PROTECTING ONESELF FROM ANTIBIOTICS - PROTECTING ANTIBIOTICS

On 7 April, the world will mark the traditional World Health Day, the date when the World Health Organization (WHO) was established in 1948. Since then, over 190 countries, including Azerbaijan, have joined the organization. World Health Day has been marked every year since 1950. This is done in order to increase understanding of the importance of health and to decide what more can be done to improve people's health internationally. Every year World Health Day is dedicated to different global problems faced by people across the globe. This year's motto will be 'Antimicrobial resistance: no action today, no cure tomorrow.'

Effectiveness of medicines 

Antimicrobial resistance is not a new problem, but is certainly an increasingly pressing one. Many countries are already taking measures to prevent a reversion to the 'pre-antibiotic era'. Collective effort is urgently required. On World Health Day 2011, the WHO is calling for a series of political measures to fight antimicrobial resistance. It should be acknowledged that we are living in a time of serious dependence on antibiotics and other antimicrobials for the treatment of conditions that would have been deadly only several decades ago and, in the case of HIV/AIDS, even several years ago. When people develop resistance to antimicrobials, the medicines become ineffective. On World Health Day 2011, the WHO will be calling for rational use of these medicines so that resistance to them does not lead to their becoming ineffective. According to the organization's experts, the global spread of antimicrobial resistance poses a threat to future generations. The world's healthcare system must do its best today to ensure that the medicines used in the treatment of infectious diseases remain effective.

Antimicrobial resistance, also known as medicinal resistance, develops when bacteria, viruses, fungi and parasites transform to the extent that medicines used for the treatment of infection become ineffective. Microorganisms that have become resistant to most antimicrobials are often called 'superbugs'. They pose the greatest threat because persistent infection may have a lethal outcome, be communicated to others and cause people and society as a whole considerable expense. Antimicrobial resistance is facilitated by the improper use of medicines, such as use of medicines in wrong doses or the early cessation of prescribed treatment. Poor-quality medicines and ineffective prophylaxis are also important contributors to medicinal resistance. Insufficient attention by governments, poor epidemic surveillance and the declining arsenal of diagnosis, treatment and prophylactic facilities hamper the fight against medicinal resistance. 

Correct prescription 

The question of appropriate and rational prescription of antibiotics for one disease or another is not alien to Azerbaijan. As mentioned, one cause of antimicrobial resistance is the improper use of medicines. In an interview with R+, Honoured Doctor of Azerbaijan Surxay Musayev, Professor in the Chair of Children's Illnesses of the Azerbaijan Medical University (AMU) and director of the University's therapeutic training clinic, said that every country is tackling the inappropriate prescription of antibiotics.   

"Medical experts recommend that antibiotics are used only for the treatment of colds. Meanwhile, in an effort to please their clients, doctors prescribe them too often. A patient comes to a doctor, is anxious and hopes for recovery, the doctor quickly prescribes antibiotics and the patient is happy! This is the gist of the problem" he says. But this does no good. The excessive use of antibiotics has led to the evolution of microorganisms, and they are now resistant to many standard medicines. Anyone who has taken antibiotics at least once runs the risk of being infected by resistant strains.

According to international statistics, 40 per cent of antibiotics prescribed in 1995 were used against viral infections, which runs counter to one of medicine's fundamental rules - antibiotics kill bacteria. They are helpless against viruses, including those that cause colds. There are no medicines for most viruses, and the infection simply recedes over time. Despite that, many people suffering from a viral infection want antibiotics, and doctors often succumb because this is easier than arguing with the patient.

But antibiotics are no panacea. They should be prescribed only as a last resort, says the doctor. According to Musayev, the application of antibiotics in paediatric practices in Azerbaijan is at a level of 98 per cent. Such high levels of prescription to children are only seen in China, a densely populated country. In France, this level stands at 24 and in the USA at 25 per cent.

According to Musayev, another issue in Azerbaijan is the prescription of reserve antibiotics to children. They can have an adverse impact on the health of even an adult. Meanwhile, antibiotics should not always be prescribed for the treatment of respiratory infections, viral etiology, infections of the upper respiratory channels or rotavirus infection. In some cases they may lead to dysbacteriosis and reduce immunity. Some doctors also use aggressive tactics by applying reserve antibiotics from the first days of a child's life.

"We must understand why a child is prescribed antibiotics. In cases when they are not needed, even the most basic medicines will not have any effect. We must acknowledge that our biggest problem today is antibiotic contamination. Why are we experimenting on our own kids? It is worse still when antibiotics are prescribed not by a doctor but by parents. This happens on the advice of neighbours, relatives and other well-wishers. It happens quite often and leads to disastrous consequences" Musayev added.

The expert believes that doctors should pay more attention to substitutive pharmaceuticals which are not antibiotics and which have a mild antibacterial effect. According to Musayev, inappropriate prescription of antibiotics may be one of the causes of child mortality. Here are the statistics: every year across the world about 10 million children die before reaching their fifth birthday. About 6 million of them die of curable diseases and could be saved if provided with access to safe, effective and affordable medicines. Pneumonia alone claims the lives of 2 million children under five years of age every year. HIV kills 330,000 children aged under 15. These diseases can be treated, but many don't have this opportunity - either due to a lack of medicines suitable for their age or because these medicines are inaccessible or too expensive (they may be three times more expensive than those prescribed for adults).

Access to medicines

Meanwhile, the WHO has repeatedly urged governments of all countries to step up scientific research to stimulate better access to children's medicines. The WHO is calling for the development of combined medicines for HIV/AIDS, tuberculosis and malaria, as well as for therapeutic agents for some tropical diseases that are considered defeated. Doctors generally give a positive assessment of the numerous scientific publications dwelling upon the excessive prescription of antibiotics for the treatment of nonbacterial respiratory diseases. Yet the level of antibiotic prescription for such conditions is still quite high and this requires further work. According to researchers, it is important for doctors to be aware of local data on antibiotic resistance in various causative agents and to develop a correct approach to the choice of antibiotics. Equally important is the joint and coordinated work of doctors and healthcare facilities and epidemiological information on the frequency of antibiotic prescription.