Weaning off antibiotics overuse

PETALING JAYA: Malaysians are using antibiotics less frequently – a pattern that first emerged during the Covid-19 period, according to a study.

Federation of Asian Pharmaceutical Associations vice-president Jack Shen Lim said the reduced intake of antibiotics from 2019 to 2021 was likely due to heightened awareness of hygiene such as the wearing of face masks and frequent handwashing then.

There was also greater health literacy on the difference between viral and bacterial infections, he said when contacted.

There is also the issue of Antimicrobial Resistance (AMR), which would lead to drug-resistant bacterial infections, and antibiotic abuse, whether through self-prescription or over-prescription, said Lim.

Globally, he said AMR is estimated to cause 700,000 deaths per year. This is why, for instance, in 2008, the Health Ministry laid out a national guideline to curb the improper usage of antibiotics.

Lim was responding to a study published three months ago that analysed antibiotic usage in Malaysia between January 2018 and December 2021 by BMC Public Health, an open access, peer-reviewed journal.

The study concluded that the utilisation rate of antibiotics had gone down in both the public and private healthcare sectors during the Covid-19 period.

“The overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019 before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021.”

(DID refers to Defined Daily Doses per 1,000 inhabitants.)

It also found that private primary care antibiotic utilisation was almost 10 times higher than in public healthcare in 2021.

“Penicillin had the highest usage, accounting for 81% of antibiotics in public and 37% in private (healthcare).”

Despite the higher antibiotic utilisation rates in the private sector compared with their public counterparts, the study noted that the trend in both sectors was in line with the World Health Organisation’s target that at least 60% of usage consisted of “access antibiotics”.

There were seven authors of the study, from the Institute for Clinical Research; National Institutes of Health, Shah Alam; and the Health Ministry’s Pharmacy Policy and Strategic Planning Division.

The study also found greater variations in the types of antibiotics used in the private sector compared with public healthcare.

It said the findings highlighted the need for more rigorous interventions, targeting both prescribers and the public.

“Improvement strategies should focus on reducing inappropriate and unnecessary prescribing,” it added.

Former Medical Practitioners Coalition Association of Malaysia president Dr Raj Kumar Maharajah said the availability of information and intervention by the Health Ministry and infectious disease specialists were among factors that contributed to the reduction of antibiotic usage.

These days, he said antibiotics are given sparingly and only when necessary.Among the commonly used antibiotics are amoxicillin, erythromycin and ciprofloxacin, while stronger ones include augmentin and cefuroxime, Dr Raj Kumar said.

Malaysian Pharmacists Society president Amrahi Buang concurred with the research but pointed out that there is still a lack of studies on the issue.

Asked about some of the common side effects of antibiotics, he listed out conditions such as upset stomach and diarrhoea, while women might have to deal with vaginal yeast infections.

Some side effects that are more severe may impair the function of the kidneys, liver, bone marrow, or other organs, he added.

Amrahi also made it clear that antibiotics must be prescribed by doctors based on proper guidelines.

“Prescriptions must be done properly as they are a legal document, whether through written or electronic means,” he said.