Melody Okereke

The threat of a time when antibiotics will fail to serve their roles in combating infectious diseases that were once treatable is currently the biggest fear of so many countries and Nigeria is not left out. We are gradually approaching such a time sooner than we think. It did not start recently however; the voyage towards this period started long back when we started using antibiotics inappropriately and uncontrollably.

In the contemporary Nigerian society where regulation of medicines have suffered setbacks, it is possible to get prescription-only medicines (POM) from the streets, open drug markets, patent vendors also are known as chemists and even in moving buses; this is very wrong as sometimes, these drugs are fake and adulterated. Currently, reports of infections not responding to treatment with antibiotics are stressing countries around the world and this is extremely prevalent in Nigeria as these kinds of cases are very frequent in hospitals and pharmacies.

READ ALSO: ICRC Concession: More Nigerians to lose access to healthcare

According to the National Agency for Food and Drug Administration and Control (NAFDAC), antimicrobial resistance (AMR) is regarded as the ability of pathogenic microorganisms to resist the effect of anti-microbial agents when used to treat an internal or external infection. Antimicrobial Resistance is primarily caused due to the misuse of antibiotics. When antibiotics are used for disease conditions that are not primarily supposed to involve antibiotics, the pathogenic organisms become resistant to them and will prove very stubborn if not impossible to treat when the real need for these antibiotics come.

This is a real problem in Nigeria because we tend to not finish antibiotic medications or buy only what can be afforded. In a local hospital in Nigeria, it was reported that many neonates or newborns acquire AMR from the mothers during childbirth. The child’s infection ended up not responding to treatment with the usual antibiotics. Many children have died as a result. This is not unique to the hospital; the situation at the particular hospital was just documented through scientific evidence. In my area of expertise, I have witnessed several cases where patients come into the pharmacy to purchase a certain popular antibiotic.

When asked of its intended use, you get responses like ‘I want to use it to treat my cold’, ‘I need it to treat my fever’, and ‘I need it to treat my flu’. On one of these occasions, patients claim that the antibiotics they buy help them to flush their body systems, or prevent unwanted pregnancy by flushing out the deposits of sperm. To date, these claims have not been proven scientifically to be correct. I would rather call them fallacies and/or myths. Antibiotics have been designed to kill infections; sperm is not an infection and as such cannot be terminated by popping and ingesting several pills of antibiotics.

These self-prescriptions have always been a major problem facing proper healthcare delivery in Nigeria. When people keep taking and taking these antibiotics for what they are not needed for, the pathogenic organisms in the body gradually get resistant to these antibiotics. The sad reality is that when this misuse of antibiotics becomes a lifestyle and one eventually falls sick and may require antibiotics, he/she may take it but they will become less effective against those infections that they were primarily once very effective against. I have cited these stories to give a real-life picture of how Antimicrobial Resistance can be acquired unknowingly and ignorantly.

Other causes of antimicrobial resistance have been linked to the use of fake, adulterated, and substandard antimicrobial agents which results in exposure of pathogenic microorganism to subclinical or no dosage of antimicrobial agents; use of antimicrobial agents for preventive measures and growth promotion in animal production; consumption of animal products with high residue of antimicrobial agents resulting from non-adherence to withdrawal period when treating food-producing animals; administration of medicated feeds in livestock production without professional advice and uncontrolled access to antimicrobials.

READ ALSO: Patient-Centred Care remains viable option to improve healthcare delivery —Okowa

How did we even get this far? Antimicrobials have always been a valuable community resource. They should have been used cautiously but instead, humankind overused and misused them, egged on by over-eager prescribers. Those who should be gatekeepers recommend antibiotics, antimalarials and other life-saving antimicrobials ‘just in case’ when we ought instead to make specific moves to confirm the diagnosis. Antimicrobial prescriptions –needed or not – are gratefully received but do not always translate into completed regimens. Resistance and inappropriate antimicrobial use outside of clinical medicine, in particular in agriculture, fuels the fire.

It might not be such a disaster to have lost or to be losing every one of the effective antibiotics that is affordable today if there were more in the drug development pipeline. However, very few replacement drugs are anticipated any time soon. Antimicrobial development is now an acknowledged hard problem worldwide, with very little activity occurring in Nigeria. In Nigeria and other countries where sanitation needs improvement, resistant organisms spread within and between communities with ease. And in hospitals, when infection control is lax, resistant epidemics thrive.

However, in as much as the effects of antimicrobial resistance have been evident in the current situation of healthcare in the country, there are tactical approaches that if employed by all and sundry will reduce the incidences of this life-threatening pandemic menace in the country. These approaches are very diverse depending on whether you are a non-health care provider, health care provider or the government. On the path of the non-healthcare professionals, you are strongly advised to buy antimicrobials from only registered pharmacies/veterinary outlets and insist on collecting a receipt.

It is also very important to seek professional guidance and counseling from a pharmacist or a medical practitioner before using antibiotics. In addition to that, antibiotics should not be used as feed additives except when prescribed by a veterinarian. This is because we ingest antibiotics through the meat, fish, and poultry that we eat, according to the Director-General of NAFDAC. The healthcare providers are not left out in this fight. We must stop the sale of antimicrobial prescription medicines as over-the-counter (OTC) drugs in Nigeria and increase monitoring; ensure that patients are counseled judiciously after purchasing an antibiotic so that the dosage regimen is completed as expected.

The government can also help to reduce availability and ease of access to antimicrobials from pharmacies and unauthorized sources with or without prescription e.g. from patent medicines vendors shops, hawkers and mobile public transit buses. Several top organizations have suggested and recommended that antibiotics sold in the Nigerian must bear the Mobile Authentication Scheme (MAS) hologram for tracking genuine products. This approach will counter the production, sales, and distribution of fake and adulterated antibiotics in the Nigerian Drug Market but implementation from the government and pharmaceutical companies has always been a barrier.

In conclusion, all stakeholders and the public have a role to play in resistance containment. However, we need to be on the lookout for health professionals for leadership. In antimicrobial resistance, the journey so far in Nigeria has not been encouraging. Awareness must be followed by action! Even as we ensure that we try our best to curb the menace of antimicrobial resistance in Nigeria, let’s rest assured that it can and will only get better.

vanguard