The World Health Organization (WHO) considers antibiotic resistance to be one of the major public health threats of this century.1 Antibiotic resistance occurs when potentially life-threatening bacteria resists the action of the agent that is administered to fight against them. Resistance of these agents can be developed through a variety of mechanisms such as drug inactivation, alteration of binding sites or metabolic pathways, or reduced drug accumulation by the bacteria.2 This can make the treatment of bacterial infections such as pneumonia or endocarditis very challenging, causing treatment delays and leaving providers with limited choices of antibiotics. Practices such as inappropriate antibiotic prescribing or use, patients failing to take antibiotics in accordance to proper directions of use, incomplete antibiotic courses or improper antibiotic disposal can all contribute to the emergence of drug-resistant bacteria.
In Malaysia, antibiotics are often inappropriately prescribed for self-limiting conditions such as the common cold, which poses a significant threat to the development of antibiotic resistance. The National Medical Care Survey (NMCS) 2014 revealed higher antibiotic prescribing rates in the private sectors compared to the public settings.3 Several reasons such as patient perception and expectation, as well as financial incentives for clinics and pharmacies could also contribute to the widespread of antibiotic use. Beyond the prescribing step, it is also important to consider the other stages of the medication use process. Patients themselves are also potential contributors to the preventable evolution of resistant bugs, also known as “Superbug”, by not taking the antibiotics as directed, which may include missed doses, and incomplete courses of antibiotic use. This practice will eventually lead to the survival of the bacteria, and allow them to thrive and evolve into resistant strains of bacteria that in worst cases may be untreatable by antibiotics currently available on the market.
As healthcare providers, we want to provide the best care possible to patients through treatment regimens that are both safe and effective. Patient education also plays an essential part in clinical practice as most individuals in this country possess poor health literacy. Since the majority of patients are deficient in basic scientific knowledge to sufficiently grasp the mechanisms of bacterial infection and the severity of antibiotic resistance development, healthcare providers here would need to be able to translate those information into layman terms that most patients can comprehend. In addition to that, ensuring that the patients understand the proper use of the prescribed antibiotics is essential, and this can be done through counseling patients on taking the prescribed antibiotic as directed and educating them on the necessity to complete the entire course. Lastly, patients should also be counselled on the proper disposal of unused antibiotics as most prescriptions are dispensed by the unit box, thus some patients prescribed with shorter antibiotic courses would be left with extra antibiotics. Proper disposal of antibiotics should be strongly encouraged as studies have shown that inappropriately discarded antibiotics can accumulate in the soil and water supplies.4
1. World Health Organization. Antimicrobial resistance: global report on surveillance 2014. Geneva: World Health Organization; 2014.
2. Aslam B, Wang W, Arshad M et al. Antibiotic resistance: a rundown of a global crisis. Infect Drug Resist. 2018;Volume 11:1645-1658. doi:10.2147/idr.s173867
3. Ab Rahman N, Teng C, Sivasampu S. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia. BMC Infect Dis. 2016;16(1). doi:10.1186/s12879-016-1530-2
4. Larsson D. Antibiotics in the environment. Ups J Med Sci. 2014;119(2):108-112. doi:10.3109/03009734.2014.896438
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