Health alarm bells: Playing games with pills? The joke’s on you

Careless use of antibiotics has made infections difficult to treat.

KARACHI:

Having led a perfectly healthy life for several years, the fever’s tenacity was a curious affair for 23-year-old Saleem Rehman*, especially after a trusted medic prescribed Augmentin tablets, which he took regularly for several days to no avail.  

Despite timely attention, Saleem’s condition deteriorated and he lost weight. Laboratory tests following the antibiotic dosage told of an infection caused by the streptococcus bacteria, usually found in the throat. The infection had spread to the patient’s heart valve, deeming his condition lethal. He was rushed to the Indus Hospital in Karachi.

What went wrong with Saleem?

Why was it becoming impossible to curb a relatively common infection — especially after a broad spectrum antibiotic like Augmentin had been administered? This was it – the hasty use of a pill as strong as Augmentin, which had deemed the bacteria unconquerable.

“If the general physician had grasped the condition correctly, he would have recommended the patient to a hospital where the right quantity of drug would have been given. The prescribed antibiotic has just made the bacteria more stubborn,” says Dr Samreen Sarfaraz, an infectious disease consultant.

The immediate dosage of a strong drug, however, was not the only culprit in Saleem’s case. His case history bore witness to similar recklessness with medicines in the past. Having had rheumatic fever as a boy, Saleem had been careless with the use of penicillin (a kind of antibiotic). As he started feeling mildly better, he left the course in the middle — decision which took a great toll on his body’s immunity.

“People often stop using antibiotics once they start feeling better, leaving the entire course of medication unfinished. This leaves a few bacteria behind and they become even more resistant,” says Dr Naseem Salahuddin, a senior consultant at the Indus Hospital.



Childhood carelessness, coupled with the use of disproportionately strong Augmentin, was making Saleem’s infection difficult to treat.

“One after another, the infection is resisting all antibiotics,” says Dr Samreen Sarfaraz. “We are trying more powerful drugs but chances are that they won’t work either.”

Since Saleem’s admission to Indus Hospital, doctors have tried two types of antibiotics penicillin and ceftriaxone — both of which have been ineffective. Vancomycin, the last resort, is now being tried.

Unchecked sale

Unchecked, off-the-counter sale of antibiotics has compounded the situation.

“Out-of-control infections have become really common for us. We are witnessing cases all the time where most of the antibiotics fail,” said Dr Shohba Laxmi, an infectious disease expert at the Liaquat National Hospital.

“Mortality rate is running between 30% and 50% because the drugs can’t fight the infections. Widespread use of antibiotics is making these bugs harder to control.”

Stemming from bodies of patients who are careless in the use of antibiotics, pill-resistant bacteria now pervade the air of hospitals – explaining the trend of hospital-borne diseases. Some pathogenic streams have found their way outside the doors of the hospital too.

More and more patients are now coming to hospitals with infections, which indicates defiance against frontline antibiotics, forcing doctors to use strong drugs that are considered to be the last defence against the bacterium onslaught.

Bugs like methicillin-resistant staphylococcus aureus, pseudomonas aeruginosa, clostridium difficile, klebsiella pneumoniae and vancomycin-resistant enterococcus faecium have become common in hospitals.

“We have come to this point ourselves. Physicians and gynaecologists prescribe two or three antibiotics to their patients at a time,” says Dr Salahuddin.

Pharmaceutical companies also use doctors to keep up the sales by handing out free samples of antibiotics.

“These companies are dictating doctors about the benefits of their products. Illnesses like urinary tract infection and pneumonia have become difficult to treat because of that.”

*Names have been changed to protect privacy

Published in The Express Tribune, February 26^th, 2013.