A health problem for the future? Singapore's pharmaceutical company has issued an antibiotic resistance alert

SINGAPORE: Dr. Lye Tong Fong, general practitioner with 20 years of experience, has met all types of patients. Among these are those that require antibiotics even when they are neither necessary nor effective.

Sometimes they have "very minor symptoms," like a fever or a slight runny nose, Dr. Lye told Channel NewsAsia in his Pasir Ris clinic.

"When they arrive, the first thing they say is" Doctor, I need antibiotics ". You have no reason to explain and use logic with them, "he said.

If they ask, he can administer the antibiotics to the patients.

"But I will tell them the situation in which they should start on the course. I think it's the best you can do after you fight with them and have a tragedy at the clinic, "he said.

For example, if the illness persists for more than a week with fever and discharge containing mucus and pus, they may need to start taking antibiotics, he said.

There are many symptoms, such as sore throat, cough or runny nose, which are often caused by viruses and therefore can not be treated with antibiotics. The drugs only work on diseases caused by bacteria.

But most often, Dr. Lye tells patients when they do not need antibiotics and they are convinced. This has become more important than ever, with the World Health Organization (WHO) reporting antibiotic resistance, which is caused by excessive and misuse of drugs.

The bacteria that people carry develops antibiotic resistance when they are repeatedly exposed to it. Finally, people become immune to these antibiotics and may not respond to them.

Nevertheless, a 2016 study conducted by the National University of Singapore revealed that four out of five patients with upper respiratory tract infections, causing symptoms such as a runny nose and sore throats. throat, do not know that antibiotics can not help relieve their condition. Many expected their doctors to include antibiotics in their treatments.

RESISTANCE TO ANTIBIOTICS INCREASING HAZARDOUSLY HIGH LEVELS

The WHO said earlier this year that antibiotic resistance "is reaching dangerously high levels in all parts of the world" and is today one of the biggest threats to health, health and safety. food security and development in the world.

"Without urgent action, we are moving toward a post-antibiotic era, in which common infections and minor injuries can again kill," warned the World Health Authority.

Closer to home, the Singapore Pharmaceutical Company has issued the same warning.

S addressing Channel NewsAsia, members of the company, Dr. Andrea Kwa, Clinical Investigator and Pharmacist Specialist (Infectious Diseases) at the Singapore General Hospital, and Dr. Jonathan Seah, Senior Pharmacist in charge of Changi General Hospital clinic, painted a dark picture of the future. Should not the situation change?

"The aggressive treatments we use can no longer be used because they will weaken your immune system. No matter what infections you are exposed to, you can kill yourself, "said Dr. Seah.

Having resistant bacteria means that health professionals will need to use more potent antibiotics, broader spectrum antibiotics, a combination of antibiotics or more toxic versions for their proper functioning, warned Dr. Seah.

CAN NEW ANTIBIOTICS BE DEVELOPED?

The urgency of the problem comes against the backdrop of slowing the production of antibiotics by pharmaceutical companies and bacteria becoming resistant to many types of drugs.

In July of this year, Novartis, one of the world's largest drug manufacturers, announced the end of its research on antibacterials and antivirals, joining other pharmaceutical companies such as AstraZeneca, Sanofi and Allergan. Another giant in the industry, GlaxoSmithKline, has indicted certain active antibiotics.

"In terms of income, it's harder to make money with antibiotics. On the commercial side, it's hard for them to justify (making antibiotics), "said Dr. Seah.

Given that it takes 15 years to design a new compound, review all stages of research and clinical trials, and then register it, it is possible that at the end of the drug, it is ineffective. , he added.

Dr. Kwa also said that the reality is that the production of drugs for chronic and long-term diseases is more cost-effective for these pharmaceutical companies because the use of antibiotics is limited to a few days each time .

She added that new antibiotics are being produced, but that they will not be able to cover all the resistant insects.

"They are all a little better or a little different from what we have. And even if you have a very good antibiotic, once you come aboard, you use it, you use it badly, resistance will occur, "she said.

DIAGNOSTIC KITS, EDUCATIONAL PART OF SOLUTIONS

Pharmacists have suggested that general practitioners use diagnostic kits that exclude bacterial infections, so antibiotics are not unnecessarily prescribed. Although they cost about 10 Singapore dollars each, investing in these kits is "better than paying the cost of taking antibiotics," said Dr. Kwa.

It is also necessary to change the mindset of the public because the expectation that he would need antibiotics could influence GPs, Dr. Kwa said.

The Health Promotion Council, which launched in October 2018 a public education campaign entitled Use Antibiotics Right, said that it was necessary to educate people about the proper use of the antibiotics, which should not be considered as miracle cures.

"The campaign serves to remind the public that antibiotics do not help upper respiratory tract infections, which can be exposed during the flu season, and to consider the advice of their doctor before taking antibiotics", said a spokesman.

In response to Channel NewsAsia's questions, the Ministry of Health said that educating doctors and patients was important to educate the public and combat antimicrobial resistance, particularly to prevent unnecessary uses.

DO IT ALLOW TO DISTRIBUTE ANTIBIOTICS FROM THE PRESCRIPTION OF HELP?

Another factor to consider is that some general practitioners may prescribe antibiotics for financial reasons, said Dr. Kwa. She suggested that the desire to keep patients happy so that they keep coming back can influence some generalists.

Dr. Lye acknowledged that some doctors prescribe antibiotics "frantically" because of commercial concerns, but this is not widespread, he said.

The Pharmaceutical Company believes that if doctors prescribe antibiotics without dispensing them, the situation could improve. In fact, patients should go to another place to follow their treatment rather than pick it up at their clinic pharmacy.

This dissociation of prescription and dispensing processes already exists in countries such as the United States, South Korea and Australia.

Dr. Lye, however, stated that dissociation did not result in the loss of multidrug-resistant bacteria.

"In fact, they have more multidrug-resistant bacteria. So this practice does not guarantee a better prescription of antibiotics, "he said.

In fact, the profits will go from doctors to pharmacies, he replied.

"The only thing that untying will do is to cause the patient an inconvenience," he said.

The Ministry of Health also said that dissociating the prescription from the prescription would not necessarily reduce the use of antimicrobials such as antibiotics.

While antibiotics can only be prescribed by qualified and licensed doctors and are not available for sale, the Ministry of Health "will continue to work with stakeholders to strengthen antimicrobial resistance surveillance and management of antimicrobials. their use, "said a spokesman.

HAND HYGIENE, IMPORTANT VACCINATIONS

While suggesting solutions to improve the situation, pharmacists stressed that prevention is better than cure. To this end, Dr. Seah urged the public to maintain hand hygiene by washing their hands, using masks when needed and avoiding public areas in case of discomfort to prevent the spread of diseases such as colds and coughs.

They also encouraged more people to get vaccinated. Primary care providers can also play a more proactive role in promoting immunizations, said Dr. Kwa.

Common vaccines are those that prevent pneumonia and influenza, pharmacists said.

Nevertheless, it is necessary to combat the overuse and misuse of antibiotics. Dr. Kwa pointed out the possible disastrous consequences. There are "a lot of costs if you take an antibiotic inappropriately," she said.

"This cost may not be obvious to you now, but it will come back to haunt you one day. Humans are very myopic. When it does not haunt you right now, it comes out of the mind, "she said.