Drug resistance growing

By Flavia Nassaka

Experts blame self-prescription, partial treatment

In July when Northern Uganda was hit by unusual malaria, thousands were hospitalized and some died. The malaria was severe and caused convulsions even in adults. The malaria parasites were able to survive and multiply despite the administration and absorption of drugs given in doses equal to or higher than those usually recommended.

Watching it all, Dr. Albert Okui, the Manager of the Malaria Control Programme at the Ministry of Health was in no doubt that something dangerous was happening – the parasites were resisting Artemether-Lumefantrine, the recommended first line treatment.

Uganda has the world’s highest incidence of malaria, with a rate of 478 cases per 1000 population per year. About 100,000 people, mainly children and women die of malaria every year. Many more remain unproductive for long periods due the malaria-induced chills, fever, headaches, and diarrheas. Any indication of malaria drug-resistance, therefore, causes major worries.

Unfortunately there are hints that Uganda could be losing the simplest defenses against not only malaria, but other infections as well. Experts warn that many administered drugs can no longer offer protection against bacterial infections like typhoid and urinary tract infections. Yet these are the most prevalent health concerns that affect people of all walks throughout the year.  Doctors say some bacteria, parasites, fungi and viruses are now resistant to drugs.

Dr. Francis Kiweewa, the Head of Research and Scientific Affairs at Makerere University Walter Reed Project says though Uganda has not conducted comprehensive research to show the extent of the problem in Uganda, surveillance on specific drugs is on- going and results indicate that the problem is growing especially with antibiotics. He says some HIV positive individuals are not responding to Anti-Retroviral (ARV) drugs as well.

What causes resistance?

Dr. Kiweewa says the problem of resistance to drugs is mainly because people are not completing the treatment doses as recommended or when doctors prescribe stronger drugs than required. He says when a disease is exposed to inadequate doses of drugs that cannot kill the bugs; they naturally mutate to eventually become immune to the drugs.

He blames a weak regulatory system which allows patients to self-medicate even when they do not know exactly what they are treating.

“Even pharmacies and drugs are not regulated and some are not owned by doctors.  They prescribe medicine without any consultations with experts. Because government is failing to monitor them then they’ll continue doing whatever they want,” he says.

Dr. Joel Okullo of the Uganda Medical and Dental Practitioners Council (UMDPC) who is tasked with regulating medical workers who operate these pharmacies says his organization is aware of the problems. He says they are brought about by the drive among private health service providers who target money more than treatment.

Dr. Ian Clarke of the International Hospital Kampala, which is part of Uganda’s biggest chain of clinics; the International Medical Group,  told the independent that common antibiotics like Amoxicillin and Septrin no longer work.

He says in Uganda, unlike other places he is familiar with, professionals do not take a very conservative view when prescribing antibiotics. They prescribe them every time there is the suspicion of an infection and use many antibiotics. Both practices, he says, should be discouraged.

“There is also a protocol for using antibiotics – first line, then move to a second line antibiotic, then to a third line,” he says.

In Uganda, many doctors are skipping the first and second line treatment and giving third line treatment for even minor infections. This means patients will develop resistance to the sophisticated antibiotics relatively quickly.

Tackling resistance

Drug resistance is a global threat and the World Health Organization (WHO) estimates show that by 2050, 10 million people will have died from drug- resistant diseases worldwide.

To tackle it, experts recommend the following: Using drugs only when they are necessary and prescribed by a doctor, completing the full prescription even if you feel better, and never sharing antibiotics with others or using leftover prescriptions.

Kiweewa is hopeful that for the HIV positive, the shift from the cocktail of ARVs to a single pill a day may increase compliance and reduce drug resistance.

According to the 2014 WHO Antimicrobial Resistance Report, there is also need to develop new diagnostics, antibiotics, and other tools to allow healthcare professionals stay ahead of emerging resistance.

Clarke says the rush to use the very latest antibiotics which are very expensive leads to the high cost of treatment in Uganda.

He says there should be controls and doctors should follow protocols.

He says if we continue with the current situation where one can access the most powerful antibiotic over the counter, strong procedures like surgeries will be hard to do as one will require too strong drugs for anesthesia and the healing process.

“This is what scientists are worried about – that we will not be able to come up with other forms of antibiotics which are effective. We would then be going back to the days before there was penicillin.”