Irrational Antibiotic Use: How We Use antibiotics Poorly


Antibiotic resistance happens when microorganisms such as bacteria change when they are exposed to antibiotic drugs such as penicillin. Infections with resistant bacteria were first reported over 60 years ago, but early on the problem was often overlooked, because if one antibiotic did not treat the infection another was usually available. Since then, infections with resistant bacteria have become more common in healthcare and community settings, and many bacteria have become resistant to more than one type or class of antibiotics. Consequently, doctors, today are faced with treating infections where antibiotic options are very limited, and in some cases, where no effective antibiotics exist.
The use of antibiotics is the single most important factor leading to antibiotic resistance around the world. Antibiotics are also commonly used indiscriminately sometimes in food animals to prevent, control, and treat disease, and to promote the growth of food-producing animals. The use of antibiotics for promoting growth is not necessary, and the practice should be phased out

The Gravity of the Problem

Antibiotic resistance is a cause for serious health concern locally and worldwide. The World Health Organization (WHO) has reported increasing levels of antimicrobial resistance, which are intimidating the control of infectious diseases.
Each year, at least 2 million people acquire serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections (CDC 2013) At least 23,000 people die each year as a direct result of these antibiotic-resistant infections. Many more die from other conditions that were complicated by an antibiotic-resistant infection (CDC 2016)
To point out the weight of Antibiotics resistance, In 2011, the World Health Day theme was “Combat drug resistance: no action today means no cure tomorrow” and for this occasion, the World Health Organization introduced a six-point policy package to fight against the spread of Antimicrobial resistance. This reflects the importance of the problem and the need to undertake some serious actions in all population groups, involved in the growth of antimicrobial resistance and irrational antibiotic use.

What is Irrational Antibiotic Use?

Irrational antibiotic use reflects not only patients’ failure to comply with the physician’s instructions on how to use antibiotics adequately but is also associated with inappropriate antibiotic prescribing. Rational antibiotic therapy should be based on the correct indication, the right drug and dosage, the drug of the first choice, the appropriate period of use, and the lowest treatment costs WHO (2015).
This irrational use ascends from the economic factors, health policies concerning medical coverage, lack of physicians’ concerns about long term resistance and consequence against treating current symptoms, pharmaceutical marketing and the sale of antibiotics without prescription in some countries.
There are various factors which may influence an increase in irrational antibiotic use. Many studies have reported that the antibiotic regime nonadherence and inappropriate antibiotic use are strongly associated with public awareness and knowledge of antibiotics.
Another important issue related to the increase in antibiotic resistance is self-medication which is defined by WHO as ‘‘the use of drugs to treat self-diagnosed disorders or symptoms without prescription, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms or sharing medicines with relatives or members of one’s social circle or using leftover medicines stored at home’’
Self-medication with antibiotics constitute a major form of irrational use of medicine and can cause significant adverse effects such as resistance to microorganisms, treatment failures, drug toxicity, increase in treatment cost, prolonged hospitalization periods and increase in morbidity

In the majority of economically deprived countries, nearly 60-80% of health-related problems are treated through self-medicated as a lower-cost alternative.

Double-Edged Sword?

When infections can no longer be treated by first-line antibiotics, more expensive medicines must be used. A longer duration of illness and treatment, often in hospitals, increases health care costs as well as the economic burden on families and societies.
Antibiotic resistance is putting the achievements of modern medicine at risk. Organ transplantations, chemotherapy and surgeries such as caesarean sections become much more dangerous without effective antibiotics for the prevention and treatment of infections.
The ongoing explosion of antibiotic-resistant infections continues to plague global health care. In the meantime, an equally alarming decline has occurred in the research and development of new antibiotics to deal with the threat.


Resistant microbes would have emerged even if antibiotics drugs were always used for the proper indication and at the proper dose and duration. However, the selective pressure would not have been as great, the pace of development of resistance would have been slower, and the extent of the problem in terms of the number of people involved would have been less.

The world immediately needs to change the way it prescribes and uses antibiotics. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. Behaviour changes must also include actions to reduce the spread of infections through vaccination, hand washing, practising safer sex, and good food hygiene.

Edited by John Afam-Osemene MBBS

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