Belief widespread that antibiotics heal common cold

Muhammad Zahir Hassan Nabil

Antibiotics bought and sold without restrictions for illnesses such as the common cold and other respiratory infections in Bangladesh continue to be a cause for concern, indicates a survey led by icddr,b.

The World Health Organization (WHO) has cautioned that these lifesaving drugs are not required when viruses instead of bacteria cause lung illness or acute respiratory infections (ARI) including cold, cough and viral flu.

Infographic: Inamul Shahriar / Muhammad Nabil / icddr,b

One-third of the 100 pharmacies surveyed by icddr,b researchers were reportedly non-licensed while only 11 percent of drug sellers had received some pharmacy training.

The study highlights patients' demand and sellers’ willingness as key influences behind the unrestricted sale of antibiotics.

"We conducted a one-day training for these drug sellers to educate them why antibiotics should not be sold randomly. Our guidelines recommend antibiotics only for children diagnosed with pneumonia," says Dr Fahmida Chowdhury, deputy project coordinator at icddr,b and author of the study published in BMC Health Services Research, supported by US Centers for Disease Control and Prevention (US CDC).

The drug dispensers received guidance on the proper management of ARI for care seekers with ARI symptoms. Six months after the training, a survey among the drug sellers revealed no significant change overall in the way they sold antibiotics for complicated ARIs (presenting with breathing difficulty) in children and adults.


icddr,b guidelines for drug sellers (in Bengali). Photo: Study authors

As for adults with complicated ARIs, antibiotics were selling more frequently. However, antibiotic sale for uncomplicated ARIs (presenting with cough and cold with or without fever) in children was decreasing.

“Drug sellers were hesitant to disappoint healthcare seekers by refusing to dispense unnecessary antibiotics. They often assumed that customers wanted antibiotics for respiratory illnesses and therefore sold those,” adds Dr Fahmida Chowdhury.


What’s wrong with antibiotics?

The icddr,b findings suggest that both patients and drug sellers essentially lack awareness of the risk from excess and unnecessary antibiotic consumption. It is widely known that antibiotics neither kill viruses, nor cure virus-induced illnesses. Rather when such illnesses are mistakenly treated by antibiotics, many bacteria become resistant to these lifesaving drugs and go on to cause incurable illnesses.

Patients' demand and sellers’ willingness infuence unrestricted sale of antibiotics. Photo: GMB Akash / icddr,b

Such needless use renders these lifesaving drugs ineffective. When released in the environment, the resistant-bacteria infect many others and the antibiotics they have grown resistant to no longer work - a matter of grave concern known as antibiotic resistance.

The icddr,b findings further refer to another study noting that 85 percent of Bangladeshi patients experiencing ARI were reported to have received antibiotics from physicians, although around 80 percent of these illnesses are caused by viruses.

WHO observes World Antibiotic Awareness Week. Infographic: WHO

"There is no reason for prescribing antibiotics at will," says Professor Dr Mahmudur Rahman, a consultant with icddr,b and former director of the Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh and a co-author of the study.

"There is an urgent need for widespread awareness raising among the general population, drug dispensers, pharmaceutical personnel and physicians to minimise such misuse," he adds.

It was not surprising that the study found the sale of antihistamines for respiratory illnesses more widespread than previously feared.

A pneumonia expert, icddr,b senior scientist Dr Jobayer Chisti, also a co-author of the study explains that antihistamines (these are not antibiotics) are not recommended for children under 5 years because it clogs tiny air vessels inside their lungs, making breathing more difficult when they already have a cold or other complicated lung illnesses.

However, the study found no change in the way drug dispensers sold these antihistamines after the one-day training.

Wrong medication can make breathing difficult for children. Photo: Shumon Ahmed / icddr,b

"We urge public health authorities and drug administration to intervene with educational messages for drug sellers and the general population to inform them of the risks posed by the misuse of antibiotics and to encourage a more rational approach to their use," suggests Dr Chowdhury.

The study also calls for additional monitoring by the Directorate General of Drug Administration (DGDA) on pharmacies to comply with appropriate drug dispensing practices.

All relevant professional bodies including the pharmaceutical companies and pharmacy owners association, if any, need to work closely to inform and educate the public about the perilous consequences such drug mis-use might lead to, observes Professor Rahman.