Behavioural changes needed in the fight against antibiotic resistance

Self-diagnosing a medical ailment is not the only patient behaviour troubling the sector. Self-treating is perhaps even more alarming, especially when done with antibiotics. Antibiotics, which stop the growth and reproduction of certain bacteria or kill them outright, are often considered amongst the greatest discoveries in the human history. They revolutionised medicine. Their introduction in patient treatment not only meant patients could be successfully treated from infections, which were previously considered fatal, but it also increased the average life expectancy by eight years^[1].

However, imagine a world, where simple procedures, such as common tooth extractions, are life threatening or where one must live in a hospital-like sterilized environment to avoid becoming seriously infected with any minor bacterial infection. Perhaps this image is not too far from becoming a reality in a couple of decades. Antibiotic resistance is not only a threat unique to the UAE, but also a global problem. Economist Jim O’Neill was reported urging the world to stop treating antibiotics like sweets, or multi-drug resistant infections will take a death toll around the globe^[2]. He also added that in 30 years antibiotic resistance is expected to kill more people than cancer and diabetes^[3]. According to other experts, antibiotic resistance would represent going back 200 years, where minor infections are deadly. By 2050, nearly 10 million people a year could die from antibiotic resistant infections^[4]. At present, in the United Kingdom, it is estimated that almost 5000 patients die every year due to having infections that cannot be treated^[5]. Similarly, in the United States, at least 23,000 people die each year from infections that are antibiotic resistant^[6]. Furthermore, the Centers for Disease Control and Prevention estimates there are more than two million people in the United States, who get infections with bacteria that are resistant to at least one antibiotic, used to treat that infection^[7].

In efforts to safeguard antibiotics, governments are taking further preventive measures. In the UAE, the Ministry of Health and Prevention (MOHAP) is drafting a new legislation, which will prohibit the sale of antibiotics at any pharmacy in the UAE without a prescription^[8]. This is expected to help put a stop to people getting antibiotics over the counter without their doctors knowing, and self-medicating. Pharmacists will also no longer be able to recommend antibiotics and sell them as over the counter drugs. This new legislation however only tackles antibiotics’ misuse from a sale’s point of view. In the UAE, antibiotics misuse also ensues from certain providers overprescribing them, or prescribing when not really needed. A platform that will help mitigate this is the Dubai Health Authority launched “Salama”, which is a unified electronic health record system, currently available in numerous public medical facilities, which will be connected to the MOH’s National Unified Medical Record (NUMR)^[9]. Having a nation-wide system that integrates all patients’ health records at public and private healthcare facilities will effectively provide a single electronic file for each UAE resident. This will also help the authorities to identify where over prescription of antibiotics is occurring and help foresee disease outbreaks, such as antibiotic resistant infections. These measures will significantly help control and regulate the sale of antibiotics and over prescriptions in the UAE.

Increased local public awareness is also needed to address the required change in mindset within the population, to put a stop to the tendency to self-medicate, especially with antibiotics. Antibiotics are designed to be taken under the supervision and instructions of a medical provider. Their repeated misuse can be as harmful as not taking them when needed. Many people in the UAE may ignore what antibiotics misuse consists of. This includes not finishing the course of an antibiotic as prescribed, interrupting its intake and then continue taking it again, or simply by self-diagnosing and self-treating with one.

Neil Buckley, CEO KCH in the UAE, explains: “The chances one can self-diagnose and self-treat properly are relatively low, primarily because most people are not qualified to do so. The choice of treatment should be made by a clinician, preferably a Family Medicine Consultant who knows the patient’s history of previous antibiotics used. This way, he or she avoids prescribing the same drug repeatedly, in the case of a recurrent infection, to prevent antibiotic resistance.

Most importantly, the chosen treatment should be derived from evidence-based care, meaning from the results of necessary diagnostic tests. This is especially important because having hard evidence is indispensable for eliminating trial and error and avoiding making an ineffective use of resources, which comes at the cost of poor patientcare outcomes and drug side effects, in addition to increased healthcare spend. This was explained a step further last week, at the Dubai Health Forum, during the moderated panel of ‘Precision medicine and wellness’, wherein using sophisticated diagnostic tools will help identify quickly how infectious diseases, including bacterial infections, will mutate, and therefore which therapies are likely to work or not. In the near future, where precision medicine (also called personalised medicine) will be more common, gene therapy (therapy which involves inserting a gene capable of fighting or preventing a disease) and immunotherapy (therapy which uses the immune system to fight certain diseases) may be the answer to preventing or curing antibiotic resistant infections. However, before these solutions become widely available, reinforcing antibiotic resistance prevention through the available resources, public awareness, is of the upmost importance.

Because antibiotics misuse by individuals is one of the leading causes to antibiotic resistant infections, clinicians need to further educate patients about taking antibiotics and the impact of doing so.

Tips: Simple steps people should follow to help avoid antibiotics misuse and resistance

by King’s College Hospital London in the UAE:

1. Do not pressure your doctor to prescribe you an antibiotic. He or she will know best how to treat your medical ailment. Nine times out of ten you will not need an antibiotic to treat a medical ailment.
2. Become more involved in your health and seek more information on what antibiotics are and what their use is intended for. Antibiotics only kill bacteria, not viruses.
3. Use antibiotics only as prescribed by your doctor. Complete the course of antibiotics as instructed by your doctor.
4. Do not save antibiotics for the next time you may be ill. Only Doctors are qualified to make a proper diagnosis. Preferably, keep visiting your Family Medicine Consultant as he or she will know your medical history best.
5. Do not share remaining antibiotics you may have at home with anyone.
6. Do not self-diagnose. Instead visit a Family Medicine Consultant, who will act as your health champion, and will diagnose you properly.
7. Ask your doctor the following questions when being prescribed an antibiotic:
8. How do you know what kind of infection I have? (Do mention to the doctor that you are aware antibiotics don’t work with viral infections, i.e. the common cold or flu).
9. Do I really need this antibiotic? What are the alternatives?
10. Can I get better without using it?
11. What side effects should I expect?

Instead of saving antibiotics, dispose of them adequately by dropping them at a trusted care provider in the UAE.

[1] “What Are Antibiotics and How Do They Work?” Microbiology Society, microbiologysociety.org/education-outreach/antibiotics-unearthed/antibiotics-and-antibiotic-resistance/what-are-antibiotics-and-how-do-they-work.html.

[2] Boseley, Sarah. “No Antibiotics without a Test, Says Report on Rising Antimicrobial Resistance.” The Guardian, 18 May 2016, www.theguardian.com/society/2016/may/19/no-antibiotics-without-a-test-says-report-on-rising-antimicrobial-resistance.

[3] “Taking Antibiotics When You Don’t Need Them Puts You at Risk.” Gov.uk, www.gov.uk/government/news/taking-antibiotics-when-you-dont-need-them-puts-you-at-risk.

[4] “’Antibiotic Apocalypse’: Doctors Sound Alarm over Drug Resistance.” The Guardian, 8 Oct. 2017, www.theguardian.com/society/2017/oct/08/world-faces-antibiotic-apocalypse-says-chief-medical-officer.

[5] “Taking Antibiotics When You Don’t Need Them Puts You at Risk.” Gov.uk, www.gov.uk/government/news/taking-antibiotics-when-you-dont-need-them-puts-you-at-risk.

[6] “Antibiotic Resistance Threats in the United States.” Centers for Disease Control and Prevention, 10 Apr. 2017, www.cdc.gov/drugresistance/threat-report-2013/index.html.

[7] Centers for Disease Control and Prevention, Antibiotic Resistance Threats in the United States, 3, 201.

[8] “UAE to Issue Law against Buying Antibiotics without Prescription.” Khaleej Times, 19 Nov. 2017, www.khaleejtimes.com/news/uae-health/uae-to-issue-law-against-buying-antibiotics-without-prescription-.

[9] “Ministry of Health and Prevention Presented Its Healthcare IT Journey at WSIS in Geneva.” Ministry of Health & Prevention Media Centre, www.mohap.gov.ae/en/MediaCenter/News/Pages/1850.aspx.