Mon | Nov 20, 2017

Michael Abrahams | The global problem of antibiotic resistance

Published:Monday | November 13, 2017 | 12:55 AM

World Antibiotic Awareness Week is observed annually during the month of November. In 2017 it will be observed during the week of November 13-19, with this year's theme being 'Seek advice from a qualified healthcare professional before taking antibiotics'.  

One of the most important developments in modern medicine has been the discovery and use of antibiotics, drugs used to treat and prevent bacterial infections, by either killing bacteria or inhibiting their growth.The discovery of penicillin, for example, is considered by many to be the most important discovery of the twentieth century, and while it is impossible to quantify how many people have escaped death because of the drug, it has been estimated to have saved at least 200 million lives.  

Unfortunately, the effectiveness of antibiotics, and easy access to them, have also led to development of resistance, which is the ability of the microbes to resist the effects of drugs. When bacteria become resistant, they are not killed, their growth is not stopped, and they continue to multiply and flourish, resulting in severe or chronic infections which may become life-threatening or even fatal.

Antibiotic resistance has now become a very serious global health concern. According to the World Health Organization (WHO), "antibiotic resistance is one of the biggest threats to global health, food security, and development today”. Although antibiotic resistance occurs naturally, the process has been accelerated by the misuse of antibiotics in humans and animals. As a result of this, a growing number of bacterial infections are becoming harder to treat.

For example, antibiotic-resistant gonorrhoea has now become nothing short of a major health crisis. Data from 77 countries show that antibiotic resistance is making the common sexually-transmitted infection much harder, and in some cases, impossible to treat. It is estimated that 78 million people are infected annually, but it has also been observed that the bacteria that causes the infection keeps developing resistance to previously effective drugs. In the not too distant past, gonorrhoea was sensitive to penicillin. Today, penicillin is of no use in treating the infection, and now two drugs, ceftrioxone and azithromycin, are recommended, with the former administered as an intramuscular injection, and the latter taken orally. However, Japan, France and Spain have documented cases of gonorrhoea that are resistant, not only to these, but to all other known antibiotics.

Misuse of antibiotics is way too common, and the populace needs to be educated about the proper use of these drugs. Firstly, antibiotics should only be prescribed by qualified health professionals. Different antibiotics are used for different infections, in varying doses, via different routes of administration, and for varying durations, and non-medical personnel may not be in a position to diagnose medical conditions accurately and hence treat them properly. For example, the antibiotics used to treat uncomplicated bladder infections are different from those used to treat bacterial vaginosis, a common vaginal infection, and complicated bladder infections require longer courses than uncomplicated ones. Also, it is best to obtain a urine culture when treating a bladder infection, because these infections are caused by a wide variety of bacteria. When a urine culture is performed, it will indicate not only which bacteria is responsible for the infection, but will also determine which antibiotics will be effective. 

With a few exceptions, antibiotics are for treating bacterial infections. They are ineffective for treating infections caused by viruses. They simply will not work for them. So, attempting to treat the common cold, influenza or herpes, all viral infections, with antibiotics, is a waste of time. Treating some non-bacterial infections with antibiotics can actually make them worse. A notorious example of this is yeast infections. These vaginal infections are caused by a category of micro-organisms known as fungi. These germs often exist in the vagina with bacteria, including so-called “good bacteria”, as not all bacteria are harmful. If a woman takes antibiotics in an effort to treat a yeast infection, the antibiotics may kill many of the bacteria in the vagina, but spare the yeast, allowing the latter to spread, worsening her symptoms.

In order for antibiotics to be effective, the full prescribed courses must be taken. Failure to do so only partially treats infections and encourages the development of resistance. They should also never be shared. If you share an antibiotic, it means that you have not taken the prescribed course, and neither will the person you share the drug with. Also, you may be giving the person the wrong drug, or a drug that they may be allergic to, and allergic reactions to drugs can be severe, or even fatal.

Another reason not to self-diagnose and treat, is that antibiotics are sometimes taken for conditions where no type of infection, bacterial or otherwise, exists. For example, what many people refer to as “sinus problems”, is often allergic rhinitis, a condition which, when uncomplicated, is responsive to a category of drugs known as antihistamines, and not to antibiotics.

Antibiotics can be life-saving when used appropriately, but their misuse can result in dire consequences. If antibiotics are prescribed for you, please ensure that you ask your doctor if they are necessary, and if they are, follow the instructions given to you. 

- Michael Abrahams is a gynaecologist and obstetrician, comedian and poet. Email feedback to and, or tweet @mikeyabrahams