A few days back, I called a friend and found out that she was suffering from a sore throat, yet again. Being a pharmacist, people talk to me quite frequently about the medicines they have been taking. This particular friend was tackling her sore throat with Amoxicillin and had disregarded the need for a prescription. Recently, however, she complained to me that Amoxicillin doesn’t work for her anymore. The truth is that she is not the only one. Most people don’t understand the dreadful consequences of misusing antibiotics. A sore throat, runny nose and fever are all inevitable gifts of the winter season and since Karachiites are less accustomed to this season than those in the rest of the country, they suffer more than the others. Therefore, I thought it best to share a few noteworthy points about the use of antibiotics so that everyone can enjoy the weather without constantly falling ill. 1) Antibiotics are prescription based Please keep in mind that antibiotics are strictly ‘prescription-only’ medicines. Most of the time, using antibiotics for a sore throat and a runny nose is absolutely unnecessary. Good general practitioners (GPs) prescribe antibiotics justifiably and never for mere allergic reactions. So my first advice is that one should never take antibiotics without a doctor’s prescription. 2) Time duration The prescriber understands the medicine and the disease better than you do so trust them when they ask you to take your medicine for a certain duration. Take your medicine for only as long as the prescriber has recommended. 3) Cost-effective medicines Considering the low income state of our country, I would also like to address the economy factor in this situation. Many people opt to discontinue therapy as doctors prescribe expensive medicines. This is where pharmacists come in as they can help you select a relatively low cost brand of the same and equally efficacious medicine. Don’t discontinue your visits to the doctor just because he suggests costly antibiotics. 4) Resistance building germs Some of you might question all this fuss about antibiotics. Well, this issue is graver than you can even imagine. Misusing antibiotics does not affect only a single individual but the whole community. The germs have a tendency to build up resistance against antibiotics (as displayed in many cartoon advertisements of antibacterial soaps). When a person takes an antibiotic unnecessarily, the germs get an opportunity to fight that type of medicine. And when this new germ multiplies and spreads in a community through viral sprees, it becomes stronger and requires a higher dose or a more sophisticated medicine to be stopped. 5) Shortage of effective medicines If old antibiotics won’t work as efficiently as they used to do in the past and the disease continues, there may come a time when doctors and prescribers will have very limited options for curing infections. Some time ago, I went to see a GP about my flu condition. Usually GPs who know that the patient is a pharmacist, let the patient select the medicine of his or her choice, since a pharmacist is a medicine expert. I do not take antibiotics very often so I asked the GP to prescribe Amoxicillin to me. The GP told me that it won’t work, Amoxicillin used to be a highly effective and very commonly used antibiotic and it’s not as effective anymore, and that I should go for Levofloxacin – an advanced form of antibiotic. So it’s already happening – once a powerful antibiotic has lost its efficacy, the simplest of infections will need to be cured with advanced medicines. We are making infections stronger and more immune to our medicines due to this excessive use of antibiotics. 6) Antibiotics are not for trivial diseases The misuse of antibiotics has a toll on highly epidemic diseases as well. Tuberculosis (TB) is a very common infection in Pakistan and in other developing countries. TB is treated with a combination of at least two or more antibiotics due to the resistant nature of the bacteria. Now imagine if an individual is already exposed to a lot of antibiotics for apparently trivial infections, won’t his body become resistant to medications? And if that same person is infected with a TB germ, the treatment options would become immensely scarce as only a few antibiotic drugs would be effective for him. Unnecessary exposure to antibiotics for common infections has reduced the treatment options for life threatening conditions. 7) Professionals’ responsibility I was attending the out-patient counter at a pharmacy once and a regular patient came up with her prescription. When I entered her medical record number in the system and viewed the patient history, I realised that the patient had already taken a full course of Cefixime (antibiotic) the previous week. I scanned her new prescription and found out that the doctor had prescribed her Ciprofloxacin (antibiotic) this week. I requested the patient to wait while I confirmed her prescription from her doctor.
“Good morning, doctor. I have this patient who has been prescribed Ciprofloxacin by you.”I forwarded the doctor the medical record number so that he would know which patient I was talking about. After he reviewed the respective patient’s medical records, he inquired what my query was regarding.
“Sir, if you can please have a look at the history, this patient was prescribed Cefixime for 10 days and her course finished only two days back. Can you please confirm the patient’s diagnosis that requires another antibiotic so soon after the first one?”In agreement with my concern, the doctor replied, “I see. Well, the patient has Gastrointestinal Infections (GI) and if she has already taken the antibiotic then I think you should not be issuing it again so soon. Cancel out the prescription and send the patient back to my office.” I told the patient to go back to her doctor. When she returned to me after meeting him, she reported that the doctor had given her some diagnostic tests – a sensitivity test – which is performed to find out which organism has caused the infection and which antibiotic will be most effective. This test is prescribed to find out why the infection was not cured by Cefixime and to assess the current status of her infection. I told the patient,
“Ok ma’am. You need to get these tests done and then your treatment will begin accordingly.”She angrily shot back at me,
“Why can’t you just give me the medicines and be done with it?”I tried to assured her,
“It is not in your best interest to take antibiotics so frequently without even knowing the kind and severity of the infection you have. The doctor has rightly recommended you to get these tests done first.”She fumed at me again saying,
“But I want to take these medicines. Just give me these; I will pay for the medicines.”I replied to her as patiently as I could,
“I did not cancel your prescription on my own. I just pointed out your history and your consultant did the cancellation. It was for your benefit. I apologise but we do not dispense antibiotics without prescriptions.”She left, fuming. The point to be noted here is that had the patient’s history gone unnoticed, she would have taken another antibiotic soon after the first one and the bacteria - which had already succeeded in defeating the first antibiotic - might have grown resistant to the second one as well. We, as professionals, need to keep a check on our patients and their medicine intakes. 8) Side effects Another argument for using antibiotics sensibly is that a misuse can lead to serious side effects. It needs to be understood that antibiotics are meant to kill germs and that germs are a kind of living cells. So the antibiotics are basically working against living cells and this is what causes adverse side effects. The prescribers are trained to recommend medicines only if the benefits outweigh their adverse effects. A common man, who doesn’t know all the factors, cannot possibly take the right decision when it comes to the intake of antibiotics. So, take care of your health and try avoiding infections as much as possible. If you are prescribed antibiotics, take them on time and for the complete and prescribed duration. After all, taking care of one’s health is a serious concern.