Antibiotics not ‘magic bullets’
July 5, 2007
Cold and flu season has hit again. To escape the pesky sore throat, cough, and aching head, many flu sufferers in Mexico this
winter will erroneously turn to antibiotics, such as ampicillin, or amoxicillin, unaware of the personal and global risks of using these drugs incorrectly.
Antibiotics are a form of medication used to treat bacterial infections. They work by destroying colonies of bacteria, but they are not effective against viruses, such as the common cold or flu.
The World Health Organization says overuse and incorrect use of antibiotics contribute to a looming public health crisis of antibiotic-resistant strains of bacteria.
Mexico City native, José Antonio Hernández, habitually self-medicates with Augmentin, a drug that includes amoxicillin, at the onset of severe flu symptoms. He has been turning to the medication almost every flu season since receiving a doctor´s recommendation to take the drug for similar symptoms in 2000.
“Some years I might take Augmentin 2 or 3 times,” said 25-year-old Hernández.
His case is not uncommon. Studies of trends in Mexico have revealed that up to 70 to 80 percent of doctors´ and pharmacy workers´ recommendations for patients to take antibiotics are inappropriate.
Dr. Anahi Dreser, an antibiotics expert at the country´s National Institute of Public Health in Cuernavaca, explained in an interview that diarrhea and respiratory infections are the most common conditions to be treated superfluously with
antibiotics.
Laboratory studies can usually determine if the patient has a bacterial infection treatable with antibiotics, but these tests are often skipped since they are an additional cost for the patient and can take a number of days to yield results.
IMS Health, a company dedicated to global healthcare information, reported that antibiotics account for the second largest portion of sales in Mexican retail pharmacies, after vitamins and metabolism products. Mexico leads Latin America in
antibiotic sales.
The same report revealed that while in Mexico in 2003, antibiotics represented 15.2 percent of total sales in pharmacies, in Brazil they accounted for 6.7 percent, and in the United Kingdom, just 3.5 percent.
In practice, any antibiotic can be bought in a Mexican pharmacy without a doctor´s prescription. Self-medication is incredibly common, making misuse – such as the use of the wrong antibiotic for a given condition, or the incorrect dosage or duration of treatment – all the more widespread.
Eduardo Gómez, 30, of Mexico City, used to self-medicate with Bacterin, a drug that combines the antibiotics trimethoprim and sulfamethoxazole, when he felt the symptoms of a throat infection.
“My family usually keeps a box of Bacterin in the house. When one of us has a really bad sore throat we take a few pills until we felt better.”
Gómez remembers that on one occasion he bought a new box of Bacterin at a private pharmacy without a prescription, and did not realize that the new pills were of a higher concentration.
“I took the same dose of two pills every eight hours like I was accustomed to doing, but by the second day I began to feel ill and felt repulsed by the pills. It was then that I realized I was accidentally taking the incorrect dose.”
Gómez is now wary of self-medicating and researches medicines on the internet before starting treatment. But information on medication can be hard to access since drugs sold in Mexico, including antibiotics, are distributed without instructions on how to use the medication safely and correctly.
Many antibiotic users do not have information about how to take the pills as intended, such as the appropriate dosage, if the pills should be taken with or without food, if other medications might have an adverse effect on the absorption of the antibiotics, and the potential risks and side effects of using the drug.
Beyond the negative implications for the patient´s health and pocketbook, antibiotic overuse has large-scale consequences for its connection with breeding antibiotic-resistant bacteria.
As biologist Dr. Jesús Silva explained in an interview, the more frequently antibiotics are used, the more opportunities bacteria have to develop resistance, rendering them invincible to the antibiotics that were designed to attack them.
According to Dr. Silva, who heads the bacteria resistance laboratory at the National Institute of Public Health, when a patient does not take the complete dose of antibiotics, or does not take the pills as indicated by the manufacturer, it provides the prime environment for bacteria to develop resistance.
High levels of antibiotics in the body over a certain period of time are necessary to wipe out the entire population of bacteria. But since patients often discontinue treatment after just a few pills when they start to feel better, with only a partial dose of the medicine, only the weakest bacterial populations in the body are destroyed.
Meanwhile, the surviving bacteria may develop resistance to the antibiotic, and will continue to multiply, thereby passing on the trait to future generations and even to other microorganisms in the body. Resistant bacteria can then be passed to other human hosts.
Unfortunately, antibiotic-resistant strains of bacteria are already a reality in Mexico.
Dr. Silva asserts that in Mexico, 50 percent of strains of pneumococcus – a bacteria that causes pneumonia, ear infections, and meningitis – are now resistant to the antibiotic penicillin.
In the case of the bacteria that commonly plague hospitals and lead to widespread infections among in-patients, more than 50 percent of these bacteria are now multi-resistant to various antibiotics. Hospitals have had to resort to employing stronger antibiotics to combat the bacteria.
The World Health Organization has made recommendations for how countries can foster appropriate antibiotic use through educational and regulatory measures. Mexico has not yet taken steps to implement the World Health Organization´s suggestions.
“If we don´t start using antibiotics more responsibly and the pharmaceutical industry doesn´t start making new antibiotics, 20 years from now, we will be back in the period before World War II when there was no penicillin,” warns Dr. Silva.
Public health advocates assert that prevention of illness is an important part of the process to reduce antibiotic use.
Dr. Anahi Dreser stresses, “Antibiotics are an important resource we need to protect for the future.”