Antibiotic abuse in an internet-fed world!

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In a recent Italian study published in the International Journal of Medical Informatics, among 913 respondents, 73.4% used Internet to search for information about antibiotic use and 32.3% respondent’s self-medicated based on internet derived information.

The internet and social media are powerful sources of communication that can be used and dangerously misused too! It is also a tendency for most people to share their views, derive their own understanding, proclaim & discuss subjects like the use of antibiotics and antibiotic resistance on social media platforms.

It is saddening to know that there is no real educated watchdog that keeps a watch on the information or the misinformation available on easily accessible and simple to use internet;which now is the primary source of information across all age groups.

For example, presence of a disease outbreak which may not require any distinctive medical treatment, could lead to mass hysteria amongst emotionally charged people via the internet, leading to abuse of antibiotics.

This leads to an antibiotic resistance which simply means that the infection can easily persist despite administering antibiotics to fight it off.

Also read: FSSAI caps permissible limit of antibiotic use in meat

In a study done by Groshek and other investigators inCogentMedicine 2018, the misuse of antibiotics was related to high levels of misinformation about antimicrobial resistance on the internet. Antibiotic consumption that stems from this misinformation leads to the development of difficult to treat bugs called the “superbugs”.

Another problem being faced by physicians is when patients and concerned relatives search internet for side-effects of the prescribed medications. Doctors prescribes medications weighing the benefits versus the risks; however overplaying the side effects seen in some websites, may incite fear amongst the patients and lead to early discontinuation of the medication leading to resistance and bad outcomes.

However, Anderson in a U.K study published in a journal in 2018 showed that the public who used the internet to garner health related information, were those with a higher level of education and were better informed on use and misuse of antibiotics.

Because of the entire internet overfeeding, people tend to use antibiotics for diseases that do not require at all.

Common cold doesn’t require antibiotics

The commonest example is that of a common cold. Most of the time, common cold is caused due to viral infection which is self-limiting and does not need antibiotics. However, most of the time, antibiotics are recommended to cold patients. Even small children have to engulf antibiotics.

Another example is of old people with indwelling urinary catheters being looked after at home. Unnecessary tests for Urinary Tract Infection (UTI) is done which shows “asymptmaticbacteruria”i.e. presence of bacteria without infection signs. Such patients don’t need antibiotics, but unfortunately such patients are subjected to high end antibiotics.

It is sad to know that antibiotic resistance now has no sex or age criteria; young children and elderly alike are coming with alarming rate of Community Acquired Infections with antibiotic resistance due to inappropriate use of antibiotics.

Those patients who unscrupulously take antibiotics when it is not necessary, or take antibiotics for a lesser duration than prescribed, or any other form of misuse are a nightmare for the doctor treating them. These patients then need hospitalization, sometimes in the ICU for treatment with intravenous (IV) broad spectrum antibiotics, turning out to be difficult to treat infections with increased average length of stay, which has a huge cost implication on the patient and their families.

For example the last week a young 16-year-old girl was admitted to the hospital for a Urinary Tract Infection (UTI). This patient had premeditated herself with antibiotics six days before hospitalization.

She had been taking medicines continuously for two days without a doctor examining or prescribing medication. She had history of doing so which at times gave her good results.

But this time she got fever returned on day-5 along with bouts of vomiting. When an ultrasound (USG) was done, she was noticed to have features of ascending Pyelonephritis or a higher Urinary Tract Infection.

A subsequent urine culture revealed difficult to treat organisms in view of resistance to most usual antibiotics, needing broad spectrum expensive antibiotics, for a prolonged period of time.

This was estimated to have occurred because of repeated use of antibiotics when it was not needed. The patient eventually recovered; however, she was markedly weaker, lost weight, missed her exams and burnt a huge hole in her pocket.

(Disclaimer: Writer is Dr Sanjith Saseedharan, Head of Intensive Care Unit, SL Raheja Hospital. Views expressed are a personal opinion.)

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