Viral infections should not be treated with antibiotics — Expert

A pharmacist at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria and Fellow of the West African Postgraduate College of Pharmacists, Mrs. Ogochukwu Onwujekwe, talks to MOTUNRAYO JOEL about antibiotics and its uses

W hat are antibiotics?
Antibiotics are medicines that fight or prevent infections caused by bacteria, certain parasites such as some types of fungus. There are several classes of antibiotics. They can be administered as an empirical therapy (in which case there is a proven or suspected infection). They can also be administered as definitive therapy (in which case the causative organism is already identified). Thirdly, they can be used as prophylaxis or chemo prevention of an infection especially after surgeries.

What then does the term ‘antibiotic resistance’ mean?
It is unresponsiveness to antimicrobial agents in standard doses that were once effective in eradicating the particular causative organism. It occurs when bacteria or other organisms in the body change so that antibiotics do not work effectively against them. It develops over a period of time and can be very slow to reverse or irreversible.

What is the implication for a patient if a doctor diagnosis his or her body as being antibiotic resistance?
Resistance decreases the effectiveness of antibiotics that were once effective in treating and eradicating infections. Antibiotic resistance has a negative impact on the health of the populace. It also encourages the outbreak of diseases leading to very high mortality and morbidity rates. It causes an unnecessary longer duration of treatment and high cost of treatment with expensive drugs. Patients act as reservoir of resistant organisms which are passed to community and health care workers.
Development of antibiotic resistance ultimately leads to an increased disease burden, huge economic loss and a breakdown of the health system of a nation. Some few examples are multidrug resistant tuberculosis, resistance of gonorrhoea to important antibiotics such as penicillin and fluoroquinolones, multi-drug resistant salmonella typhi causing about 10 per cent case fatality in children. It has been found that more than 50 per cent isolates in hospitals are methicillin-resistant to staphylococcus aureus.
Multi drug-resistance to pseudomonas, klebsiella and serratia persist in hospital settings causing a lot of illness and death (World Health Organisation, 2011).

Why are bacteria becoming resistant to antibiotics?
There are several reasons for the antibiotic resistant strains and species. These include incorrect or suboptimal use of antibiotics for certain bacterial infection; inappropriate antibiotic treatment; and overuse of antibiotics (are also associated with emerging resistance e.g. penicillin and erythromycin).
Also, the use of antibiotics to treat symptoms or diseases that are more likely to resolve on their own without treatment e.g. the case of flu and common cold is also implicated in antibiotic resistance. Other causes include failure to prescribe the correct dosage of antibiotics based on patients’ weight and history of prior use, failure to take the entire course of the antibiotics especially when one starts feeling better.

Should viral infections be treated with antibiotics?
Viral infections like the common cold and flu should not be treated with antibiotics. They are usually self-limiting infections and usually undergo their normal courses and resolve on their own. However, in some exceptional cases where such viral infections are accompanied by fever and have lasted for quite a long time with yellow or green purulent sputum (should be normally thin and clear), then a culture and sensitivity test should be carried out on the specimen and an appropriate antibiotic given.

What are ailments in adults which can require the use of antibiotics?
Adults are the main culprits in the irrational use of antibiotics. They are most likely to engage in self-diagnosis, rush to a nearby pharmacy or patent medicine store to obtain two or three capsules of an antibiotic alongside with other mix of pain relievers. This results to inappropriate use which is a main cause of drug resistance. People should only take antibiotics when prescribed by a qualified medical practitioner.

Which is the appropriate way to take antibiotics prescribed by a doctor?
There is need to adhere to instructions on the dose, the dosing interval, the frequency and the duration of use. Antibiotics are a class of drugs that should be taken with caution and not carelessly in other to avoid the issue of resistance. Hence, the rule of rational use of drugs comes into play whereby the right patient receives the right drug, in the right dose and quantity, for the right indication, the right duration and appropriate information on use. There should be a clear instruction on the dosing interval, a six or eight hourly antibiotics should be taken as such so that at every six or eight hours as the case may be. There is a re-administration of the drug into general blood circulation and this should be done throughout the duration prescribed by the medical doctor. This helps to promote the efficacy of the drug and reduce resistance.
However, it is important to reemphasis the fact, as mentioned above, that antibiotics are not needed for viral infections for example, common cold and flu unless in extreme cases where there is a secondary infection.

Can children be given antibiotics for cough and catarrh?
It depends on the doctors’ diagnosis. This basically lies in the doctors’ discretion after examination and listening to chest sounds.

Which antibiotics are best for children knowing that there are many in the market?
There are so many antibiotics in the market for children. They usually come in powders and granules for reconstituting before use. The choice of drug depends on the doctors’ prescription. However, choice should be based on susceptibility of the drug to the organism and the dose should be calculated based on the body weight of the child and adequate instruction on use.
Most of the oral suspensions for children come in powders and granules and should be reconstituted with freshly boiled and cooled water. A little cooled water is poured to dissolve the granules and then made up to volume with the water. Once opened, the drug should be stored in the refrigerator and discarded after about a week or two depending on the instruction on the label. Instructions like shaking the bottle before use should be strictly adhered to ensure even dispersion of the medication and for assured efficacy.

What else can one do to reduce the risk of antibiotic resistance?
There is need to ensure that antibiotics are used rationally and appropriately. Self- medication, drug abuse and misuse should be avoided. There should be restrictions of over-the-counter sale of antibiotics. There should be adequate training of prescribers on rational use of antibiotics. Government should engage on operational research in order to discover, develop and disseminate new antimicrobial agents. Finally, there should be information, education and counselling on the procurement, use and administration of antibiotics.