Antibiotics and antibiotic resistance: Your questions answered
Posted on 5 July 2018
A physician and an Infectious disease specialist weigh in on frequently asked questions about antibiotics and antibiotic resistance.
Can you take antibiotics without a prescription?
“In South Africa you can’t take antibiotics without a prescription,” says Dr Amima Sundas, a physician at Mediclinic Newcastle. “Your healthcare provider first needs the evidence of the infection, and then they need to know how to appropriately prescribe the antibiotic to treat that infection.”
Why are patients advised to complete their course of antibiotics?
“If you stop your treatment in the middle of your course, it’s very difficult to treat the same infection with the same antibiotic again,” Dr Sundas explains. “The bacteria get clever – and if they have been sub-optimally exposed to an antibiotic, they will know how to fight it. That creates resistance.” She emphasises that the course of antibiotics must be prescribed and taken appropriately.
What is an ‘appropriate’ prescription?
Most bacterial infections are treated with antibiotics, but bacteria can also develop mechanisms which enable them to thrive in the presence of those antibiotics. This, warn Professors Pascal Bessong and Richard Guerrant in the South African Medical Journal, leads to antibiotic resistance and to what’s known as antibiotic-resistant ‘superbugs’.
Ironically, the main driver of antibiotic resistance is misuse and overuse of antibiotics – and inappropriate prescriptions play a significant role in that. “The only way to beat the superbugs is through awareness, both on the patient side and on the doctor side,” says Dr Sundas. “You need to know what, where and when to prescribe – and whether [it] really needs to be prescribed in the first place.” The research on this is very clear: without proper action, we’re facing a near future where we won’t be able to use antibiotics to treat common infections any more.
What are the dangers of inappropriate doses of antibiotics?
“It is absolutely wrong to say that you have to finish your course of antibiotics, regardless,” says Dr Cloete van Vuuren, an Infectious Disease Specialist who contributed to a practical study at Mediclinic Bloemfontein, which led to a significant reduction in antibiotic use in the hospital’s Critical Care Unit. “What might happen is that you’ll get a course of antibiotics, but then when you realise that it’s actually not a bacterial infection but a viral infection, you’ll persist and finish your course of antibiotics anyway. Most conditions in which you would need to use antibiotics are those which need a short course, high dosage antibiotic. Then when the situation is resolved, you should stop the antibiotics immediately.”
Are there any other dangers?
Yes. “There are billions of good bacteria inside your gut, which are vital for your general health and wellbeing,” says Dr Van Vuuren. “Those are destroyed by antibiotics. Your body controls resistance by allowing those healthy bacteria to outgrow the nasty ones. When you take antibiotics, you’re taking away the competition and allowing the nasty ones to flourish.” That’s why it’s best to use antibiotics for as short a course as possible and at an appropriate dosage.
What can doctors do?
It’s all about awareness, says Dr Sundas. “Once a patient reaches the specialist, we often find that they’ve already been exposed to quite a few inappropriate antibiotics,” she says. “It’s a big issue, and there needs to be more awareness about this, because some patients see antibiotics as the solution to every problem.”
What can patients do?
“If you’ve got a sore throat, once it’s improved you should stop taking the antibiotics,” says Dr Van Vuuren, pointing to the work of the South African Antibiotic Stewardship Programme. “If your condition doesn’t improve, then it’s not a bacterial infection; it’s much more likely to be a viral infection. If you’re better, stop. If you’re not better, you shouldn’t take a second course because you’re only causing more harm by altering the bioflora in your gut.”