Antibiotics: A Friend Turning Enemy - EDITORIAL

ri Lanka’s private health sector has apparently suffered a major heart attack and by-pass surgery is needed. Imagery and realities apart, President Maithripala Sirisena-- deeply committed to the restoration of a patient-friendly health service – yesterday went to his home-base of Polonnaruwa to open the cardiology unit of the renovated district hospital there. 
As for the heart attack, some of the serious symptoms were exposed at a seminar held last Friday by the Sri Lanka Medical Association on the theme ‘Antibiotics: A Friend Turning Enemy’. The well-attended seminar chaired by Prof. Gita Fernando and Dr. Iyanthi Abeywickreme, was addressed by Prof. Chandanie Wanigatunga, Prof. Shalini Sri Ranganathan, Dr. Kushlani Jayatilleke and Dr. Eugene Corea among others.

Important facts were given in the opening address by Prof. Gita Fernando, Consultant Physician and Emeritus Prof. of Pharmacology, Faculty of Medical Sciences at the University of Sri Jayewardenepura. According to her, antibiotics must be used mainly for treatment of infections caused by bacteria. They act either by stopping the multiplication of bacteria or killing bacteria. Hence, an adequate dose of antibiotics should be given at appropriate intervals to achieve this purpose.
It is important to use antibiotics only if they are necessary and they should be prescribed by a doctor. They should not be used for treatment of viral infections such as the common cold or viral diarrhoeas which are self limiting and do not benefit from the use of antibiotics. Selection of antibiotics is based on how effective the drug is on a particular bacterium.

Prof. Fernando has warned that the inappropriate use of antibiotics leads to the problem of antibiotic resistance. As a result, some antibiotics may become ineffective when used for certain bacterial infections. Antibiotic resistance is a global problem. To reduce resistance, she recommends some measures: use antibiotics only when necessary; avoid self medication, use the correct dose for the appropriate duration, follow the doctor’s advice about the correct dosage regimen, do not stop antibiotics early when you feel better, do not keep any remaining antibiotics at home and such antibiotics should not be given to any other person, look at the expiry date of the antibiotic and do not use antibiotics for prevention of bacterial infection except in specific instances to be decided by your doctor.

Among the distinguished guests present was Professor Laal Jayakody, Chairman of the newly-appointed National Medicines Regulatory Authority (NMRA) which is now playing a major role in implementing Prof. Senaka Bibile’s principle for the rational use of medicines and the essential medicines concept with the objective of making quality drugs available to the people at affordable prices. 

One of the speakers exposed a major scandal. During the past few decades, about a hundred varieties or compounds of the antibiotic Amoxicillin have been registered for import and prescription in Sri Lanka. In contrast, Britain which is known to have one of the best National Health Services allows the prescription or sale of only five varieties of this antibiotic. With about hundred varieties being registered here, we see chaos and dangerous confusion, with even doctors not knowing what to prescribe for whom, while the price difference ranges from Rs. 5 to about Rs.100. We urge the NMRA to act urgently to reduce the number of antibiotics being imported. This will be a major step towards implementing the Bibile-principles and restoring a health service where the well being of patients is given top priority. 

With about 40 percent of the pharmacies knowing to be indulging in a profitable business without a qualified pharmacist being present, an appeal was made for doctors to write prescriptions in block letters because most of the time the pharmacy sales people cannot read their fowl scratches, and therefore there is a danger of the wrong drug being given. An appeal was also made for doctors to follow the regulations and prescribe drugs not only under the brand name but also to write the generic name. We hope all parties will cooperate to restore a patient-friendly health service because the reality is that the once sacred vocation of medicine or healing has now to a large extent become a big poly-pharmacy business with attendant rackets.