By Dr. Ismail Muhammad Bello
Abuse of Antibiotics: Abuse of antibiotics entails both overuse and misuse. Medical professionals, veterinary practitioners, drug vendors, animal farmers and individuals in the community are all culpable in this detrimental practice.
Antibiotics Abuse in Veterinary Practice and Animal Husbandry: In humans, antibiotics are primarily utilized for therapeutic purposes, but in veterinary practice, they are extensively employed for non-therapeutic reasons, such as promoting growth to meet the rising global demand for animal protein. Even for therapeutic purposes, a common practice involves administering antibiotics, sometimes even below the therapeutic dose, to entire herds for “disease prevention” when only some animals are ill.
The environment plays a crucial role in the evolution and dissemination of antibiotic resistance. Major sources of antibiotic resistance genes and antibiotic pollution in the environment include waste from large-scale animal and aquaculture farms, wastewater from antibiotic manufacturing, as well as from hospitals and municipalities. A portion of the antibiotics administered to humans and animals is excreted unaltered in faeces and urine. Such animal waste is rich in nutrients and commonly used as fertilizer on crop fields, resulting in direct environmental contamination with both antibiotic residues and resistant bacteria.
Antibiotics Abuse in Human Medicine: In human medical practice, the lack of adherence to standard treatment guidelines has led to unwarranted prescriptions of antibiotics by medical professionals. A common occurrence is the prescription of antibiotics for non-bacterial conditions like the common cold (viral rhinitis).
Antibiotics Abuse in Hospitals: Moreover, medical professionals are also guilty of prescribing these drugs below the standard treatment dosage or for a shorter duration, particularly at the primary level of healthcare. This is particularly important because correct dosing is pivotal in drug therapeutics and serves as a significant distinction between orthodox and traditional practitioners. Paracelsus succinctly captures this in his renowned toxicology maxim: “All drugs are poisons; the benefit depends on the dosage.”
A common scenario in pediatric practice involves practitioners prescribing drugs based on volume rather than the calculated amount per child’s body weight. For instance, it’s not uncommon for a child to receive a prescription for 5mls of Amoxiclav Suspension to be taken twice daily. This practice poses a challenge for pharmacists during dispensing, as Amoxiclav Suspension is available in various strengths, ranging from 125mg to as high as 600mg of Amoxicillin in a 5ml dose.
A related situation arises when patients are instructed to take 1, 2, or 3 tablets of medications with varying dosage forms and strengths. For instance, Amoxiclav is available in tablets with 250mg, 500mg, 875mg, and 1000mg of Amoxicillin. This leaves the patient reliant on the drug vendor to select and dispense from his catalog, potentially leading to under-dosage or over-dosage, unless fortunate enough to be attended by a skilled pharmacist.
Another related practice involves the management of children with fever and multiple convulsions. In our setting, top among the list of differentials are severe malaria and acute bacterial meningitis. These conditions can be effectively distinguished through thorough good history-taking, physical examinations and investigations such as malaria parasite test (MP), cerebrospinal fluid (CSF) analysis and full blood count. Despite evidence favouring one treatment over the other, some practitioners often combine parenteral antibiotics and anti-malarials. While simultaneous severe infections are not impossible, they are typically uncommon, emphasizing the merciful nature of God.
The repercussions of this lack of precision extend beyond medical concerns to economic ones, particularly in our context. An unnecessary 7-10 day antibiotic course can result in an additional estimated bill of approximately N40,000 ($50.66). A good brand of Ceftriaxone nowadays costs about N2500-N6000 ($3.2-$7.6) per vial, varying by location. This is a significant expenditure for a country with the highest level of poverty globally compounded by a poor health insurance scheme and a paltry minimum wage of N33,000 ($41.8).
Such harmful practices may result in under-dosing, subjecting organisms to sub-therapeutic drug levels which are nonlethal, promoting drug resistance. It’s comparable to confronting a machine gun-wielding terrorist with a tiny stick, eliciting a reaction that can only be better imagined.
In this regard, health professionals should undergo continuous training on the proper use of antibiotics and adhere to standard treatment guidelines in disease management. Health institutions should also implement antibiotic stewardship programs to systematically educate and guide practitioners in the effective utilization of these drugs.
Job aids should be provided to assist in the accurate prescription of medicines. In this context, both healthcare workers and patients should recognize that medical practice is guided by the principle of “Primum Non-nocere” – First, do no harm – underscoring the importance of patient safety. Both patients and practitioners must understand that cross-checking when uncertain is not a sign of incompetence but a commitment to due diligence. Patient safety surpasses individual egos, as it’s wiser to be safe than sorry. Physicians’ reactions to patients’ treatment expectations contribute significantly to inappropriate antibiotic use. This often occurs when a patient arrives with preconceived notions about their condition and preferred medications. Emphasis should be placed on educating the patient rather than yielding to their requests and pressure. Patients need to be adequately counselled on their condition and the reasons why prescribed medication may not be necessary. Additionally, physicians should be mindful that non-drug therapies can be as effective, or even superior, in certain conditions.
Dr. Ismail Muhammad Bello is a proud graduate of ABU Zaria. He is a Malnutrition Inpatient Care trainer and currently serves as a Medical Officer at both Khalifa Sheikh Isyaka Rabiu Paediatric Hospital in Kano and Yobe State Specialists Hospital in Damaturu. He can be reached at ismobello@gmail.com