An­tibi­otics mis­use, overuse a grow­ing con­cern

Bhutan Times - - Front Page - Lhakpa Tsh­er­ing

The grow­ing prob­lem of the mis­use of an­tibi­otics re­mains a se­ri­ous chal­lenge to the pub­lic health, re­sult­ing in an alarm­ing in­crease in the bur­den of be­com­ing col­o­nized or in­fected with a re­sis­tant or­gan­ism.

Speak­ing on the oc­ca­sion, Dr Pema Chuki of JDWNRH re­ported that be­tween 20 to 50 per­cent of an­tibi­otic pre­scrip­tions are ei­ther un­nec­es­sary or in­ap­pro­pri­ate.

The mis­use of an­tibi­otics, she re­ported was given when they are not needed, the wrong an­tibi­otic is cho­sen to treat an in­fec­tion, con­tin­ued when they are no longer nec­es­sary, given at the wrong dose and broad spec­trum agents are used to treat very sus­cep­ti­ble bac­te­ria.

Overuse of an­tibi­otics may re­sult in the in­creased emer­gence and spread of mul­tidrug-re­sis­tant bac­te­ria. Dr Pema Chuki said, “In­creas­ing use of an­tibi­otics in health­care set­tings in­creases the preva­lence of re­sis­tant bac­te­ria in hos­pi­tals.”

Dr Pema Chuki said, “The ris­ing num­ber of An­tibi­otics mis­use and overuse are re­sis­tant to an­timi­cro­bials is of great con­cern.”

She said a lead­er­ship com­mit­ment is re­quired to sup­port for ef­forts to im­prove and mon­i­tor an­tibi­otic pre­scrib­ing, as­sur­ance that the in­volved staff has time, and au­thor­ity and ac­count­abil­ity in the place.

Dr Pema Chuki said the guide­lines, poli­cies, and pro­to­cols alone would prob­a­bly not change the prac­tice. How­ever, she rec­om­mended that ac­tive in­ter­ven­tions such as prospec­tive au­dit, for­mu­lary re­stric­tion and preau­tho­riza­tion, An­tibi­otic ‘Time Out', IV to oral switch, de-es­ca­la­tion ther­apy and dose op­ti­miza­tion are most ef­fec­tive.

Ch­himi Lhamo with nurs­ing de­part­ment also rec­om­mended that ded­i­cated full time in­fec­tion con­trol nurse is re­quired in the hos­pi­tal and clean­ing re­source and dis­in­fec­tants need to be avali­able all the time. “Hand hy­giene com­pli­ance need to be im­proved among all the health work­ers, and re­quired reg­u­lar mon­i­tor­ing and su­per­vi­sion of IC prac­tices,” she said, adding that iso­la­tion ward is also re­quired in the hos­pi­tal.

Thupten Tsh­er­ing, Head of Phar­macy De­part­ment, said it is time for a na­tional data on an­tibi­otic use. He said, “In­for­ma­tion on an­tibi­otic con­sump­tion is use­ful in in­flu­enc­ing the an­tibi­otic pre­scrib­ing be­hav­iour.”

Tandin Dorji, Chief pro­gram of­fi­cer of Health Care and Di­ag­nos­tic Di­vi­sion, De­part­ment of Med­i­cal ser­vices, said peo­ple

are not ed­u­cated on the im­pact of an­tibi­otics if taken with­out the ad­vice of health pro­fes­sion­als as health care be­ing free, and in par­tic­u­lar, medicines be­ing free of charge. He said, “This not only puts them in dan­ger but also ex­ac­er­bates the cost in­volved in treat­ing the pa­tients.”

The press re­lease from health min­istry states that in many places, an­tibi­otics are overused and mis­used in peo­ple and an­i­mals, and of­ten given with­out pro­fes­sional over­sight. “Ex­am­ples of mis­use in­clude when they are taken by peo­ple with vi­ral in­fec­tions like colds and flu, and when they are given as growth pro­mot­ers in an­i­mals or used to pre­vent dis­eases in healthy an­i­mals.”

Com­bat­ing an­timi­cro­bial re­sis­tance should not be dif­fi­cult in Bhutan as the use of an­tibi­otics is mainly re­stricted to gov­ern­ment hos­pi­tals and ve­teri­nary cen­ters.

Ac­cord­ing to the health min­istry, the sale of an­tibi­otics from the pri­vate phar­ma­cies con­sti­tutes only a small frac­tion of an­tibi­otics used in the coun­try whose sale is well reg­u­lated and the use of an­tibi­otics in agri­cul­ture sec­tor has been kept to min­i­mum.

How­ever, the coun­try can­not be com­pla­cent and ef­fec­tive mon­i­tor­ing and sur­veil­lance of the an­tibi­otic use in both hu­man and an­i­mal health has to be es­tab­lished and sus­tained. The min­istry says, “The core fo­cus at this time how­ever, should be on en­sur­ing the ra­tio­nal use of an­tibi­otics in the hos­pi­tals and ve­teri­nary cen­ters and en­hanc­ing pub­lic ed­u­ca­tion and at the same time.”

The health min­istry seeks ac­tion against an­tibi­otics to pro­tect the gen­er­a­tion from in­fec­tions. “We have to act now and we have to act to­gether. We owe it to our­selves, and we owe it even more to our chil­dren.”

The World Health Or­ga­ni­za­tion (WHO) also warned that an­tibi­otics con­sump­tion is dan­ger­ously high in some coun­tries while a short­age in oth­ers is spurring risky mis­use, driv­ing the emer­gence of deadly su­per­bug in­fec­tions.

The WHO re­port, based on 2015 data from 65 coun­tries and re­gions, showed a sig­nif­i­cant dif­fer­ence in con­sump­tion rates. It states, “The large dif­fer­ence in an­tibi­otic use world­wide in­di­cates that some coun­tries are prob­a­bly overus­ing an­tibi­otics while other coun­tries may not have suf­fi­cient ac­cess to these lives-sav­ing medicines.”

To stop the un­nec­es­sary use of an­timi­cro­bials in health­care and in agri­cul­ture, and through bet­ter di­ag­no­sis and preven­tion of in­fec­tion in health­care set­tings and com­mu­ni­ties, the Min­istry of Health in col­lab­o­ra­tion with the WHO ob­served the World An­tibi­otics Aware­ness Week glob­ally from 12 to 18 Novem­ber in Thim­phu and other hos­pi­tals in nine Dzongkhags.

The themed “Our Time with An­tibi­otics is Run­ning Out. Change Can't Wait” is aimed at spear­head­ing the ad­vo­cacy and aware­ness ac­tiv­i­ties to the pub­lic on the in­creas­ing threat of AMR glob­ally.

In many places, an­tibi­otics are overused and mis­used in peo­ple and an­i­mals, and of­ten given with­out pro­fes­sional over­sight

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