‘It is time to rationalise use of antibiotics in Pakistan’

Updated April 07, 2019

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Many pharmacists do not ask for a prescription from people who demand antibiotics because they might lose customers. — Photo by Mohammad Asim
Many pharmacists do not ask for a prescription from people who demand antibiotics because they might lose customers. — Photo by Mohammad Asim

Many antibiotics have been introduced over the years, but bacteria are smart and adapt themselves in order to be able to resist the antibiotics, National Institute of Health Executive Director Dr Aamer Ikram said.

“It is unfortunate that there is excessive use of antibiotics across the globe. The time for rationalising the use of antibiotics in Pakistan has come and it should be ensured that doctors do not prescribe them unnecessarily. We want to ensure that the sale of antibiotics without a prescription is stopped,” he told Dawn.

According to a report from the Review on Antimicrobial Resistance, it is estimated that 700,000 deaths globally are attributable to infections by drug-resistant pathogens and if the situations remains unchecked, the deaths will increase to 10 million by 2050.

The resistance developed by the bacteria is called Antimicrobial Resistance (AMR).

Dr Ikram said that around one and half years ago, the government had made a National Strategic Policy Framework and after that the National Action Plan (NAP) was also established.

“There are two parts of NAP. The first one does not require any funding and the second requires funding. Steps which do not require funding include a policy in the hospitals that only professors can prescribe antibiotics and medical officers would be allowed to prescribe just a few medicines.

“Moreover, every hospital has to establish its own anti-bio gram to see what kinds of bacteria are common there. However, the proper disposal of hospital waste and other steps to control infections need funding,” he said.

He added that an Infection Prevention and Control policy was also being made. The Drug Regulatory Authority of Pakistan has been involved to ensure that people would not get medicines without a prescription.

Dr Ikram said that efforts were also being made to raise awareness among masses for which the World Health Organisation has been involved as well.

“The positive thing is that the international partners are also aware that we are serious about the issue,” he said.

A citizen, Mohammad Bilal told Dawn that he has observed that doctors mostly prescribe antibiotics for coughs and sore throat.

“I used to take my children to the doctor when they had a cough or a sore throat, but I just get them medicines now since all doctors prescribe the same medicines,” he said.

A pharmacist Sheraz Ahmed said that a number of people come and demand antibiotics from him.

“I cannot demand a prescription because otherwise they will buy the medicine from some other medical store,” he said.

Health expert at the Pakistan Institute of Medical Sciences, Dr Waseem Khawaja told Dawn that antibiotics are among the most commonly prescribed drugs in human medicine.

“It is observed that the bacteria have internal intelligence due to which it changes itself according to the medicine and creates resistance against them. In the past, bacteria could be killed with low potency medicines but now for the same bacteria and virus, high potency medicines are required which is due to AMR,” he said.

“There is need to create awareness both in among the masses and health officials because a super bug can be created at any time which may not be killed with any antibiotic,” he said.

University of Health Sciences Vice Chancellor Dr Javed Akram said that Pakistan is a country where prescriptions are not required to purchase antibiotics.

“Almost 70pc of antibiotics are sold without prescription. On the other hand, choices of medicine are decreasing. Here people advise each other on the kind of medicines they should use. Antibiotics are also used in the agriculture sector, animal and poultry sector which are ultimately consumed by humans,” he said.

Dr Akram said that even if patients get prescriptions from doctors, they don’t complete the course, because of which bacteria remains in the body and the next time, it becomes difficult to kill it with the same medicine.

He said that in Pakistan antibiotic use is alarmingly high both in humans and animals. Approximately 90pc of upper respiratory infections (URTIs) are viral and self-resolving. Approximately 70pc to 90pc of patients for viral URTIs are prescribed antibiotics unnecessarily that are mostly self-limiting. Resistant infections due to these ‘super bugs’ are causing thousands of deaths and hospitalizations each year.

“Solutions to combat AMR include use of antibiotics only if there is a clear and definite need, avoiding overuse in viral infections and also broad-spectrum antibiotics, avoiding their use in healthy animals and poultry and following good Infection Control and Prevention practices,” he said.

Published in Dawn, April 7th, 2019