The star
BY LOH FOON FONG
Unnecessary use of antibiotics can result in drug-resistant bacteria.
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KUALA LUMPUR: Doctors should restrict the unnecessary use of broad spectrum antibiotics.
Limiting their prescription rights is also necessary in view of the increasing bacteria resistance to a wide range of antibiotics, said Universiti Malaya’s department of medicine Assoc Prof Dr Sasheela Ponnampalavanar, who specialises in infectious diseases.
“Although all antibiotics used for bacterial infection could cause resistance, some such as fluoroquinolones, broad spectrum cephalosporins and carbapenams are the main drives of multi-drug resistant organisms,” she told The Star.
“These drugs should be strictly restricted to the treatment of specific bacterial infections and used only if alternative antibiotics are not available.”
Dr Sasheela said the Health Ministry should strictly monitor their use not only in public and university hospitals but also among general practitioners and private hospitals.
She said prescribing rights to these antibiotics should also be limited.
“To reduce multi-drug resistant organisms in our community, the right to prescribe these antibiotics should be given to only doctors trained to use them prudently,” she said.
For public hospitals, the prescribing of medicines, including antibiotics, is guided by the ministry’s drug formulary. The category of prescriber determines what medicines, including antibiotics, can be initiated.
In Australia, broad spectrum antibiotics could only be prescribed with approval by designated authorities for very specific infections, Dr Sasheela said.
The World Health Organisation’s Anti-microbial Resistance Global Report on Surveillance 2014 revealed antimicrobial resistance was a major threat to public health worldwide and, without urgent coordinated action by many stakeholders, common infections and minor injuries that had been treatable for decades could once again kill.
The Star reported on Friday that the National Surveillance of Antibiotic Resistance (NSAR) showed increasing resistance in bacteria towards antibiotics which could lead to some people dying when the last line of antibiotics do not work.
Dr Sasheela also said the NSAR should include private hospitals and be made easily available on the Health Ministry’s website.
“This will keep hospitals on their toes to maintain good antibiotic prescribing and infection control practices,” she said.
Most sore throat cases do not merit antibiotics use
KUALA LUMPUR: Chris (not her real name) went to see a doctor for a sore throat and he gave her antibiotics without even knowing whether the cause was bacterial or viral.
According to Sungai Buloh Medical Department head and consultant infectious diseases physician Datuk Dr Christopher Lee, 85% of sore throats were from viral infection and patients did not need antibiotics.
“Doctors need to be judicious in giving antibiotics and use clinical tools such as the Centor score to gauge whether patients have a bacterial sore throat,” he said, warning that antibiotic-resistant bacteria or superbugs could affect everyone.
He said that if patient A, loaded with normal bacteria and a small amount of resistant bacteria (superbug) as a result of previous history of overusing antibiotics, came in and was given regular antibiotics for the normal bacteria, he might be well for a while as the antibiotics would kill the normal bacteria.
However, the superbug would continue to replicate and he would become ill again with the infection driven by the superbug.
Dr Lee said those in contact with the patient could be infected by the superbug and if they had a weak immune system and other medical problems, he or she might die or require a long hospital stay.
He said doctors would then have to use stronger drugs such as carbapenems or polymixin as a result of antibiotic resistance but these drugs could impair some organs.
He stressed that the fight against antibiotic resistance must be a community, national and global effort.
MMA: Monitor private hospitals and GPs for antibiotic abuse
KUALA LUMPUR: The Malaysian Medical Association wants the private sector to be accountable for the use of antibiotics too as careless usage had contributed to the rise in antibiotic resistance.
Its president Datuk Dr N.K.S. Tharmaseelan said private hospitals should also be included in the National Surveillance of Antibiotic Resistance report, which only monitored public hospitals at present.
“As patients are paying, there may be a tendency to use more ‘expensive and stronger’ antibiotics even when there are no indications,” he said.
Dr Tharmaseelan said the Health Ministry should ensure the private sector adhered to clinical practice guidelines on antibiotic usage and urged patients not to doctor-hop and change antibiotics without completing them as this could perpetuate antibiotic resistance.
He concurred with infectious diseases expert Universiti Malaya’s department of medicine Assoc Prof Dr Sasheela Ponnampalavanar that certain classes of antibiotics be restricted in the treatment of specific bacterial infections and used only if alternative antibiotics were not available.
Dr Tharmaseelan said general practitioners did not routinely do tests to ascertain the organism causing the infection because culture and sensitivity tests could be expensive and waiting for results could delay treatment.
“As such, doctors would initiate therapy based on experience and provisional diagnosis, which may lead to drug resistance too,” he said.
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