PGTW: “Indiscriminate” use of antibiotics a no-no

POP GOES THE WORLD By Jenny Ortuoste for Manila Standard-Today, 28 November 2013, Thursday

“Indiscriminate” use of antibiotics a no-no

After the massive devastation caused by supertyphoon Haiyan, it was gratifying to see how many nations rushed to our aid, sending not only money and relief goods but also troops to ensure peace and order and medical teams to care for the ill and wounded.

In terms of medical care, so many supplies have been donated that it has to be ascertained whether these are being dispensed properly or appropriately.

Take the case of antibiotics. An antibiotic that is being touted these days is doxycycline for prophylaxis after exposure to floods. How many medical advisories have we seen after typhoons that recommend such-and-such a dose for a certain number of days, without having to consult a physician?

Is this a good thing?

Microbiologist Richard Yulo, who is now taking doctoral studies in New Zealand, warns against “…the indiscriminate use of antibiotics among both volunteers and victims in shelters.”

He has had experience with assisting in outreach programs and has been involved in rescue and relief operations, most recently with the Philippine Red Cross during the Pedring and Habagat calamities.

Yulo says, “Out in the field, I’ve noticed a rampant misuse of doxycycline, which people take for fear of leptospirosis which is in many cases misdiagnosed and really rather rare.”

“The improper use of antibiotics,” he says, “be it taking them needlessly, incorrectly, or with the wrong dosage and duration, will increase the likelihood of drug resistance in pathogenic bacteria.

“The trouble is, people taking them don’t know any of these and seem to think that taking one or two pills is already enough to prevent disease. Likewise, volunteers who usually don’t receive sufficient training on this dispense antibiotics without proper guidance.

“”That’s what I’m really worried about. That in an effort to fix the problem at hand, we may be setting up a bigger problem that would be so much more difficult to solve than broken homes and hungry stomachs.”

He recommends that aid groups “hand antibiotics directly to hospitals or medical teams with doctors and not to dispense them indiscriminately to anyone who comes asking for them.

“The general public also needs to be aware that antibiotics are not the cure for colds that are caused by viruses, not bacteria. It’s also important to take the correct dose of prescribed antibiotics at the exact time to minimize the threat of antibiotic resistance, which could potentially lead to incurable infections.”

Recently, he said, someone from the Red Cross went on TV asking people to donate antibacterials soaps, “which isn’t a good idea. It would be better to use mild unscented soaps instead,” he adds, because antibacterial soaps “would kill most of the ‘good’ bacteria inhabiting our skin, which would expose us to colonization by more virulent bacteria.

“Mild soaps would be good enough for general hygiene while keeping our normal flora healthy at the same time.”

Yulo says ordinary citizens, instead of donating antibiotics, could give medical supplies such as “bandages, gauze, medical tape, Band-aids, cotton balls, and Betadine. That’s a great basic kit for minor wounds. As for medicines, basic over-the-counter drugs like paracetamol, Ponstan [painkiller], Neozep, and rehydration salts would also be helpful.”

He adds, “The scale of the devastation is already so epic, but things like indiscriminate distribution and use of antibiotics could make it even worse.”

Certainly some health organizations are wary of giving away antibiotics for people to take on their own. The Philippine Charity Sweepstakes Office (PCSO), for instance, includes only mefenamic acid (for pain), loperamide (for diarrhea), and paracetamol (for pain and fever) in its Family Emergency Medicine (FEM) kits that it distributes during times of calamities and national emergencies.

Recently, PCSO sent 100,00 FEM kits to Haiyan-stricken areas in Leyte and Samar.

According to PCSO Assistant General Manager for Charity Sector Dr. Larry Cedro “Antibiotics address a specific condition, such as infection. We simply can’t just incorporate antibiotics in our relief packages because there are also issues with regard to sensitivity. For example, we can’t include penicillin because some people are allergic to it. We only dispense antibiotics as prescribed by a physician.”

Let us hope that organizations handing out antibiotics will revisit their guidelines for distribution, just to make sure that despite their good intentions, help won’t turn into harm.

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