All you need to know about Antibiotic Usage
NH: Is there a limit on how many times a year that a person can be safely prescribed antibiotics for his/her ailment?
Dr Sujana: We seem to have started with a complex question which unfortunately has no straightforward answer! If enquiring whether there is a measurable point beyond which antibiotic exposure in a year can lead to adverse events including antibiotic resistant bacteria, then there isn’t any limit that can be considered as ‘safe’ .
It is important to note that we all have a multitude of bacteria naturally residing in our bodies, especially in our gut. These ‘good bacteria’ help maintain our bodies’ important functions, such as digesting the food we consume. When you are prescribed a certain antibiotic, it will kill the infecting bacteria it targets, but will also to an extent kill off part of the ‘good bacteria’ population in the same environment. When this occurs, other bacteria which are resistant to that antibiotic can be selected out, that is, increase in number to replace the bacteria which have been killed off. This effect will not be as significant if the antibiotic used is narrow spectrum, meaning that it is specific for that particular infecting bacteria and is used for an appropriate time period.
Problems can arise when the antibiotic used is broad spectrum, meaning that it will eradicate a much wider range of bacteria, leading to greater damage to the residual ‘bacteria ecosystem’ and thus increasing the risk of selecting out more resistant bacteria strains. A similar effect will occur if the antibiotic is given for a longer rather than shorter duration, especially if this exceeds the correct duration of treatment.
Many healthy people are already carrying these resistant strains in their bodies without knowing it, as simply harbouring these resistant bacteria does not automatically make you sick.
However should such people fall ill or undergo surgery, their body defence systems could be affected, putting them at risk of developing a resistant bacterial infection.
Thus any antibiotic exposure, warranted or not, will change the ‘bacteria ecosystem’ in your body. If you are taking a course of antibiotics for a valid reason, for example an urinary tract infection and you recover from that infection, then the benefit of taking that course outweighs the small risk of increasing the resistant bacteria in your body. Conversely if you take a course of antibiotics when it was not necessary, for example a viral respiratory infection or if the course was not prescribed by a registered doctor, you would have put yourself at risk of developing these resistant bacteria without any corresponding benefit to yourself.
NH: We are often asked to finish a course of antibiotics prescribed to us. What are the ramifications of not completing a course of antibiotics?
Dr Sujana: When your doctor prescribes a course of antibiotics to you, it is because based on clinical evaluation, you have a physical ailment due to a particular bacterial infection. The duration of the course can vary between a few days and a couple of weeks, but the actual period would depend on that bacteria and the type of infection it causes.
Concerns arise when the patient fails to complete the course, such as stopping a 7 day course after only 3 to 4 days. This may happen because they find it difficult to follow the dosing schedule or worse still, they stop taking the antibiotics prematurely because they feel better, and may decide to save the balance of their pills ‘for next time just in case’! In both instances this would increase the risk of developing resistance and hence treatment failure in the future.
NH: How will we know if we need antibiotics when we’re sick?
Dr Sujana: The simple answer is that you will not know by yourself! The vast majority of infections that a person will experience in the community such as the common cold, flu, sore throat or bronchitis are caused by viruses and thus do not require antibiotics. You will need to be examined by your doctor, who will then decide if antibiotic therapy is required for your ailment.
In addition, some symptoms commonly associated with infections, such as fever or cough, may be due to other causes. A persistent fever could be due to conditions causing an inflammatory state in the body such as connective tissue disease or cancer, while a chronic cough may be due to structural lung disease like asthma or fibrosis. If in doubt, always consult your doctor.
NH: How do antibiotics work in the body?
Dr Sujana: Antibiotics work by targeting the bacteria causing infection in the body by different methods. They can attach themselves to the outer surface of the bacteria or enter directly into the bacteria, which will either kill the bacteria or control it by blocking its reproduction. By these methods, the infection will be successfully treated if the correct antibiotic is prescribed for the appropriate period of time and is taken as directed by the patient.
Problems can arise when the patient does not take the antibiotic following the dosing instructions, or if he/she stops taking it altogether without informing the doctor. The bacteria is thus exposed to the antibiotic without being killed or controlled, which will give it the opportunity to develop resistance to this antibiotic, which can cause failure of treatment in the future if the same antibiotic is used again.
NH: Are there any known risks linked to the use of antibiotics?
Dr Sujana: Like all prescribed medications, antibiotics can cause side effects in patients using them. For the most part these are minor and tolerable, such as nausea, stomach discomfort and diarrhoea and will resolve once the antibiotic course is completed. A small proportion of patients may find that these effects persist, which would make it difficult for them to complete the course. These patients should reconsult the same doctor who initially treated them (as far as possible) so that an alternative and better tolerated antibiotic can be substituted. Even less commonly, a patient may develop an allergic reaction to the antibiotic (which in rare cases can become life threatening) or complications such as hearing loss, kidney damage or liver inflammation. These uncommon complications can still be reversible if the patient seeks early medical attention.
NH: Is there any group of people who should not be prescribed with antibiotics?
Dr Sujana: Antibiotics are generally prescribed for bacterial infections which if left untreated, could be life threatening or fatal in some cases. As such infections can potentially affect everyone in the community, anyone in the community who develops such an infection should be treated. However it must be noted that in certain patient groups, such as pregnant women or those with chronic kidney disease, the choice of antibiotics will be limited, as the normal 1st choice antibiotic may cause more harm than benefit. In these patients, either a safer alternative would be used (if pregnant) or the antibiotic dosage would be adjusted (if kidney disease).
Patients who are already aware that they are allergic to a particular antibiotic or any other type of medication should always inform their doctor before any new antibiotic is prescribed. Patients who are already taking medications for other conditions like diabetes or heart disease should likewise inform their doctor about this, in order to minimise the chance of new adverse effects caused by the newly prescribed antibiotic interacting with their original medications. Women who are pregnant or who suspect they could be pregnant should also share this information with their doctor in advance.
It is important to highlight that antibiotics, when used correctly, are potentially life saving or limb saving medications. One should not hesitate to use them if they are prescribed for a specific bacterial infection that needs treatment.
NH: What is antibiotic resistance and why should we be more aware about it?
Dr Sujana: Antibiotic resistance refers to the partial or total failure of an antibiotic to kill or control the bacteria against which it was originally prescribed. This occurs due to the survival mechanisms that bacteria develops in order to protect themselves from the action of antibiotics. These survival mechanisms are more likely to be triggered if the antibiotic use was inappropriate, as was noted in question 1. As a result an antibiotic which could previously successfully treat a bacterial infection will now fail if the bacteria causing this infection has developed resistance, as mentioned earlier.
This is causing serious concern worldwide for several reasons. If the commonly used 1st choice antibiotics no longer work due to resistance, stronger antibiotics would be needed, which generally need to be given in hospital and for longer periods, resulting in increased healthcare costs and a higher rate of more serious adverse effects. Mortality rates would also be higher in such patients, and there would also be an increased risk of spread of these resistant bacteria in the community and hospitals. The situation will only become worse as development of new antibiotics is an extremely slow and expensive process and cannot keep up with the rate of new bacterial resistance, if antibiotics continue to be misused.
NH: How do bacteria become resistant to antibiotics?
Dr Sujana: Antibiotic resistance occurs naturally and is selected out when surrounding friendly bacteria are killed, which can occur with any antibiotic. As I mentioned earlier but is important to reemphasise, if the antibiotic is appropriate then this effect will be minimal; magnification of this effect occurs if too ‘broad spectrum’ antibiotics are used which will kill off far too many friendly bacteria (which would be replaced by the resistant bacteria instead) or if the appropriate antibiotic is taken for a shortened or prolonged course rather than following the correct treatment duration.
NH: Is there anything a person can do to help prevent the spread of antibiotic resistance?
Dr Sujana: The public have an important role to play in helping to prevent the spread of antibiotic resistance, since most infections would be managed in the community at either government or private health clinics
Never pressure your doctor into prescribing you antibiotics for your current ailment, even if you may have received antibiotics for similar complaints in the past. Your doctor would have to reassess your condition and make a decision based on clinical judgment.
If you are prescribed antibiotics, always complete the full course following the dosing instructions. In the event you experience side effects and are unable to, or uncertain if you should complete the course, consult your doctor again as early as possible.
Never share your prescribed antibiotics with any other person such as your family members or friends even if their ailments appear similar to yours. They should always consult their own doctors instead.
Do not try to buy antibiotics over the counter at pharmacies without a valid prescription from a registered doctor. Attempting to do so would be against Malaysian prescribing laws.
Learn about common infections in the community from your doctor or local healthcare institution. Alternatively, access reliable online sources for further information, such as the websites of the Ministry of Health Malaysia, the Malaysian Pharmaceutical Society or the World Health Organization
Keep up to date with your vaccines as appropriate for your age, as they will prevent certain infections and so lead to less illnesses and potential for antibiotic misuse.
Lastly, remember that prevention is better than cure! Stay home from work or school if you have an infection to prevent spreading it to others. Take appropriate measures such as maintaining a safe distance and proper hand hygiene when visiting someone with an infection that can be spread by close contact or coughing/sneezing. Maintain a healthy lifestyle in terms of your diet, weight and personal habits, as this will also help reduce the risk of developing many infections.
Q & A with Dr Sujana LS Saravanamuttu
Infectious Diseases Physician,
Hospital Kuala Lumpur
Kwa mfano, kuna kiwango cha mara ngapi kwa mwaka mtu anaweza kupewa dawa za kuua viini kwa ugonjwa wake. Dr. Sujana: Inaonekana tumeanza na swali tata ambalo kwa bahati mbaya halina jibu la moja kwa moja! Kama kuuliza kama kuna hatua ya kupimwa zaidi ambayo antibiotic mfiduo katika mwaka inaweza kusababisha matukio mabaya ikiwa ni pamoja na bakteria sugu kwa antibiotic, basi hakuna kikomo ambacho inaweza kuchukuliwa kama "salama". Ni muhimu kutambua kwamba kila mtu ana bakteria nyingi katika mwili wake, hasa katika matumbo. "Bakteria hizo nzuri" husaidia kudumisha kazi muhimu za mwili wetu, kama vile kumeng'enya chakula tunachokula. "Kama unaagizwa dawa fulani ya kuua viini, itaua bakteria zinazohusika, lakini pia kwa kiasi fulani itaua sehemu ya idadi ya ""bacteria nzuri"" katika mazingira yaleyale." Wakati hii inatokea, bakteria nyingine ambazo ni sugu kwa antibiotic hiyo zinaweza kuchaguliwa nje, ambayo ni kuongezeka kwa idadi ya kuchukua nafasi ya bakteria ambazo zimeuawa. Matokeo haya hayakuwa muhimu kama dawa ya kuua viini inayotumiwa ni ndogo, ikimaanisha kuwa ni maalum kwa bakteria hiyo hususa inayoharibu na hutumiwa kwa kipindi cha wakati sahihi. Matatizo yanaweza kutokea wakati antibiotic kutumika ni pana-spectrum, maana kwamba itakuwa kuangamiza mbalimbali pana sana ya bakteria, na kusababisha uharibifu mkubwa kwa mabaki ya "bacteria mazingira" na hivyo kuongeza hatari ya kuchagua nje ya bakteria zaidi seli. Matokeo kama hayo yatatokea ikiwa dawa ya kuua viini itatolewa kwa muda mrefu badala ya muda mfupi, hasa ikiwa muda huo unazidi muda unaofaa wa matibabu. Watu wengi wenye afya tayari wana aina hizi za bakteria katika miili yao bila kujua, kwa kuwa kuwa na bakteria hizi za sugu haikuhitaji kuwa mgonjwa. Hata hivyo, ikiwa watu hao watakuwa wagonjwa au kufanyiwa upasuaji, mfumo wao wa kinga ya mwili unaweza kuathiriwa, na kuwaweka katika hatari ya kuambukizwa na bakteria sugu. Hivyo, kuambukizwa kwa viuavijasumu, iwe ni haki au la, kutabadilisha "mfumo wa ikolojia ya bakteria" mwilini mwako. Ikiwa unachukua antibiotics kwa sababu halali, kwa mfano, maambukizo ya njia za mkojo, na unapata nafuu kutoka kwa maambukizo hayo, basi faida ya kuchukua dawa hiyo inazidi hatari ndogo ya kuongeza bakteria sugu katika mwili wako. Kwa upande mwingine, ikiwa utachukua antibiotics wakati hauhitaji, kwa mfano, maambukizo ya mfumo wa kupumua, au ikiwa matibabu hayajaagizwa na daktari, utajiweka katika hatari ya kuendeleza bakteria hizi za sugu bila faida yoyote. "Mwanamke mmoja alisema: ""Mimi na ndugu zangu wengi tunahitaji kutumia dawa za kuua viini ambazo tumepokea kutoka kwa daktari." Kuna matokeo gani ya kutokamilisha utaratibu wa kutumia viuavijasumu? "Daktari wako anapokuagiza kutumia dawa za kuua viini, ni kwa sababu kulingana na tathmini ya kliniki, una ugonjwa wa mwili unaosababishwa na maambukizo fulani ya bakteria.""" Muda wa matibabu unaweza kutofautiana kutoka siku chache hadi wiki chache, lakini muda halisi unategemea bakteria na aina ya maambukizo. Matatizo ya ugonjwa wa akili yanatokea wakati mgonjwa anashindwa kumaliza kozi, kama vile kuacha kozi ya siku 7 baada ya siku 3 tu. Hii inaweza kutokea kwa sababu wanapata ugumu wa kufuata ratiba ya kipimo au mbaya zaidi, wao kuacha kuchukua antibiotics mapema kwa sababu wanahisi vizuri, na wanaweza kuamua kuhifadhi usawa wa dawa zao <unk> kwa wakati ujao tu kwa ajili ya kesi <unk>! Katika visa vyote viwili hii ingeongeza hatari ya kuendeleza upinzani na kwa hiyo kushindwa kwa matibabu katika siku zijazo. NH: Tutajuaje ikiwa tunahitaji viuavijasumu tunapokuwa wagonjwa? Dr. Sujana: Jibu rahisi ni kwamba huwezi kujua peke yako! Ugonjwa wa kawaida wa kawaida wa kawaida, kama vile homa, homa, homa ya koo au bronchitis, husababishwa na virusi na kwa hivyo hauhitaji dawa za kuua viini. Unahitaji kuchunguzwa na daktari wako, ambaye kisha ataamua kama matibabu ya antibiotic yanahitajika kwa ugonjwa wako. Kwa kuongezea, dalili fulani zinazohusiana kwa kawaida na maambukizo, kama vile homa au kikohozi, zaweza kusababishwa na visababishi vingine. Homa ya kudumu inaweza kuwa kutokana na hali zinazosababisha hali ya uvimbe katika mwili kama ugonjwa wa tishu ya kuunganisha au kansa, wakati kikohozi cha kudumu kinaweza kuwa kutokana na ugonjwa wa mapafu kama pumu au fibrosis. Ikiwa una shaka, sikuzote wasiliana na daktari wako. "Mwanamke mmoja aliuliza: ""Antibiotiki hufanyaje kazi katika mwili?""" Antibiotics hufanya kazi kwa kulenga bakteria zinazosababisha maambukizi katika mwili kwa njia tofauti. Wanaweza kujifunga kwenye uso wa nje wa bakteria au kuingia moja kwa moja ndani ya bakteria, ambayo itaua bakteria au kuidhibiti kwa kuzuia uzazi wake. Kwa njia hizi, maambukizo yatatibiwa kwa mafanikio ikiwa dawa sahihi ya kuua viini itaagizwa kwa kipindi cha wakati sahihi na inachukuliwa kama ilivyoelekezwa na mgonjwa. Matatizo yanaweza kutokea wakati mgonjwa hachukui dawa ya kuua viini kulingana na maagizo ya kipimo, au kama yeye huacha kuchukua kabisa bila kumjulisha daktari. Kwa hivyo bakteria hufunuliwa kwa antibiotiki bila kuuawa au kudhibitiwa, ambayo itampa fursa ya kuendeleza upinzani kwa antibiotiki hii, ambayo inaweza kusababisha kushindwa kwa matibabu katika siku zijazo ikiwa antibiotiki hiyo hutumiwa tena. Je, kuna hatari yoyote inayojulikana inayohusiana na matumizi ya antibiotics? "Sujana: ""Kama dawa zote zinazopendekezwa, dawa za kuua viini zinaweza kusababisha athari mbaya kwa wagonjwa wanaozitumia." Kwa sehemu kubwa hizi ni ndogo na kuvumilika, kama vile kichefuchefu, tumbo usumbufu na kuhara na itatatua mara moja antibiotic kozi ni kukamilika. Idadi ndogo ya wagonjwa wanaweza kupata kwamba athari hizi kudumu, ambayo ingekuwa vigumu kwa ajili yao kumaliza kozi. Wagonjwa hawa wanapaswa kuwasiliana tena na daktari yule yule aliyewatibu awali (kama inavyowezekana) ili dawa mbadala na inayovumilika vizuri iweze kubadilishwa. Hata mara chache zaidi, mgonjwa anaweza kuendeleza athari ya mzio kwa antibiotic (ambayo katika kesi nadra inaweza kuwa hatari kwa maisha) au matatizo kama vile kupoteza kusikia, uharibifu wa figo au uvimbe wa ini. Matatizo hayo yasiyo ya kawaida yanaweza kubadilika ikiwa mgonjwa atapata matibabu mapema. Je, kuna kikundi chochote cha watu ambao hawapaswi kupewa dawa za kuua viini? Kwa kawaida, dawa za kuua viini huagizwa kwa maambukizi ya bakteria ambayo, ikiwa hayatatibiwa, yanaweza kuhatarisha maisha au kuua katika visa fulani. Kwa kuwa maambukizi kama hayo yanaweza kuathiri kila mtu katika jamii, mtu yeyote katika jamii ambaye hupata maambukizo kama hayo anapaswa kutibiwa. Hata hivyo, ni lazima ieleweke kwamba katika vikundi fulani vya wagonjwa, kama vile wanawake wajawazito au wale walio na ugonjwa wa figo, chaguo la antibiotics itakuwa mdogo, kama kawaida ya kwanza chaguo antibiotic inaweza kusababisha madhara zaidi kuliko faida. Katika wagonjwa hawa, ama mbadala salama itatumiwa (ikiwa mjamzito) au kipimo cha antibiotic kitabadilishwa (ikiwa ugonjwa wa figo). Wagonjwa ambao tayari wanajua kuwa wana mzio wa dawa fulani au aina nyingine yoyote ya dawa wanapaswa kumjulisha daktari wao kabla ya dawa yoyote mpya kuagizwa. Wagonjwa ambao tayari wanakunywa dawa za matibabu ya hali nyingine kama vile kisukari au ugonjwa wa moyo wanapaswa pia kumjulisha daktari wao kuhusu hili, ili kupunguza uwezekano wa athari mpya za athari zinazosababishwa na dawa mpya ya antibiotic inayohusika na dawa zao za awali. Wanawake ambao ni wajawazito au wanaotarajia kuwa na mimba wanapaswa pia kushiriki habari hii na daktari wao mapema. Ni muhimu kukazia kwamba dawa za kuua viini, zinapotumiwa kwa usahihi, zinaweza kuokoa maisha au kuokoa viungo. Mtu hapaswi kusita kuzitumia ikiwa zimeagizwa kwa maambukizo fulani ya bakteria yanayohitaji kutibiwa. Uvumilivu wa viuavijasumu ni nini na kwa nini tunapaswa kuwa na ufahamu zaidi? "Sujana anasema: ""Ukinga wa viuavijasumu unahusu kushindwa kwa sehemu au kabisa kwa viuavijasumu kuua au kudhibiti bakteria ambazo zilikuwa zimependekezwa." Hii hutokea kwa sababu ya utaratibu wa kuishi ambao bakteria huendeleza ili kujilinda dhidi ya athari za viuavijasumu. Uwezo wa kuokoa maisha ni muhimu kwa sababu ya matumizi ya antibiotics, kama ilivyoelezwa katika swali la kwanza. Matokeo yake, dawa ya kuua viini ambayo hapo awali iliweza kutibu maambukizi ya bakteria sasa itashindwa ikiwa bakteria inayosababisha maambukizo haya imesababisha upinzani, kama ilivyoelezwa hapo awali. Jambo hilo linasababisha hangaiko kubwa ulimwenguni pote kwa sababu kadhaa. Ikiwa dawa za kwanza zinazotumiwa kwa kawaida hazifanyi kazi tena kwa sababu ya upinzani, dawa kali zaidi za antibiotiki zinahitajika, ambazo kwa ujumla zinahitaji kutolewa hospitalini na kwa vipindi virefu, na kusababisha kuongezeka kwa gharama za huduma za afya na kiwango cha juu cha athari mbaya zaidi. Kiwango cha vifo pia kitakuwa juu kwa wagonjwa kama hao, na kutakuwa na hatari kubwa ya kuenea kwa bakteria hizi sugu katika jamii na hospitali. Hali itakuwa mbaya zaidi kama maendeleo ya antibiotics mpya ni mchakato wa polepole na gharama kubwa na haiwezi kushikilia kasi ya upinzani mpya wa bakteria, kama antibiotics kuendelea kutumiwa vibaya. Jinsi bakteria zinavyoweza kuwa na sugu kwa viuavijasumu "Sujana anasema: ""Ukinga wa viuavijasumu hutokea kwa asili na huchaguliwa wakati bakteria za karibu zinauawa, ambayo inaweza kutokea na viuavijasumu vyovyote." Kama nilivyosema hapo awali, lakini ni muhimu kusisitiza tena, ikiwa antibiotic inafaa basi athari hii itakuwa ndogo; kuongezeka kwa athari hii hutokea ikiwa antibiotics nyingi sana za'spectrum pana' hutumiwa ambazo zitaua bakteria nyingi sana za rafiki (ambazo zingeweza kubadilishwa na bakteria sugu badala yake) au ikiwa antibiotic inayofaa inachukuliwa kwa kozi fupi au ndefu badala ya kufuata muda sahihi wa matibabu. Je, kuna jambo lolote ambalo mtu anaweza kufanya ili kuzuia kuenea kwa upinzani wa viuavijasumu? """Watu wote wana jukumu muhimu la kusaidia kuzuia kuenea kwa upinzani wa viuavijasumu, kwani maambukizi mengi yangesimamiwa katika jamii katika kliniki za afya za serikali au za kibinafsi, kamwe usimlazimishe daktari wako kukupa dawa za kuua vimelea kwa ugonjwa wako wa sasa, hata ikiwa unaweza kuwa umepokea dawa za kuua vimelea kwa malalamiko kama hayo hapo zamani." Daktari wako atahitaji kuchunguza hali yako na kufanya uamuzi kulingana na uamuzi wa kliniki. Ikiwa umepatiwa dawa za kuua viini, sikuzote timiza dawa zote kwa kufuata maagizo ya kipimo. Ikiwa una athari za upande na huwezi au haujui ikiwa unapaswa kumaliza kozi, wasiliana na daktari wako tena mapema iwezekanavyo. Kamwe usishiriki dawa za kuua viini na mtu mwingine yeyote, kama vile wanafamilia au marafiki, hata kama magonjwa yao yanaonekana sawa na yako. Sikuzote wapaswa kushauriana na madaktari wao wenyewe badala yake. Usijaribu kununua dawa za kuua viini bila dawa kutoka kwa daktari aliyeandikishwa. Kujaribu kufanya hivyo kungekuwa kinyume na sheria za kuagiza dawa za Malaysia. Jifunze kuhusu maambukizo ya kawaida katika jamii kutoka kwa daktari wako au taasisi ya huduma ya afya ya eneo lako. Kwa upande mwingine, unaweza kupata habari zaidi kutoka kwa vyanzo vya kuaminika vya mtandaoni kama vile tovuti za Wizara ya Afya ya Malaysia, Shirika la Dawa la Malaysia au Shirika la Afya Ulimwenguni, na uendelee kuwa na chanjo zinazofaa kwa umri wako, kwani zitakuzuia maambukizi fulani na hivyo kupunguza magonjwa na uwezekano wa matumizi mabaya ya viuavijasumu. Mwishowe, kumbuka kwamba ni afadhali kuzuia kuliko kutibu! Usiondoke kazini au shuleni ikiwa una maambukizi ili kuzuia kueneza kwa wengine. Chukua hatua sahihi kama vile kudumisha umbali salama na usafi wa mikono wakati wa kumtembelea mtu aliye na maambukizi ambayo yanaweza kuenea kwa kuwasiliana karibu au kukohoa au kupiga chafya. Kuendelea na maisha ya afya katika suala la chakula, uzito na tabia za kibinafsi, kama hii pia kusaidia kupunguza hatari ya kuendeleza maambukizi mengi. Mwalimu wa magonjwa ya kuambukiza wa Kuala Lumpur, Dr. Sujana L.S. Saravanamuttu