Drug overkill

Irrational drug prescriptions are giving rise to drug-resistant bacteria

Published: Monday 15 December 1997

prescribing drugs according to the will of patients is proving hazardous throughout the world. Private hospitals and clinics on the street are often suspected of adopting such practices. As a result, more and more bacteria are responding to people's overuse of antibiotics by evolving new ways to combat drug effects. If the trend continues, experts fear, some of the most powerful weapons against infections would become useless.

A study shows that such irrational prescription of antibiotics is even widespread in the us . Ralph Gonzales and his colleagues at the Colorado Health Sciences Center, Denver, usa , report that nearly 12 million prescriptions were issued in 1992 for colds, non-specific upper respiratory tract infections and bronchitis. Of these, about 60 per cent patients were given antibiotics despite the fact that those medicines have little or no beneficial effect in such complications. According to the researchers, about 90 per cent of them could be caused by viruses impervious to antibiotics ( Journal of American Medical Association , Vol 128, No 11).

Last year, the Mumbai-based Foundation for Research in Community Health reported a similar study on irrational use of drugs as reflected in physicians' prescriptions. The irrational prescription of drugs was found to be 19 per cent, unnecessary in 43 per cent and hazardous in 12 per cent. The study, however, did not specifically focus on irrational use of antibiotics.

Antibiotics kill bacteria in the body including useful ones that aid in digestion and keep other body systems humming along. Such killings of useful bacteria result in diarrhoea or vaginal yeast infection in some people. Whenever a patient takes medicines, all the bacteria do not get knocked out no matter how strong the dose is. In this process, some of the harmful bacteria manage to fight the drug and develop drug resistance.

There is another common and more dangerous habit of patients that compounds the problem of drug resistance. It happens when a patient takes antibiotics, as prescribed by the doctor, and discontinues drug intake before the specified time. Once the patient starts feeling better, he avoids medicines further. In such cases, when the disease causing bacteria have just shown temporary tactical retreat, they may strike back with more vigour, once the patient becomes vulnerable.

Why do physicians over-prescribe such antimicrobials? According to data collected by the Centers for Disease Prevention and Control ( cdcp ), Atlanta, usa , one of the major reasons is unrealistic expectations of patients that they can get well quickly if they seek doctor's advice. Further, doctors do not have sufficient time to discuss with patients why an antibiotic is not required and some simple symptom-relieving measures would do.

A team of researchers led by Benjamin Schwartz at the cdcp does not rule out the possibility of ignorance on the part of physicians about the spectrum of symptoms and signs. The natural history of such illnesses may not necessarily warrant antimicrobial use. Physicians in their defence argue that when they try to explain the concept of rational therapy and refuse to prescribe antibiotics unless absolutely essential, patients get angry. At times, they go to another doctor who is willing to prescribe medicines according to their wish. Patients take such decision in an eager to recover fast.

As a large number of doctors depend upon repeated visits by patients, they prescribe medicines to keep patients happy. However, doctors say that often it becomes necessary to prescribe antibiotics in a viral infection to prevent an occasional secondary infection. A virus can weaken upper respiratory tract and make it susceptible to be attacked by bacteria. They say even if you send a patient home to treat the symptoms with rest, fluids and medicines, he might come back a week later with an infection for which antibiotics are required.

Health policy experts argue that educating physicians and patients of proper use of medicines are necessary. Patients should not be merely influenced by advertisements of pharmaceutical companies that every ailment has a fast cure with drugs. Physicians, on the other hand, should not cave into the patients' pressure and try to convince them that whatever is being done is in their interest.

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