Responsible Antibiotic Use Key to Preventing Resistance

Antibiotics, also known as antimicrobials, are an important part of modern medicine, and the use of the drugs saves lives, preventing millions of people from dying of bacterial infections.

However, the misuse of antimicrobials, through overprescription, or persons not using them as prescribed, has seen a rise in antibiotic resistance globally.

In fact, the World Health Organization (WHO) recognises antibiotic resistance as one of the top-10 public health threats facing the world.

With antimicrobial resistance, germs like bacteria and fungi develop the ability to defeat the drugs designed to kill them and they continue to grow.

Resistant infections can be difficult, and sometimes impossible to treat.

Locally, steps are being taken to ensure more responsible antibiotic use, with stewardship programmes being developed at the University Hospital of the West Indies (UHWI) and the Cornwall Regional Hospital (CRH).

The programmes seek to enhance the monitoring of the medicines, including prescribing patterns and practices, proper storage and administration.

The objective is to improve how the medicines are prescribed to ensure that they are used by patients only when necessary and appropriate.

Research undertaken by Internal Medicine Physician at the hospitals, Dr. David McGowan, along with a team of collaborators, is being utilised to develop the programmes.

The team gathered data from a cross-sectional survey on antibiotic use among in-patients at the facilities.

Dr. McGowan tells JIS News that a lack of understanding of how to use antibiotics for their intended purpose was a common issue emerging from the study.

He says that antibiotics should only be utilised when necessary, noting that they are not to be prescribed for viral infections.

“One of the challenges we have is that we use antibiotics for viral infections a lot. Antibiotics are not needed for flu or anything else viral because they don’t affect viruses. You can have the flu and a secondary bacterial infection and you may need antibiotics in that case. But in general, we have to make sure we are using antibiotics only when needed,” he says.

Dr. McGowan also cautions patients against sharing their prescription antibiotics, stopping treatment against doctors’ recommendations and not fulfilling the requirements of the antibiotic course.

“In order to completely eradicate the bacteria you are looking at, you actually need to finish the recommended course. So, even though you feel better after three days, if the recommended course is a week, you should finish the week. Many people will take four days and keep some for the next time they think they have the same thing or to share with somebody else who has a similar complaint,” he points out.

He recommends that patients discuss, in detail, their course of treatment with their doctor, to ensure that they understand how the medication should be taken.

“So, the first thing is to have dialogue with your doctor. Sometimes, you need a long course of antibiotics. Some conditions require six weeks or longer of antibiotics”, he points out.

In addition to patient misuse of antibiotics, Dr. McGowan says some physicians, from time to time, inappropriately prescribe the drugs after pressure from patients to receive the medication even when unnecessary.

“If you came to the doctor and you said, ‘I feel terrible, I have the cold’ and he says, ‘You don’t need antibiotics, I’m going to give you, let’s say, an antihistamine, antipyretics, something for fever, something to help you with this stuffiness and so on’, many people will pressure a doctor into getting an antibiotic because they feel there is a need. That’s one thing that we need to address,” he says.

Dr. McGowan tells JIS News that ensuring that the most effective antibiotics are being prescribed for the particular condition is integral in preventing misuse that can lead to resistance.

As such, he says it is important that bacteria cultures (tests) are done to know exactly what antibiotic should be prescribed.

“Sometimes, it means expanding your antibiotics. So, you look at it and say, ‘This antibiotic you’re using is not for this; you need to use a more powerful antibiotic’. It’s not always going to result in cost reduction; sometimes stewardship means using a more expensive or more potent antibiotics, when necessary,” he points out.

Dr. McGowan points out that resistance can also occur from using the incorrect drug dosage and for the wrong duration.

“We hope that we can begin to look at our antibiotic use and once we implement stewardship programmes, it should make a difference, and hopefully, we can begin to address the issue.

“There are several different parameters you can look at to determine how to use the antibiotic, but it is really trying to get the best use and there are well-established principles governing that which can be applied across the island,” he tells JIS News.

Dr. McGowan was awarded for ‘Most Impactful Oral Presentation’ at the 14th Annual National Health Research Conference in November 2023.