Antibiotics are powerful medicines for bacterial infections
The global fight against antibiotic resistance can only succeed if the context, the specific rules and situations of a country are taken into account. “Not ‘one-size-fits-all’, but a tailor-made approach is needed,” says Heiman Wertheim of Radboudumc. It appears from research in Africa and Asia funded by the British Wellcome Trust that he has published in The Lancet Global Health with a large group of international researchers.
Antibiotics are powerful medicines for bacterial infections. Antibiotics are indispensable in the fight against, for example, pneumonia, meningitis or blood poisoning (sepsis) caused by bacteria. But they don’t work for a flu or cold caused by viral infections. And also not with infections with a parasite, fungus or yeast.
Increasing resistance
Incorrect use of antibiotics increases the risk of antibiotic resistance. This means that the bacteria adapt, so that the antibiotic no longer works properly and the disease can no longer be controlled. Antibiotic resistance is now a major problem worldwide, which is only likely to get worse.
The problem is growing especially in the less wealthy countries (Low and Middle Income Countries; LMIC). In those countries, antibiotic use increased by 35 percent between 2000 and 2010. Research in Africa showed that 80 percent of children under the age of five with respiratory infections were prescribed antibiotics. In many cases unjustified. In order to get a clearer picture of the how and why of the problem, a large group of international researchers led by Heiman Wertheim from Radboudumc carried out the ABACUS project. ABACUS stands for AntiBiotic ACces and USe.
Big differences between them
The results of the study, which was conducted in LMIC countries in Africa (Mozambique, Ghana, South Africa) and Asia (Bangladesh, Vietnam, Thailand), are now published in The Lancet Global Health. Wertheim: “We therefore mainly looked at how easy or difficult to obtain antibiotics in those countries and in which situations they are used. On those points alone, enormous differences appear to exist between those six countries. For example, it makes a big difference whether you can only get an antibiotic in the pharmacy after a note from a doctor, or if you can get it at any time without restriction from the pharmacy around the corner. We see that antibiotics are much more readily available in Asia than in Africa. And that the weather is going a bit better in relatively richer countries such as Thailand and South Africa. ”
Self-medication
Nga Thi Thuy Do, researcher at the Oxford University Clinical Research Unit in Vietnam and lead author of the paper: “Bangladesh and Vietnam have the most outlets where antibiotics are available without a prescription. In some settings you already have 1 point of sale for antibiotics per 500 inhabitants, which is an awful lot. This is reflected in the extent to which antibiotics are used as self-medication. In Vietnam, Bangladesh and Ghana, 57, 45 and 36 percent of the population, respectively, sometimes takes antibiotics for self-medication. This hardly happens in Mozambique, Thailand and South Africa, with 8, 4 and 1 percent respectively. The difference is enormous. ”
The researchers also saw that there is a lot of uncertainty among the local population and even among the drug sellers about what an antibiotic actually is and how you can recognize it. Painkillers, for example, were confused with antibiotics. In a follow-up study with Wellcome Trust funding, the consortium will investigate whether better recognition of antibiotics can lead to better use.
Context, context, context
The reasons for opting for self-medication are obvious: getting antibiotics from the drugstore without a note is faster, cheaper and easier. But of course that must be possible. And that again depends on all kinds of factors such as the way in which care is organized, trust in the supplier and the severity of the disease. Wertheim: “Our research makes it clear that a general approach to combat antibiotic resistance makes no sense. To have any chance of success, you need to consider the context that affects the availability and use of antibiotics in each country. The conclusions of our research are an excellent starting point for further shaping global initiatives to improve antibiotic use, so that those who really need it get the right antibiotic and those with a snot nose a ‘cup of tea’. ”
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