Triwik Kurniasari, The Jakarta Post, Jakarta | Sun, 08/29/2010 11:19 AM
The widespread use of antibiotics has become a major global public health sector problem. The UN World Health Organization (WHO) has urged countries to reinforce national policies on the prudent use of antibiotics to reduce the alarming increase in poorly monitored consumption.
 |
A traveler walks past a drug store at Gambir train
station in Central Jakarta. Different brand of antibiotics
are easily available as over-the-counter medicine,
which contributes to the excessive use of the drugs.
JP/Ricky Yudhistira |
How have antibiotics become a new source of addiction?
As health experts are busy debating the impact of excessive use of antibiotics, the WHO has called on governments, medical practitioners and the pharmaceutical industry to guard against possible problems associated with antibiotics, especially the potential for microbial resistance.
But what exactly is an antibiotic?
An antibiotic is essentially a substance used for curing illnesses by killing or injuring microbes, including bacteria, pharmacologist Nicolaski Lumbuun of the Pelita Harapan University Medical School said.
Antibiotics have widely been used since the 19th century following research on bacteria by Louis Pasteur and Robert Koch, who discovered that some microorganisms were capable of destroying other microorganisms. The experiment led to Alexander Fleming’s discovery of penicillin in 1928, which was developed further by English and German scientists.
The invention resulted in a medical revolution, first by significantly reducing mortality rate, Nicolaski said.
“Antibiotics are safe for most human beings, but it have side effects causing allergies, rashes, itching, swelling and even Stevens-Johnson syndrome, which can lead to death,” Nicolaski told The Jakarta Post recently.
Stevens-Johnson syndrome is a life-threatening condition affecting the skin.
Antibiotics should only be used to treat bacterial infections with symptoms such as fever or inflammation lasting longer than five days, Nicolaski said.
“Antibiotics fight bacteria-related illness, so they are not suitable for treating influenza or the common cold, which are caused by viruses,” he added.
In Indonesia, people tend to excessively consume antibiotics because they are over-the-counter medicines that can be found in drugstores, or even in roadside stalls. In many cases, physicians easily prescribe antibiotics in hopes that their patients swiftly recover.
Nicolaski once again warned about the side effects of antibiotics.
“First, it is a waste of money because antibiotics are usually expensive. They can lead to allergic reactions and digestion problems. But the most serious effect is that excessive use of antibiotics can
raise the resistance to dangerous bacteria. This situation makes it difficult for doctors to control
infections.”
Some bacteria become immune if an antibiotic is used over a long period of time, Nicolaski said, adding that this is why some countries have imposed strict regulations over the use of antibiotics.
“In Singapore, for instance, drug stores can only give antibiotics to customers with a prescription from licensed physicians. Such regulations protect citizens,” Nicolaski said.
Other experts have warned about the issue of antibiotics resistance because of microorganisms’ ability to mutate and develop immunity, the chairman of Eijkman Institute for Molecular Biology Malaria Laboratory, Syafruddin, said.
Research indicated that some organisms, such as Staphylococcus aureus, had built up immunity against meticillin, a penicillin-class antibiotic used to treat infection, he said.
Syafruddin also blasted doctors who over-prescribed antibiotics despite knowledge of the associated risks, and suggested that doctors asked their patients about allergies to antibiotics.
“If doctors are not sure about their diagnoses, they shouldn’t give their patients antibiotics,” he said.
Syafruddin added that doctors should be encouraged to provide patients with more general medicines to prevent antibiotic resistance.
While many doctors freely offer their patients antibiotics, there are other doctors who are more cautious.
Nina, a doctor who refused to give her full name, said that she only prescribed antibiotics if her patient suffered from a high fever for more than three days.
“I will prescribe regular [non-antibiotic] medication if my patient’s fever lasts less than three days. If the fever lasts longer than three days, I will prescribe an antibiotic. But I check the patient’s condition before I make the prescription,” she said.
It is also important to ask patients whether they have allergies when they request prescriptions for antibiotics, Nina said.
“Sometimes parents panic when their children are sick and ask the doctor to prescribe antibiotics. Many people think that antibiotics will solve illnesses immediately.
I myself will not prescribe antibiotics if the patients don’t need it, and I will give the reason why,” Nina said, adding that pregnant women have to be careful because the consumption of antibiotics can give harm the fetus.
But some people are simply clueless about antibiotics and the possible effects they may have.
“I don’t even know what an antibiotic is. All I know is that if the doctor gives us an antibiotic, we must eat it, but I never ask my doctor why,” said Gayatri Nur Andewi, a 28-year-old mother of two.
“I don’t want my kids taking too much of any medicine, and I stop giving them the drugs once they feel better.
The most important thing is that the sickness is gone,” Gayatri said. She said she never bought antibiotics without a prescription because it was too risky.
“It’s a matter of safety. I don’t know what antibiotics are available in stores,” she said.
For others, antibiotics are their drugs of choice. Private employee Gracia Maya Savitri said she bought antibiotics from drugstores without a prescription.
“Yes, I bought Amoxicillin for my toothache. My dentist suggested I take the antibiotic and I buy them without a prescription,” she said.
“I used to give my sick toddlers antibiotic syrup, but I only gave it for three days,” she said.
Why does not she consult a physician? “I don’t want to stand in line, especially as my pediatrician
has a lot of patients,” Gracia said.
Nicolaski urged the public not to buy antibiotics without a prescription.
“If you get a cough, cold or flu [for less than three days], it’s not recommended to take antibiotics without a doctor’s prescription, because these illnesses are caused by viruses and antibiotics won’t work,” Nicolaski said. The excessive use of antibiotics to fight ailments like common colds has contributed to a global antibiotic resistance crisis, he said.
“Don’t use antibiotics for prevention, such as taking antibiotics before or after having sexual intercourse with a sex worker. The medicine will not prevent sexually transmitted infections,” he said.
Nicolaski also encouraged patients to prevent infection and side effects by maintaining discipline when a doctor prescribed an antibiotic.
The WHO also recommended that governments ensure rational use of antibiotics by educating healthcare workers and the public on the most appropriate dosage.
