Wednesday, January 4, 2017

Powercef: Medicine widely used and ‘abused’ in TZ

From a medical point of view, administering a

From a medical point of view, administering a child with Ceftriaxone injection for a mild chicken pox is very wrong. PHOTO | FILE 

By Dr Mpokigwa Kiputa mpokigwakiputa@gmail.com

There is this popular and widely used antibiotic in Tanzania, known as Powercef whose generic name is Ceftriaxone. It’s being prescribed ‘irrationally’ in the country.

In both rural and urban settings, from hospitals to health centers, all the way to dispensaries and pharmacies—ceftriaxone is revered as a “magical drug” of our era.

In its injectable form, it’s widely believed by most medics to be a quick and sure way of eliminating most forms of bacterial infection.

Powercef is the kind of antibiotic that acts against a wide range of disease-causing bacteria—used in the treatment of pneumonia, meningitis, urinary tract infections (UTI) and so on.

But, look here! This antibiotic is in danger of losing its effectiveness because of how we are using it—here is one scenario.

Recently, while at the hospital, I witnessed a child with mild chicken pox infection (caused by virus), being administered with Ceftriaxone injection. From a medical point of view, that was very wrong!

You see, chicken pox is caused by a virus and at times, it could heal on its own—we call this a self-limiting process.

In this case, a patient just needs supportive care, unless a bacterial infection has been also confirmed in that particular patient.

In case a patient with chicken pox has a simultaneous bacterial infection, that’s when a medic can resort to using antibiotics such as powercef.

I have also been at hospital settings where I saw many clinical officers prescribing Ceftriaxone injection, and at times, without clear reasons why they prescribed it.

That, to me as a medical doctor, is “blind prescription.” This is because; you give a drug to a patient without actually identifying (being sure) what you are treating.

This practice, if not put at bay, will eventually create Ceftriaxone drug resistance in the country and the drug will lose its effectiveness completely.

There are reports from South America and other parts of the world where a common sexually transmitted disease, gonorrhea, is no longer responsive to ceftriaxone because of resistance.

That means, the Neisseria gonorrhea, the bacteria causing gonorrhea, can no longer respond to ceftriaxone. The drug, is losing its effectiveness.

What’s happening to ceftriaxone is similar to what happened to antimalarial drugs over the years in Tanzania-we’ve all heard how we had to switch from one drug to another because of resistance.

Chloroquine, which was once a widely prescribed drug for malaria could no longer treat the disease. Due to widespread abuse of the antimalarial,  the parasites developed resistance against it, and later on it was abandoned.

The abuse of antimalarials in the country which has been contributing to the developed resistance against the drugs has led the current slogan, “sio kila homa ni malaria,” meaning: not every fever is malaria.

 The Ministry of Health, Community Development, Gender, Children and the Elderly is now raising awareness so that the common anti-malarial drugs don’t lose effectiveness. The public is being educated on the importance of testing before using any drug.

For those who are getting used to ceftriaxone, stay warned too—“fever is not a sign of Ceftriaxone deficiency.” This message goes to healthcare professionals too.

 Using Ceftriaxone as a first line of treatment in every kind of bacterial infection will render it ineffective in the long run.

Using other alternative antibiotics before resorting to Ceftriaxone will help. Also making sure you know what kind of infection you are dealing with before prescribing will save the drug from resistance.

In developed nations, their laboratories have the capacity to identify a disease causing organism and test its susceptibility to various antimicrobials hence making the work of a doctor easy at the same time avoiding the emergence of a drug resistance.

However, here in Tanzania and other developing countries, there is shortage of lab diagnostics so, healthcare professionals end up treating blindly, hence drug resistance.

Drug resistance is a burden to the individual families and the country at large.

Just recently, the WHO announced a rapid emergence of antimicrobial resistance in Neisseria gonorrhoeae to a range of antibiotics with no new therapeutic agents being produced.

Gonorrhea, represents 88 million of the estimated 448 million new cases of curable STIs – that also includes syphilis, chlamydia and trichomoniasis – which occur globally every year.

WHO said Gonorrhoea may thus become virtually untreatable. Action is needed to contain antimicrobial resistance to Neisseria gonorrhoeae as well as to put in place a mitigation strategy to prevent that eventuality.

All key players in the health system from a medical specialist to a patient seeking care have a role to play.

The author is a Medical Officer at the Ministry of Health.

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