3 February 2022
Professor Mendelson, who works at Groote Schuur, explains what we all can do to lower our risk of ending up in hospital with an antibiotic resistant infection. Photo: Wikimedia user A3alb (CC BY-SA 3.0)
You need to try to avoid getting an antibiotic-resistant infection for two reasons. You don’t want to end up in hospital with a difficult-to-treat potentially fatal disease and you don’t want to spread such an infection and put other people in hospital.
Here’s how to reduce your risk of getting an infection against which antibiotics don’t work.
Prevention is better than cure: If you can avoid the need for an antibiotic in the first place, whether given to you rightly or wrongly, then you’re halfway there.
Vaccination reduces antibiotic exposure for two reasons. First, some vaccines are directed specifically against bacteria. For instance, pneumococcal vaccination protects you against the commonest type of pneumonia, preventing the need for an antibiotic.
Second, and perhaps paradoxically since antibiotics do not treat viruses, vaccines directed against viral infections like Covid also reduce your likelihood of being given an antibiotic. This is because you are less likely to come to your doctor with symptoms which may be confused for a bacterial infection such as fever, cough, diarrhoea for which the doctor may give you an antibiotic “just in case”.
Vaccination against another common respiratory virus, influenza, has been shown to reduce antibiotic prescription.
Non-bloody diarrhoea too is a leading cause of antibiotic misuse. Childhood vaccination against rotavirus dramatically reduces visits to a doctor with diarrhoea, and reduces a child’s chance of dying from rotavirus diarrhoea by one third.
Most of our vaccines form part of the programme of immunisation that all South African children should receive. But in 2019, just over 80% of children received pneumococcal vaccination and 80% received rotavirus vaccination, so there is a gap in coverage, which has a knock-on effect on antibiotic use.
As explained in the second article in this series, antibiotic-resistant bacteria can be transmitted by touch and during food preparation.
The most common setting for this is hospitals and clinics. The simplest way to reduce transmission in these settings is to wash hands with sanitiser containing a minimum of 70% alcohol or with soap and water. There is no extra benefit from expensive ‘antibacterial soaps’. Just plain regular soap will do.
Many dedicated health workers perform hand hygiene meticulously, but there are far too many who don’t. When we watch health workers on hospital wards, it is not unusual to find less than half are compliant with basic hand hygiene. Interestingly, during Covid, hand hygiene compliance improved dramatically.
So what can you do? Educating yourself is the first step (reading this series of articles is a good start). Next is to realise that doctors, nurses, and other health workers are fallible and could do with a gentle reminder. Patients often feel that if they speak up, they will be singled out as ‘difficult’ and get inferior care. That’s really not the case. In fact, it shows a real sense of health literacy and health workers welcome that.
So, get involved with your own health care more. If people come to touch you in a health setting, ask them to perform hand hygiene first, whoever they are. Sadly, it’s often the most senior health workers who are the worst culprits. You have a voice. It’s okay to use it!
Outside health settings, continue the good practice of hand hygiene that you’ve learned over the past two years. It’s going to benefit your health by preventing infections in general, whether bacterial, viral or others.
Good food preparation practices are also important. Antibiotic misuse in food production means that antibiotic resistant bacteria originating in animals or crops can be transferred from farm-to-fork.
If possible, look out for food items where animals have been reared in an antibiotic-free environment. The problem is that antibiotic-free produce is often more expensive. But the more pressure we put on stores, the more impact we are likely to have. Some large outlets such as MacDonalds have come onboard by insisting on beef reared without antibiotics. You, the consumer, have a voice. Again, you need to use it.
Two things we should all remember: the more antibiotics we use, the more resistance develops; and antibiotics only treat bacterial infections.
Yet 50% of all antibiotics we receive are not given to us because we have a bacterial infection. They are given to us for viral infections, or any manner of non-specific symptom that might take us to the doctor – a sore throat, a cough, runny nose, headache, joint and muscle aches, and so on.
It might seem as if they work in these cases, but that is often just a coincidence. Consider the timeline of a common mild illness such as a cold. If you get a sore throat, runny nose or feel ‘fluey’, do you go to your doctor immediately? No. Most people go to see their doctor on day three or four.
On that day you may be given an antibiotic and you may start to feel better the next day. But it’s not the antibiotic which did the trick: it’s the natural trajectory of the viral infection, which is independent of whatever antibiotic or drug you take. Symptoms most commonly peak around day three or four, just when you are seeing the doctor, so you would have got better anyway.
In the same way, symptoms of inflammation, like muscle and joint pains, will respond to anti-inflammatories that the doctor probably gave you with an antibiotic. Most times, antibiotics play no role.
Next time you have a cold, ‘flu’, non-bloody diarrhoea, aches, pains or other mild symptoms, don’t go to your doctor immediately. Try treating the symptoms with paracetamol, decongestants, good hydration. This is especially relevant to coughs and colds. If you take an antibiotic for these you are only doing yourself harm.
You may well be baffled as to why any doctor or nurse would give you an antibiotic unnecessarily. The reasons are explained in the third article in this series, and range from poor education to wanting to please the patient.
Remember that many prescriptions are appropriate (if 50% of antibiotics are unnecessary, then 50% will be necessary). Doctors and nurses should be respected, as you would hope to be yourself, but they are not ‘gods’, unapproachable and all-knowing. It’s okay to ask your doctor or nurse whether you really need an antibiotic.
In countries such as the UK, ‘delayed prescriptions’ may be employed to reduce antibiotic use. The doctor gives you a prescription, but you don’t go immediately to get the antibiotic. If your symptoms improve, then you’ve been spared the antibiotic. If they don’t (over an agreed time frame depending on your illness), then you take the antibiotic. That is another perfectly acceptable strategy.
Why aren’t there any easy tests to help your doctor decide if it’s a bacterial or viral infection? While most viral infections are pretty obvious if a good history and examination are taken by the doctor, some are not, and without any test, your doctor will err on the side of caution ‘just in case’.
There are some simple tests that can tip the balance and can be available in the doctor’s surgery. The problem is, who’s going to pay for them? Most medical aids will not pay for ‘point-of-care’ tests — those which are not performed in a laboratory — so the patient has to pay. If we put pressure on medical aids to change their stance, we may be able to reduce antibiotic prescription. Again, your voice counts.
You can help reduce antibiotic-resistant bacterial infections by disposing of your leftover antibiotics safely. Take them to your local pharmacist who has methods for safe disposal. If you chuck the antibiotics down the toilet, they will enter the sewerage system and contribute to increasing antibiotic resistance in environmental bacteria. And so the cycle will continue.
Your voice matters as does your understanding. It’s time to start using both.