Dubai It is against the law in the UAE and the Gulf States to sell antibiotics over the counter (OTC) without a doctor’s prescription.
But a pharmacist says the Ministry of Health directive is mostly ignored and the strong antibacterials or antimicrobials can easily be bought OTC. He believes pharmacies make huge profits selling these drugs without a prescription.
Ultimately, ease of access may be subjecting children and adults to serious physical harm depending on the dosage consumed and the length of consumption.
“A simple drug sells for Dh20. An antibiotic pushes up the bill to Dh 100,” says Navaz Valiyakath, store manager at Boots Pharmacy. “It’s all about high margins.”
Boots strictly follows the ministry advice but the problem is that customers know they can easily get the antibiotics elsewhere, he says.
“Many Asian and Arab customers come asking for antibiotics for a cold or the flu,” he says. “People from the UK and Europe understand why antibiotics are a prescription medicine and even refuse them when a pharmacist suggests it,” he says. Valiyakath points out that most people are unaware of the dangers of antibiotic misuse.
“Teenagers with severe breakout of acne continue to use antibiotic creams beyond the recommended course time by the doctor,” he says. “If it is a 10-day prescription, they come and ask for a refill of the prescription and use the antibiotic for three months. It could damage the liver,” he says.
Besides the ignorance about antibiotic use, some parents pressure the doctor to prescribe the drugs as they feel their children are missing school due to their illness.
“The popular concept (among parents) is to give an antibiotic to any symptom that is not responding to a medication fast,” says Dr Mandar V. Bichu, specialist paediatrician.
Most people are unaware that an antibiotic is useless against viral infection such as a cold and a flu. The viral infections take their own course and the child will be fine in a few days, says the doctor.
An antibiotic is basically a drug that is administered to fight off a bacterial infection, such as a painful ear infection or an infection of the urinary tract.
There are various groups of antibiotics such as penicillins, tetracyclines, cephalosporins, aminoglycosides and fluoroquinolones.
Each of these is effective only against a certain type of bacteria and is prescribed by the doctor for a certain type of infection.
But many patients also tend to take antibiotics that have been left over from an earlier prescription. These are most often taken by people who do not wish to go to the doctor again for a prescription, one pharmacist says.
Dr Bichu says there are special protocols or guidelines to follow when prescribing an antibiotic. But even when a doctor does not prescribe an antibiotic, the impatient and worried parent goes to the pharmacy and gets the drug OTC.
The problem does not end there.
Even when an antibiotic is prescribed for a bacterial infection, the parents do not follow the doctor’s orders and discontinue the drug once the child shows some improvement.
What happens when an antibiotic is taken for a viral infection and what happens when an improper dosage is taken?
Dr G.Y. Naroo at the Rashid Hospital’s Trauma Centre and a specialist in Emergency Medicine, explains: “A certain dosage (250mg) of antibiotic is prescribed for a certain period of time (say, five days),” he says.
When an antibiotic is taken for a viral infection, it is ineffective against that virus but kills off the good bacteria in the body. When this occurs over a period of time, the body becomes resistant to the drug and the harmful bacteria engulf the system.
“We are seeing resistance from about 35 percent of the patients to a simple antibiotic such as amoxicillin,” he says.
Amoxicillin is generally administered for infections of the ear, nose and throat, the urinary tract and the skin.
When an antibiotic is misused or improperly administrated, it loses its efficacy and is no longer effective against killing the many bacteria that cause infection. The bacteria then also mutate into new forms that no longer respond to the drug.
Several ‘super-bug’ highly resistant bacteria strains have evolved over the years such as staphylococcus aureus that is methicillin-resistant and enterococci, that is vancomycin-resistant. According to scientists, a new strain of Clostridium Difficile has been found that causes serious problems in the intestine in people taking antibiotics for other infections. It is very difficult to treat.
Children at risk
“When you push the doctor to prescribe an antibiotic for a viral infection for a child, you are actually harming the child,” says Dr Sameem Matto, specialist internal medicine and diabetologist at the Canadian Specialist Hospital in Dubai.
He says he is now getting a number of patients with urinary infections who are resistant to antibiotic treatment.
“When that happens we have to resort to ‘high-end’ antibiotics that are much stronger,” says the doctor.
The stronger dose antibiotics are then delivered directly into the bloodstream with an IV (intra-venous) drip. The stronger dosage requires hospitalisation and also pushes up the treatment costs. The number of patients who require such antibiotics has gone up sharply, according to a doctor.
Health Authority Abu Dhabi (HAAD) is worried that antibiotics and painkillers are the most prescribed medicines by physicians and has set up programmes to educate the medical professionals and community members on its proper use.
Antibiotic and painkillers sales are shooting up and in one year alone people had spent Dh 200 million on these drugs, a senior physician with the authority had warned. According to an audit it was found that 73 percent of prescriptions at Abu Dhabi Hospitals during a particular year were for antibiotics.
The authority believes that with proper use of antibiotics its can reduce hospital admissions.
Antibiotic resistant bacteria is not only a problem here in the UAE but is a matter of concern globally. The European Centre for Disease Prevention and Control has warned that antibiotic resistance is now a serious threat. It estimates that in the EU (European Union) 25,000 people die every year from antibiotic resistant infections.
It notes that the consumption of Carbapenems, an antibiotic of last resort for many bacterial infections, had increased sharply.
To add to the problem of antibiotic misuse is the lack of interest by the pharmaceutical companies to manufacture new antibiotics.
“Drug manufacturers are more focused on drugs for lifestyle diseases,” says Dr Lalit Uchil, Specialist Physician at Mediclinic Al Sufouh. He told Gulf News earlier that lifestyle drugs are more profitable to the companies.
“Not a single new antibiotic has hit the market for close to 20 years. It costs over Dh2 billion from research and human trials for any new product, before it comes into the market,” he says.
It is feared that the era of antibiotics has now come to an end.
This alarming statement was made by a high-ranking official with the Centers for Disease Control and Prevention, recently.
Dr Arjun Srinivasan said over-medication of both humans and livestock have gone up so much that bacteria are resistant to antibiotics.
“We are in the post-antibiotic era,” the doctor is quoted as saying. He said that there are patients for whom there is no cure. “We are literally in a position of having a patient in a bed who has an infection, something that even five years ago we could have treated, but now we cannot,” he says.
