The controversy over Antibiotics prescription

The misuse of antibiotic happens knowingly or unknowingly by the people. In some cases, even the health staff are known to give antibiotics under the pressure from the patients, for even the common cold.

Medical Superintendent of JDWNRH, Dr Gosar Pemba, said antibiotics are used to prevent mainly bacterial infection and to stop the infection from further spreading in the body. Prophylaxis antibiotic are used before a patient undergoes an operation.

Dr Gosar said the antibiotics are misused in a way that even for a minor ailment, people want antibiotics. “Not knowing whether it (ailment) is caused by virus or bacteria and as virus cannot be killed by antibiotics. It should be used rationally,” Dr Gosar added. It will take time to cure whatever infection a person has.

In other countries, most of the doctors prescribe the higher generation antibiotics. In Bhutan, less is prescribed, and no one can give antibiotics without the doctor’s prescription.

Program officer from Ministry of Health (MoH) said if there is no bacteria causing the infection and the person is still taking antibiotics, firstly that kills the normal bacteria which is already in our body which is not harmful, and secondly, when the person is actually sick and takes antibiotics, those antibiotics will not work because the bacteria has already become resistant.

“In our body, we have micro-organism which are not harmful and when we are attacked by the harmful bacteria, which is known as pathogens, that is how we get infections. So antibiotics are given to kill those harmful bacteria and not the normal micro-organism which is already present in our body,” said the program officer.

However, there were few incidence of appendectomy or the surgical removal of the appendix, where patients have complained of infection because of the antibiotics they took.

There are also other post surgery instances where patients claim the lack of good antibiotics led to infections- a fact validated by hospitals and doctors abroad.

Dr Gosar clarified that the infection was not caused because of the antibiotics that patient took. He said especially with the case of appendicitis, when the appendix has already burst, the chance of infection is much higher than in other normal surgery because there is already an infection in the appendix where the pus is formed. Even though the infected area is cleaned with normal saline and antiseptic solution, there is the chance of infection.

He said antibiotics prevent the infection from further spreading to other parts of the body and also going into the blood stream. The sepsis happens when the bacteria gets into the blood stream. So to prevent that, the antibiotics are given which would kill all the bacteria, and it will depend on how virulent the bacteria is. Antibiotics are given for 5 to 7 days or as long as 14 days looking at how big the infection is, said Dr Gosar.

He said doctors can’t prescribe just any antibiotics they like, especially the higher generation antibiotics which is the latest one. People should not go directly to the higher generation antibiotics, he cautioned.

“Doctors normally prescribe the normal antibiotic but if the patients is very serious then the doctors will discuss whether to give him or her the higher generation antibiotics or not. The higher generation antibiotics are very expensive and for simple infection, doctors are not allowed to prescribe them,” said Dr Gosar.

There are several kinds of antibiotics used for different infections, said Dr. Gosar.

According to the program officer, people must not to take antibiotics without proper medical prescription. Or without doctor’s examination. People should not to self-medicate.

As per the Medicine Act of the Kingdom of Bhutan, antibiotics are not to be sold over the counter or without a doctor’s prescription in the pharmacies. Currently, JDWNRH uses normal antibiotics and the higher generation antibiotics.