Is there anything wrong on the use of antibiotics in the community? Dr dra apt Ida Ayu Alit Widhiartini, M.Si Departement of Pharmacology and Therapy Faculty of Medicine Udayana University e-mail: widhiartini@unud.ac.id This pandemic has made us r

Is there anything wrong on the use of antibiotics in the community?

Dr dra apt Ida Ayu Alit Widhiartini, M.Si

Department of Pharmacology and Therapy Faculty of Medicine Udayana University

e-mail: widhiartini@unud.ac.id

      This pandemic has made us realize that selecting the right pharmacotherapy is a challenging task. Not only on prevention but also on infection treatment. Up to now, the pharmacological treatment is prescribed based on trial and error as a process of exploration an accurate, effective, and safe treatment. Choosing the best pharmacological treatment for infection is a systematic process, it is evidence-based. Anti-infection was recommended only based on appropriate indication and clinical microbial findings. But, antiinfection mainly antibiotics are used excessively even without clear indication. This community has to concern about this problem, antibiotics use may be controlled and the use of antibiotics should be followed by improving of public knowledge about antibiotic treatment. This article will describe a fact to be taken into consideration by the community in order to ensure a safe and effective treatment in the future.

       The use of antibiotics is a common practice in our community. In a certain circumstance, a patient may come to a community pharmacy with the antibiotics name and even with torn packaging. There is no prescription to support antibiotics legality upon administration and its consultation, although on the antibiotics packaging is clearly written that it is a prescribed medicine. This phenomenon not only occurs in urban but also in suburban areas. Further, antibiotics may also be purchased online. This has made people believed that antibiotics do not need a prescription or its copy to obtain them.

Why antibiotics are used excessively?

        In general, the community wants to be free from symptoms immediately, thus they used antibiotics. Easy access to medicine and to online information as well as lots of exposure to drug promotion are contributed to the massive use of medicine including antibiotics. In addition, our community also quite frequently doing a self-diagnosis which then led to a physician’s decision on antibiotics prescription. Unfortunately, the excessive use of antibiotics may cause several unexpected outcomes and the community may not aware of this. For instance, ineffective antibiotics treatment is related to excessive antibiotics used. The ineffective treatment is due to antibiotics resistance which has already occurred for years. Most of the population has used antibiotics for all symptoms. This is misleading because all drugs have their own directions of use including antibiotics.

What are antibiotics?

       Antibiotics are a class of drugs to inhibit the growth of or even kill microbes/bacteria. Cough, cold, and diarrhea for unknown cause may not necessarily need antibacterial agents. Similarly, for infections caused by a virus, antibiotics are not effective. Special consideration for antibiotics is related to antibacterial resistance, its toxicity, high cost, and environmental consequences. These considerations are really needed due to the high prevalence of infections in Indonesia.

What are considerations in using antibiotics?

       There are some considerations in using antibiotics which required consultation with doctors or pharmacists. The considerations include types of diseases based on patient’s clinical symptoms, past medical and medication history, physical condition, age, body weight, pregnancy or lactation status, system disorders like gastrointestinal, liver, or renal. In addition, a personalized approach is also emerging in a specific population.

Is there any unexpected adverse drug reaction when taking antibiotics irrationally?

       Similar to other drugs, antibiotics may have unexpected adverse drug reactions, for instance, gastrointestinal disturbance like nausea, vomiting, bloating, and diarrhea. Other symptoms like skin rashes or swollen in the eyes, tongue, or face which requires an immediate response. Another adverse drug reaction for long terms used of antibiotics is fungi infection in the mouth or gastrointestinal due to normal flora growth disruptions by the antibiotics. Shock anaphylactic is the most serious adverse drug reactions which may experience by the patients.

What is the impact of antibiotics to body systems?

            Oral antibiotics may influence our systems directly and indirectly. Tetracycline may cause teeth discoloration and bone developments, thus, its use among children should be avoided. Chloramphenicol may suppress bone marrow productions thus blood cell formation may be disturbed. Sulfamethoxazole may cause calcium oxalate formation in renal if taken with acid food/drink. Aminoglycoside may cause vertigo, renal dysfunction, and deaf. Patients with liver or renal diseases need to limit antibiotics uses and monitoring is essential. In addition, this monitoring is also required in pregnant women and lactating mothers.

What is the long term effect of antibiotics uses?

        Irrational antibiotics use without long term clinical monitoring may lead to unexpected outcomes particularly to children because they may reduce the children’s natural immunity. The children became more prone to infection and allergic and metabolic syndrome was deemed to be related to this. This fact may also experience by the adult population Other impacts such as delayed of disease treatment, longer illness, longer treatment, higher risk of polypharmacy, and higher cost of treatment.

Is there any natural ingredients effective as antibiotics?

At the moment, there are no natural resources or herbal medicine could replace antibiotics yet.  Natural antibiotics such as garlic, echinacea, ginger, green tea which declared effective in some infections, of course, they need more studies related to the efficacy and safety in clinical patients. This is particularly important, they still need strong clinical evidence before antibiotic or antibacterial labeled to its indication.   

How to get optimal therapy when taking antibiotics?

Please take antibiotics based on physicians or pharmacists as the following:

1. For oral dry syrup, get confirmation whether it has been prepared or does it require reconstitution or dilution? If it is not, please see the preparation information in the packaging or leaflet inserted. See the volume of water added thoroughly.
2. For powder oral administration, you may add 2-5ml of water for ease of administration.
3. If on the label stated once daily, twice or thrice daily, it means it needs to be taken every 24 hours, 12 hours, or every 8 hours respectively.
4. Confirmation of before, during, or after food, please take it accordingly for effective drug effects.
5. Please use the regular drug dose measurement provided by the drug manufacturers. If you are in doubt, please ask the right measurement with your pharmacists.
6. Please contact your physicians or pharmacists if any unexpected adverse drug reactions identified.
7. Keep the antibiotics in the drug packaging in a closed container within the expected room temperature and humidity as shown on the label or ask your pharmacist to ensure drug stability.
8. Take antibiotics based on the amount and volume of drugs recommended by your doctors or pharmacists. Do not stop taking the antibiotics although symptoms resolved.
9. Discharged the remaining unused antibiotics, in a closed container in a separate container.
10. Do not use antibiotics used for previous symptoms. It needs to be remembered that although the symptoms are similar, the cause may be different. For instance, fever is not only caused by a bacterial infection, but viral infection may also cause fever, thus antibiotics administration maybe not relevant for this case. 

New antibiotics development is not an easy task. This development is racing with its resistance. Physicians and pharmacists need to work hand in hand to ensure safe and effective antibiotics used in the community. Unnecessary antibiotics used may require further evaluation. Similarly, the community members should also change their behaviors in taking unnecessary antibiotics uses particularly in taking them for cough, cold, or diarrhea. The current antibiotics used pattern indicates future infection management.  

Denpasar, 30 June 2020