Mr AS walks into a pharmacy store to buy a sachet of Ampiclox capsules. And the following ensues:
Rx: do you have a prescription for it?
AS: No, do I need a prescription for it?
Rx: yes you do.
AS: why? I have been buying it before around my work place and no one has ever asked for anything before selling it.
Rx: that’s because they may not be bothered about your future and mine.
AS: what does that mean?
Rx: let me explain. Ampiclox just as you know is an antibiotic, antibiotics are produced with the aim of killing or stoping the growth and spread of bacteria at low doses. There’s something called antibiotic resistance, and as you may perceive, it has to do with the micro organisms becoming resistant to the antibiotics used. In antibiotic resistance, the antibiotic is no longer able to kill or stop the growth of the bacteria at those low doses or in some cases, it no longer has any effect on it.
AS: all these grammar you are speaking is unnecessary, how does this relate to me? You people will sort that out somehow.
Rx: no sir. It does relate to you. Before the advent of antibiotics, a lot of people died from different diseases/infections, ranging from what we now refer to as small cough, little boil on my hand to typhoid, and as far as some sexually transmitted diseases. With the discovery and the use of antibiotics, people have been able to get treated for these infections and death rate from them has drastically reduced.
AS: I see! That’s interesting, but I still don’t understand how this relates to me.
Rx: it does relate to you, because you like many of us are unknowingly promoting antibiotic resistance. Let me tell you how:
- One common way you as a patient promotes antibiotic resistance is through incomplete usage or distorted usage of an antibiotic. Now, bacteria infections are such that when an individual attempts to treat an infection with the use of antibiotic and doesn’t complete the duration of treatment, using the prescribed antibiotic, there’s the tendency for the the bacteria to come back stronger and hence develop resistance to the said antibiotic. Some cases have I seen in my profession where people apply wrong dosages of antibiotics and unknowingly promote antibiotic resistance. With respect to not completing the full dosage of the antibiotic, many times have I met individuals who do not complete the treatment course of their antibiotic because of reasons ranging from not liking too many drugs, to not being able to afford the complete treatment regimen. To this I always say, you can buy cheaper brands of the antibiotic, generic brands are equally as good as the innovator brands of any antibiotic, and because they are cheaper and equally effective, complete the treatment course shouldn’t be any issue.
AS: oh! I see.
Rx: there is more.
- Another common cause is when people use antibiotics for the wrong infection. Take for example, the Ampiclox you have come here for. Many times have I met ladies who feel after having unprotected sex and taking Ampiclox, it can be used to treat any STDs that may be lurking around the corner. And I always do my best to tell them, no! Another common instance is people saying they want to buy a particular antibiotic because a friend had a similar infection and used the antibiotic and so they feel if they use it, they will get better. Doing this is dangerous, because firstly, two diseases can have similar bodily effects but not be treated by the same drug, secondly, our bodies react to drugs differently, so if Mr A uses antibiotic C and has no issues with it, it doesn’t mean if Mr B uses it, he won’t suffer issues.
AS: ehen?! Well, what actually happened is I met with one girl like that when I travelled to the east. (Please don’t tell my wife) so I met a friend who told me to use it to prevent any infections. That’s actually why I’m here. Actually, I’ve been feeling a little somehow of late “down there” and that’s what pushed me to coming to buy this.
Rx: ok! What you’ll have to do first of all is to go for a lab test. When you do so, come back with the results and I’ll give you the antibiotic that’s best situated for your condition. Is that ok?
AS: that’s fine. I’ll do that. I can’t be blaming the government for everything and not contribute my own quota to ensuring our safety abi na?
Rx: that’s the spirit! Exactly! So do that and get back to me. Have a nice day!
AS: but I want to ask, what can one do to prevent having infections. Because i think if we can reduce us having infections, there will be less need for the antibiotics and so resistance will reduce.
Rx: yes of course and you asked a good question. First way is by having a good hygiene, washing our hands regularly, using hand sanitizers. Avoiding unprotected sex. Keeping our environments clean and a whole lot more.
AS: oh Ok. Thank you very much. I’m grateful. I’ll be back with the test results.
Then intern pharmacist after having listened to the conversation was then forced to ask, what can we pharmacists do to stop antibiotic resistance?
Rx: that’s a good question and I’m glad you asked it. There are a number of ways pharmacists can prevent antibiotic resistance because truth be told a lot of microorganisms are becoming resistant to our antibiotic in the market. Even the innovator brands. I’ll list a few ways we as healthcare providers can tackle it:
- One major atrocity committed in many pharmacies is the act of selling antibiotics in single doses. As a matter of fact, till today do people still come here asking for a capsule or tablet of any antibiotic they want. When I refuse, they go on about how they got it like that elsewhere and how that one is enough for them. I had this discussion with a colleague some time ago and it was made known to me that they see it as a survival technique, they feel that’s the only way they can make money and sell it, sometimes because of their location. What’s funny is, we know very well that that one capsule or tablet is insufficient to produce any desired result in the individual, so the question which begs answering is why we indulge in such unscrupulous practices. Doing this, will only ensure that the microorganism isn’t killed and enables it to gain resistance to fight back.
- Another common act is the desire to include antibiotics in the management of almost any health condition, sometimes the wrong antibiotic. Let’s take for example, do you remember on Sunday when a man came with a fresh cough and wanted me to give him an antibiotic with the cough syrup and I told him to hang on to the cough syrup for a while before giving him the antibiotic? Some pharmacists are of the act of pushing forward the antibiotic right from the scratch even for a cough that’s merely disturbing, sometimes without mentioning to the patient the lifestyle management of it which includes avoiding extreme cold, cold drinks and so on. Also, a majority of cough and cold are caused by viruses and as such can be self-limiting, therefor the use of antibiotics in these cases only promotes antibiotic resistance. In cases like this, the cough stops and we assume it’s because of the antibiotic, not knowing it just relieved on its own. By then you are making the antibiotic ineffective for a time when it will be the best available drug.
- Lastly, I’ll talk about what’s called antibiotic stewardship program. This is aimed at promoting appropriate use of antibiotics, reducing antibiotic resistance and decreasing the spread of multi-drug resistant organisms and ultimately improving patient outcomes. The program comprises of some core elements namely: leadership commitment by dedicating necessary resources by the pharmaceutical industry and the government, accountability on the part of the pharmacist, drug expertise on the part of the pharmacist, implementation of recommended actions regarding antibiotic usage, tracking which entails monitoring antibiotic prescribing and resistance patterns, is achieved through effective collaboration among patients, pharmacists and the government, reporting antibiotic use and resistance and lastly educating physicians and pharmacists about resistance and optimal prescribing. You can read more about it here https://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html
Intern: that’s a whole lot. Antibiotic resistance is clearly no small thing. Thanks for the information. I hope to do my best to combating antibiotic resistance.
- Rx: you are welcome and I hope we can do that. As men of honour, let’s join hands to battling it.