Dr. Mattias Larsson. — Photo courtesy of Family Medical Practice Hanoi

By Dr. Mattias Larsson*

In an earlier article I brought up the problem with overuse of antibiotics and how it makes it increasingly more difficult to treat common infections and in some cases where there are no antibiotics left to use (vietnamnews.vn/life-style/481171/the-antibiotic-apocalypse-and-what-you-can-do-to-prevent-it.html#SvckYvh8ha0PlXCO.97).

The other day I had a patient who was diagnosed with pneumonia. The family had a relative who had been treated at a larger Vietnamese hospital and during that time caught an hospital infection and died. Our patient was treated with IV antibiotics for five days as we could not guarantee that any oral antibiotics would work due to resistance. The outcome was fine and the child survived. But it is a problem that even with the strongest IV antibiotics we don’t always know if the treatment will be effective.

The tragedy of the commons is when you have a common asset like antibiotics, individuals are acting independently according to their own self-interests, depleting the resource through their collective actions. The most common examples are unregulated grazing on common land or the depletion of fisheries in the oceans.

This is a good analogy for the erosion of the effect of antibiotics. Compounds with antibiotic effects have been used by organisms throughout evolution. Alexander Fleming, who first discovered penicillin, was a microbiologist. He studied bacteria, but he was so sloppy with his cultures that mold started growing and killed the bacteria. Many scientists might have seen this as a failed experiment, but Fleming saw the potential this mold, penicillin,  had to save lives, and it has, but he also noticed in his experiments that  bacteria developed penicillin resistance.

Antibiotics are drugs that work on bacteria, different antibiotics work for different bacteria.

Antibiotics have no effect on viruses. If we use antibiotics for viral infections there is a risk of adverse effects as diarrhea as many good bacteria in the gut are necessary. Unnecessary antibiotic use also selects the bacteria that have resistance genes, these are then spread and become more common with risks for treatment failure if the resistant bacteria cause infections.

Although there are prescription regulations in Việt Nam, most drugs including antibiotics are available in private pharmacies. A large proportion of antibiotics used are not prescribed by a physician but bought directly from private pharmacies and used as self-medication. Also, many healthcare providers have their own clinics where they conduct examinations and sell drugs. In studies we have conducted, the majority of children had used antibiotics within the past month, mostly for viral infections.

In the clinic I met many children who has been to healthcare providers and received several drugs including antibiotics, where in most cases they were not needed.

How can we tell if we have a viral or bacterial infection? Viral infections generally effect many parts of the body, like a flu when you get respiratory symptoms with a runny nose, cough, fever and possibly muscle ace. Bacterial infections are usually more localized and more severe, like pneumonia which causes difficulty breathing, a cough and high fever.

In many cases it is hard to know if you or your child has a viral or bacterial infection, so it is best to go to a healthcare provider. However, that might not be enough. In many cases lack of resources including staff, time, equipment and competence might still cause uncertain diagnosis with the risk of unnecessary treatment with antibiotics and other drugs.  Providing good examination and diagnostics is expensive – you need well trained staff, tests and equipment. Drugs are relatively cheap – and hence many times it might be tempting to skip some diagnostics and just use antibiotics.

Antibiotics are not only used on humans, but also for livestock, poultry and aqua cultures. Often they are used not for treatment of diseases but as a growth promoter. This is now banned in the EU but still common in many countries like Việt Nam. One of the antibiotics that is now the last resort for some human infections when bacteria are resistant to all other antibiotics – colistin – is used a lot for veterinary use and as growth promoter. We can now see how resistance genes formed in animal bacteria has been found in human bacteria and caused severe infections. The overlap between human and animal health is called “one health” – as what we do with animals will ultimately affect us.

The overuse of antibiotics in the community, hospitals and for animals has led to a situation where we now have bacteria that are resistant to almost all antibiotics, so called “superbugs”. These are now spreading in hospitals causing infections that are very hard to treat with high rates of mortality and costs.  Also, these superbugs follow discharged patients out in the community where they spread.

For you as individual this might seem to be overwhelming – as with global warming – what can I do about it? The most important is to avoid self-medication with antibiotics, in case of disease go to a healthcare provider that can do through examination – then you will increase the chance to get the right diagnosis and treatment as well as avoid unnecessary antibiotic use. — Family Medical Practice

*Dr. Mattias Larsson first came to Viêt Nam in 1997 conducting research on child infections and antibiotic use and resistance. In 2003 he defended his PhD and graduated from his medical training. Since then he has spent about half of his time in Sweden working as a physician in paediatrics and infectious diseases. The other half in Việt Nam and other developing countries working with medical training and research. Dr. Mattias speaks English, Swedish, German and Vietnamese as well as some Spanish. At Family Medical Practice he is participating in providing diagnostics care and treatment with the best international evidence based standards.

For more advice on any medical topics, visit Family Medical Practice Hanoi at: 298 I Kim Mã, Ba Đình. Tel: (024) 3843 0748.  E: hanoi@vietnammedicalpractice.com.

FMP’s downtown Hồ Chí Minh location is: Diamond Plaza, 34 Lê Duẩn, District 1; 95 Thảo Điền, District 2. Tel: (028) 38227848. E: hcmc@vietnammedicalpractice.com

FMP Đà Nẵng is located at 96-98 Nguyễn Văn Linh, Hải Châu District, Đà Nẵng. Tel: (0236) 3582 699. E: danang@vietnammedicalpractice.com