Antimicrobial resistance prevalence due to misuse of drugs, self medication – Pharm Oni

Pharm. Israel Oni is a Pharmacist currently practicing in Nigeria. With a vast background in hospital, community, and public health pharmacy practices, Israel specializes in promoting responsible use of antimicrobials.

His initiative, “Pharm Radio,” bridges health information gaps through the use of social media, while also promoting safe and responsible drug use. Israel Oni is a dynamic pharmacist with a proven track record aimed at elevating Antimicrobial Stewardship initiatives through expertise, leadership, and a genuine dedication to health advocacy.

In an Interview with Business Hallmark’s Tumininu Ojelabi Hassan, he spoke extensively on Antimicrobial Resistance (AMR), factors contributing to its prevalence, and its effects.

What exactly is Antimicrobial Resistance?

We have what we call microorganisms in our body. Some of them are good while some are bad. That is, some are beneficial while some can cause harm or diseases. We don’t have any problem with the ones that are good. For the bad ones, we have come up with great Antimicrobial agents, which can be in form of antibiotics, antiviral agents, anti-parasitic agents, anti fungal agents to combat or kill these bad microorganisms before they cause diseases or as soon as they cause diseases for us. It is either the Antimicrobial agents kill them or stop the growth of these microorganisms.

These microorganisms are living things too and they have the ability to resist the effect of whatever drug you are trying to use to kill them. The point where these microorganisms form a shield, mutate or change their structures just to ensure that anytime you introduce those drugs into your system, it won’t affect them or kill them effectively, this is exactly what we call Antimicrobial Resistance (AMR). That is, these microorganisms have built resistance to the Antimicrobial agents that have been designed to kill them or stop their growth. Once this happens the bad microorganisms keep thriving, growing and keep getting more until they cause a problem for the host whether human beings or animals and these microorganisms can spread from one person to the other.

What are the factors promoting the prevalence of AMR in our society?

There are several factors that can promote AMR. The number one factor is the fact that many of us misuse Antimicrobial Agents, antibiotics, antiviral, anti parasitic agents and anti fungal agents. A typical example of anti parasitic agent is the antimalarial. For example, when you give someone a medication and you tell the person take for five days. Take in the morning, afternoon and at night. and the person decides to take once daily for two days. The person may feel slightly better because that initial dose is already killing some of these microorganisms. However, the moment you don’t complete your dose, you are already misusing and abusing that drug. The remaining microorganisms that you haven’t killed will have enough room for them to come up with structures or mutations that will resist the effect of that drug when next you introduce it into your system. Misuse and Abuse of medications can lead to AMR.

Another thing that can lead to AMR is the fact that quite a number of people use drugs through Self Medication. They keep exposing themselves to drugs that are actually not needed through self medication. Before you know it, it gives room for these microorganisms that I mentioned earlier to start mutating and start forming resistance to these drugs when you really need them.

Another thing that can lead to this issue is the fact that quite a number of regulations and policies have not been fully enacted so it is making people, who don’t know anything about drugs have access to drugs and this comes back to misuse of drugs. Also, in agriculture, some farmers inject antibiotics into their animals because they want the animals to grow big and fat. Human beings end up eating those animals, this can also lead to resistance issue like I mentioned earlier.

What are the effects of AMR on humans and our society at large?

The number one effect of AMR is that it makes infection harder to treat. Infections that would have cost maybe a thousand Naira would cost more, so you get to spend more trying to treat a simple infection. It leads to a longer stay in the hospital because an infection that would have been treated within five days is getting very hard to treat, you have to stay longer in the hospital just to ensure that the infection is effectively treated. The more you stay, the more you spend. It causes a huge financial burden on the people. This resistant infection can spread from one person to another. Just like the way Covid was spreading, this infection can spread too. Once it spreads, and a lot of people are infected, this can lead to death/loss of lives. These are the things AMR can cause to our people and society at large. It is not just about one person because no one is safe until everybody is safe. If one person has this problem, the person can spread it to other people and cause a bigger problem for the society at large.

People often say that they don’t consult doctors and they don’t use drugs based on doctors prescription due to Financial constraint. What is your take on this?

For people who don’t consult doctors or use drugs based on doctors prescription because of financial constraints and they tend to do self medication, these kind of people end up spending more than they would have spent if they had consulted a professional to help them with their health conditions and recommendations. For instance, let’s say I have a bacterial infection and the symptoms of that bacterial infection is slightly similar to the symptoms of malaria, because I don’t have knowledge, I will probably think it is just malaria and go ahead to get malaria medication. Let’s say malaria medication is about N3000 and I use it for about three days, I still don’t get better, then I proceed to using Agbo, maybe for about four or five days, I still don’t get better, I have spent eight days trying to do trial and error. I will eventually go back to the hospital because I’m not getting better and I end up spending more than I would have spent if I had gone to the hospital straight.

Self medication is actually more expensive because you don’t know what exactly is wrong with you, you are only doing trial and error, which can lead to Antimicrobial resistance that we talked about earlier. It is not a good thing for you not to consult your doctor, I understand that sometimes it might be difficult but it is better you to do the right thing in order to get the right result at the right time.

What are the preventive measures that can be adopted to curb the prevalence of AMR in our society?

The first thing is to prevent the infection in the first place. Once this can be done, a large percentage of our work is done. As simple as proper hand hygiene can go a long way in preventing AMR. Washing of hands can help prevent infections. This is one very important thing to do. We need to imbibe the culture of using medications as they have been prescribed. Don’t self medicate. This can help slow down the development of resistance.

The third way to curb AMR is by stopping the spread of this resistance when it develops. For example, if I have a sexually transmitted infection that is resistant to many drugs, I can actually curb AMR by reducing the transmission of that infection to other people until I get better and get back to the society. The final point to consider is that, we need to get our regulatory bodies to do the right thing by enacting laws, implementing policies that will guide the use of antibiotics and antimicrobials, because if these laws are not there, if our regulations are ineffective, it will still come back to haunt us with AMR issue. If nobody is allowed to dispense medications except you are licensed to do so and you are dispensing for the right reason, this will help reduce the rate at which people have access to these drugs and then reduce AMR.

Another thing that can curb this problem is implementing public health campaigns to educate and inform the general public on the appropriate use of antimicrobials and then also making them understand the implications or the potential consequences that these AMR issue can cause them.

Can you explain the role of pharmaceutical companies/pharmacies towards combating AMR in Nigeria?

First of all, for pharmacies, antimicrobials, antibiotics, anti fungal and the likes should only be dispensed or given to those who need them. Don’t succumb to any pressure from anybody requesting for these antimicrobials without necessarily seeing a need for it. Ensure that prescription medicines are only given based on the prescription of a doctor.

If we adhere by these rules strictly, it will help reduce the way people have access to these medications, which in turn can reduce the rate of AMR. Pharmacies need to ensure that we are serving as gatekeepers to ensure that nobody has access to medications when they don’t need them. Pharmaceutical companies can also help in going into more of research and development to ensure that newer molecules, newer medicines to combat these stubborn infections are being created or formulated.

Education is also very important. Pharmacists should continually educate both the patients and other healthcare professionals on AMR. Make them understand what they need to know about these medications. Professionals when it comes to medications and drugs should use their knowledge about drugs to always educate people around them in the society.

Do you think roadside drug vendors contribute to the prevalence of AMR in Nigeria?

Roadside drug vendors are people that shouldn’t have access to medications in the first place. This is why our regulatory bodies need to step up with stricter regulations so that these people don’t keep on having access to medications. Roadside drug vendors, who do not have any knowledge about drugs keep selling these drugs to unsuspecting public and this is where the issue stems from. They contribute towards AMR in Nigeria and that is why we have to act very fast and do the right thing.

Like I said, nobody is safe until everybody is safe. These roadside vendors should never have access to medicines including over the counter medicines. If you are not licensed to sell over the counter medicines, you should not have access to them. If you’re not licensed to own or run a pharmacy, you should not have access to these medications. These are the issues that we need to combat very fast.

The use of fake drugs has worsened AMR in our society, how can fake drugs be identified?

The use of Fake medications can contribute to AMR. For instance, I’m using an antibiotics that contains 500mg. If I buy a fake one, it might contain 50 or 100mg instead of the actual 500mg. Imagine using 100mg for a disease you are supposed to use 500mg for. You are under-dosing yourself, you are taking a suboptimal dose meaning you are giving the disease chance for it to recuperate because you are not using exact concentration that can kill them. Instead they form more shield to resist the drug when next you use it. This is because you have used a fake drug that is not adequately killing the microorganisms that have caused the infection. You will give them chance to develop resistance which in turn leads to Antimicrobial resistance. The fist thing is to get your medications from licensed pharmacies. This is how you know a licensed pharmacy, when you enter you will see their license on the wall, it has to be there. Then you will find a pharmacist on duty. These are way to ensure that you are getting the right medication at the right place. However, if you patronise quacks, and roadside vendors all in the name of they are selling medicines, you will most likely end up with fake medications. Another way to identify a fake drug is through the scratch panel that reveals the number you send to a code, this can help you confirm the authenticity of the drug.

What role can the Nigerian government play towards curtailing AMR in our society?

The role of the Nigerian government is to ensure that they enact strict laws/rules and implement policies that will ensure that the right persons have access to the right drugs at the right time. Also, ensure that the right professionals are the ones handling these drugs. Enact policies that will help us fight AMR together and encourage Antimicrobial stewardship in every angle of healthcare. If government can pump in money into research and development, it can also help pharmaceutical companies come up with formulations of new molecules that will help combat these resistant infections.

Another thing is to support our healthcare system. When you are saying people indulge in self medication, they are probably doing this because they can’t afford healthcare in the first place. Government should pump in enough money into the healthcare system so that people can have access to primary health centers, secondary health centers and tertiary institutions. There is a level to it. If the primary healthcare centers are working effectively, people can easily go there and access good quality healthcare. It will help in curtailing AMR issue.