The enemy behind the friend

Antibiotic misuse can cause greater harm than good. They should be taken only with medical guidance
By Dr. Ruvini Abeygunaratne Karunaratne

Although a Neurosurgeon, whenever I visit Sri Lanka my services are called upon by relatives and friends for all manner of ailments from coughs and colds to lumps and bumps and general aches and pains. I have to explain that I am not the best person for this and ask my father to see them instead - he is a family doctor and better equipped to treat such issues.

I do notice though, that by the time they ask for advice most have already started or considered taking a course of antibiotics. These may be left over from a previous illness or even be someone else’s leftover medication! This is dangerous and the fact that till recently you could obtain over-the-counter medication without prescriptions from pharmacies in Sri Lanka compounded this problem. Taking antibiotics without medical guidance can cause significant harm. Their use needs to be controlled and carefully monitored to prevent future problems.

I find this is not a problem faced just in Sri Lanka but also in the UK, but as the availability of drugs is controlled and can only be obtained by prescription the onus lies with the doctor in the UK. Especially when faced with an ill child who has caught another cold, sore throat, or virus, the tired parents would expect a kindly doctor to prescribe some antibiotics that would make their child feel better quicker. This would enable the parents to get some sleep and would be the easy option for the doctor. Many parents do expect this and can be very surprised and angry if they have to leave without a prescription. But this may be the wrong thing to do, and can cause more harm than good. Whether an adult or a child, antibiotics should be used with caution.

How do they work?

When first used in the 1940s, antibiotics were considered a miracle cure. This can still be true if they are used in the appropriate manner. But overuse throughout the years has resulted in the development of bacteria which are becoming more and more unresponsive to them.

There are two major types of germs that make people ill. These are bacteria and viruses. People who have an infection caused by these may have similar symptoms but the way they attack a person’s immune system is different.

Bacteria are alive- they are everywhere and most don’t cause any harm. Some are good, some bad. The good ones can help digest food for instance. The bad ones invade the body and stop the body from carrying out its normal processes. Antibiotics are effective in these as they act on stopping the reproduction and growth of the bacteria.

Viruses are particles - they are not alive. They can only reproduce after they have invaded a body. These cannot be treated with antibiotics. For instance a common cold is caused by a virus, so antibiotics will not help.

So why is antibiotic overuse dangerous?

If you take an antibiotic for an infection caused by a virus it will not kill the virus but may destroy the good bacteria working in your favour. There is also the risk that new forms of bacteria will form as a response to counteract the antibiotics. So if you have a very bad infection in the future which can be treated by antibiotics they may not be effective.

You may require the antibiotics for a serious illness and if they are not effective it may lead to serious heath issues. An example of a new bacteria which is becoming increasingly prevalent due to antibiotic overuse is MRSA (methelin resistant staph aureus). If such an infection develops, it is extremely hard to treat and can even lead to death.

So, the next time you reach for a few antibiotics left over from a previous illness, think twice before taking them as you are enabling the bacteria to take over the world (or your body). This may not leave you with any treatment options if you develop a life-threatening infection in the future.

(The writer is a Consultant Neurosurgeon in the UK)

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