Tackling antibiotics abuse: A call for action

I sat down recently in a popular community pharmacy, waiting to be attended to. Then came a fairly educated middle-aged man who seemed to be a familiar face to the pharmacist on duty. “Give me that drug I bought that day,” he requested, pointing to a particular medication on the shelf. The pharmacist hesitated for a moment, then asked, “What do you want to use it for?” Without thinking about it, the man gave a response I thought was the most ridiculous I had ever heard: he wanted to use it for typhoid, which he did not have at that point. He said he just wanted to take it as a preventive measure since he worked hard and did not want to start having body pains. The pharmacist had to explain to him the dangers of taking antibiotics without proper diagnosis and prescription. Although the man left without the drug, the pharmacist confided that he was certain he would come back when someone else was on duty or go somewhere else to buy it.

Also known as ‘antibiotic misuse or overuse’, antibiotic abuse refers to the improper use of antibiotics, and its key aspects include self-medication and inappropriate use. A good number of people self-medicate with antibiotics, meaning they obtain and use them without consulting a healthcare professional, and some use them for viral infections, at the wrong dose or frequency, or without completing the prescribed course.

Prevalence rates of antibiotic abuse vary significantly, with higher rates often seen in low- and middle-income countries. A systematic review and meta-analysis estimated that the overall global prevalence of antibiotic self-medication was 38.8% in developing countries. One study indicated that the highest prevalence of antibiotic self-medication was in sub-Saharan Africa, while a study in Nigeria found that 47.7% of respondents self-medicated with antibiotics and 50.2% used them inappropriately for viral infections.

Among the causes of antibiotic abuse are prescribing antibiotics for viral infections (like colds or flu) or other conditions they do not treat and using antibiotics without a doctor’s prescription, including taking leftover medication or someone else’s.

In some areas, people may not have access to healthcare providers and so resort to self-medication or purchase antibiotics without a prescription. Also, antibiotics are sometimes used in agriculture to promote growth in livestock, and this can contribute to resistance. In addition, patients may pressure doctors to prescribe antibiotics, even when they are not needed.

Now, antibiotic abuse can lead to serious health consequences, primarily driven by the development of antibiotic resistance and increased susceptibility to adverse effects. When antibiotics are used excessively, bacteria can develop resistance, meaning the drugs become less effective or ineffective against infections. Resistant bacteria can spread, leading to infections that are more difficult to treat and potentially causing more severe illness. Antimicrobial resistance is a major global health threat, with resistant infections contributing to significant mortality and morbidity.

Furthermore, antibiotics can disrupt the balance of gut bacteria, leading to diarrhoea, nausea, vomiting, and other digestive problems. Some people may experience allergic reactions to antibiotics, ranging from mild skin rashes to severe, life-threatening anaphylaxis. Antibiotics can interact with other medications, potentially increasing the risk of toxicity or reduced effectiveness. Also, antibiotic use can increase the risk of infections like Clostridioides difficile (C. diff), which can cause severe diarrhoea.

Depending on the specific antibiotic, potential side effects of antibiotic abuse can include kidney or liver damage, skin discolouration, and other complications. Antibiotics can disrupt the delicate balance of the gut microbiome, potentially affecting digestion, immunity, and overall health. And antibiotic-resistant infections often require more expensive and prolonged treatment, and this strains healthcare resources.

In addition, antibiotics used inappropriately can mask symptoms of other illnesses and delay proper diagnosis and treatment. Some studies suggest a possible link between antibiotic use and the development of certain chronic diseases, such as colon cancer, though more research is needed in that regard.

To prevent or stop antibiotic abuse, it is important to always consult a healthcare professional before using antibiotics, as they can determine if an antibiotic is necessary and prescribe the appropriate one. It is equally important to take the prescribed dosage and complete the entire course of antibiotics, even if you feel better. Never use antibiotics prescribed for someone else or save leftover antibiotics for later use.

Practicing good hygiene, like frequent handwashing, especially after being in public places or before handling food, can help prevent infections and reduce the need for antibiotics. Equally important is getting vaccinated, where a vaccine is available, as vaccinations can protect you from diseases that might require antibiotics.

It is also important that health professionals prescribe antibiotics only when necessary—they should be prescribed only when a bacterial infection is confirmed and not for viral infections like colds or the flu. It is similarly important to provide clear information about the appropriate use of antibiotics and the risks of misuse and encourage responsible antibiotic use through education and awareness programmes.

Furthermore, the government and health authorities have a unique role to play in raising awareness by educating the public about antibiotic resistance and the importance of proper antibiotic use, implementing and enforcing regulations to prevent the misuse of antibiotics in both human and animal health, and investing in research, especially by supporting research into new antibiotics and alternative treatments.

Antibiotic abuse is a growing and dangerous trend which needs to be contained with all the seriousness and urgency required in tackling any serious health concern. By working together, individuals, healthcare professionals, communities, and governments can all play a vital role in preventing this abuse and combating the growing resistance to antibiotics.

Ojenagbon, a health communication expert and certified management trainer and consultant, lives in Lagos.