Tuesday 15 November 2016 – Antibiotics help save lives, but are not the answer when we come down with a case of the ‘sniffles’. The misuse of antibiotics has already resulted in them becoming less effective, which has serious implications for treating bacterial infections in the future. 

Speaking during World Antibiotic Awareness Week, 14 to 20 November, Dr Dena van den Bergh, Director: Quality Leadership at Netcare, said that many people still view antibiotics as a cure for all.

She explains:

“Antibiotics treat bacterial infections, so they should only be prescribed in the event of a suspected or proven bacterial infection. Antibiotics are not effective against viral infections, and even for bacterial infections they should not be taken unless there is a compelling medical reason why the body’s natural defences may require help. This is because overusing antibiotics, continuously and without real need, breeds more resilient bacterial strains, which then become more resistant to the medication.”

According to Dr Van den Bergh, the increasing incidence of antibiotic resistant organisms has highlighted the importance of correct antibiotic prescribing, including “bug-drug matching”, use of narrower spectrum antibiotics, appropriate duration of the course of treatment and correct dosage.

She asserts:

“At the same time, patients also contribute to antibiotic resistance when they pressure their doctors to prescribe antibiotics to treat non-bacterial infections, and by not taking the antibiotics as prescribed. At Netcare we believe that information is empowering and that the choices made by ordinary South Africans can play a meaningful role in helping to prevent the problems posed by the overuse and incorrect use of antibiotics.”

The following frequently asked questions will go a long way to empowering healthcare consumers with the necessary information to help counter the threat presented by antibiotic resistance.

WHAT IS AN ANTIBIOTIC ?

Antibiotics are a group of medicines that are capable of destroying or inhibiting the growth of bacteria. An example of a commonly used antibiotic is penicillin, which was discovered in 1928 by Alexander Fleming.

WHAT TYPE OF ILLNESS ARE ANTIBIOTICS EFFECTIVE IN TREATING ?

Antibiotics are used to treat bacterial infections such as pneumonia, ear infections, strep throat, tuberculosis (TB) and urinary tract infections. Antibiotics are not effective against viruses, such as the common cold or influenza.

WHAT IS ANTIBIOTICS RESISTANCE ?    

Bacteria are constantly evolving, producing different ‘strains’ which have slight differences in their genetic make up. Just as humans can build up resistance to certain types of illness, the evolution of bacteria strains enables them to develop resistance to the antibiotics we rely on to treat bacterial infections.

This means that the antibiotic loses its ability to effectively control or kill bacterial growth, and the bacteria are increasingly able to withstand or resist the curative effect of antibiotic drugs and continue to multiply. In other words, the antibiotic was once able to kill off the bacteria and treat the infection but, due to development of resistance, that antibiotic has now become ineffective in treating the infection.

WHY IS THERE GLOBAL CONCEARN WITH REGARD TO ANTIBIOTIC RESISTANCE ?

Antibiotic resistance is now a global problem, as it has risen to dangerously high levels in many parts of the world. Common infectious illnesses such as pneumonia, tuberculosis and gonorrhoea are becoming more difficult to treat because the antibiotics used to treat them are becoming less effective. Without antibiotics that work, essential medical procedures like hip operations, caesarean sections, organ transplants and treatments such as chemotherapy would be much more risky. If we do not take urgent action we will soon head for a post-antibiotic era, in which common infections and minor injuries will once again cause death and disability. This would also lead to higher medical costs and prolonged hospital stays. Already, in the European Union alone, it is estimated that drug-resistant bacteria cause 25 000 deaths and cost more than US$1.5 billion each year in healthcare expenses and productivity losses.

WHAT ARE MULTI-DRUG RESISTANT GERMS ?

Multi-drug resistant (MDR) bacteria are germs that have developed resistance to at least three different antibiotics. These are particularly dangerous to patients who have other underlying health problems or injuries, or are undergoing surgery, for example. Internationally and in South Africa, we urgently need to change our patterns of antibiotic prescription and usage. Without such behavioural change, antibiotic resistance will remain a major threat even if new medicines are developed.

HOW IS THE WORLD HEALTH ORGANIZATION (WHO) RESPONDING TO THIS THREAT ?

The WHO has flagged antibiotic resistance as a high priority issue, endorsing a global action plan on antibiotic resistance at the World Health Assembly in May 2015. The global action plan aims to ensure the prevention and treatment of infectious diseases with safe and effective medicines continues. The global action plan has five strategic objectives:

• To improve awareness and understanding of antimicrobial resistance
• To strengthen surveillance and research
• To reduce the incidence of infection
• To optimise the use of antimicrobial medicines
• To ensure sustainable investment in countering antimicrobial resistance.

During the first annual World Antibiotic Awareness Week in November 2015, the WHO launched and led a global campaign with the theme “Antibiotics: Handle with care”. The WHO is supporting member states to develop their own national action plans to address antimicrobial resistance, aligned with the objectives of the global plan.

WHAT CAN WE DO ABOUT ANTIBIOTICS RESISTANCE ?

It is not too late to reduce the impact of antibiotic resistance and we all have a part to play in preserving the effectiveness of antibiotics. In terms of the WHO initiative, interventions should be made at four levels: the general public, healthcare workers including pharmacists, policymakers and the agricultural sector.

How can the general public help to prevent antibiotic resistance ?

• Embrace a healthy lifestyle, through eating a balanced nutritious diet, getting enough exercise, and practicing good hygiene. Through staying healthy, you can prevent many infectious bacterial illnesses and thereby avoid the need for antibiotics.
• Cleaning your hands regularly and thoroughly with soap in your home, office, school, gym and other places.
• If you do fall ill, do not demand antibiotics from your doctor. Antibiotics generally do not work for viral infections, such as flu or the common cold.
• If it is medically necessary to take antibiotics, then take them exactly as prescribed by the doctor or pharmacist. Take them continuously, do not skip any doses.
• Do not ‘save’ antibiotics prescribed for one illness, to take them when you fall ill at a later date. Even if the illness seems the same, remember that many different infections may exhibit similar symptoms. This does not mean that the same antibiotic is appropriate for the treatment of illnesses with similar symptoms.
• Do not share your prescribed antibiotics with others – this can lead to misuse and fuel the development of antibiotic resistance. Remember that antibiotics are powerful drugs and can have negative side effects.
• Keep your vaccinations up to date.
• Talk to your family and friends about the importance of only taking antibiotics when necessary and appropriate.

WHAT IS ANTIBIOTICS STEWARDSHIP AND HOW CAN IT HELP TO PREVENT ANTIBIOTICS RESISTANCE ?

Antibiotic stewardship ensures that the correct antibiotic is chosen and administered at the correct dose, duration and route of administration. Ultimately, antibiotic stewardship improves patient outcomes, reduces microbial resistance and decreases the spread of infections. All healthcare professionals and patients need to support and participate in antibiotic stewardship, which involves a co-ordinated programme that promotes the appropriate use of antibiotics.

HOW DOES NETCARE CONTRIBUTE TO REDUCING ANTIBIOTICS CONSUMTION ?

Netcare hospitals have implemented comprehensive and collaborative antibiotic stewardship programmes in each of its hospitals, and this initiative is now in its sixth year. Each hospital has a formal multi-disciplinary antibiotic stewardship committee that is comprised of all the different disciplines including doctors, nurses, infection prevention practitioners, microbiologists, pharmacists and management. The committee meets regularly to discuss ways of reducing the impact of antibiotic resistance and to ensure that antibiotics are being used appropriately in the hospital setting. Pharmacists engage in daily clinical ward rounds and review patients’ antibiotics to ensure that they are being used correctly, at the right dose and for the appropriate duration. They also ensure that cultures are done in order to identify the correct antibiotic to use in each specific case. Key interventions are monitored on a daily basis to ensure optimal and appropriate therapy for patients. Any related concerns raised are discussed with the doctors and microbiologists and appropriate interventions are then made.

Antibiotic stewardship initiatives at Netcare hospitals have been proven to reduce the quantity of antibiotics that are being used. The achievements of this programme were highlighted in a research paper recently published in Lancet Infectious Diseases on behalf of the Netcare multi-disciplinary antimicrobial stewardship teams. The Netcare programme achieved an 18% reduction in the consumption of antibiotics by in-hospital patients and demonstrated that a meaningful reduction in antibiotic usage can be achieved through a number of basic interventions. This study demonstrated the impact that collaborative teams can make in minimising unnecessary antibiotic use in hospital patients.