As health workers, often, we receive calls from family, friends and different people in the community complaining of not feeling well, with headaches, general body weakness and fevers among others. We always advise them to visit a nearby health facility, see a trained health worker, and have some assessments done including performing relevant laboratory tests prior to starting any medications.
Unfortunately, most people do not visit the health facilities as advised but instead go to pharmacies and buy drugs including antibiotics of all nature which haven’t been prescribed by a health worker. In short, they practice self-medication with antibiotics.
Whereas as health workers we promote self-care, which involves self-medication, we strongly discourage the use of antibiotics if not prescribed by a health worker. This is meant to prevent antimicrobial resistance amongst other consequences.
Antibiotics are one of the most cost-effective, life-saving medicines and contribute to an extended lifespan. However, the effect of antibiotics is compromised by the rapid escalation of antibiotic resistance (ABR), which, combined with the paucity of development of new antibiotics (or antibiotic combinations) with novel mode(s) of action is considered a major global health threat.
A key driver of ABR is the irrational use of antibiotics. According to the World Health Organization (WHO) definition, medicines are used rationally when patients receive the appropriate medicines, for appropriate indications, in doses that meet their own individual requirements, for an adequate period of time, at the lowest cost both to them and the society and with appropriate information. Irrational or unnecessary use of medicines occurs when one or more of these conditions is not met
Bacterial infections are the second-leading cause of death worldwide. This was evidenced by global statistics made in 2022 which showed that 7.7 million deaths were found linked to bacterial infections. In-fact, 13.6%, or 1 in 8, of all deaths around the world with large differences in burden as well as distribution of bacterial pathogens across regions.
These infections are effectively managed with antibiotics which either kill or stop the bacteria from multiplying. However, they are being used irrationally, according to CDC. About 1/3 of antibiotic use in people is not needed nor appropriate.
Irrational use of antibiotics can take many forms, including the use of too many medicines per patient (polypharmacy), the inappropriate use of self-medication (often with prescription-only medicines), in non-bacterial infections, outside clinical guidelines or with inadequate dosage or inappropriate route.
The irrational use of antibiotics is more attributed to inadequate knowledge about antibiotic use and other forces which are categorised as those deriving from patients, prescribers, workplace, the supply system including industry influences, regulation, drug information and misinformation- a combination of these factors influences irrational use of medicine.
The overuse of antibiotics in recent years means they are becoming less effective and has led to the emergence of “superbugs”. These are strains of bacteria that have developed resistance to many different types of antibiotics.
Additionally, irrational antibiotics use leads to poor health outcomes, longer hospitalization, increased cost for both the patient and government and increased mortality. Urinary tract infections (UTIs) & Upper respiratory tract infections (URTIs) are the most common reason for requesting antibiotics in the drug outlets. Examples of antibiotics used irrationally include penicillins, macrolides, and fluoroquinolones, among others.
Some infections have similar signs and symptoms to those of bacterial infections, therefore there is a need for health professionals to do thorough clinical assessment, physical examination and use of laboratory diagnostics before they prescribe antibiotics.
Additionally, government policies in the health system should be strengthened on appropriate use of antibiotics that’s to say; timely provision of updated clinical guidelines to health facilities and monitoring usage, restricting prescription of antibiotics as it is to some medicines like antimalarials. As this will help to promote rational antibiotics use in Uganda.
Therefore, rational use of antibiotics is paramount as it helps in avoiding preventable adverse drug effects, maximizing therapeutic outcomes by promoting patient adherence and minimizing the cost of drug therapy. It ensures that patients receive medications appropriate to their illness, in doses that meet their own individual requirements for an adequate period, and at the lowest cost to them and their community.
The authors are; Aisha Naava, a Nursing officer at Kawolo Hospital and Lilian Nuwabaine Luyima; a BSc Nurse and Women’s’ Health Specialist