puts pressure on the doctor by demanding antibiotics,” says Patel. “And some doctors, unfortunately, find it’s easier to prescribe them than having the harder conversation and explaining to a biased patient why they don’t require these particular pills, and changing that patient’s mentality.”

The biases we all tend to carry can have a major impact on the medical care we seek out, both physically and via ‘Doctor Google’. “If you search online for ‘antibiotics for a cough’, that article will be there; and if you look for ‘no antibiotics needed for a cough’, that article will be there as well. Whether self-doctoring using the internet helps or not depends on the quality of the article you’re reading, but it is likely the piece fits in with your pre-existing biases, which have driven you to read it in the first place,” explains Patel. “Very few people have the ability to source and read the literature found online in a competent way. And for patients who are anxious, the internet can cause more harm, by feeding your anxiety, and getting you to take something you might not need.”

An antibiotic should be consumed only in the case of a bacterial infection. Taking it otherwise is really compromising yourself

DR MITESH PATEL

Medical director, Aetna International