Yesterday the World Awareness Antibiotic week came to an end. The campaign under the theme, ‘Antibiotics: Handle with Care’, aimed at increasing awareness about global antibiotic resistance and encouraging best practices among the general public, health workers and policy makers to avoid further emergence and spread of antibiotic resistance. 

According to health reports, self-medication especially for ‘simple’ illnesses such as headache, cough and body pain, among others, is on the increase and this has greatly contributed to drug resistance. Unfortunately, a large section of the public does not understand how and why antibiotic resistance happens, according to the latest findings.

More surprising however, is the fact that some knowledgeable people who spoke to the Healthy Times, maintained that despite the dangers that come with self-medication, they are not about to stop doing it.For example, Peter Mugiraneza, a resident of Kabeza, says cold cap will always be his solution to flu and cough.

"Those drugs help me get better within a short time. I don’t think these drugs can stop being effective because I have been using them for long,” Mugiraneza explains.

For Aisha Nkuranga, who lives in Kimihurura, Kigali, continuing with the dose when feeling much better is a waste of time. "Everyone wants to finish the course but some tablets really smell bad. As soon as I start feeling okay, I immediately stop taking the drugs,” she says.

Such practices according to health experts are among the root causes of antibiotic resistance.What are antibiotics?

Antibiotics are medicines used to treat infections caused by bacteria such as respiratory tract infections, pneumonia, whooping cough, skin infections and infected wounds.

According to the Journal of Antibiotics, these drugs work by blocking vital processes in bacteria, killing the bacteria, or stopping them from multiplying which helps the body’s natural immune system to fight the bacterial infection.

However, they differ depending on which type of bacterial infection they are used to treat. Drugs such as amoxylin and gentamicin that affect a wide range of bacteria are called broad spectrum antibiotics while those that affect few types of bacteria are called narrow spectrum antibiotics.

The first antibiotic was penicillin but derivatives such as ampicillin, amoxicillin and benzylpenicilllin are widely used today.

Research has, however, shown that there is a growing problem of resistance to antibiotics and other antimicrobial medicines. Antibiotic resistance occurs when an antibiotic loses its ability to effectively control or kill bacterial growth. This means that bacteria continue to multiply even in the presence of therapeutic levels of an antibiotic.

In other situations, the antibiotic can kill susceptible bacteria while resistant strains survive this selective pressure.

According to the Alliance for the Prudence Use of Antibiotics (APUA), a global coalition to promote proper use of antibiotics, some resistance occurs without human action, as bacteria can produce and use antibiotics against other bacteria, leading to a low-level of natural selection for resistance to antibiotics.

Resistance can also be acquired through mutations or contact with resistant bacteria.Cost of treating a resistant bacterial infection

Unfortunately, the current higher-levels of antibiotic-resistant bacteria are attributed to abuse of antibiotics.

Dr John Muganda, a physician at Polyclinique La Medicale in town, says when patients become resistant to one drug type, the alternative is finding another drug in the same line.

"Take an example where one has Tuberculosis. Once the patient fails to follow the first prescription, the whole doze becomes ineffective, which calls for another drug,” Dr Muganda explains.

He adds that there is a high possibility of the sickness resurfacing but could worsen with poor response to the first drug.

More tests are required and action has to be fast since a bigger population is put at risk, according to Dr Muganda.

"It is costly; we have to do more medical check ups before prescribing another drug. The biggest challenge is TB being air borne, many people are put at a risk because of only one individual,” he adds.

Dr Felix Shimimana, a specialist in internal medicine, warns that individuals who self medicate with antibiotics out of continued resistance are likely to overdose themselves.

"In this case, the person will take the first dose; if it does not work he will want to take another to treat the disease. Without knowing that microorganisms have acquired resistance, obviously the second dose won’t work and in the end it could be a case of overdose,” Dr Shimimana explains.‘Public to blame’

From the latest survey by the World Health Organization of 10,000 people across 12 countries, it was found that 64 per cent of respondents believed that antibiotics can be used to treat colds, flu notwithstanding the fact that these drugs have no impact on such viral infections.

The study also established that 32 per cent of respondents stopped taking antibiotics as soon as they felt better, ignoring the prescribed course of treatment.

Dr Rachna Pande, a specialist in Internal Medicine at Ruhengeri Hospital, points out that much as infectious strains are coming up, misuse of antibiotics for minor infections is leading to resistance.

"For minor problems such as flu, allergies, diarrhoea and bronchitis, antibiotics should be avoided because these are not clearly bacterial infections,” Pande explains.

She also points out that during treatment, it is possible to switch to another antibiotic within the same spectrum or combine 2 antibiotics with the same spectrum but with caution on sensitivity.

"It is challenging to treat resistant infection. Ideally, before starting antibiotics, a culture and drug sensitivity test is done to find out the causative germ and antibiotic, which would be effective,” she adds.

Dr Osee Sebatunzi, the director of Kibagabaga Hospital, also blames the continuous failure by patients to adhere to medical prescriptions as the biggest root cause of antibiotic resistance.

"Doctors usually prescribe the right dosage and drugs which patients are supposed to follow but if these are continuously abused then the risk of antibiotic resistance is a likely result,” Dr Sebatunzi says.

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 What do you think about self medication?

Joseph Mumbogo, a waiter at Lemigo Hotel

I rarely fall sick but whenever I do, I always seek advice from doctors. Some diseases such as malaria are resistant to some drugs so I wouldn’t want to endager my life by self-medicating. In most cases, ignorance is the reason people avoid going to hospital for treatment.

Yusuf Hakizimana, an employee at Inyarwanda Limited

I was a master at self medication until it almost cost me my life. I used to take paracetamol whenever I got headache until one day when the headache persisted and I was forced to see a doctor. It later emerged that I was suffering from migraines, not headache. That completely changed my thinking.

Anne Salim, an IT specialist

I, just like many women, normally swallow some tablets during my periods to reduce the pain. Of course there comes a time when the drug becomes resistant, that’s when I consult a doctor for help.

Cleria Dushime, works with AIESEC Rwanda

I had a simple headache recently and took one of the most popular painkillers. However, it did not help me so I was rushed to hospital only to be told that my condition was more serious than I thought.

Michael Bumann, a computer scientist

People should avoid self medication, some pharmacists are even not aware of what they are selling and may prescribe for you the wrong medicine because their aim is to make money. The only person supposed to prescribe for a patient is a doctor.

Benjamin Akitunde, an IT manager

I once had a cold and took pain killers but they did not help. It was until I visited the clinic that I recovered properly. It’s not good to use medicine without consulting a physician.

Compiled by Lydia Atieno