The Independent Uganda: You get the Truth we Pay the Price
Kampala, Uganda | THE INDEPENDENT | Half of all antibiotics currently prescribed by doctors are not needed, experts attending World Health Organization-WHO meeting in which they were assessing strides made by countries on implementation of National Action Plans on Antimicrobial Resistance (AMR) have revealed.
Speaking at the meeting on Tuesday, Dr. Loice Achieng Ombajo, a lecturer at the School of Medicine of Nairobi University said currently, 50% of inpatients in hospitals in low and middle income countries are being treated unnecessarily with antibiotics that have been categorized as watch medicines, supposed to be used when first category medicines fail.
She said the commonest antibiotic used in Kenya public health facilities for instance is ceftriaxone, which is a watch medicine and it is worse in private health facilities where broad spectrum medicines meant for advanced disease are used to treat simple ailments.
Despite many warnings of antimicrobial resistance dangers arising from misuse of the drugs, experts said world over, there is still over-prescription of antibiotics which is why WHO has created additional guidance in a new booklet where they offer guidance on what antibiotics can be used at what stage.
They have categorized the medicines into three categories listed as Access which are most recommended to use and should be available at health facilities at all times. The Watch and Reserve categories of medicines are supposed to be used sparingly and as a last resort.
Dr. Marc Mendelson, an infectious diseases expert says this book isn’t intended to replace national guidelines on dispensing antibiotics but meant to help countries that are struggling to at least achieve 60% of their national antibiotic prescriptions being picked from the Access category.
So far however, even with a lot of guidance available, Mendelson says doctors are still prescribing antibiotics for infections such as acute bronchitis and sore throat, even with overwhelming evidence from scientific research that they don’t work.
For him, before prescribing an antibiotic, medics have to do an investigation to check whether a patient really needs that particular medicine and whether they are suffering from a bacterial, fungal or viral infection.
On his part, Dr. Benedikt Huttner, the team leader at the WHO Essential Medicines List Secretariat urged countries to align their essential medicines lists with the antibiotic book such that only necessary medicines are made available.
In public facilities for instance, experts note use of broad spectrum antibiotics is not as prevalent as it is for private facilities and Achieng says this is mainly because private providers are a target in marketing by pharmaceutical companies. For her, to tackle over-prescription, health workers need to be made to account for every antibiotic they prescribe.
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Antibiotic use!
As we get towards dementia some stories need to be told
In the year 1984, antibiotics were classified such that one group was for routine use
Another was only prescribed with approval of an experienced person and others were reserved, only to be used when it was absolutely necessary
Drugs used for agricultural purposes were equally controlled.
Access was restricted to registered practitioners
I recall one surgeon operating from Wilson Street, he stocked only one antibiotic, an injectable penicillin and referred patients who visited his clinic to a pharmacy
In the hospital juniors prescribed antibiotics but this paper was counter signed by a supervisor
A lot has happened since then, however we get puzzled at some decisions. In Kampala, areas where the health center III is relatively private, the expected standard of care takes place . This involves the laboratory investigations followed by prescription. There is a cost incurred (recently a complaint of fever in a 17 year old female, cost Ushs; 72,000). Other residents who may not afford such a service settle for ordinary clinics.
They may not afford a complete dose as prescibed, but may also miss out on the expected service, depending on the resources at the facility. Needless to mention others who solve the problem by resorting to self treatment
As the implementation of National action plans takes shape, there is a gap. To who are the interventions being directed in this setting?