Dar es Salaam. A review by British researchers urging doctors to stop telling their patients to finish an entire course of antibiotics, has been received with caution and uproar by some public health stakeholders in Tanzania and beyond.
The stakeholders warn that if the message the study contains found its way into the local media, it would not augur well with the efforts to control the growing trend of antibiotic resistance in the countries where people lack enough health education and; with no strong policies to regulate the prescription of the medications.
This week, 10 researchers from the United Kingdom published the findings in the British Medical Journal (BMJ) and stated, “Doctors must stop telling patients to finish an entire course of antibiotics because it is driving antimicrobial resistance.”
In the BMJ article, titled, “The antibiotics course has had its day,” the experts argue that when a patient takes any antibiotics it allows dangerous strains of bacteria to grow on the skin and gut which could cause problems later. The longer the course, the more the resistance builds.
“Patients should be encouraged to continue taking medication only until they feel better, to avoid the overuse of drugs,’’ the experts suggested.
But according to the current guidelines from the World Health Organisation (WHO), patients taking the drugs must “finish the course of antibiotics,’’ to avoid triggering more virulent forms of the disease.
In the latest study, the British researchers claimed that the message which doctors usually give to their patients, saying, “Ensure you finish the course”—was not backed by evidence and should be dropped because it actually puts the public at greater risk from antibiotic resistance.
Here in Tanzania, a clinical pharmacist and public health advocate, Dr Sajjad Fazel, expressed his fears that if the message being carried in the study was picked by the local media and highly publicized, “…It would cause a firestorm, causing patients to demand short courses from health practitioners, making matters worse.”
“The scenario in England is quite different from Tanzania and Africa in general, a message such as the one published in the recent antibiotic study in the BMJ could cripple the health system in Africa as it is,’’ he warned.
“Often times in Tanzania, antibiotics can be bought over the counter and many patients self-medicate. As a clinical pharmacist who strives to educate patients to complete their course of medications and advise doctors to not prescribe antibiotics irrationally, I find the recent study lacking evidence and needing more research before being incorporated into policy.
A Tanzanian scholar at the Oxford University in the UK, Dr Frank Kagoro, told The Citizen on Sunday that if there was a plausible possibility of what the British researchers claim, they should have suggested for a systematic review to build evidence.
“Absence of evidence is not evidence of absence. I would question a lot of their findings and their methodology,’’ he said, “I can sense a lot of misleading statements,’’ he added.
A science journalist based in Nairobi, Ms Sarah Ooko, told The Citizen on Sunday that the British study risked being taken out of context and would confuse the patients.
Ms Ooko said, “I read the study and was disturbed. If taken out of context, it is likely to confuse the patients at a time when we are just beginning to deal with the problem of antimicrobial resistance in Africa.”
In the UK, the chairperson of the Royal College of GPs, Prof Helen Stokes-Lampard, was quoted by a UK newspaper, The Telegrah, as saying the GPs were ‘concerned’ about allowing patients to judge for themselves when to stop taking medication, and argue it could cause confusion.
Prof Stokes-Lampar, said: “We are concerned about the concept of patients stopping taking their medication mid-way through a course once they ‘feel better’, because improvement in symptoms does not necessarily mean the infection has been completely eradicated.
“It’s important that patients have clear messages and the mantra to always take the full course of antibiotics is well known – changing this will simply confuse people.”
Tanzania recently launched the National Action Plan to curb antibiotic resistance. The Chief Medical Officer, Prof Mohammed Kambi, said the plan was aimed at dealing the irrational prescription practices among medics and establish strict laws that would stop livestock keepers using antibiotics as animal feeds.
About three weeks ago, the WHO released data from 77 countries showing that antibiotic resistance is making gonorrhoea – a common sexually-transmitted infection – much harder, and sometimes impossible, to treat.