PENICILLIN, the world’s first antibiotic, was discovered at St Mary’s hospital in London by Dr Alexander Fleming in September 28, 1928. Initially, Penicillin was used to treat deadly bacterial infections including Staphylococcus aureus and Streptococcal infections.
Dr Fleming, the discoverer of the above antibiotic, was awarded a Nobel Prize for the discovery. In his acceptance speech, Dr Fleming, having knowledge before it happens, warned people that the overuse of penicillin might lead to bacterial resistance.
The society in which we live today is experiencing what Dr Fleming told the world at that time. The aim of this article is to advise you to refrain from haphazard use of antibiotics so as to protect yourself and your family. For almost 90 years we have used antibiotics to treat boils, ear and respiratory infections in children.
Similarly, in adults we have safely used Penicillin to treat organisms that cause syphilis and gonorrhea and many people recovered. Now because of misuse of antibiotics by doctors and farmers we are almost on the verge of getting an epidemic.
The literature is full about the increasing trend of Methicillin Resistant Staphylococcus aureus (MRSA). We have also read about resistance of other antimicrobial products including multi-drug-resistant TB (MDR-TB) and extensively drug resistant TB (XDRTB) which have become major global health threats.
The World Health Organisation estimates that 480,000 people developed MDR-TB in 2015, but only 52 per cent of patients were identified and treated appropriately.
Although the aim of giving antibiotics is to kill the sensitive organisms, in the same token we have killed other organisms which are part of the normal flora in the throat, gut, skin, and the genital urinary systems.
The normal flora is needed by the body. Recently you have heard in the media, of some patients talking about urinary tract infections, the famous UTI. A UTI is an infection of the urinary system including the kidneys, ureter, urinary bladder and the urethra.
We know UTI is more common in women than men because they have a short urethra. If you ask how they diagnosed UTI, you will hear all sorts of stories.
The standard method of diagnosing UTI is not adhered to. People do not abide to appropriate technique to diagnose any of the infections. The commonest organisms that cause UTI are Escherichia coli, Chlamydia and Mycoplasma.
To diagnose UTI, you need to get a good history from the patient. The patient is instructed to bring a urine specimen to the laboratory. The urine has to be taken in the morning. Prior to taking the urine the patient has to wash the genitalia with clean water.
Then she should obtain a mid stream urine (MSU) and get a clean catch. The patient is instructed to pass some of the urine first then catch the mid stream in an empty sterile bottle before she completely finishes urinating.
The specimen has to be sent to the laboratory within a period of two hours. At the lab the urine specimen is centrifuged and examined by direct microscopy so as to observe presence of white blood cells (WBCs). At least 10-15 WBCs per high per power field is suggestive of UTI.
Some of the small labs in the country do report information pertaining to the turbidity, specific gravity, presence of epithelial cells and the WBC count.
In order to diagnose UTI properly one needs to do a culture and sensitivity of the urine specimen. Whenever there is growth of bacterial colonies the laboratory technician does an antibiotic sensitivity test using commonly available drugs at the facility.
The lab tech puts a few antibiotic discs on an agar plate and he leaves them to grow at room temperature for 24 hours. If the organisms are sensitive there wouldn’t be any growth of bacterial colonies at the spots where he had put the discs.
If he finds the colonies have grown at the site it means the organisms are resistant to that specific antibiotic. In reporting the results the lab tech would state which colonies were identified and which ones are sensitive or resistant.
If a doctor prescribes a drug to which the organism is resistant the patient wouldn’t recover. If the drug is sensitive, the patient will be required to complete the dosage for the days she was asked to take the medicines.
If she doesn’t she will get a recurrence of the signs of UTI. Therefore it is imperative to complete the dose as instructed by your doctor. Another area where we are noticing haphazard use of antibiotics is in the diagnosis of typhoid fever.
Many labs don’t have facilities to diagnose typhoid. Ideally to diagnose typhoid fever, according to Fredrick Wright’s standard Textbook of Medicine you have to take a good history, examine the patient and do a Widal test. There are three antibodies that we look for.
These are H, O, and Vi antibodies. If the titre of the Widal test is 1/160 or more we say the patient has typhoid. Unfortunately many young doctors don’t know how to interpret the findings. Sometimes you see results of 1/20 or 1/80 and the individuals are told they have typhoid fever. Thereafter they are prescribed one of the very expensive antibiotics for almost 10 days which are unnecessary.
The point I want to bring home is that it isn’t necessary to give antibiotics to every infection or dry cough that their children get. If you check the throat of a child with a spatula you will not see any sign of pus. Instead you will see reddening of the throat meaning it is a viral infection.
Majority of coughs in children are due to viral infections. Therefore, a prescription of an antibiotic is unnecessary. In as far as possible parents should try to avoid giving antibiotics to their children.
Instead they should use natural products such as honey and cinnamon. Steam inhalation is also helpful. Children who develop serious acute respiratory tract infections are the ones who should be prescribed an antibiotic such as Cotrimoxazole (Septrin).
Mothers should be advised to keep their children warm whenever they develop a cold. Similarly, they should be asked to watch out for signs of severity including flaring of the ala nasi (nostrils), increased rate of breathing and retraction of the ribs.
Whenever they see those signs they should take the child to a dispensary or health centre so that they can be issued a prescription of an appropriate antibiotic.
A study done in 1985 in Bagamoyo, Dr. Neuvians and Dr. FDE Mtango reported that village health workers can effectively train mothers to identify signs of severe acute respiratory infections and in so doing they managed to reduce mortality in under-five children.
The author of this article is a strong advocator of honey as a natural product to treat bacterial infections. On several occasions he has used honey to treat a ”mdudu” on a finger. When he was working in upcountry, at Newala district hospital, he used honey to dress septic abdominal wounds of patients and they recovered.
If you want to read more about the use of honey in treating wounds, you are advised to read papers by Dr Peter Armon. To sum up the author is advising you to refrain from using antibiotics especially if there isn’t enough evidence that it is needed for the condition you want to treat.
The best is to establish the need for the antibiotic lest you may kill the normal flora and eventually see antibiotic resistance becoming a problem. In a previous article we mentioned that in 1994 there was an epidemic of bloody diarrhea in the country and we didn’t have a single drug to which the causative organism was sensitive. We nearly lost patients because we didn’t have another alternative antibiotic to treat the resistant strains of Shigella, the causative organism of bloody diarrhoea.
- Prepared by Gernard Msamanga, MD, ScD. Professor of Community Health, Muhimbili University of Health and Allied Sciences (MUHAS), P.O. Box 65015, Dar es Salaam,Tanzania. E-Mail: gmsamanga748@ gmail.com; Phone: (+255) 754 291971.