Without immediate action, there is real risk of the world turning to post-antibiotic periodAntibiotics, crucial life-saving medicines, have served to save humanity for long but misuse and overuse in animal and human health have made them ineffective to cure diseases. Antibiotic Resistance (AMR) occurs when microbes become resistant to drugs. AMR is a global problem and can affect anyone, of any age in any country. World Health Organization (WHO) reports show that AMR is everywhere. It has been estimated that in the next 35 years, 300 million people will lose their lives prematurely if the rate of AMR goes on the same speed as today and it will occur mainly in developing countries like Nepal. Nearly one million people are dying every year from bacterial infections. And in the last five years many bacteria have developed resistance to antibiotics.
Community pharmacists usually dispense medicine to patients with prescription and also sell it when legally permitted without prescription. According to an estimate approximately 80 percent of antibiotics are used by public with or without prescription. Community pharmacy has become the cheapest point for patients to cure their health for general diseases in developing and least developed countries. Globally, more people live in developing countries where people depend on community pharmacies for common ailments.
Hence, community pharmacists play crucial role in promoting proper and rational use of antibiotic in the community. In rural areas of developing countries, community pharmacies are often operated by non-pharmacists and in some places local drug shop is their immediate place of patients.
Community pharmacists should have required training and education on appropriate use of antibiotics. They should be updated with new antibiotic usage and pattern of AMR in local setting. The irrational use of antibiotics is high mainly in community of developing countries. In community pharmacies there is severe shortage of qualified pharmacists which has flourished AMR burden. Many research findings show even board-spectrum antibiotic like amoxicillin and azithromycin are being dispensed without health professionals’ prescription, which directly contributes to AMR. Furthermore, overuse, misuse and incomplete dose of antibiotic and lack of trained pharmacist in local pharmacies of countries like Nepal are other factors which support pathogens to become antimicrobial resistant.
Tools to fight
To reduce alarming rate of AMR, we must explore its solutions urgently. First, pharmacy staffs should have updated knowledge about real risks of AMR on public health and their main role in controlling and decreasing rampant use of antibiotics. Many countries have laws regarding restriction on distribution of antibiotic without proper diagnosis and prescription but due to lack of their implementation, AMR is increasing.
Only qualified and trained pharmacists can prescribe and distribute correct and standard dose of antibiotics. Pharmacists should have updated information on rational use and diverse side effects of antibiotics.
The key process in controlling AMR is to avoid overuse, misuse and underuse of antibiotics. This requires awareness and knowledge on AMR which can be generated through education, communication and training. While prescribing medicines, health professionals should counsel patients how to take full dose.
Similarly, community pharmacists should also make public aware on good hygienic practices, proper hand washing, intake of healthy food, smoking and alcohol cessation, isolation of infected people, suggestion on how to cure minor injuries etc. Some of the infections can also be controlled through immunization, which ultimately reduced the misuse of antibiotic against virus.
Imparting knowledge about importance of vaccine to people will increase rate of vaccination and decrease AMR. Antibiotic does not work against viruses. Therefore it should not be used for treatment of influenza and other viral respiratory problems. Many patients think antibiotic cures every ailment. Community pharmacists need to debunk such myths.
In healthy animals, large amount of antibiotics is used for growth promotion and to prevent many diseases. According to an estimate, almost 80 percent of antibiotics are used in livestock farming while the rate is much higher in agriculture-based countries. In Nepal, use of antibiotics in livestock farming is increasing day by day. When we feed antibiotics as food supplement in animal farm, it can help the bacteria to become resistant to same or similar drugs used during infection in human.
Additionally, most of the farmers purchase antibiotics from local retailers without veterinarian’s prescription. Data shows that the market of veterinary antibiotics in Nepal has risen over 50 percent from 2008 to 2012. But no attention has been paid on how antibiotics use in livestock and agricultural farming rises AMR. The use of antibiotics in Nepali farm is increasing excessively but exact figure of amount and dose is not available.
Food and Drug Administration (FDA) and public health community have proposed rational use of antibiotics. Pharmacists need to select only those antibiotics which are listed in “least important” to human being by WHO for livestock and agricultural farming.
Improving hygiene in livestock farming and proper use of vaccination in animals reduce huge amount of antibiotics being used in livestock farming. The European Union has banned the use of growth promoter antibiotic in 2006 to reduce antibiotic use in livestock. In 2005, FDA banned use of ciprofloxacin antibiotic in poultry farm.
Antimicrobial resistance travels beyond borders through food, water and air. All should work together to ensure rational use of antibiotic. Without immediate action, there is real risk of the world turning to post-antibiotic period where treatable infections can kill millions of people.
Implementing strict rule against sale of antibiotic without prescription, public awareness, counseling of patients, and immunization will go a long way in reducing burden of antibiotic resistance for the world.
Rayamajhee is a Research Faculty at Department of Infectious Diseases and Immunology, Kathmandu and Maharjan is Quality Controller of Meat Products, Valley Cold Store Pvt Ltd, Kathmandu