Prescription-free sales have helped spawn an invasion of drug-resistant superbugs
In a softly lit suite of Bangkok’s Praram 9 Hospital, Songchai (not his real name) slowly scrawls out his thoughts on paper. Five months in a coma have left him with throat muscles so weak he needs a breathing tube, which reduces his words to hollow rasps. Just months ago, his heart was straining to pump blood through a body under attack by a strain of severe and drug-resistant bacteria.
“The doctor told my wife to be prepared for my death,” says Songchai, who spoke to the Straits Times on condition of anonymity.
To save his life, doctors gave him the strongest antibiotic available. It helped him pull through, but also destroyed his kidneys. The 66-year-old retired marketing director now has to undergo thrice-weekly dialysis for the rest of his life.
Songchai is lucky. An average of two people die every hour from multidrug-resistant bacterial infections in Thailand, according to a landmark study funded by the Kingdom’s health ministry and Britain’s Wellcome Trust, and published in September.
The study used microbiology databases, hospital admissions and the national death registry to estimate that multidrug-resistant bacterial infections killed 19,122 people in Thailand in 2010. Thailand’s population is 68 million. That death rate is many times higher than in the West. Europe suffered just 25,000 such deaths amid its 500-million population in 2007, according to the study’s senior author, Dr Direk Limmathurotsakul of Mahidol University.
The problem is not confined to these countries. Some call it the “silent tsunami”: The improper use of antibiotics for humans and livestock around the world is leading to the proliferation of increasingly drug-resistant microorganisms, creating new strains of “superbugs” that can be defeated only by “last resort” medicine with toxic side effects.
Amoxicillin for sore throat
The World Health Organisation (WHO) warns that “improvements in global health over recent decades are under threat”. The microorganisms that cause tuberculosis, malaria, urinary tract infections, pneumonia and food poisoning, for example, are becoming increasingly resistant to a wide range of medicines.
“Some cases of tuberculosis and gonorrhoea are now resistant even to antibiotics of the last resort,” the WHO said last year.
The problem is particularly stark in Thailand. “[People] feel they can buy stronger and stronger antibiotics,” said Dr Direk.
“They feel the problem is confined to them. They don’t understand second-hand antibiotic resistance, that it can affect friends and family and other people in the hospital.”
Many developing countries with poor healthcare systems allow antibiotics to be sold without a prescription. In middle-income Thailand, which draws medical tourists from all over the world, antibiotics are freely available in pharmacies and even convenience stores.
The Thai capital is dotted with pharmacies dispensing drugs. Indeed, a particularly popular hub can be found around Victory Monument in central Bangkok.
Standing on the other side of one of the counters here is Nattiya Apisittinantakul, a 25-year-old pharmacist. She fishes out a selection of the antibiotics on sale, ranging from generic blue-green capsules of amoxicillin to brand-name versions like Pfizer’s Zithromax. Some Thais buy the medicine because the wait to see a doctor is too long, she says. Others bring empty boxes of drugs previously prescribed to them. Many are familiar with amoxicillin.
“If they had a sore throat yesterday, they would come in and say ‘I want amoxi’,” says Nattiya in exasperation. “Even if I explain that they don’t need it, they won’t believe it. Or they say, ‘I want to buy it to keep it in my house’.”
Many also ask for the smallest available packs of amoxicillin – a Bt30 strip of 10 generic capsules – and need to be persuaded to buy another strip to make it a full course of antibiotics. Taking an inadequate amount of antibiotics can create drug-resistant bacteria.
Some directly request Norfloxacin, which can be used to treat travellers’ diarrhoea. “They don’t even say they have diarrhoea anymore,” Nattiya laments. “They ask, do you have ‘norflox’?”
It’s in your meat too
Antibiotics used on livestock is another concern. Drug-resistant bacteria spreads through direct contact between humans and farm animals, ingested meat or the environment.
In many large industrial animal and fish farms, where cramped conditions allow diseases to spread fast, antibiotics are often used on healthy animals to prevent rather than treat illnesses.
At Bangkok’s public Ramathibodi Hospital, staff have to wear a fresh Bt12 protection gown every time they approach a patient infected with a superbug. Staff in one intensive-care ward go through 10,000 such gowns a month, reveals the hospital’s deputy director Kumthorn Malathum.
In conjunction with the ongoing World Antibiotics Awareness Week starting, the hospital will set up information booths to educate patients about proper use of antibiotics. “People don’t often see the long-term effects caused by superbugs,” says Dr Kumthorn. “People think patients just die quickly and the [treatment] cost is low. But infection caused by superbugs also affects your long-term quality of life.”
Songchai, an avid golf and billiards player, is now reduced to watching such tournaments on television at home.
He scribbles glumly on a piece of paper: “Don’t use [antibiotics] by yourself. Ask the doctor first.”