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Doctors raise alarm over surge in antibiotics use

March 29, 2011

Health professions in Pakistan warned against the misuse of antibiotics. – Reuters Photo

KARACHI, March 29: Speakers at a medical symposium on Tuesday observed that the misuse of antibiotics had emerged as a major health problem in Pakistan in recent years, leading to an increased resistance in microbes against certain drugs.

They said the situation was alarming as new drugs to counter deadly organisms were often not available on the market. Besides, they said, the patient and his family suffered enormously when an easy-to-treat infection got complicated due to the irrational use of antibiotics, for the treatment then became expensive, painful and, at times, risky.

These points were highlighted on the second day of the 48th annual symposium being organised at the Jinnah Postgraduate Medical Centre.

The theme of the three-day event is ‘Health profession and community: understandings and misunderstandings’.

Delivering a keynote speech on the rational use of antibiotics in medical practice, Dr Naseem Salahuddin, a consultant physician at the Indus Hospital, said that doctors’ decision to prescribe antibiotics must be preceded by a caveat on diagnosis through laboratory tests as far as possible and a lot of thinking. She explained that inadequate or higher dose of antibiotics could create a lot of problems for the patient.

“The misuse of antibiotics in any form could make the germs resistant to certain drugs and, resultantly, the disease could become difficult to treat. Firstly, doctors must do lab tests for diagnosis before prescribing antibiotics and not vice versa. Secondly, a dose should be well-calculated,” she said while cautioning against self-medication.

She said most viral infections were self-limiting and there was no need of antibiotics as was the case in dengue.

With the help of slides, she cited different cases where patients with easy-to-treat infections ended up having complicated problems only because they had consumed antibiotics they didn’t need.

She said the same phenomenon happened in multi-drug resistant tuberculosis (MDR-TB). “The disease, which could easily be treated with commonly available drugs in a few months, now requires long, painful and expensive treatment. Second line drugs have more side-effects as they are more toxic. Mutated germs produce certain chemicals which neutralise the effect of drugs,” she explained.

Infection control steps

Dr Salahuddin also highlighted the issue of infections acquired from hospital settings and said that there was a dire need to put infection control measures in place. “If such measures are not in place, the drug-resistant microbes can easily infect other patients. Mortality and morbidity will definitely increase in such a situation,” she said.

Dr Saifullah Baig representing the JPMC chest medicine department recommended a drug susceptibility test before the start of anti-TB treatment for all patients who once remained on TB drugs as according to him over 50 per cent of such patients had MDR-TB.

He also highlighted the need for having non-invasive ventilation at district hospitals. The equipment, he said, was proved to be very effective in saving lives especially of patients with chronic obstructive pulmonary disease.

Later in the question-answer session, Dr Nadeem Rizvi who heads the JPMC chest department said that most public-sector hospitals in the country, including the JPMC, didn’t have facilities for TB culture and sensitivity testing which was unfortunate. He said the government should take steps to provide the same.

Sharing the findings of his research, Dr Waquaruddin of the Pakistan Medical Research Council said that a large number of patients suffering from chronic hepatitis C infection might have normal enzymes and might not need interferon therapy. “Therefore, it is strongly recommended that a liver biopsy should be done in all these cases before anti-viral therapy,” he said.

Rheumatoid arthritis

Dr Kamran Hameed, the dean at the Ziauddin Medical University and Hospital, gave an update on the management of rheumatoid arthritis that he said was the most common connective disorder in Pakistan. The treatment required a multi-disciplinary approach but relevant facilities were available in few hospitals, he added.

“Rheumatoid arthritis is more common in females. The drugs used in treating this disease are highly toxic and need to be supervised by experienced physicians,” he said.

Earlier, chairman of the symposium’s organising committee Prof Dr Tariq Rafi said that on behalf of JPMC employees he demanded that the hospital be retained under the federal government and given the status of a university as it had all the necessary facilities for the purpose that included a nursing college, an institute for basic medical sciences, school for medical technology and a medical college attached with the hospital for over 30 years.